Articles in this section delve into the intricacies of the healthcare system in the United States, speciﬁcally, the effects of COVID-19 on the accessibility and affordability of doctors’ visits. The articles critically analyze the American government’s response to the pandemic and the subsequent effect on America’s people.
Pandemic Pandemonium: How a ‘Developed’ Country Delivered an Undeveloped Response
“ ” BY: SUMAYYAH FAROOQ
According to a 2019 World Economic Forum article, the United States was predicted to be the best prepared country in the world to deal with a pandemic in terms of “[having] proper tools in place to deal with large scale outbreaks of disease.”
ccording to a 2019 World Economic Forum article, the United States was predicted to be the best prepared country in the world to deal with a pandemic in terms of “[having] proper tools in place to deal with large scale outbreaks of disease.” During the current COVID-19 pandemic, however, we have seen that the U.S. has not only failed to meet this prediction but has fallen quite short of it. A supposedly ‘developed’ country with numerous resources available at its disposal, it seems shocking that the U.S. is not only failing to live up to expectations during the COVID-19 pandemic, but is even underperforming compared to its ‘underdeveloped’ counterparts. The developed versus developing countries argument states that developed countries attain better standards of living and handle situations better than developing countries, thus predicting a correlation between resources and capability of successfully handling pandemics. Yet surprisingly during this pandemic we see that the mortality burden of COVID-19 actually falls heaviest on ‘developed’ countries. Further, as countries across the globe attempt to curve their number of coronavirus cases, the U.S.—again, one of the most recognized ‘developed’ countries—seems to be responding more similarly to its ‘developing’ counterparts in terms of its rising cases. From experiencing shortages of ICU beds in hospitals to coming to host the world’s epicenter of the pandemic, how did the U.S. end up in this situation? How did one of the most ‘developed’ countries produce one of the worst pandemic outcomes? This article compares the pandemic response of the United States, Brazil, and India to answer this question
and shows that the ‘developing’ countries argument does not necessarily correlate with pandemic response.
Further, as countries across the globe attempt to curve their number of coronavirus cases, the U.S.—again, one of the most recognized ‘developed’ countries—seems to be responding more similarly to its ‘developing’ counterparts in terms of its rising cases.
in disbelief. From the onset, instead of taking the pandemic threat seriously, President Donald Trump called the virus a “hoax” and failed to deliver timely provisions. Similarly, the Bolsonaro Administration of Brazil had also doubted the severity of the pandemic and was in denial of its detrimental impact. Both countries’ presidents initially ignored scientiﬁc ﬁndings and denied the existence of the coronavirus and its severity. Adding on to that, both presidents made claims that coronavirus was “just like the ﬂu,” understating the severity of deaths and justifying a focus on economic issues instead. Even though the United States is a ‘developed’ country with vast resources and advanced facilities, its leaders’ initial response—like Brazil’s—failed to recognize the urgency of utilizing their resources towards the pandemic early on.
Surprisingly, while the United States shares many similarities and differences with ‘developed’ countries, in the case of their pandemic response, it parallels more so with those of ‘developing’ countries. By analyzing the United States’ similarities and differences with ‘developing’ countries, one can ﬁnd similarities in terms of the governments’ pandemic responses, lack of uniﬁed decision making, and inadequate healthcare systems. Although this argument focuses primarily on these shared similarities of countries failing at their coronavirus pandemic response, varying factors such as levels of travel, population density, geographic area, and cultural differences may also play important roles in the resulting outcomes. Throughout the ongoing pandemic, the U.S. has been in the lead with the most conﬁrmed coronavirus cases, followed by Brazil, then India, both of which are considered ‘developing’ countries. Each country accounts for over one million cases and these numbers continue to rise on a daily basis. Despite each country having access to varying levels of resources based on their development status, we see here that all three countries have a similar trend of increasing COVID-19 cases.
GOVERNMENTAL RESPONSE In the case of the United States and Brazil, both governments failed to respond adequately and in a timely manner. The United States’ initial governmental response to the pandemic was ﬁlled with disbelief and lacked concern for the issue at hand on the global stage, leaving many other ‘developed’ countries like the United Kingdom
Now we wonder why both countries had similar responses despite their differences in resources? The reason for the poor response is due to the fact that both leaders disagreed with the science and continued to create their own rules in efforts to promote their own priorities. They decided to lift their lockdowns too early or never even properly placed a lockdown in their country to begin with. Another ﬂaw was leaving decisions to the states and their government to handle rather than making a national policy. Both countries left mandating masks and creating social distancing rules to the states rather than taking matters into their own hands on a federal level. This allowed for some states to be more lenient with restrictions which in the long run affects those states who had strict requirements. That eventually creates setbacks for the country as a whole in eliminating the virus because some states are having a surge of cases while others aren’t, leading to a divided country. Additionally, both leaders have been seen not wearing a mask themselves, setting an impression that masks aren’t necessary. These countries had a “failed” response to the pandemic due to the lack of leadership found in their leaders.
HEALTHCARE RESPONSE The United States and India have both been struggling with their healthcare response during the pandemic as well. Although it may not be surprising that both countries have a lot of differences in their healthcare system, they also share much in common. Both of them, for example, have a decentralized public healthcare system. With this system, most healthcare decisions are made by local or state authorities rather than the federal government. With the ongoing pandemic, the decentralized system resulted in chaos as it allowed for a variety of uncoordinated healthcare decisions to be made. Additionally, when looking at the healthcare systems’ responses to the pandemic of each country, we see similar resulting deﬁciencies in personal protective equipment (PPE), hospital beds, ventilators, and spaces in ICU units. This ultimately made both countries unable to handle the unexpected surge of incoming patients. India being a ‘developing’ country and the U.S. being a ‘developed’ country, what lead both into the same predicament?The United States has been known to spend more per capita on healthcare than any other OECD (Organisation for 6
Economic Co-operation and Development) peer. From just looking at these statistics, it seems as if the U.S. must have the best healthcare due to their signiﬁcant spending but this isn’t the case. The U.S. has a ﬂawed healthcare system which spends so much on healthcare only to provide coverage for just 90% of the population which is signiﬁcantly less compared to other OECD countries. On top of that, there are many unnecessary expenses and barriers to healthcare which make it more of a commodity rather than a necessity. The reason the U.S. has the same predicament as India is the lack of emphasis on universal healthcare that is adequate enough to support the entire population. Also, the U.S. did not develop enough supplies and even prepare for the pandemic beforehand with its delayed government response. India has a population of 1.38 billion people while the United States only has 330 million people. The difference may explain why India is struggling to cater to people in hospitals, but at the same time develops the case that the United States hasn’t done enough for its people in handling a pandemic and being able to guarantee health care.
“How did the U.S. end up in this situation?” The United States ﬁrst went wrong with its delayed response to the pandemic. The government should have responded earlier rather than initially considering it a “hoax” and being internally split on the issue. The U.S. should have followed expert advice on the pandemic to make sure their decisions were accurate and backed up by research proven to diminish the spread of COVID-19, rather than be divided along political party lines.On top of that, the U.S. government lacked leadership by not mandating masks and social distancing, as well as not following and enforcing changing CDC guidelines as new research releases. With the delayed response, the U.S. not only made itself a danger for other countries due to rapid spread, but also became a danger for its own citizens. If the federal government had been more involved and serious about this matter from the onset, hospitals would have been prepared in advance with sufﬁcient equipment and COVID testing, which would have made consequent responses more efﬁcient and rapid. The governmental lag of an accurate and powerful response led the U.S. to handle the pandemic in a disorderly and dismissive manner, causing the U.S.’s coronavirus cases to surge exponentially.
“ ”“ ” The fact that India has a larger population density and less resources than the United States, yet still has fewer cases than the United States suggests that the U.S. has failed to utilize its resources effectively.
ACROSS THE GLOBE On the other hand, there were many countries that were applauded for their efﬁcient and well-organized pandemic response. Canada, a neighbor of the United States, is a good example of this. Canada’s universal healthcare system made it well suited to handle the COVID-19 pandemic since it allowed all citizens to receive health care efﬁciently by increasing COVID testing and space in ICU units. This is important as the spread of the pandemic requires testing of as many citizens as possible. Additionally, unlike the U.S, Canada decided to listen to scientists and initiate a plan with no delay. Another example would be Australia, in which the government decided to put aside their political difference and let the scientists lead. Their government’s response led to a high success rate and a low rate of cases. In addition to these examples from ‘developed countries,’ Vietnam is a successful example from a ‘developing country.’ Although equipped with less resources and located near the original epicenter of the outbreak making it more susceptible to infected travelers, Vietnam implemented strict quarantine regulations early on and ramped up its testing capacity. These countries, together, are some examples of successful responses to the pandemic irregardless of development status. WHAT WENT WRONG: Combining the United States’ downfall in both government response and healthcare efﬁciency, we can then answer the question posed at the beginning of this article:
These comparisons were made to shed light on the unfortunate outcome the United States has experienced in their pandemic response.
It illuminates the idea that the stature and power of a country does not guarantee successful responses to disasters, such as ﬁghting pandemics, if the government isn’t able to look past differences in political opinions.
It illuminates the idea that the stature and power of a country does not guarantee successful responses to disasters, such as ﬁghting pandemics, if the government isn’t able to look past differences in political opinions, follow rules developed by highly educated agencies, and respond to the problem at hand in a reasonable manner. The COVID-19 pandemic has also highlighted that ‘developed’ countries will not always fare better than ‘developing’ countries simply because they have more resources. Further, it shows that labels of ‘developed’ and ‘developing’ countries fail to equally acknowledge the failures present in all countries regardless of level of development. Instead, these labels only serve to create inaccurate predictions of disaster response and inequitable, unnecessary hierarchies. In the future, the U.S. government should take a ﬁrm, unbiased stance and allocate resources towards preparation for pandemics earlier on by listening to expert advice, setting examples for the public and—most importantly—taking a national, centralized approach. It should not rely only on having plentiful resources but managing those resources well. Moving forward, then, we hope the U.S. government is able to learn from its mistakes seen during this pandemic and handle pervasive events better in the future. Edited by Mila Ho, Artwork and Design by Angela Chen
COVID, Joblessness, and Health: How the COVID-19 Unemployment Spike Aﬀects Patients with Existing Health Conditions
BY PAYTON KIM
ith the sudden spike in unemployment due to COVID-19, millions of Americans found themselves without a job and a steady means of income. Though massive expansion of federal aid for unemployment has managed to stabilize poverty levels, many Americans still face daily struggles to pay rent, buy groceries, and care for their families. Among those most strongly affected by unemployment are patients already dealing with health conditions that can hardly be put on hold for the pandemic. In an effort to better understand the struggles that these patients face, I spoke with Rebeca Massey, a Licensed Master Social Worker who works with families in the pediatric hematology center at Texas Children’s Hospital in Houston. Massey recalls the widespread effects of just the initial spike in unemployment, estimating that “when it ﬁrst started and Texas closed…about 80 percent of what I did was helping recently unemployed families with things like rent assistance or utilities.” Many of the families under her care had lost employment suddenly and unexpectedly and were now scrambling to ﬁgure out how to pay bills without their usual income. Unfortunately, Massey’s experience is no exception. Over the course of the pandemic, unemployment jumped from 4.4% in March to a staggering 14.7% in April before dropping to around 13% in May, leaving nearly 21 million Americans still unemployed and patients around the country struggling to manage both ﬁnancial and physical wellbeing. In our interview, Massey discussed the effect of unemployment on patients’ access to healthcare and treatment, showing concern that some patients may not be able to afford the treatment they need. “We don’t know if they can afford their medications, and a lot of my lower income families don’t have savings,” she explained. “So not getting paid, even for just a week, could set someone back.”
“We don’t know if they can afford their medications, and a lot of my lower income families don’t have savings.” -REBECA MASSEY, LMSW
Indeed, a Reuter’s analysis of job losses in March found that job losses were signiﬁcantly concentrated in sectors such as hotels, service, and education as restaurants and schools began to close down. Many of these service industries tend to have hourly-paid workers, especially employed at small businesses. Hourly workers tend to face signiﬁcant hurdles to saving money, including unpredictable income and over 75% have less than $500 in savings. For these people, even temporary unemployment can completely eliminate any savings they have accrued, leaving little left for medical bills. The fear that patients may no longer be able to afford necessary treatments also comes from the mass loss of employer healthcare due to COVID-19 unemployment. Families USA estimated in a recent study that nearly 5.4 million Americans became uninsured following unemployment between February and May of this year, meaning that many Americans are now unexpectedly without income or healthcare coverage. For these families, difﬁcult decisions must be made between medications and rent checks. Even if they are able to set aside money for necessary expenses and medication, unemployment can still prevent patients from receiving telemedicine by limiting the doctor’s ability to communicate with the patient. According to Dr. Anne Peters, a professor of medicine at the University of Southern California, some patients lose access to technology that would allow them to receive telehealth such as cell phones or internet access, limiting doctors’ ability to contact and treat the patients.
While Massey encourages patients’ families to continue searching for positions, she also acknowledges that doing so in the time of COVID-19 can be exceptionally difﬁcult. “I have immunocompromised [patients] as well, [whose parents] don’t want to put their other kids in daycare because they don’t want to get their kids sick,” she explains “so the parents have to stay home with the children, and if that is a single parent household… it’s really hard.” Massey adds that “as a social worker, that’s really hard because I can’t watch their kids, but they need someone who can.” Yet despite her pressing fears about patients’ ability to maintain their ﬁscal and physical health, Massey is vigilantly attentive to patients’ mental health during unemployment. Patients often have very little control over their situations. One cannot control whether or not they have an understanding landlord or family nearby. Massey therefore urges that patients focus on their mental health as well, recommending listening to audiobooks or trying similar activities in an effort to ease tension when there is little that can be done. She says that “especially with the primary caregiver, there’s a lot of stress … with school closures and not being able to go outside.” Families dealing with illness, unemployment and the stress of a global pandemic can become quickly overwhelmed. She explains that “I still have families that are looking for positions and are not able to ﬁnd one, and they’re still struggling with having to pay their rent, and they don’t have family close.” While mental health is rarely at the forefront of patients’ minds in times like these, Massey repeatedly reminds the families she works with that focusing on mental wellbeing is not only beneﬁcial but necessary. Similarly, Dr. Jennifer Sherr, a pediatric endocrinologist at the Yale School of Medicine, advocates for mental health screens on all returning patients during COVID-19, with a special focus on those who have become unemployed. “This way I have some sense of what I’m walking into,” she explains. “I can look for resources while we talk.” Screening patients who have recently become unemployed can help healthcare workers to spot potential mental health crises earlier on and can help physicians to better understand their patients when performing telehealth. Focusing on mental health can also be a good way to lend patients some sense of control over a chaotic situation, as they ﬁnd themselves with a sudden excess of time and deﬁcit of resources.
Edited by Anusha Zaman Artwork and Design by Payton Kim
Although helping patients who have lost employment is fairly common work for social workers, the mass unemployment caused by COVID-19 has given rise to new challenges in the healthcare system. Massey describes that resources established for patients and the beginning of the epidemic are starting to wane now several months in. “At ﬁrst,” she says “a lot of our normal programs were offering COVID assistance funds … but now because it’s gone so long, a lot of those funds are diminishing.” With Houston’s COVID case count still on the rise, many local hospitals have minimized the number of elective procedures being performed and have begun to allocate more funding for COVID preparation, leaving little funding for the already overwhelmed programs intended to support unemployed patients. All these factors make dealing with unemployment during COVID-19 exceptionally hard for patients. Massey describes that “we have a set standard of programs that the family can qualify for … but because it’s being used so much, I’m running out of resources for these parents.” The effect is also compounded for single-parent households, Massey adds. “[Unemployment] puts them in a really difﬁcult situation; a lot of my single parents are very emotionally stressed right now.” And with hospital aid diminishing, these situations are set to become harder still. “These families,” Massey says, “right now, they need someone.” With expansions on federal unemployment beneﬁts set to expire next month, many patients experiencing unemployment worry that their months-long struggle to support themselves, their families, and their health is nowhere near done and that the ﬁght may become substantially harder without the extra relief from the CARES act, which has thus far managed to stabilize poverty levels during the pandemic. In the meantime, however, patients can take action to support themselves through patient advocacy programs like the Patient Advocate Foundation, which seeks to help reduce the ﬁnancial burden of the epidemic on patients and aid in insurance navigation and enrollment. Programs like these can help patients to cope with the immediate effects of the epidemic by providing assistance in decision-making and helping them better understand the options available to them. Ultimately, however, with Houston’s recovery czar predicting that business recovery could take upwards of a year, it is evident that additional measures will need to be taken to protect unemployed patients not only now, but for months to come.
COULD WE LOSE OBAMACARE DURING A PANDEMIC? » BY GRIFFIN HARRIS
The venerated political columnist Michael Kinsley once quipped that there was “a prize for being liberals’ favorite conservative”: a column in the New York Times. Today, however, every liberal’s favorite conservative seems to hold a different job title: Chief Justice of the Supreme Court. Conﬁrmation of this belief echoed across newspaper front pages and blue-checked Twitter accounts through June and July, when the conservative-controlled Supreme Court issued several decidedly liberal rulings—protecting LGBTQ workers from job discrimination, declining to strike down a restrictive Louisiana abortion law, reminding the President that his ofﬁce does not put him above the law—with Chief Justice John Roberts in, and often writing for, the otherwise liberal majority. “John Roberts is just who the Supreme Court needed,” The Atlantic declared. He is a “political genius,” Slate offered; “the real” John Roberts, the New York Times explained, was a “judicial minimalist.” Or what about this, from Newsweek: “Conservatives blast John Roberts”? The enemy of my enemy, the old saying goes… More than any recent case, though, the left-leaning public’s conception of Roberts–as a conservative who is jurisprudentially fair, intellectually honest, politically sensible, and, ultimately, not that conservative–owes to his vote in the most politically prominent ruling of his 15-year tenure. That is, of course, the Obamacare case. That decision is the jewel in Roberts’ reputational crown of bipartisanship. Presiding over a Court with a ﬁve-to-four conservative majority, Roberts deﬁed expectations to side with his liberal colleagues in saving the Affordable Care Act, President Obama’s landmark healthcare law. It was a surprising but nonetheless proud victory: an assurance from the nation’s highest court that the right to healthcare for millions of U.S. Americans was secure. That, at least, is the popular version of NFIB v. Sebelius, the 2012 case. It’s also a misleading version: the constitutionality of the ACA is far from settled, and Roberts’ ruling left the law in a vulnerable, not soundly protected position that might soon be exposed. For years, the already thin legal ice on which Obamacare stands has been melting in the heat of a conservative political climate, as state and federal legislatures, Republican-appointed federal judges, think-
tanks, and this presidential administration have sought to undermine the Act. When the Supreme Court revisits the ACA in its coming term, in California v. Texas, that ice could ﬁnally crack. Indeed, the case that originally upheld Obamacare could be the legal foundation for a future ruling that potentially strikes down the very same law. This apparent contradiction is the result of Roberts’ excessively narrow and surreptitiously conservative opinion in Sebelius, and it is the reason that that ostensible victory in 2012 deserves more scrutiny from the left than it gets. To assess the legal insecurity of Obamacare today, it is important to understand that decision from eight years ago. The Court was asked to answer several questions about the constitutionality of the ACA—and some are of such temple-rubbing complexity that without a law degree, they are hardly worth visiting. But one is most relevant to the Act’s forthcoming challenge. One of the most important features of the ACA was its “individual mandate,” a provision that required most U.S. citizens to have healthcare or else pay a ﬁne to the government. Any act of Congress must be justiﬁed under one of the powers the Constitution grants the federal government, and the individual mandate, creators of the law argued, was acceptable because of the federal legislature’s power “to regulate commerce… among the several states.” That part of the Constitution—the interstate commerce clause—is the grounds on which a huge number of federal laws are passed. The Court has historically recognized it to be an extensive power, acceptable for use even when interstate commerce is not immediately or obviously relevant to the law. For example, in 1964, the Court upheld the federal ban on racial segregation in public accommodations for an Atlanta motel because many of its clients came from other states, and excluding clients of a certain race would impact interstate commerce. In another famous decision, the Court ruled that Congress could ban an individual farmer from growing wheat on his farm to feed his livestock. That ruling noted that even though the farmer was growing his own wheat for his own consumption in one state—an act that appears to be neither commerce nor of interstate relevance—he would therefore not buy others’ wheat. The national wheat market, in the aggregate, might change as a result. The ruling in that 1942 case, Wickard v. Filburn, set a broad standard: an activity might be “local” and it “may not be regarded as commerce,” but “if it exerts a substantial economic effect on interstate commerce” then the Congress may regulate it. So when the 111th Congress justiﬁed the individual mandate in Obamacare on Commerce Clause grounds, it made sense: one person not having healthcare could, in the aggregate, substantially impact the massive national market for healthcare. The much-praised Roberts decision, however, rejected that argument, claiming that Congress’ authority to 10
regulate commerce did not include the power to order or create commerce. “Construing the Commerce Clause to permit Congress to regulate individuals precisely because they are doing nothing,” Roberts wrote of an individual mandate for those uninsured, “would open a new and potentially vast domain to congressional authority.” Instead of rendering the individual mandate and possibly the entire law unconstitutional, Roberts found another way to uphold it: he called the individual mandate a tax. Congress also has the power to tax and spend; and the individual mandate, Roberts noticed, was indeed a kind of tax, listed in the tax code, collected by the IRS, and used to fund government programs. “Because the Constitution permits such a tax, it is not our role to forbid it,” Roberts concluded. So the law, passed by the progressive party, stood because of a conservative justice. The immediate result was a victory for those who recognize and advocate for the right to affordable healthcare. The most comprehensive program in U.S. history to accomplish that goal was still in place. But Roberts’ decision, many legal scholars on the left noted at the time, was not the protection some imagined it to be. Because the individual mandate was a tax—the only Constitutional way it could exist–then it could be changed in tax laws. Had that mandate stood on the ground that Congress had argued for—under Commerce Clause authority—undermining it would require repealing or at least altering the health care law, a much heavier political undertaking. So when Republicans took control of both houses of Congress and the White House in 2017, Roberts’ decision became an invitation to accomplish a long-standing policy goal. But to repeal and replace Obamacare and its individual mandate, as Trump and others had promised, was difﬁcult, and despite near-total legislative power, the GOP failed to do so. It did not, however, fail to pass the Tax Cuts and Jobs Act of 2017, which reduced the individual mandate to tax to zero dollars, rendering it effectively useless—and possibly now unconstitutional. This fall, the Court will hear California v. Texas, an apt name for a lawsuit that is essentially groups of conservative states versus groups of liberal ones, one suing to undo the ACA and the other counter-suing to protect it. The case asks two questions about the current status of the ACA. The ﬁrst question: if the tax penalty for not having health insurance is zero dollars, is the mandate still “operative”? Does it still exist? The answer will almost certainly be no. For the mandate to be legal, Roberts originally argued, it must be a tax; if no tax penalty exists, then the mandate cannot stand.
This outcome is harder to predict. Some powerful conservative institutions, including the Wall Street Journal editorial page, have argued against a total repeal by the Court of the law, and Republican legislators are cautious of continuing the attack on Obamacare that cost them control of the House in 2018. But lower court decisions in this case, all of which have been decided by conservative justices, hold that the mandate and the ACA are inseparable: if one falls, so must the other. The Trump administration and its Department of Justice—to which the Roberts Court has been mostly sympathetic—have ﬁled briefs in the case arguing for the entirety of the Affordable Care Act to fall. What would that mean, for the Supreme Court to invalidate the Affordable Care Act? For the only branch of the federal government not accountable to the electorate to destroy a massive healthcare program in the middle (or, hopefully, near the end) of a pandemic? Without the Affordable Care Act, more than 12 million low-income adults could lose access to their Medicaid entitlements, according to a New York Times analysis. Without the law, 133 million U.S. Americans with pre-existing conditions would no longer be guaranteed coverage. A study by the Urban Institute found that a repeal of the Act would cause the number of uninsured people to rise by 19.5 million. Another study estimated that over 2 million young people under the age of 26 could also lose access to the insurance they can receive through their parents. And all this would happen in the middle of a pandemic that has already killed more than 150,000 and will soon infect 5 million. Losing the ACA would mean nothing less than chaos. It would also mean shattering any pretense that John Roberts has tried to build of a Supreme Court that is jurisprudentially constrained or above the political fray—a pretense that his fellow conservatives have put little effort into maintaining. To strike down Obamacare would be the ultimate act of judicial activism, of partisan battle. Roberts often speaks about the Court as if he were a civics teacher: preaching what can feel like platitudes about independence, the eyes of history, the importance of fairness and balanced power to our government. “We do not have Obama judges or Trump judges, Bush judges or Clinton judges,” Roberts said last year. There are legal complexities and intricacies to this case, but perhaps this case is less about those than it is about much more basic questions: does he actually believe that? Should John Roberts really be your favorite conservative?
Edited by Evangelos Kassos Designed by Kavya Parekh
And that will bring the Court to a second question. Is the individual mandate “severable” from the rest of the ACA, a 900-plus-page law? In other words, if the individual mandate is no longer constitutional, must the entire law be unconstitutional? 11
the need for cultural competence in healthcare.
BY ISHANI PAUL
t had been 3 weeks now that Seema had been suffering from an intense pain in her ear, and she couldn’t stand it any longer. When she reached the doctor’s ofﬁce, she was a little nervous, but not for the reasons one might typically expect. As an Asian immigrant, she had faced many experiences where her doctors had trouble understanding her. Was this because of her unique accent? Because she spoke English slightly differently? Meeting a new doctor had always been a nerve wracking experience for her.
When she ﬁnally met her doctor, she had hoped that he would be able to help her quickly and efﬁciently— a reasonable expectation. But this was not the case. When the doctor asked her questions, she felt as though she were being interrogated. And as he performed the check up she felt as though she were a farm animal, being poked and prodded without any concern for how it hurt her. Seema wanted it to stop, but how could she disrespect him? She had always been told that it was rude and disrespectful to talk back to authorities. Remembering those values that had been instilled in her, she remained quiet and instead tried to pull away, hoping the doctor would realize that he was hurting her. He did not. The doctor continued his harsh procedure until he eventually drew blood, and then he blamed Seema for moving and causing it. Seema left in tears. She couldn’t understand why this had happened to her or why the doctor had been so aggressive throughout her appointment. Her pain had not been
addressed and on top of that her ear was now bleeding. ► So why did Seema have such a terrible experience with this doctor? All she had wanted was a treatment for her ear pain— she had never expected to come out in more pain than before. In this situation, it boils down to a lack of cultural understanding between the doctor and the patient. While Seema came from a culture that valued not talking back to authority ﬁgures and offering them unlimited respect, the doctor came from a culture where verbal expression and directly stating one’s issues were valued. He could not understand the nonverbal communication coming from Seema, and Seema did not want to offend him by telling him that he was being too harsh. This lack of understanding between the patient and the doctor led to a miserable clinical experience. Unfortunately, this is a scenario that occurs often in today’s medical practices. There are many situations where a patient does not receive good quality healthcare due to their race or cultural background. This may be due to lack of understanding between the doctor and the patient— as it was in this situation— or it may be due to prejudices held by the medical professional, which result in providing lower quality of care. This brings us to the issue of cultural competence. Cultural competence in healthcare emphasizes medical professionals 12
appreciating diverse values and being able to adapt interactions with a variety of patients to better ﬁt their speciﬁc values. There have been various studies showing the importance of cultural competence in medicine as well as its effects on “improving patient centered care and increas[ing] access to high-quality care.” It has been shown that “biases, prejudices, and stereotypes held by healthcare providers result in lower-quality healthcare provided to racial and ethnic minority populations.” In response, this lower-quality care often leads to building more distrust of medical professionals in minority communities. The end result is a decrease of communication between the patient and the professional, further increasing the challenge of providing proper health care to these patients. By increasing the emphasis on cultural competency, these biases can easily be avoided as medical professionals take the time to learn about how cultures and values can vary from patient to patient. In addition to impacting the general quality of care, cultural competency also has a large impact on patient compliance. It has been shown that patients are less likely to follow recommendations made by any health care providers when the need for the treatment or medicine has not been explained to them. This issue is further ampliﬁed in culturally diverse communities that tend to have their own treatments to help alleviate symptoms. Certain cultures value these natural remedies over Western medicines and if these remedies are used alongside any prescribed medications they could lead to side effects if the ingredients were to interact. For example, St. John’s Wort is a yellow ﬂowering plant used in traditional European medicine, and is currently used for depression, ADHD, OCD, and menopausal symptoms; however, when it is taken alongside some medications (including antidepressants and birth control), it can reduce the effects of the drug and may also lead to increased serotonin production resulting in potentially dangerous side effects. It is important to explain these risks to patients in a respectful manner in order to ensure that their ailments do not worsen due to improper use of medications. This issue of cultural competence is not something that will eventually fade away— especially in a nation like America, where the population grows in diversity every year, and a number of different cultures are represented in various communities across the nation. As diversity increases, the need for improved cultural competence training increases as well. Read the rest at healthrighters.com Edited by Bindu Srinivasa Artwork by Antoinette Fang Design by Kavya Parekh
A Patient Advocate’s Guide to Being Prepared for COVID-19 BY: CATHERINE XU SINCE COVID-19 WAS DECLARED a global pandemic in March, its accompanying symptoms — “fever, cough, shortness of breath, loss of taste or smell” — have practically been etched in our brains. However, we forget another shared occurrence between COVID-19 patients: their inevitable feeling of isolation. Consider two COVID-19 patients with differing backgrounds: Paul Dewyse, a 57-year-old Michigan resident and a father to three, and Ernesto Castro, a 37-year-old care worker. As a double lung transplant recipient, Dewyse already had experience staying in the hospital several times due to chronic lung issues, but this case was different. The mandatory social isolation from the real world coupled with the intrusion into his personal life from the online world left him with an unimaginable amount of emotional stress. Because his case was one of Michigan’s ﬁrst two cases, news outlets trivialized his case down to one of “an adult man from Wayne County with recent domestic travel”, inadvertently doxing him for the whole world to judge. In the other case, 35-year-old Ernesto Castro, treated at the UCHealth Medical Center of the Rockies in Loveland, spent seven days in a medically induced coma for COVID-19. Recalling his feelings after he woke up, Castro said that “the hardest part was that no visitors were allowed in the hospital. I wanted my girlfriend to hold my hand. I wanted my mom to tell me everything is going to be okay.”
However, we forget another shared occurrence between COVID-19 patients: their inevitable feeling of isolation.
Stuck in arguably the most complex healthcare system in the world, U.S patients have always had trouble tracking their bills, insurance, and treatment plans due to unknown administrative costs. When we now add social isolation and unfamiliarity with COVID-19 to this existing mess, patients can’t help but feel absolutely powerless in the hospital. Out of the 4 million cases of COVID-19 in the U.S since January, we have seen a general trend of psychological and ﬁnancial distress for hospitalized patients. Multiple studies have shown that patients in quarantine experienced more long-term psychological problems than those who weren’t. Now, with many COVID-19 patients already showing signs of anxiety, depression, and stress in the hospital, we can expect many of them to similarly experience the same long-term emotional damage from being in quarantine. From a study done on the psychological impact on quarantine, researchers found that there were multiple causes (or stressors) during quarantine that possibly led to these damages: fear of infecting others, frustration and boredom, inadequate supplies, and inadequate information. Even after quarantine, the ﬁnancial stressor of having to pay the hospital bills possibly exacerbated these psychological issues. Based on previous hospitalizations for respiratory infections, the independent nonproﬁt FAIR Health projects that the cost for hospitalizations could range from over $21,000 to $38,755 for patients with employer insurance, with the patients spending about $1,300 to $1,464 out of pocket. What’s even worse is that, for the uninsured who will be hospitalized (approximately 670,000 to 2 million people), we can plausibly expect astronomical prices of at least $42,486 to $74,310. Because two-thirds of the uninsured are members of low-income families who are more susceptible to getting COVID-19, we can expect to see tremendous difﬁculties for these families in trying to navigate the healthcare system to get additional ﬁnancial aid.
The National Cancer Institute deﬁnes a patient advocate as “a person who helps guide a patient through the healthcare system.” Examples of their work include helping patients communicate with their healthcare providers so they get the information they need to make decisions, helping them get ﬁnancial support, and working with insurance companies and employers. Some patients may be able to have a relative or close friend take the time to do research and be their personal patient advocate or pay a professional to be their patient advocate.
While there are a few nonproﬁt patient advocacy groups that have developed over the past decades that do help less privileged patients, we have yet to see reform that can create a long-lasting impact…
However, many patients, speciﬁcally those in poor communities, aren’t privileged enough to afford either of these options. And while there are a few nonproﬁt patient advocacy groups that have developed over the past decades that do help less privileged patients, we have yet to see reform that can create a long-lasting impact on these communities. To get some insight into the effects of patient advocacy on COVID-19 patients from an individual perspective and a reform-based perspective, I interviewed Caitlin Donovan, the senior director and spokesperson for the National Patient Advocate Foundation and the Patient Advocate Foundation. The Advocacy Process When people normally think of patient advocacy, they tend to associate a patient receiving aid on an individual basis, but that’s only one half of it. For example, the Patient Advocate Foundation (PAF) and the National Patient Advocate Foundation (NPAF) are sister organizations. The former deals with individual patients, offering free specialized support on a case-by-case basis, while the latter deals with the national reform that can improve our health care system’s equity, access, affordability, and quality of care.
For individuals looking to receive a patient advocate, Donovan recommends that people start out deciding which kind of aid they’d like to receive. “There are two ways that people can look at it. On one hand, you can have someone help you professionally, who would be able to help you over the phone but can’t go to the doctor’s ofﬁce with you, ” said Donovan. “ On the other hand, a patient may want someone who can be with them at the doctor’s ofﬁce to help facilitate important conversations with the doctor, who are more likely to be a family friend or a loved one.” However, in both cases, Donovan recommended seeking an advocate “who is responsible, diplomatic yet assertive, and trustful because you are ultimately letting them deal with your personal health”. The patient advocates in the PAF would fall in the professional category, speciﬁcally serving patients with chronic, life-threatening illnesses. However, there are a variety of other patient advocacy nonproﬁts that serve different purposes; Needy Meds provides patients with prescription drug assistance, Pulse Center for Patient Safety focuses on patient safety and takes on patients that are survivors of medical injuries. For the patients who qualify to be served by the Patient Advocacy Foundation, there are a variety of services that they can receive: case management, co-pay relief, etc. Case management is usually the most sought-after service for the PAF, as it provides one on one assistance, helping patients appeal for denied services or ﬁnd available ﬁnancial support systems. Case managers have taken on an even larger role since the onset of COVID-19, as they also aid patients who have been hospitalized for COVID-19 or have had their chronic illness directly/indirectly worsened by COVID-19. A few examples of these new services include connecting patients to COVID-19 speciﬁc programs that address loan deferrals, accessing unemployment beneﬁts, and evaluating whether a patient’s insurance covers COVID-19 testing, telehealth, and treatment. In addition to case management, as of May 20, 2020, the PAF has allocated a COVID Care Recovery Fund for eligible patients in need of non-medical day to day costs of living expenses due to their diagnosis, such as food expenses, utility bills. For patients that don’t qualify for either case management or for the COVID Care Recovery Fund, the PAF has provided a plethora of resources under the COVID Care Resource Center, which includes updates on legislation being passed, websites to relief funds, and checklists to help prepare one for a COVID-19 hospitalization. The COVID-19 Planning Tip Sheet, one of the many checklists, provides an extensive list of important tasks patients normally would neglect in thinking about hospitalization for COVID-19, including “three action steps for a patient to plan out their care” and essential items to bring to a hospital stay.
Lastly, since some states don’t provide patients with a telephone, the responsibility is placed upon the patients to prepare their own phone and charger. For example, Arizona only recently passed a waiver on its previous rule that stated that its hospitals must provide access to a phone to its patients. One would assume that, especially during these times, hospitals would prioritize patients and their rights.
Reference to COVID-19 Planning Tip Sheet. Donovan highlighted two points on the list that she recommended everyone consider before going to the hospital: a phone and charger and an assigned medical decision maker. She noted that, with COVID-19, many “shared experiences have been outcries from caregivers, such as spouses and children, whose loved ones are in the hospital and they aren’t allowed to visit, so their phone becomes their lifeline.” Not only do phones help caregivers keep in touch with the patient, but they also allow caregivers to stay in touch with providers via Facetime, which more efﬁciently facilitates conversation between the hospital providing the treatment, the doctor, the patient, and their caregiver. This is especially important when we consider HIPAA (The Health Insurance Portability and Accountability Act of 1996), which prevents providers from sharing information with anyone who isn’t the patient. Although HIPAA acts in the patient’s best interest to protect their basic right of privacy, the pandemic has created a dilemma in which patients might not have the mental or physical capacity to make important decisions but caregivers are also not allowed to be at the hospital to help them make these decisions, making a phone and an assigned medical decision maker absolutely crucial.
Many “shared experiences have been outcries from caregivers, such as spouses and children, whose loved ones are in the hospital and they aren’t allowed to visit, so their phone becomes their lifeline.” CAITLIN DONOVAN
However, Donovan actually mentions this as one of the biggest misconceptions: “patients think that being hospitalized for COVID-19 will be like going to the hospital under normal circumstances, but hospitals are focused on saving the greatest number of people, even if it means that someone will die who normally would not”.
For high-risk patients, this future is extremely bleak, as they will be in the center of subjective decisions made by medical professionals on whether their life is worth saving over another patient’s and, for low-risk patients, this also means that hospitals will be able to neglect their rights in order to save the lives of the high-risk patients, placing the onus of education onto each patient. While the Arizona waiver may seem like an anomaly, if more hospitals nation-wide are experiencing difﬁculties implementing their emergency plans and suffering from surge capacity, we can expect to see a greater number of states signing waivers limiting patient’s rights for the greater good of the hospital. Ultimately, this places more pressure on the patient to be prepared and, until we can see permanent reform being placed onto the healthcare system, patient advocates and being prepared are a patient’s best bet in getting the best quality care they can get at the hospital. This is the ﬁrst article in a two-part series about patient advocacy. The second installment will focus on the national reform and policy coming from the NPAF and other patient advocacy groups in regards to COVID-19.
Edited by Akila Muthukumar, Anu Zaman Artwork and Design by Angela Chen 16
COVID-19: EXPOSING THE INTRINSIC FLAWS OF OUR HEALTHCARE SYSTEM BY ANNIE LIU
fter two months of the US’s delayed response to COVID-19, our country took widespread measures to quarantine starting in March. Non-essential businesses closed down, companies adopted remote structures, and people were strongly encouraged to stay inside in hopes of minimizing the spread of the virus, watching from home as this pandemic swept the world. Amongst many other upsets with our society, jobs became a huge concern as companies were forced to reallocate their resources and determine how employees would be able to work from home. For those who worked in a setting where virtual hours were simply not an option, such as in the dining and retail industries, this became an even bigger problem. As a result, unemployment numbers skyrocketed from 3.8% in February to 13% in May, an increase of roughly 14 million people. Even this is a conservative estimate, due to inaccuracies from COVID-19-related complications. This also does not count those who dropped out of the labor force during this time period, which would account for about 4 million people. Including these statistics, the unemployment rate is closer to 25%.
Unfortunately, those of lower socioeconomic status, or SES, are impacted harder than those of higher SES. As of 2018, 67.3% of people were under private health insurance typically provided by their employer, while only 34.4% were under public health insurance (Berchick et al). Of Americans earning in the top 25% of incomes, nearly 6 out of 10 had the ability to work from home, compared to only 3 out of 10 earning in the lowest 25%. In addition to losing much-needed income, another major concern for employees is health insurance. This includes coverage of the minimum ten essentials marketplace health insurance is required to cover under the Affordable Care Act, or ACA: ambulatory patient services; emergency services; hospitalization; pregnancy, maternity, and newborn care; mental health and substance use disorder services; some prescription drugs; rehabilitative services and devices; laboratory services; preventive and wellness services; and pediatric services.
Undoubtedly, there are still plenty of problems with health insurance and healthcare expenses that still must be addressed. The system only covers relatively inexpensive and regular costs, which typically excludes surprise medical bills and the bulk of treatment costs for serious medical conditions. Prescription costs have always been an issue, as pharmaceutical companies have consistently found various ways to synthesize new drugs and subsequently charge more. Americans may even have to ﬁght their insurance company for coverage of various hospital, test, or drug bills. As of 2018, 34% of adults on health insurance already found it difﬁcult to pay deductibles, 28% the cost of health insurance, and 24% copays for doctor visits and prescriptions.
Amongst many other upsets with our society, jobs became a huge concern as companies were forced to reallocate their resources and determine how employees would be able to work from home.
So what about the coronavirus? What additional ﬁnancial impact has it brought to America’s already ﬂawed healthcare system? In addition to losing income and health insurance, cases in the US continue to grow, outpacing every other country. COVID-19 testing and hospitalization costs are no small feat, and due to the immense privatization of health insurance, coverage varies between providers. Fortunately, all comprehensive health insurance plans must cover all general COVID-19 testing costs. Antibody testing costs are also covered, but the reliability of these tests is still questionable. Several companies are waiving in-network copayments and deductibles. Some are also waiving out-of-network costs, which is beneﬁcial for those living in more isolated areas where an in-network healthcare facility may not be readily accessible. But for the uninsured, these costs will be a challenge to cover. Most of them will be charged by the hospital with prices that have no discounts and are usually signiﬁcantly higher than private insurance reimbursement. Speaking conservatively, costs for uninsured healthcare relief across the country are estimated to range anywhere from $13.9 to $41.8 billion, which would occupy a signiﬁcant portion of the $175 billion fund Congress set up for COVID relief. More of this money will likely be given to states without Medicaid expansion, throwing into uncertainty the ability to cover other important COVID-related costs, such as medical supplies and healthcare facilities.
Given the ever-growing numbers of unemployed persons in the United States with COVID-19 cases still on the rise, the continual pursuit by the Trump administration of ACA repeal, a bill passed during the Obama administration designed to increase the affordability and accessibility of healthcare, has been widely criticized. If the case is ruled in their favor and the ACA is repealed, this will result in the loss of insurance for 23 million Americans, as well as many provisions the ACA provided, such as the guarantee of essential beneﬁts, various consumer protections, and holding insurers accountable for spending premium money on patient healthcare. Of course, the ACA has its own issues that remain to be addressed. Businesses are still able to ﬁnd ways around transparency regarding their employees’ insurance plans, and some businesses have cut employees’ working hours in order to prevent covering insurance. As insurance plans have become more comprehensive, so have the costs of premiums, which continually rise, This inevitably makes payment more difﬁcult, especially for those of lower socioeconomic status And there is a lack of public outreach regarding health insurance. Enrollment day is often a mess. There are no solid education programs established to help people navigate the undoubtedly complicated world of health insurance, leading to poor decisions, the inability to pay, or other problems people simply cannot predict because they do not know enough about how health insurance works, because they are health illiterate.
However, completely repealing an act that still provides a signiﬁcant amount of beneﬁt to those across America and starting from scratch, something the Trump administration is still actively trying to accomplish, would leave millions more uninsured and thus unable to pay the high costs of healthcare. The ACA is especially important during this COVID-19 pandemic for many low-income families, when more people than ever are in need of healthcare and thus insurance coverage. Instead of completely tearing away the shelter the ACA currently provides for many people from the worst ﬁnancial burdens of healthcare, the federal government should aim for the overarching goal of universal healthcare and take steady measures towards it.
As for those whose healthcare accessibility is directly under attack due to a lack of insurance, some measures have been taken in attempts to alleviate their ﬁnancial burden. The Coronavirus Aid, Relief, and Economic Security Act, or CARES Act, instilled in April, allocated $175 billion for COVID-19 relief. Of that $175 billion, $10 billion has been allocated to hospitals with over 100 COVID patients, $12 billion for hospitals with less than 100 COVID patients, $10 billion for safety net hospitals, $15 billion for Medicaid providers, $50 billion for Medicare providers, $10 billion for rural communities, $4.9 billion for Skilled Nursing Facilities (SNF), and $500 M for Indian Health Services (IHS), with $62.6 billion unallocated. However, should funding run out, those uninsured may have to cover the medical bills themselves or possibly be delayed in their access to care. Additionally, not all hospitals are participating; some smaller hospitals are still unaware of the program, which entails the costs falling again on uninsured persons. Furthermore, to be eligible for reimbursement, a patient’s primary diagnosis must be COVID-19, meaning patients with COVID-19 but currently being treated for another health issue are illegible. Transparency is another issue; providers are not required to participate, and patients cannot easily learn whether or not a certain provider is participating in the program.
Instead of completely tearing away the shelter the ACA currently provides for many people
from the worst ﬁnancial burdens of healthcare, the federal government should aim for the overarching goal of universal healthcare and take steady measures towards it.
As COVID-19 continues to strangle our nation, various intrinsic ﬂaws embedded in our current health system repeatedly come to light.
A partial and temporary solution to this problem is to increase enrollment in Medicaid, as patients under Medicaid receive CARES funding and don’t have to worry about whether or not a private provider is participating in the reimbursement program. With unemployment rates rivaling those of the Great Depression Era, states are experiencing elevated rates of Medicaid enrollment and thus costs. Some states have taken measures to facilitate the Medicaid enrollment process, such as adding the ability to enroll online or over the phone, shortening waiting times for application processing, and allocating more resources towards increasing the efﬁciency in determining eligibility. Of course, still more can be done to further streamline the enrollment process: more hospitals should establish presumptive eligibility programs that instantly enroll patients in Medicaid temporarily until full eligibility is processed; presumptive eligibility facilities should be expanded beyond hospitals to providers such as schools, community-based providers, and state agencies; federally facilitated marketplace enrollment determinations should be adopted which would decrease wait times for documents to be processed; and documentation requirements should be minimized for eligibility by implementing the use of more electronic data systems.
For employees and their families who have lost their jobs in the time of the pandemic or no longer qualify for health insurance from their employer, they are able to apply for temporary COBRA coverage, during which they can stay on their previous workplace insurance, typically for up to 18 months. Some modiﬁcations have been made to COBRA in light of the pandemic. The typical election period of 60 days in which employees must choose whether or not to stay on COBRA does not begin until the end of the Outbreak Period, which is deﬁned by 60 days after the end of the declared COVID-19 national emergency; premium payment and grace periods also do not start until the end of the Outbreak Period. Essentially, employees adversely affected by COVID-19 in terms of health insurance have a greater time period to continue on their current workplace health insurance, which may provide additional time needed for soon-to-be uninsured workers to transition to another program such as Medicaid.
Edited by Rohan Ravirala Artwork and Design by Annie Liu
As COVID-19 continues to strangle our nation, the various intrinsic ﬂaws embedded in our current health system repeatedly come to light. Costs of care remain a massive problem entangled deep in the US’s health industry. This huge inﬂux of uninsured persons ampliﬁes the persistent struggle for people of lower socioeconomic status, who for various reasons are unqualiﬁed for adequate health insurance. They face staggering medical bills from hospitals, emergency visits, prescriptions, and various other healthcare-related costs. Enrollment for Medicaid is a long and oftentimes confusing process, with no deﬁned program dedicated to increasing healthcare literacy for those who have trouble navigating the nuances of the healthcare industry on their own. A handful of states still have yet to pass Medicaid expansion, which would signiﬁcantly increase those eligible for Medicaid. And the Trump administration, aside from continually delaying or altogether striking various aspects of the ACA, is currently pursuing complete repeal of the act, which would cause millions more to lose health insurance in the middle of a health crisis. These problems will most certainly take an overwhelming amount of time to solve, if even possible, but until then, as individuals, our efforts should be directed towards properly quarantining and otherwise observing the necessary measures to minimize the spread of COVID-19, to both ensure our own health and to help those less fortunate who are impacted much harder than the average individual by this pandemic.
Articles in this section discuss the societal impacts of the COVID-19 pandemic. New normals include wearing masks, carrying sanitizers, and maintaining a 6 feet distance. In addition to detrimental mental health and loneliness, human interactions themselves are being reshaped. Further, the pandemic has given us a moment to reďŹ&#x201A;ect on societal constructs, from healthcare to social class, that have went unchallenged for years before.
EXT REME MASK OVER HOW TO GET THE REST OF AMERICA TO START WEARING MASKS | BY GABI FOWLER
AS ECONOMIES CONTINUE to reopen and coronavirus cases and related deaths climb, face masks continue to be a vital form of protection. Initially, many states skipped the crucial step of mandating masks when reopening. However, recognizing the need, many states have recently implemented mask mandates in public spaces. Yet even with these mask mandates, a small yet vocal minority adamantly refuses to wear masks. While initially the guidance regarding masks was confusing, research has since proven the effectiveness of masks and health organizations have agreed on their importance. Today, the mask debate extends beyond being merely an issue of public health, but also a political and social one. In addition to mandates, the roots of the mask-wearing reluctance needs to be understood to counteract the cultural arguments at the heart of the debate. To understand masks and their role in American society today, we must ﬁrst look back and understand the path of confusing guidance by top global and national leaders over the past few months. Initially, as a result of a lack of sufﬁcient evidence and fear of personal protective equipment (PPE) shortages for health workers, the World Health Organization (WHO), the world’s leading global health institution recommended against masks for non-healthcare workers and asymptomatic people. It wasn’t until June 5th, 2020 that the WHO reversed course on this and recommended masks for everyone (although not medical grade ones nece-
-ssarily). On top of changing recommendations, on the national stage, President Trump initially had not only refused to wear a mask—the only exception being his July 11th visit to the Walter Reed Medical Center—but had also decried other leaders who have worn masks. President Trump’s encouragement that masks were merely “voluntary” and a matter of choice rather than necessity compounded with changing recommendations from health organizations caused the average American citizen to become wary and distrustful of the public health value of masks and the purpose of masks generally. Although Trump ﬁnally ended up giving in and wearing masks on July 21st after three long months of ofﬁcials within his administration pushing the importance of masks, such mixed guidance through the initial course of the pandemic has resulted in the planting of the idea that masks were a threat to basic national values of freedom. Polling done by National Geographic in late June showed that 15% of those polled said they either “rarely” or “never” wear a mask when leaving the house. These polls also indicated that people’s opinion of Trump greatly correlated with their mask-wearing. Of those who had a “very favorable” opinion of Trump, 42% always wear a mask compared to 72% of those with a “very unfavorable” opinion of Trump. Similarly, 46% of Republicans said they 22
always wear a mask compared with 75% of Democrats. While 15% may seem like a small minority of Americans, it is a signiﬁcant population considering masks are a basic measure to curb the ongoing pandemic and requires as much compliance by all as possible to be successful. The 15% of people who are not wearing masks are likely to be
Most importantly, masks need to be reframed as a catalyst for freedom rather than an inhibitor of freedom. of the same population who are distrustful of masks and see them as an infringement to personal liberties. They additionally are more likely to be right-leaning politically. One approach to increase mask use, which many states and cities have taken up, is to create laws mandating masks in public spaces for all. A study in Mexico City during the H1N1 outbreak in 2009 examined this approach. Alongside other intense infection control measures, the federal government of Mexico had recommended masks for all users of public transportation, while Mexico City mandated masks for public transportation drivers with the highest penalties going toward taxi drivers. This study found that mandates do slightly increase compliance with mask wearing and the higher the penalty, the higher the resulting compliance. However, this study also stressed the importance of public perception of the implementation of public health measures and how that can greatly impact their outcomes. This suggests that positive public perceptions is a critical component of higher compliance. Unfortunately, in many places across the United States, although there are laws mandating the use of masks, the punishments for noncompliance are often nonexistent and/or police are not prioritizing their enforcement. Moreover, many studies have even proven that enforcement of lower level offenses tend to target poor and minority communities, so there is a likelihood that mask mandates, intended to protect vulnerable communities, would turn back around and harm those same communities. This is particularly concerning given the already hostile political atmosphere regarding police brutality and their targeting of poor and minority communities. Thus, creating penalties for noncompliance of wearing masks may not only fail to target the remainder of the population who aren’t wearing masks, but result in increased inequities in populations who are already most vulnerable during this pandemic. Thus, while policies are an important start, in order to increase mask-wearing in the United States, a more social strategy needs to be undergone. To truly universalize masks across the country, leaders, especially those who have a signiﬁcant “anti-mask” following, need to reframe what it means to wear a mask and normalize them across American society to target those who still see masks as unnecessary or an infringement of rights —
thus, reversing the remaining negative perception of masks. One example of this is Representative Liz Cheney’s tweet captioned “#realmenwearmasks” featuring a picture of her father, former Vice President Dick Cheney, in a mask. Leaders using their social media platforms to normalize mask-wearing and to encourage their supporters to do the same is powerful. This particular tweet was especially powerful given that Representative Liz Cheney represents a consistently conservative state and Dick Cheney is an important Republican ﬁgure. Freedom, here, is not the choice to wear a mask or not, but rather the choice for all of us—who are past ready for the pandemic to be over—to go outside safely and freely. For the past couple of weeks, we have been hitting the wrong kind of records: record conﬁrmed cases in a day, record cases per capita, etc. As the need for everyone to wear masks becomes increasingly important to combat these rising ﬁgures, new strategies need to be used to target the remainder of people who are still reluctant to use masks. Although there is little research into what works in increasing compliance of public health measures mid-pandemic, it is clear that endorsements by health professionals and mandates are not enough. The polling cited earlier indicates that one’s opinion of Trump correlates with their opinion of masks. Thus,
Having political leaders who are supported and trusted by their communities actively wearing masks rewrites mask-wearing as an act of freedom rather than a government intrusion of rights. Likewise, it reinforces the trust that masks are not some oppressive conspiracy, but rather a real measure to end this pandemic. President Trump’s recent tweet this month of him donning a mask and endorsing it as patriotic shows a step in the right direction in this regard. His rebranding of wearing masks as an American value could make a real difference in inﬂuencing his supporters’ decisions to wear masks, as well as the decisions of others who were still distrustful of mandates to wear masks. For the safety of all Americans, masks need to become a part of the new normal and it is now up to America’s leaders and ﬁgureheads to ensure that happens. Edited by Mila Ho Artwork and Design by Kavya Parekh 23
The Downward Spiral of Health Inequality And What We Can Do to Prevent It BY RICKY ILLINDALA
merica is knee-deep in combating the dangerous threat posed by COVID-19. The coronavirus pandemic is currently testing the government's ability to protect its people and has thrown nearly all Americans’ lives into disarray. Most of us desire a return to normalcy; a life where we can go about our daily routines without fear of catching a life-threatening virus at any time. However, for some people, their lives have been riddled with impending difﬁculties stemming from their inherent disposition prior to this pandemic.
While the pandemic will eventually come to a close, it has unearthed other long-standing issues of healthcare inequality that will persist even after the pandemic.
People of lower socioeconomic status (SES) have been burdened with poor health and a lack of healthcare access in recent years. These groups face more health problems while receiving less healthcare, an obstacle referred to as health inequity. The current coronavirus pandemic only serves to highlight those inequities. The virus has caught everyone’s attention, and America is currently all hands on deck to shut down its spread. While the pandemic will eventually come to a close, it has unearthed other long-standing issues of healthcare inequality that will persist even after the pandemic. Therefore, while the pandemic deserves much of our attention right now, we should also pay attention to healthcare inequity in order to lessen the damage that this pandemic and future health crises can cause.
According to 2017 United States Census Bureau data, the median household income was $68,145 for White people while it was $50,486 and $40,258 for Hispanic and Black people respectively. Furthermore, according to 2017 educational attainment data, 34.2% of white adults have a high school degree or less while 60.5% and 44.9% of Hispanic and Black adults, respectively, have a high school degree or less. Those identifying as Black and Hispanic people generally have lower incomes and less education attainment than White people. If we also take a look at the CDC data on COVID-19 hospitalization rates per 100,000 population, White people have a rate of 40.1 while Black and Hispanic people have rates of 178.1 and 160.7, respectively. The income and education statistics above correlates well with the signiﬁcantly higher hospitalization rates for Black and Hispanic people compared to White people.
If we all, little by little, day by day, open our minds up to people of different races and social classes, we can gradually drive out the poisonous ideals that promote inequality in our society.
According to Dr. Samuel Dickman, at the University of California, San Francisco, low SES individuals are particularly vulnerable to poor health conditions. When these Americans fall into bad health, the minimal availability of healthcare resources for them enables their health to worsen. As the healthcare industry pushes resources into well-performing hospitals in afﬂuent areas, poor Americans have no means of securing the health care they need. As their health worsens, they can’t work, thus making it increasingly more difﬁcult to afford necessary medications or treatments. This leads to a downward spiral that traps Americans in a cycle of poor health and poverty. Ultimately, this further stresses both the US economy and healthcare system as low SES groups develop complex conditions and are unable to work. It is in all of our best interests to advocate for healthcare equity. While the coronavirus has illuminated such issues of healthcare inequity and health disparity, they have been haunting the US for many years now. Consider, for example, patterns of chronic conditions affecting minority groups. A report conducted by the National Academy of Medicine indicated that minority groups, when compared to white persons, have limited access to appropriate cardiac care, kidney transplants or dialysis, and quality treatments for stroke, cancer, or AIDS. While these conditions are currently affecting less people than the coronavirus, they are still causing avoidable deaths that stem from a lack of proper healthcare for lower SES citizens.
There are plenty of community-based organizations (CBO), such as the National Collaborative for Health Equity, that we should join and get involved with. CBOs like the National Collaborative have infrastructure and opportunities set up to promote health equity, making them a great opportunity to get engaged immediately. Being a part of one of these groups can serve as a guide for those who want to be active in their community but are not sure how. Even if the above options are too complex or demanding, we owe it to each other to take on the following fundamental duty: enact real change by altering the way we treat each other. Health disparities are rooted in long-standing beliefs of privilege and bias. If we all, little by little, day by day, open our minds up to people of different races and social classes, we can gradually drive out the poisonous ideals that promote inequality in our society. Those in or aspiring to be in healthcare jobs (physicians, pharmacists, nurses, healthcare management, etc.) should also use their unique position to inﬂuence the healthcare industry. You should express your concerns for healthcare inequality among your peers and interact kindly with patients of different classes and identity. The causes of inequity ultimately stem from people’s mindsets. If everyone who enters a healthcare job can care for their patients’ health and identity, we can transform the general mindset of the industry to care for all people, regardless of identity.
Now that we know about the level of inequality in our healthcare system, what can we do with this information? Federal and state governments determine policies that dictate access and affordability of healthcare. You can have the government hear your voice by spreading awareness of healthcare issues in your local community, voting in local and federal elections, and reaching out to local government ofﬁcials regarding your concern for healthcare inequality. If patiently waiting for change in government policies does not suit you, there are still plenty of other pathways to take action and create change.
Edited by Rena Lenchitz Artwork and Design by Annie Liu
Exploring Casteism and the Making of Modern Tamil Nadu BY AKILA MUTHUKUMAR Portrayal of Caste A quick Google search for “caste” brings up a four-tiered pyramid with Brahmins (priests and teachers), Kshatriyas (warriors and rulers), Vaishyas (farmers, traders, and merchants), and Shudras (laborers). These four upper-caste varnas together are referred to as savarnas. Below these four tiers (avarna), are the Dalits, subject to the harshest forms of oppression. The Manusmriti, a text within the Hindu Vedas, details how each group was related to parts of Brahma’s body: the head, the arms, the thighs and the feet. These Sanskirt verses codiﬁed discriminatory social stratiﬁcation, making it indefensible to blame colonial rule for casteism within the South Asian subcontinent. However, these four-tiered images fail to note the diversity in the origins of caste outside of a singular text and fail to help us understand modern manifestations of thousands of castes. Since the construction of caste has varied temporally and geographically across South Asia and even within India, an oversimpliﬁed narrative of caste is actually a disservice to the very cause — a righteous ﬁght against casteism — that it purports to support. While generalized schematics of caste can be counterproductive, it is powerful to adopt the generalized term “Dalit,” which literally translates to divided or broken. Dalit is a powerful community-adopted, self-deterministic name that has come to replace a variety of more degrading terms like “untouchables” or backwards people. In understanding and combatting casteism, it is crucial to center Dalit stories and voices. History and Evolution of Caste In the interest of acknowledging the origins of caste in different localities, the focus here is a brief history of caste in Tamil Nadu (TN), a southern state in India. This is especially important because South Indian history is often overlooked or underrepresented in mainstream or Westernized representations of India.Analyzing history addresses how traditions were codiﬁed, how population makeup changed over time, and, importantly, whose stories are told and whose voices remain unheard. From 200 to 100 BC, social stratiﬁcations were evident
in the Tolkappiyam, a treatise on Tamil grammar and classical poetry, with the following groups: Anthanars or Parpanars (priests or Brahmins), Arasars (kings or Kshatriyan), Vanikars (merchants or Vaishyas) and Vellalars (agriculturists). Although these groups have parallels to the previously described four-tier varna system, the two cannot be superimposed. In the Tolkappiyam, these groups are associated with profession as opposed to birth and there are nuances: Brahmins described in secular jobs, acknowledgements that the warrior profession could be undertaken by multiple castes, and divisions within the Vellalars. These exceptions do not absolve traditional texts from blame for casteism; however, they can be wielded to challenge those who misuse or misrepresent tradition and religion to justify casteism. Between 400 BCE and 300 CE, Sangam literature describes at least 20 other caste divisions endemic to Tamil Nadu on the basis of shared customs or village communities. During the Pallava period from 200 to 900 CE, North Indian inﬂuence began to affect South India as Brahmin majorities migrated and enforced institutions of Vedic learning, which provided a rationale for the birth-based varna system; Brahmanism is an early version of Hinduism that relied on caste-based divisions and is equated with social stratiﬁcation today. From 700 to 1500 CE, the Bhakti movement brought limited religious reform as the Brahmanical form of social order from Vedic tradition was denounced and inter-caste mingling or sharing of food was celebrated. At this time, one of few recorded Dalit saints in history, Saint Nandanar, was born to a Pulaiyar (untouchable) family. His name lives on in the Tamil tradition, although there are variations in his story, ranging from tales written by upper caste authors declaring that he was a Brahmin trapped in an untouchable’s body to more progressive, reformist Brahmin characters in literature supporting Nandanar. Throughout this time, Brahmin ruling elite and scholars documented and determined how history was told, allowing their legacy to live on in South Asian cultural and intellectual traditions. Today, Dalit activists highlight Nandanar’s religiosity, stressing that devotion has never been and can never be limited by caste.
Next, during the Vijayanagar dynasty from 1333 to 1646, migration from Telangana introduced new groups like Kammas, Reddys and Nayaks to TN. The Chola army of this also time mentions 98 castes within two groups, Valangai (right-handed) and Idangai (left-handed) that are potentially linked to profession. As the complexity of TN social fabric diversiﬁed, Portuguese and British colonizers arrived, solidifying caste in administrative language as better jobs opportunities were afforded to upper castes or Christians. The word caste itself is derived from casta (Portuguese) after Jesuit missionary Henriques used the term in his observations of society in the 1500s. The history of caste would be incomplete without mention of Christian missionaries attempting to proselytize lower-caste communities. Post-colonial rule, the Indian constitution outlawed caste-based discrimination, but it continues to be omnipresent in society. B.R. Ambedkar, a Dalit who helped author the constitution, and other caste liberation ﬁgures rose to prominence in the late 1900s. Although Ambedkar’s revolutionary communication with Du Bois and work with the Dalit Panthers, christened after the Black Panthers, are widely recognized (with good reason), Dalit leadership and voices from TN have received less attention. Manifestations of Caste in Present Day Moving into the 2000s, I wrestle with how the historical roots of casteism have translated to modern Tamil Nadu, where classical literature no longer dominates political culture and diasporas continue to carry on deep-rooted social stratiﬁcation.
Caste informs every aspect of life in Tamil Nadu, which has become especially evident through increased violence on Dalit communities during the pandemic. Within the political arena, caste groups are vying for greater protections from the Government of India. Currently, the reservation system, akin to afﬁrmative action in America, attempts to equalize opportunities, in public education and the government workforce, by creating seats for Dalits, other backwards classes (OBCs), scheduled classes (SC), and scheduled tribes (ST or Adivasis). “That we have so many caste outﬁts with political strength is the reason for the violence that we don’t see in other southern states,” according to Dalit scholar and VCK (party representing Dalit people) leader D. Ravikumar. His comment speaks to how groups experiencing varying levels of oppression often lack solidarity. For example Vanniyars, classiﬁed with OBCs, ﬁght ardently against upper-castes Brahmins to demand quotas for themselves, but simultaneously restrict Vanniyar-Dalit marriages. Every political group AIDMK (current ruling party), DMK (opposition party), and VCK (formerly Dalit Panthers) tends to prioritize ﬁghting for a particular caste of people, but clashing political agendas and widespread corruption have only detracted from ﬁghting larger systems of oppression. Outside of political parties, caste also informs public ofﬁce, ranging from the IPS (Indian Police Service) to the IAS (Indian Administrative Service). The Jayaraj and Bennix case that’s been trending this month involves two men targeted by the police for leaving their store open 15-minutes past curfew (in place for the pandemic). The father-son duo were brutally abused in police custody, spurring public outrage and leading to this article covering the comprehensive history of policing in TN. The article uncovered that “a government-appointed Commission found out that members of a particular dominant intermediate caste were prevalent in the police.” It is possible to develop caste rankings by a number of factors other than population: political power, land ownership, wealth, religious and spiritual elitism, or even violence inﬂicted upon other groups. There is no clear hierarchy that can encompass hundreds of castes and subcastes. However, the complexity of power structures within upper/forward-castes, should not distract us from the obvious human rights violations that Dalit communities face. To continue reading, visit www.healthrighters.com
Top to bottom: 1. Shankar and Kausalya (Source: Huff Post) 2. Special arrangement for Kiccha (Source: Sandhya Ravishankar) 3. Jayaraj and Bennix, (Source: Twitter) 4. Melavalavu Tribute (Source: Express)
Edited by Sumayyah Farooq Artwork by Amulya Garimella Design by Akila Muthukumar
Social Distancing, Masks, and Creativity: How to take care of your mind and body as COVID-19 cases continue to rise
BY RIA PARIKH
n addition to the physical effects of the Coronavirus pandemic, the quarantine and social distancing that come along with it have taken a huge toll on the mental health of people of all ages. The mental impact of social isolation is as prominent as ever. Along with it, we have seen increased health anxiety and uncertainty about the future. Initially, we thought that the summer would be it. That once that fall hit, COVID-19 would be a thing of the past. But clearly, that is not the case. In order to understand the severity and probability of a second wave, I spoke to Infectious Disease Specialist Dr. Omar Kawwaff, MD. Dr. Kawwaff said that one of the most intriguing aspects of the Coronavirus is that it is very easily transmissible in all types of conditions. “The special thing about COVID-19 is that it is completely new, and we are all susceptible to get it,” Dr. Kawwaff said. “It has very easy transmission. The wet, hot, dry, weather cannot suspend it.” By contrast, environmental conditions such as temperature, rainfall, and altitude have drastic effects on common diseases, including Malaria, Lyme disease, dengue, and many more. The fact that research has not found decreased transmission of COVID-19 in certain weather conditions makes it more likely to surge. With all that being said, Dr. Kawwaff thinks that another surge of COVID-19 is highly likely. In fact, the day I spoke to him, Tuesday, June 30th 2020, he had 10 new coronavirus patients in just that day. “We are not going to be able to control the surge unless we have a vaccine, or (if) we are going to change the behavior of people,” Dr. Kawwaff said. “Low socio-economic groups cannot have adequate social distancing and have to go to work. And people still aren’t wearing masks.” So it seems as though we will be unable to fully prevent a surge of the virus, but there are still some things we can do to make it as low-impact as possible. According to Dr. Kawwaff, two of the most important things for us to maintain are social distancing and wearing masks.
Illustration by Ria Parikh and Varshini Odayar “Distancing and masks,” Dr. Kawwaff asserted. “Shaking hands is over, socializing in bars and restaurants is one of the most dangerous things we can do. Masks are the number one. People have a right (not to wear them), but other people have a right, and masks are about protecting others, not just you.” According to a 2020 article from the University of California San Francisco, lab research and real world epidemiologic data serve as evidence that cloth masks are very effective for preventing the spread of disease. Most of this data consists of dramatic decrease in COVID-19 transmission and death rates across 198 countries. In order to do our best to control the spread of the coronavirus, social distancing is still a must. But what does that mean for our mental health? To understand more about the way social distancing continues to impact our mental health, I spoke to Psychologist and Psychology Professor Dr. Debjani Sinha, PhD. Dr. Sinha introduced me to the topic of Touch Hunger, which relates to the need that all humans have to be in close proximity to others. “COVID has taken away our ability to connect with people,” Dr. Sinha said. (It deprives us of) “the need to be physically connected and touch a human being.” 28
More speciﬁcally, touch hunger or touch starvation occurs as a result of deprivation of physical connection when physical contact is limited. This feeling can consume your mind and body and bring with it dissatisfaction and unease. In addition, the touch starvation that results from social distancing can lead to psychological distress (depression, stress, and anxiety) as well as physical distress, including increased blood pressure and decreased effectiveness of the immune system. Aside from social isolation, there are so many other ways that quarantine and the coronavirus can impact our mental health. From virus anxiety, to loneliness, to boredom, to stress, it seems as though no one is safe from COVID-19’s mental impact. You may be wondering why mental health matters at a time like this. Did you know that poor mental health is strongly associated with a weakened immune system? There is a ﬁeld called Affective Immunology which explores the very apparent link between psychological/emotional distress and immune response. Research has shown that experiencing both acute and chronic stress can not only lead to mental health disorders but also inﬂammation throughout the body due to an immune response. With everything we are doing to try and keep ourselves healthy, it is crucial to add mental health into the mix.
Creativity can do wonders for our mental health. According to an article from ICS Digital Therapies, being creative puts your mind in a state of tranquility, similar to meditation. But that’s not all. Have you noticed that many creative activities involve repetitive body movements? Think about knitting, cooking, dancing, painting, just to name a few! It turns out that these repetitive movements actually connect to reward centers in our brains and trigger the release of dopamine, a feel-good chemical. So while you’re in quarantine or spending some extra time alone, consider taking up something creative in between Netﬂix binges–you’ll feel so much better before you know it. Social distancing is in no way easy or desirable. During this time, however, it couldn’t be more necessary. It is so important to take care of your mental health all the time, but especially now, and creativity is a fun, easy way to help do so. In the words of Dr. Sinha, “taking care of the mind is so critical, because if that doesn’t work, you can’t really do anything else.” So in addition to wearing a mask and keeping your distance, it is imperative to ﬁnd ways to stimulate your mind through creativity to keep yourself as healthy as can be during this time.
So what can we do about it? I think that we’ve already done a good job of trying to connect virtually, through Zoom, WebEX and the like, which has helped buffer some of the consequences of social distancing. But I also think that it would be beneﬁcial to learn how to enjoy time alone. When it comes to spending time alone, it’s easy to hit a wall. Depriving ourselves of that social need for so long can be damaging. During the potential surge of COVID-19, protecting our mental health is a must and I have found that creativity is a front runner in helping us do so. In addition to being solo activities, creative things help our minds in so many ways and can actually make us happier!
Edited by Charlotte Milone Artwork by Varshini Odayar and Ria Parikh Design by Payton Kim
Articles in this section discuss the effects of the COVID-19 pandemic on American schools and education, including health literacy. Pre-existing socioeconomic gaps are increasing and online learning has diminished studentsâ&#x20AC;&#x2122; academic and social life as they adjust to new forms of learning. Meanwhile, the adult population navigates a misinformation epidemic.
Today, we have the ability to make decisions that will impact our society for generations. Our very ideals, institutions and future are at stake. Entire decades of progress uprooted and now open to new change. The way we transform society will be pivotal in shaping the generations to come, yet the institution that will shape our future, education, is in need of true transformation to come out the other side of this crisis.
Education in the
COVID Era BY RATAN KALIANI
hese are unprecedented times. Too often in our lives, we hear these words and brush off the issues we’re facing. After all, when you’re facing a monumental crisis with no end in sight, it’s easy to resign yourself to the fact that there’s nothing you can do. If all of the progress and human innovation we’ve accomplished over the millenia can’t prevent this crisis from happening, what kind of an impact can we truly have? Yet, when we dive deeper, those four words hold so much power. Rarely in our lives are we faced with a period that we know we will remember for decades, yet that’s precisely the opportunity that this pandemic presents. Today, we have the ability to make decisions that will impact our society for generations. Our very ideals, institutions and future are at stake. Entire decades of progress uprooted and now open to new change. The way we transform society will be pivotal in shaping the generations to come, yet the institution that will shape our future, education, is in need of true transformation to come out the other side of this crisis.
The very structure of primary education (i.e. elementary school) that we’ve seen develop over the past two centuries in the United States is what makes it so susceptible to being irrevocably transformed by COVID. With primary schools providing “fundamental skills in reading, writing, mathematics, history, music, science, art and physical education”, the physical, emotional, and mental development of students is increasing at the highest rate at the primary education level. Due to this, we’ll see in the future that the transition to online learning will have long lasting impacts upon each student’s educational journey. In breaking down the impacts of COVID on primary education, it’s important to separate the three key categories where the ripple effect of the pandemic is most signiﬁcantly seen: social, economic and educational. To understand the wide-ranging impacts of COVID on primary schools, we must take a deep dive into how speciﬁc counties are handling the coronavirus outbreak.
Fairfax County Public Schools, where my hometown of Herndon, Virginia is located, recently decided to transition from a mixed in-person, online system for fall semester to an entirely virtual environment for school due to health concerns. Typically, there are many points in the day to socialize with classmates and teachers, from riding the school bus, discourse and interaction within classes, and most of all, lunch and recess. These activities are difﬁcult to translate and emulate in a virtual environment, and according to the CDC, the lack of these activities will likely stunt the “development of language, communication, social, emotional, and interpersonal skills” in students. In fact, several studies focusing on the long-term effects of pandemics found a “strong association between length of quarantine and Post Traumatic Stress Disorder symptoms, avoidance behavior, and anger,” with post-traumatic stress scores nearly 4 times higher than those who were not quarantined. The lack of access to facilities within schools, including counselors and therapists, within a virtual environment will result in signiﬁcant mental health impacts within young children, possibly leaving unﬁxable obstacles preventing educational progress in many students’ lives.
Without a clear sense of direction at state and federal levels, it’s clear that the impacts of transitioning to virtual learning will be extremely severe. For both students that are unable to have direct 1-1 interaction with their teachers and those whose families have been impacted ﬁnancially due to the economic effects of the pandemic, ensuring that no child is left behind will be essential to ﬂattening the impact of COVID. However, COVID’s impacts extend far beyond the classroom. Across the United States, nearly 30 million children participate in the National School Lunch Program and 15 million participate in the School Breakfast Program. For low-income families and students, these meals provide a necessary form of affordable, healthy food and deliver a sense of security that is sure to be lost as students are forced to stay at home and are unable to access those resources, especially in rural areas. With an increased strain on the resources to deliver food to low-income families during COVID, it will be more important now more than ever to ensure that students have the ability to access affordable food and have security at home.
would lose nearly a year of learning
However, this transition won’t look the same for all students. In a county with over 141 elementary schools and 187,000 students, the socioeconomic diversity of students cannot be understated. With varying degrees of access to high-speed internet, portable and mobile technology, as well as support for individual learning, such as online tutoring at home, the achievement gap between students is bound to increase during the COVID pandemic. A study recently conducted by McKinsey & Company found that in the case of low-income students who were unable to return to school until the spring, nearly 60% of students would be unable to receive even average quality remote instruction. Directly due to this, low-income students would lose nearly a year of learning when compared to typical in-classroom learning, resulting in a 15-20% increase in the achievement gap.
Parents forced to juggle work responsibilities, lack of childcare options and educating their children all while adapting to uncertain school schedules will prove to be a key driver between inequality created directly from the pandemic. Though the situation seems bleak, school districts are breaking ground on many key initiatives to ensure that all students will be able to continue their learning with equal access to resources during virtual learning. Furthermore, within the United States, we can look towards countries both in Asia and Europe that have managed to bring students back into school with minimal health impacts via stringent and effective back-to-school policies. By implementing concrete, mindful plans about how to best manage the transition to online learning, as well as providing a stable and supportive environment for all students, elementary school administrators across the United States can ensure that the learning experience for students will retain its value. The decision between virtual learning and in-person learning needs to be navigated carefully on region-by-region, if not locality basis. Each and every community is in a different stage of pandemic, and a combination of federal regulations paired with local standards is the best way to go forward. According to Dr. Gabrielle Shapiro, chair of the American Psychiatric Association’s Council on Children, Adolescents and their Families, “every child is different - one might thrive in virtual learning and another might not do well. Overall the decision to return to school should be individualized.”
New measures include staggering arrivals, banning food sharing and eliminating pre-class student meetings.
To understand how the educational administrators in the United States can bring back in-person learning, we must dive directly into similar nations which can offer a model that the United States can replicate. Denmark and Finland provide prime examples for how to do so. After initially transitioning to remote learning, decision-makers coordinated with the central government in Denmark to provide blanket regulations paired with local rules to bring students back into school. The decision to come back was staggered by age, as signiﬁcant evidence has indicated that children play a small role in spreading the virus, with primary school students (ages 5-9) among the ﬁrst age groups to come back. New measures include staggering arrivals, banning food sharing and eliminating pre-class student meetings. Within the classroom, social distancing and hygiene became the new paradigm, with students seated a minimum of 6 meters apart, required to wash their hands every two hours and educational equipment being cleaned twice per day. Regardless, some sacriﬁces in the greater community needed to be made: the opening of public parks just for students, families with one parent at home keeping their children at home, and those who are immunocompromised to stay home as well. By implementing similar standards health-wise in the United States, the transition to in-person learning in certain localities can be ensured with safety and efﬁcacy in mind. However, the importance of truly reevaluating the way we conduct virtual learning cannot be understated. In the past, remote learning has been characterized by content overload with a lack of focus on speciﬁc students. With the need for online learning in areas deeply afﬂicted by COVID, the educational archetype is in need of transformation to a model that is more reﬂective of each individual student’s needs: Engagement, Personalization and Fun (E.P.F.). Teachers can make the most of online learning by maintaining the personality and engagement that comes from 1-1 and classroom interaction with students. This includes making material personalized through gamiﬁcation from Kahoot to Jeopardy to in-classroom debates - to leveraging small breakout rooms via platforms like Zoom, teachers drive student engagement. Engaged students are students who will learn the material better, remember it more effectively and build interest in the material.
Furthermore, teachers and administrators must also realize that the gap between students is exacerbated when online learning is conducted, so leveraging platforms like Dreambox Learning or Zearn will enable teachers to adapt to the learning of each individual student. By putting into place Individualized Education Plans (IEPs), teachers can improve existing teaching systems and help usher in a new era - where education and technology are intertwined to make student learning more effective. In a time when the events in our daily lives are uncertain, the educational system can be the stalwart of stability. The actions, policies and decisions that we put into place over the next year will be scruitized for decades. In a time so consequential to the future of our nation and our values, it is vital that we place our focus on those who will usher in the new era - the youth of this country currently in the educational system. By interweaving effective policies for both in-person and remote learning that drive student engagement while ensuring safety, we can shape our future. Unprecedented times are frightening. But, they’re not impossible to weather. Instead, they provide a blank canvas upon which we can paint our future. Today, that begins with navigating the transformation of our educational system in the era of coronavirus to ensure that future generations have the resources to make their impact on the world. As for what’s revolutionized tomorrow, that’s up to you.
Edited by Blair Hoeting Artwork and Design by Annie Liu
Health Literacy: The Key to Navigating the COVID-19 “Infodemic” BY: GRACE GERBI
pproximately 90 million Americans have limited health literacy, according to the National Assessment of Adult Literacy Survey. Health literacy is deﬁned as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions” (US Department of Health and Human Rights). Since 90 million Americans compose almost a third of the population, an alarmingly high number of individuals are not able to fully understand diagnoses, health information, and available resources. In turn, each of these individuals is at a greater risk of facing worse overall health statuses, more emergency room visits, and heightened mortality rates. In a pandemic, these risks are magniﬁed because many people are in a state of confusion and uncertainty. Additionally, health literacy has complex socio-demographic roots that may cause its rates to ﬂuctuate, such as aging in communities or population shifts.
Health literacy is “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.”
Mean Health Literacy Levels for Population (Source: Missouri Foundation of Health)
- US DEPARTMENT OF HEALTH AND HUMAN RIGHTS During the pandemic of the novel coronavirus, individuals are entrusted to understand important health information and adapt their behaviors to prevent the spread. Differing and ambiguous COVID-19 online information may give a foothold for coronavirus conspiracies, a misunderstanding of symptoms, as well as a lack of trust between communities and medical providers. The greatest issue at hand is that individuals are inhibited from making appropriate decisions about preventative care and treatment while receiving mixed, often contradictory, information from news media platforms. The World Health Organization has named this overabundance of health information an “infodemic,” escalating quickly after the global outbreak.
Among the varying health information about COVID-19, there is a continuous underlying expectation for individuals to be health literate. A mapping of health literacy rates by the Missouri Foundation of Health identiﬁes that the inner city communities of St. Louis have the lowest literacy rates in the state of Missouri. The foundation states that, “The maps described [in this report] provide an important step towards advancing action on health literacy in the state of Missouri. However, to be maximally effective, they must be used in concert with an understanding of the demographic distribution of the area and how low health literacy may affect their health and quality of care.” Historic segregation of suburbs and poor urban housing projects in many American cities has exacerbated poor health outcomes in low-income communities, speciﬁcally because
Case Data by Zip Code Tabulated Area in St. Louis (Source: City of St. Louis)
these areas experience a lack of public service and supportive infrastructure.
According to the Center of Health Care Strategies, many individuals with low health literacy are those with low socioeconomic status, low English proﬁciency, and publicly-ﬁnanced health insurance coverage. In St. Louis, a majority of these individuals are minorities that live in areas which have been disproportionately affected by health issues like asthma, obesity, and diabetes. The health issues that many people endure are exacerbated by socioeconomic, racial, and political factors with deep historical underpinnings. On April 1st, 2020, the City of St. Louis released an interactive map of the conﬁrmed coronavirus cases based on patients’ zip code.
“Health literacy might help people to grasp
The provided data afﬁrms that the highest number of cases exist in low-income communities with limited health literacy rates and lower socioeconomic statuses; COVID-19 is another manifestation of the location-based health inequalities that St. Louis has historically encountered.
the reasons behind the recommendations
Health Literacy Media, a St. Louis-based organization, is inspiring systemic change by engaging with both patients and providers. The organization works to educate patients and caregivers about diagnosis and care, promote comprehensible health information, and train professionals to communicate clearly with patients. In the current pandemic, at-home care poses a large risk of spreading disease to caregivers. Therefore, Health Literacy Media has created a webpage to disseminate health information and communicate national health resources to community members. This page clearly informs individuals of the proper preventative steps to avoid sickness in the current pandemic, as well as how to strengthen one’s health decisions for the future.
- LANCET PUBLIC HEALTH
In Lancet Public Health’s article detailing the impact of health literacy on the current coronavirus pandemic, Paakkari and Okan afﬁrm that “health literacy might help people to grasp the reasons behind the recommendations and reﬂect on outcomes of their various possible actions.” Increased social responsibility during the COVID-19 pandemic may spring from an understanding of public health — knowledge which is rooted in health literacy. The development of health literacy is especially crucial in preparing people for situations that require behavioral change and rapid reaction.
and reﬂect on outcomes of their various possible actions.”
While health literacy concerns the individual’s competence to meet the demands of public health, it is also entangled with solidarity and community health. Low health literacy has become an afterthought in conversations regarding national health issues, despite its resonance in vulnerable populations. Rather than underestimating its impact, institutions must further emphasize the close relationship between health literacy and public health. Above all, it is crucial that future development of health literacy includes plain language and accessible information rooted in preparing disadvantaged populations. In order to combat future international health crises, change is required now. Edited by Amna Hassan Artwork and Design by Antoinette Fang
Widening Gaps: A Result of COVID’s Discrimination The Pandemic’s Eﬀect on Education
BY VALERIE SPEIRS
s schools scramble to work toward reopening in the fall, they are faced with many different concerns. Educators and health ofﬁcials alike are wrestling with the prospects of remote learning or altered in person education as they attempt to mitigate the spread of COVID-19. The virus threatens to derail the structure of education as we know it and impact the health of students. The pandemic poses an additional threat to the achievement of students – speciﬁcally the achievement of low-income, Black, Indigenous, and Hispanic students.
Educational Achievement Gap Since 1970, the National Assessment of Educational Progress (NAEP) has been monitoring trends in students’ standardized reading and math scores. Every few years nationally representative data is collected from 9-, 13-, and 17- year olds as a way to track growth in educational achievement over time. This data has exposed signiﬁcant gaps in achievement between high-income and low-income, white and Black, white and indigenous, and white and Hispanic students.
Graph by Valerie Spears The graph above displays trends in eighth-grade reading scores as provided by the NAEP. White students consistently score higher than Black, Hispanic, and Indigenous students not only in this category, but at all.
grade levels and tested subjects Since 1990, improvements in the scores of non-white students have begun to lessen the achievement gap, but the pace in which this gap lessens is stalling. Though white-Black, white-Hispanic, and white-Indigenous gaps have decreased since 1990, educational achievement disparities between these races are still notable. Stanford’s Center for Education Policy Analysis explains that though these gaps have decreased over time, they are still very large with standard deviations ranging from 0.5 to 0.9. Furthermore, while the national average suggests that gaps have declined since 1990, this is not true in all states. Between 2003-2013, twenty-one states reported no signiﬁcant decrease in white-Black achievement gaps and twenty-eight reported no signiﬁcant decrease in white-Hispanic gaps. Four states – Maine, Vermont, Colorado, and West Virginia – have experienced widening gaps. Furthermore, across the nation, gaps between low-income and high-income students show signs of virtually no reduction. The Root of the Problem Looking at the NAEP’s results as simply gaps in success or intelligence between different demographics of students, however, undermines the existence of the systemic problems that caused the gaps in the ﬁrst place. Gaps in opportunity are the root cause of achievement gaps. In 1954, the landmark Brown v. Board of Education case decided that “separate but equal” education was inherently unequal. However, following this decision schools did not simply become integrated. In the south, integration of schools was met with staunch opposition. In northern cities, desegregation processes were hindered when a Supreme Court case stuck down desegregation policies that would integrate students across district lines. Harmful racist zoning and mortgage policies along with the “white ﬂight” subjected segregated non-white schools to higher rates of poverty which still persists today. Today, though not by law, many schools are still segregated. According to the New York Times, “more than half of the nation’s schoolchildren are in racially concentrated districts, where over 75 percent of students are either white or nonwhite.” This continuation of segregation and the unequal school funding that accompanies it are direct causes of the achievement gaps. Studies have shown that non-white school districts 36
receive $23 billion less in funding than white school districts, despite serving the same number of students. School district borders ensure that predominantly white districts receive funding through property taxes while non-white districts in poverty fall behind, unable to generate the revenue. This lack of funding has a direct impact on resources allocated to these schools. They are less likely to have updated textbooks, adequate technology, tech training, and tutoring options. Non-white and low-income students are also more likely to be taught by unlicensed and unqualiﬁed teachers. Systemic racism imbedded within U.S. schools and the perpetuation of segregation strips adequate funding and resources away from many non-white and low-income students, causing the achievement gap. The existence of the racial and income achievement gaps are part of a harmful cycle. Students in underfunded schools who are victims of systemic racism score lower on achievement tests. Because of these low scores, schools receive less funding, teachers are paid less or laid off, students are denied resources, and the cycle continues.
Covid-19 and Student Achievement Unfortunately, research shows that COVID-19 will likely impact the achievement of students, especially low-income, Black, Hispanic, and Indigenous students. In the midst of a global pandemic, many schools have turned to online learning instead of face to face classroom education. Studies – including Stanford University’s Online Charter School Study – have shown that online learning is not as conducive to academic growth as in person learning. Stanford’s study found that this is particularly true for low-income, Black, and Hispanic students who experience lower academic growth rates online than white students. With online learning due to COVID, it is likely that certain demographics of students will fall even further behind regarding academic achievement. Many factors also impact whether or not students are able to log in for online instruction. Stable internet connection,
quiet work space, parental guidance, adequate computer skills, and access to a device all play a role in determining students’ ability to participate in online classes. While 90% of high-income students have been found to regularly log on to online instruction during the pandemic, only 60% of low-income students have been found to do so. This number holds consistent at 60% in predominantly non-white school districts as well. Due to the lack of resources that are provided for these students and their inability to succeed during online instruction, achievement gaps will likely increase further. COVID-19 may also increase drop out rates for the same students who are affected by the achievement gap. Black, Hispanic, and Indegenous students already have signiﬁcantly higher dropout rates than white students. These particular students may be faced with hardships at home that prevent them from returning to school. Such hardships include sickness, becoming the primary caregiver for a family member, or the loss of income. Black individuals are more at risk for losing their job due to the pandemic with 39% of jobs held by Black Americans at risk compared to 34% of jobs held by white Americans at risk. A student may be tasked with supporting their family after a parent or sibling loses their job, causing them to drop out. The chance of sickness is also a much more serious threat for some minority groups. Black and Indigenous individuals are ﬁve times more likely than a white person to contract COVID-19 and Hispanic individuals are four times more likely. All of these factors may impact a student’s ability to participate in school or the decision for a student to drop out. Systemic issues imbedded in the U.S. education system have perpetuated discrimination against Black, Indigenous, Hispanic, and low-income students. The lack of resources that these students receive has caused a signiﬁcant gap in achievement scores which only prolongs the cycle of oppression. The impact of COVID-19 on these individuals could be detrimental if particular focus is not put on catering to the needs of these students. Attention, funding, and resources need to be directed towards potentially at-risk students in order to mitigate the possible effects of COVID-19 on education. Edited by Nidhi Talasani Artwork and Design by Payton Kim 37
GPA, SAT, and…COVID-19? ↬ COLLEGE ADMISSIONS IN THE WAKE OF A PANDEMIC BY NIDHI TALASANI
EACH YEAR, over three million high school seniors across the country apply to college. For the most part, the application process has stayed fairly constant over the years. However, due to the recent COVID-19 pandemic, rising seniors all over the country are staring at a black box. What are colleges looking for? This year’s college application process will be challenging not only for students, but also for college admissions ofﬁcers. Changes to the generally structured application process will make it difﬁcult for students to predict colleges expectations and for colleges to understand student proﬁles. Furthermore, this pandemic may be exacerbating the widening gap between the rich and the poor. Wealthier students will have the time and capabilities to pursue unique extracurricular activities for their college applications while their less fortunate counterparts will be preoccupied with more serious concerns. Many colleges are now temporarily test-optional, meaning they are not requiring standardized test scores from applicants for the 2020-2021 admission cycle. However, if submitted, most schools are still seriously considering these scores. Laurie Kopp Weingarten, an independent college admissions counselor and member of the National Association for College Admission Counseling, spoke about standardized testing policies and the various stances taken by different colleges. “Which college is truly test optional and which colleges are what I’m calling reluctantly test optional? Those schools that are saying that it’s a two years or three years pilot, they really mean it. They’re really trying this.”
↬ This pandemic may be exacerbating the widening gap between the rich and the poor.
The University of Chicago, which has been test-optional since before the pandemic, writes that standardized tests can “provide valuable information” about an applicant. They add that they “encourage students to take standardized tests, like the ACT and SAT, and to share your scores with us.” This position reafﬁrms that schools will in fact look at standardized scores and these scores will be used as a factor in admissions, if submitted. Many schools also understand that due to the pandemic, students are unable to take the SAT or ACT before applications are due and state that this will not harm the student’s chances of admission.
Cornell University, which is test-optional for this year only, writes that “As appears to be true at test-optional colleges and universities, we anticipate that many students who will have had reasonable and uninterrupted opportunities to take the ACT and/or SAT during 2020 administrations will continue to submit results, and those results will continue to demonstrate preparation for college-level work.” This statement suggests that Cornell will also look to standardized testing as a measure of an applicant’s success in college and will be strongly considered if submitted. They add that “Applicants with no test results might more often be asked after review has begun for additional evidence of continuing preparation, including grade reports from current senior year enrollment when that can be made available in time for Cornell admission review.” This clause goes to show that many elite universities claim to be test-optional without truly embracing the policy. It will be much more difﬁcult for students who do not submit test scores to prove to the universities that they are deserving of admission. Students will need to show strong supporting evidence that they were unable to take a standardized test yet still have a proﬁle worthy of the school. Without standardized testing, it is unclear how colleges will effectively choose the right candidates. The ACT and SAT are typically considered a strong predictor of a student’s success in their ﬁrst year of college. Since GPAs are highly variable between schools, standardized tests provide a rough but efﬁcient measure of comparison between students across the nation. The lack of standardization among grading in high schools complicates this matter further. Each school district implemented a unique way of assessing students this past semester including only giving a pass or fail grade, attendance based grading, or a no-harm system where grades can only increase during the disrupted school-year. These inconsistencies make it difﬁcult for admissions ofﬁcers to assess improvement over the year and consider grades this past semester, which are generally important factors in the application process. In order to account for this, Weingarten believes that “Teacher recs and counselor recs will be more important 38
than ever. [Colleges are] saying they’re going to scrutinize the transcript up until COVID. Some are going to start doing interviews.” She says that if a student’s grades during COVID are reﬂective of their grades before, “schools will give students the beneﬁt of the doubt and will look to past years.” If students showed great improvement this past year, she says to “get those teacher recs to say that although almost everyone ended up with an A, this student from September to March had a strong A average, so colleges can see that it wasn’t a ‘COVID A’, it was a real A.”
communities, and explore their passions while their less fortunate peers will be struggling to make ends meet. This pandemic may be contributing to the already widening educational gap between the rich and the poor as important resources are being disproportionately taken away from the poor. When students do not know where their next meal will come from, they will not be able to put in the time to research what schools are looking for and implement those ideas.
Students will need to go beyond and prove to the school that they have been continuing to work hard over the past several months. Colleges need to see that students will continue to work hard once they enroll and will be an asset to have on campus. It is still unclear how the academic quality of the incoming class will be impacted by these new measures. Weingarten believes the quality of students at highly selective institutions will not diminish as those schools have the time and resources to choose worthy candidates. However, some of the less prestigious schools are struggling to ﬁll their classes as students are increasingly worried about the pandemic’s spread and its effect on campus life. These schools may be looking to accept students that they normally would not to ensure normal class sizes. Another large part of a student’s college application is the student’s extracurricular achievements. Outside the classroom, high school students are involved in numerous activities including varsity sports, clubs, and research. College admissions ofﬁcers understand that many students’ summer plans and internships have been cancelled due to the pandemic. The Harvard admissions department stated “Students who ﬁnd themselves limited in the activities they can pursue due to the current coronavirus outbreak will not be disadvantaged as a result” Though they attempt to put students at ease by reassuring them that a lack of extracurriculars will not harm their applications, they fail to provide an alternative and leave students struggling to ﬁnd another way to stand out from the tens of thousands of other applicants. Yale University adds with a similar statement by advising their candidates to “demonstrate a deep commitment to and genuine appreciation for whatever you spend your time doing.” Unfortunately, few students can afford to take unique approaches to express these traits in an attempt to appeal to an admissions counselor. Wealthier students with heavily invested parents will be able to start non-proﬁts, support local
↬ “Teacher recs and counselor recs will be more important than ever. [Colleges are] saying they’re going to scrutinize the transcript up until COVID.”
↫ LAURIE KOPP WEINGARTEN, COLLEGE ADMISSIONS COUNSELOR
Furthermore, wealthier students attending private schools will be given more resources and information to help guide them during this pandemic. Their counselors will provide them with speciﬁc guidelines on how to create an appealing application while also providing constant updates on new policies adopted by various colleges. Teachers at private schools tend to write stronger letters of recommendation, which will hold more weight for the upcoming admissions cycle. The wealthy ten percent of students attending private schools will have a signiﬁcant advantage compared to their public school peers this year. Weingarten offers alternatives for lower income students by suggesting that students pursue volunteer opportunities, many of which are virtual. Students can record singing telegrams to patients in hospitals, write letters to sick children, teach kids online, or even teach themselves something. She emphasizes “I don’t think you need to be wealthy to be productive during this time but I also don’t think you need to be productive if something serious is going on in your family [regardless of income]. Many colleges are telling students to take care of themselves. Just be safe, take care of yourself, don’t worry about your extracurriculars.” To help account for students affected by the pandemic, the Common App has added an optional question for students to describe the impact of COVID-19 on their living situation. This opportunity gives them a chance to explain their situation and help admissions ofﬁcers understand why they were not as busy this past summer. Hopefully, colleges will take this question into serious consideration when looking at the applications of affected students. Even with questions like this, it will be a challenge for counselors to compare students from across the nation and determine who belongs at their school come fall.
Edited by Josh Keller Artwork by Riya Damaraju Design by Kavya Parekh 39
Articles in this section discuss how the pandemic has led to increased creativity and competition, oftentimes in pursuit of a vaccine.
“Non-Essential” Research: Another Victim of the Coronavirus Pandemic BY SIONA PRASAD
n February of this year, Michael Gentry had ﬁnally made a breakthrough. Gentry, a biochemist at The University of Kentucky College of Medicine, was racing to run animal experiments on a new enzymatic compound that ﬁghts Lafora disease. The promising drug was on track to enter human trials early in 2021. Lafora disease is a neurodegenerative condition characterized by intellectual decline and recurring seizures. The disease is usually diagnosed in adolescence and manifests in a way similar to Alzheimer’s disease: loss of memory, diminished judgement, and confusion. “Your child sort of disappears in terms of who they are,” writes Frank Harris, president of Chelsea’s Hope, a nonproﬁt dedicated to Lafora disease. “It’s very similar to what you would see with an elderly Alzheimer’s victim. Imagine seeing it with a 16-, 18-, or 20-year-old child.” Patients usually survive for only 10 years after symptoms appear. For Anissa Marriam, a vibrant and intelligent 22-year old with Lafora’s disease, Gentry’s research was something to watch. Her mother writes, “I was given a death sentence for my daughter ten years ago and sent home. They gave me hope that I will not have to bury my daughter.” For Anissa and other patients with the rare disease, this was so much more than another clinical trial—it was a real chance for a life past their 30th birthdays.
For Anissa and other patients with the rare Lafora disease, this was so much more than another clinical trial, it was a real chance for a life past their 30th birthday.
But then the pandemic hit. Gentry’s lab, along with 77% of other labs in the United States deemed “non-essential,” was shut down to reduce the spread of COVID-19. Gentry’s animal experiments came to a jolting halt, and the timetable of Lafora treatment was postponed indeﬁnitely. Many of us asked what difference a few months delay really makes. Karen Burns, researcher at the Li Ka Shing Knowledge Institute, explains that, for every progressive
disease, there is often a short time period to act after which the condition is no longer salvageable. And the scary part is that, for less-understood diseases, nobody knows this exact “point of no return.” By the time the Lafora trial is up and running, there’s a chance that Marriam’s case will have progressed too far for her to participate. For cases like hers, the passage of time—even a few short months—can be devastating. Anissa is not the only one. Hundreds of thousands of people are dependent on experimental treatment. Just among active clinical trials, over 440 studies have been suspended, a quarter of which were experimental cancer treatments. According to NPR, this affects over 200,000 people. It is frightening to think of how many patients potentially missed their chance at a clinical trial because of delays in research on their condition. Although it is easy to see how these delays affect individual patients like Anissa, the repercussions of stalling medical research will extend well into the future. The head researcher of a diabetes lab at the Molecular Cell Biology section of the National Institutes of Health (who requested anonymity), has been teleworking since stay-at-home orders beckoned in March. Wet-lab experiments like the ones done at her lab are impossible to continue from home. But, even worse, restarting these experiments once researchers return is no simple task. The diabetes lab works with mice, bred over many generations to ensure speciﬁc genotypes. However, upon COVID-induced shut-downs, labs are being encouraged to euthanize thousands of mice and other organisms used in experiments. Tissues and cells that have been carefully cultured cannot be maintained without daily supervision. Work that scientists have dedicated years to has all been lost. Rebreeding mice and restarting these experiments will likely take months—potentially longer. For studies like the ones done in this diabetes lab, it is clear that the end
of the shutdown will only be the beginning of a long road to recovery. Further, the halting of “non-essential” research has had signiﬁcant impacts on burgeoning researchers and students as well. A professor of neuroscience at Georgetown University (who wished to remain anonymous) commented on how hard the pandemic has hit students early in their research careers. There are “fewer opportunities for training new researchers (undergraduates, Master’s students) who need more close interaction with current lab members, given the new requirements for social distancing in the lab.” Additionally, funding is getting more difﬁcult to obtain because most resources are currently directed towards the pandemic. For new researchers whose careers depend on quickly gathering data and publishing, the loss of ﬁnancial support may mean they will never get a chance to restart. Cullen Taniguchi, assistant professor at University of Texas MD Anderson Cancer Center warns that “we may lose a whole generation of researchers because of this.”
is complete. On the other hand, I understand the importance of mobilizing research efforts to the pandemic, leaving us with no choice but to make these hard trade-offs. Yet deciding that certain studies are more important than others seems equivalent to telling Anissa Marriam, or anyone else, that their life isn’t important enough to try and save. The future of research for all stakeholders—patients and caretakers, scientists and students—is uncertain at best. All that is clear is that there are thousands of people without coronavirus who could still die during this pandemic.
We may lose a whole generation of researchers because of this. -Cullen Taniguchi
The cost of these delays on medical research begs the question of how we decide what research is “non-essential.” Shouldn’t everyone have an equal chance at a life—whether they have COVID-19, Lafora disease, cancer, or any other serious condition? Duke University School of Medicine deﬁnes non-essential clinical research studies as ones that hold the prospect of direct beneﬁt to a participant. To me, these deﬁnitions are vague and unhelpful at best. Every research study is ultimately aimed at directly beneﬁting people, regardless of whether it is at the clinical trial stage or still in preliminary stages. Research, by its very nature, is unpredictable;it is often impossible to predict if research will be successful until it
Edited by Tyler Schutt Artwork and Design by Payton Kim
art and grassroots activism: learning from frontline ﬁghters BY AMULYA GARIMELLA
Left to right: Portraits of Taylor, a CNA / Lorenzo, an activist / Starr, Junior Creative Director of Black, Young, & Educated by Amulya Garimella
have loved to draw ever since I could pick up a pencil. I doodled in the margins of my homework assignments and tests, and getting a digital art tablet at 13 was one of my happiest moments. Yet I’d always relegated art to a hobby; an unrealistic career choice that couldn’t make money. But until recently, I was unsure of how art could ﬁt into my life. I had always enjoyed drawing but never quite understood how art can impact the world and connect with individual people.
My English teacher motivated me to search for the deeper arguments, meanings, and layers of connection in art, whether it be a drawing, a poem, or a novel. I started to look at pieces differently. I started to consider not only whether a piece looked good on the surface, but what the artist was trying to convey, and began to learn just how powerful art could be. Increasingly, I found myself inspired by artists like Janelle Monáe, a musician, and Diana Ferrus, a poet. Monáe’s albums use science ﬁction themes and intricate allusions to tell a story of liberation and power, and every performance is bold and beautiful. One of Ferrus’s most famous poems, “I’ve come to take you home,” is a gorgeous tribute to one of the ﬁrst Black female trafﬁcking victims, Saartjie Baartman. Ferrus’s poem is believed to be responsible for the return of her remains to South Africa from France in 2002, and was published in a French law. These artists use their mediums to create change from very personal places. I realized that art gives people the power to speak out and amplify others’ voices. I’m seeing the power of art ﬁrsthand in Pittsburgh, my hometown. Max Gonzales, a local artist, painted tributes to Antwon Rose II, George Floyd, Breonna Taylor, and Ahmaud Arbery downtown. A group of 15 Black artists and activists created a richly gorgeous Black Lives Matter mural by the Allegheny River, adding their own unique touches. Art as a tribute can bring not only catharsis and healing, but also urgency. These activists use art to call out from a voice that has been forcefully suppressed for centuries. In fact, some still try to suppress Black voices as these tribute murals are vandalized. Art can be powerful from the political and personal voice; in the current movement, the two dovetail. During the ongoing pandemic and protests, I saw people from all different backg44
rounds creating art that tells a story. It is a way to stay connected in a time when it’s easier than ever to isolate ourselves. I considered ways that I could create my own art; ways that I could tell stories to aid the cause. I wanted a way to honor these individuals while still concretely promoting their causes. That idea led
media to voice their concerns and organize demonstrations, I could instantly get in touch with them through the Internet. I’ve had the opportunity to talk to and learn about the experiences of essential workers from all over the world — Taylor, a mental health worker in the UK; Darian and Haley, EMS workers;
“I’ve seen this play out time and time again. I’ve seen this with Trayvon Martin, with Tamir Rice. I’ve seen this with Sandra Bland. I’ve seen this with Antwon Rose Jr. You know, and I’ve seen this with George Floyd, and I’ve seen enough. So I deﬁnitely need some change.” NICK, CO-FOUNDER OF BLACK, YOUNG & EDUCATED
me to create the Draw Attention project: I draw portraits of essential workers and community organizers, asking them for a quote to include and a place to which people could donate — a personal Venmo, a mutual aid fund, Doctors Without Borders. Integrating these quotes and donation links seamlessly with portraits could
“Being consistent in your actions will bring recognition. Recognition is a step to change.” STARR, JUNIOR CREATIVE DIRECTOR OF BLACK, YOUNG, & EDUCATED
move people to listen to those stories. Living with an at-risk family member precludes me from going out a lot now, but through art, I can show my support for a movement and center important activist voices. I started reaching out to essential workers all over. This took various forms: through a friend, to her mom, a nurse; emailing my mom’s coworker, a paramedic for a local department. I expanded my reach, talking to people over Twitter and Instagram. Since so many activists are taking to social
Teiona, a nursing student; Lexi, a lab tech — as well as community organizers right here in Pittsburgh like the students who founded Black, Young, and Educated. It has been an incredible experience to learn from people who are ﬁghting on the frontlines. It can be challenging: especially after these conversations, it’s absurd to see people complaining about wearing masks while volunteer COVID-19 testers work for hours in full PPE under the hot sun, and it’s enraging to hear about police blocking student marchers. After all the tweeted congratulations, clapping at 7pm, and performative do-better letters, how much do we actually care about, help, and support the essential workers and activists in our communities?
“I do it because I care for everyone, not just those that think like me. I don’t know how else to explain to you that you should care about people.”
For me, the answer lies in centering their voices. Especially for new activists like me who come from a place of privilege and don’t have on-the-ground experience, I think it’s important to contribute to the movement by joining and centering those who lead the movement and are most affected. Through art, we can center other people’s voices and tell their stories. It’s easy to feel as though your voice isn’t heard, especially if you’re young. Through connecting with the local activists working to make change in my city, I realized that supporting and becoming involved in local activism is an effective way to make changes that will have an immediate and direct impact on you and your community. From organizing protests in your city and spreading the word to attending school board and town hall meetings, local activism is important and often overlooked. By working with the local organizers in my area and, over the past few months, learning more about the issues directly affecting my community, I was able to ﬁnd my voice. Edited by Varshini Odayar Artwork by Amulya Garimella Design by Kavya Parekh
NOAH, PATIENT CARE TECH 45
Crowdsourcing: Fluke or Future? By: Rishi Shyamala
n March 25th, 2020, the most powerful computer on the planet exceeded a speed of 1.5 exaFLOPS, meaning a speed of 1,500,000,000,000,000,000 operations per second. This computer is not some massive supercomputer in a top secret lab, but a network of computers all over the world owned by ordinary people. The effort coordinated by the Folding@Home organization sent out simulations to be solved by anyone who volunteered their computer’s processing power. At its peak, over 700,000 people were contributing to this project, making it one of the biggest collaborative projects to solve the coronavirus problem. To understand this phenomenon, it’s important to understand what crowdsourcing is and how it is used. With the increasingly connected nature of the internet, more issues are being approached collaboratively, and the coronavirus is no exception. Crowdsourcing is “the practice of obtaining needed services, ideas, or content by soliciting contributions from a large group of people…”. Historically, crowdsourcing has been applied to low stakes problems or issues which are not time sensitive. This would in turn lead to the solutions from the crowd being less practical. Often these problems would be local and non-critical which created a stigma of crowdsourcing being an ineffective way to solve problems. This all changed when it came to the Coronavirus pandemic. With many people stuck at home when the virus data was made public, people capitalized on it in unique ways. One of the earliest projects was the data released by Johns Hopkins University tracking the spread of Coronavirus infections. Maps and graphs made from this data visually depicted how far and fast the infection could spread. Johns Hopkins opened up the data they used to make their tools to the public, and the internet
“With the increasingly connected nature of the internet, more issues are being approached collaboratively, and the
capitalized on this and made other resources the average person can use to inform themselves. This more implicit way to crowdsource is in contrast to the approach taken by other organizations like MIT. MIT created an open-ended competition for different solutions and asked people to be creative. To follow up, Google and Apple collaborated to create a coronavirus contact tracing API that apps can use to notify users if they were in close contact with infected individuals. This API was not enabled by default, but rather apps had to build this technology into the software and users had to opt in to install the apps and all the attached consequences. Privacy concerns arose among the public, who considered that Google does not have a track record of respecting users’ privacy if not speciﬁcally requested to do so. If everyone participated in this project, then it would be a lot easier to track and mitigate the spread of the virus, but if no one did, then the work put into the API would be essentially useless. This raises the question of if it is worth giving up personal information to a large corporation to secure the health of the community. As more data is collected on the success of these apps, a better conclusion can be drawn on how effective this crowdsourcing attempt was. A very successful crowdsourced project recently was the Folding@Home simulation. Folding@Home creates models of the virus and investigates how the proteins in the virus fold and interact with other molecules the virus comes in contact with. Simulations of the folds are created and sent off to anyone who has the Folding@Home app installed on their computer. So many people installed the app and accepted simulations the servers were overloaded and could not provide any more simulations to people getting started. One contributing factor to the success is the relatively low cost of entry. The app can be conﬁgured to only receive and work on data when the device is not in use, and requires no additional work on the part of the user to contribute. Another factor that boosted Folding@Home’s popularity is the fact that this project was also somewhat gamiﬁed — with users being able to join teams and keep track of contributions on a public scoreboard. Unfortunately, the success of this project might be difﬁcult to replicate in the future as it requires minimal effort for anyone contributing, but still has to
coronavirus is no exception.”
be an effective use of all that computing power. Finally, a massive crowdsourced effort was to create masks and face shields for the local community to compensate for the breakdown in transportation at the beginning of the pandemic. Due to the lack of easy access to PPE, people across the nation stepped up and knitted cloth masks and 3D printed face masks to donate them to essential and healthcare workers. This crowdsourced solution was not prompted by anyone, but the movement was able to get widespread enough through word of mouth and social media that it was almost enough to make up for the lack of support through the ofﬁcial channels. This form of crowdsourcing relies on volunteers willing to do something to make a change on their own despite no group directly pushing for a change. It seems to be the hardest to replicate, and might only be possible in the most dire situations.
“This form of crowdsourcing relies on volunteers willing to do something to make a change on their own despite no group directly pushing for a change. It seems to be the hardest to replicate, and might only be possible in the most dire situations.”
All of these examples show how with the right conditions the community can come together to solve problems faster and more effectively as a collective than as separate individuals, even if some were more successful than others. In the past, crowdsourcing was seen as a lazy way to solve a minor problem whereas now it seems like a viable way to create solutions for the global community. Was this just a ﬂuke of the right conditions at the right time, or does this mark a shift towards a future where crowdsourcing becomes the norm rather than the exception? How can a project best optimize itself for crowdsourcing? These questions are what might take us into the future but right now, collaboration is saving lives in ways individuals simply cannot.
exception? How can a project best optimize itself for crowdsourcing? These questions are what might take us into the future but right now, collaboration is saving lives in ways individuals simply cannot. Edited by Lina Itenberg Artwork by Nandini Shyamala Design by Akila Muthukumar
The War Against COVID-19: A Race for Innovation and its Future Impacts
years ago, a compact metal cylinder raised its ﬁxed wooden wings and took to the skies. On the surface it ﬂashed no extraordinary features, its sole purpose to wage war beside the expanding ranks of the mighty German Luftwaffe. Inside, however, it boasted a heart of diamond, a heart that would rocket human civilization into the future–the ﬁrst functional aircraft turbojet engine. A recurring sentiment across global politics seems to emphasize procrastination and delay. Societies fail to take action, fail to fund the ﬁght against climate change, fail to develop new antibiotics for resistant pathogens unless it is absolutely necessary for survival. However, when only a few breaths remain, society has repeatedly proven itself capable of organizing resources and capital on a remarkable scale in order to ﬁnd its cure.
However, when only a few breaths remain, society has repeatedly proven itself capable of organizing resources and capital on a remarkable scale in order to ﬁnd its cure. Most notably, the Jet Age, nuclear technology, and space race birthed from a tragic and devastating Second World War sculpted society into the modern ﬁgure often taken for granted. Today, we ﬁnd ourselves in a similar struggle, desperate to “WIN THIS WAR” against COVID-19. For what developments, now, have we “hit the gas”? Where do they ﬁt into the puzzle of our future? Technological innovation begins with building blocks. Piecing them together in various orientations constitutes the driving force behind advancement. The composition of our global toolkit is continuously evolving, with ﬁelds growing increasingly interconnected. In the modern age, a block as small as a mobile app holds the potential to revolutionize industries such as healthcare and retail. In our ﬁght against the SARS-CoV-2 virus, the building blocks of past ages, nuclear physics and aerodynamics, have transitioned into automobiles and biotechnology. To many of us, a car is simple–it has an engine/battery, wheels, and manages to go from point A to B with added bonuses of radio entertainment and possible ﬂashy branding. Its thousands of components, however, hold the keys to near inﬁnite possibilities. One electric vehicle manufacturer, Tesla, has decided to put the pieces together in an entirely novel manner, repurposing Model 3 parts into a smart-ventilator.
BY SOHAN RAO
In order to take on such a challenge, engineers ﬁrst tapped into the knowledge of medical personnel to understand the processes of both natural respiration and mechanical ventilation. According to experienced nurse Chris Vanderstock, in order to breathe, the diaphragm and intercostal muscles pull down your lungs, establishing negative pressure within your lung space. And so, the air outside has to go only but one way down into your body. When you breathe out, the muscles relax and create a positive pressure that expels the air back out. We typically do this twelve to twenty times per minute. When it comes to mechanical ventilation, however, we actually push mixtures of nitrogen, oxygen and acidic gases into the patient. This is known as positive pressure ventilation and it differs drastically from normal breathing. Tesla’s solution utilizes much of the company’s software and engineering developments that have made its electric vehicles so efﬁcient. According to engineers from the company, its prototype begins with a hospital grade air supply descending into a warm mixing chamber that synthesizes a humidiﬁed air-oxygen solution at body temperature. This is a key component in Tesla’s vehicle ventilation systems. The oxygen rich air passes through a wall body device that pumps it in preset pressure and volume waveforms, preventing over inﬂation and damage to the alveoli responsible for oxygen exchange in the lungs. The air exiting this device is puriﬁed through a ﬁlter, ﬁnally entering the patient’s lungs. Note that Tesla’s system utilizes two ﬁlters, one protecting hospital staff from potentially biohazardous air departing through exhalation and one for inhalation and patient safety. The air, now infused with CO2, leaves the lungs, and travels out an exit valve measuring pressure and carbon dioxide concentration. All the while, the ﬁnal pressure sensor helps maintain what’s known in the ﬁeld as positive and expired pressure that constantly inﬂates the lungs and prevents them from collapsing. The fully packaged ventilator is powered by the Model 3 infotainment system highlighted by the Model 3 center display touchscreen. 48
This provides two methods of control: pressure regulated volume control or individual pressure and volume control. The ﬁrst improves oxygenation and provides better gas exchange while the remaining offers broader regulation for less demanding practices such as anesthesia. While this solution has most of the industry requirements ticked off, Tesla is still in progress of developing synchronization systems that work in conjunction with patients retaining the capability to breathe and aid rather than take over the process. Currently, the primary objective of this project is to boost the increasingly scarce ventilator supply in the United States. Tesla’s solution, moreover, offers a compact, user-friendly interface holding the potential to extend the reach of the ventilator market. Tesla’s components are easily and inexpensively sourced, enabling the company to mass produce affordable electric vehicles. According to Medtronic, a leading medical device manufacturer, hospital grade ventilators can cost up to $50,000. To put that in perspective, a brand-new Tesla Model 3 starts at $35,000. The difference amounts to one whole semester of college tuition! Mass production of Tesla’s smart-ventilator could introduce both more advanced and affordable solutions to many markets, including widespread use for emergency medical technicians in ambulances and at-home use for children suffering from respiratory conditions. The battle against the pandemic has spurred radical innovation in more closely related ﬁelds as well, speciﬁcally medicine. COVID-19 has intensively stressed the limits of modern medical diagnostic technologies and scientists have turned to other areas for inspiration. One noteworthy source is the futuristic ﬁeld of genetic engineering and its workhorse CRISPR (clustered regularly interspaced short palindromic repeats) based systems. Traditional diagnostic technologies fall into one of two categories: polymerase chain reaction (PCR) or antibody based. Those utilizing PCR extract and selectively amplify certain DNA or RNA fragments from patient samples to see if viral or bacterial genetic material is present. Antibody based techniques use immunoassays where synthetic antibodies bind to surface proteins present on pathogens and ﬂuoresce to indicate infected patient samples. These protocols often take hours and extensive laboratory resources to complete, during which a patient’s illness can progress dangerously.However, CRISPR systems now modiﬁed to detect the SARS-CoV-2 virus offer a quick and inexpensive lifesaving alternative to these onerous procedures.
The famous CRISPR-Cas9 system is a tool originally designed to excise and replace target DNA sequences with desired codes. CRISPR are fragments of DNA found in prokaryotes used to detect and destroy bacteriophage (viruses that infect prokaryotes such as bacteria) genetic material and defend against viral infection. The CRISPR associated protein 9 (Cas9) cleaves complementary viral genetic material. This enzyme serves as the key component of speciﬁcity in genome editing and is the backbone behind Cardia Bio’s new graphene based CRISPR diagnostic tool. This technology employs a Cas9 enzyme and guide RNA (gRNA) speciﬁc to SARS-CoV-2 genetic material both immobilized on a graphene chip. The gRNA identiﬁes the target region in the SARS-CoV-2 genome and directs the Cas9 nuclease. If the speciﬁed sequence is present in a patient sample, the chip conducts a conclusive electrical signal and offers results within 15 minutes. The company originally developed the technology to detect genetic mutations that cause Duchenne muscular dystrophy but have repurposed the device to attend to the needs of the pandemic. These chips can utilize multiple gRNA’s and have the potential to rapidly diagnose the presence of a variety of pathogenic microbes. Human civilization has shown a unique ability to survive high pressure situations. We’re the lazy teenager who puts off a 10-page essay until the night before it’s due but ends up winning the nationwide contest. Collectively, we have the potential to change the world and the COVID-19 pandemic has provided a unique opportunity for us to do so. Time and time again, we have been forced to improve and adapt in order to overcome. In 1939 we developed our ﬁrst jet aircraft, and 30 short years later we landed on the moon. Today, just as we have done before, we will learn to put our minds together and ﬁght this pandemic. We will put an end to the thousands of daily fatalities across the globe. We will outlive this virus. However, whether we remained tethered to the ground or rocket into the skies like we did 81 years ago is entirely up to us.
Edited by Kenneth Li Artwork and Design by Payton Kim
The Worldwide Race for a COVID-19 Vaccine: The Major Players
BY: SAAGAR SHETH
he global pandemic currently ravaging the world began in the Huanan Seafood Wholesale Market in the Hubei Province of China. According to an article in the New England Journal of Medicine, in late December of 2019, Chinese authorities discovered several cases of pneumonia all associated with the Huanan Seafood Wholesale Market in Wuhan. Within one week, on January 7th, Chinese health authorities determined that this cluster of cases was actually due to a novel virus, 2019-nCoV. The announcement that this new species of coronavirus could be transmitted from person- to-person is what should have jolted the general public to treat COVID-19 as a legitimate threat. However, leaders worldwide awaited further news before taking action.
-lations may seem like unnecessary red tape, but a vaccine that does not work or is unsafe will cause even greater problems. Even on the fast track, Gallagher claims that experts predict the vaccine will be fully developed in mid-2021 at the earliest. Finally, Gallagher asserts that the most difﬁcult part of the vaccine development process will be successfully distributing the vaccine and immunising most of the world’s population.
The New England Journal of Medicine also states that within three more weeks, by January 30th, 9976 cases were reported in at least 21 different countries. In fact, the ﬁrst reported case of COVID-19 in the United States was on January 20th, 2020 in Snohomish County, Washington. From just the ﬁrst few cases to today, Worldometer displays that we have surpassed 17.7 million conﬁrmed cases worldwide and 4.7 million cases in just the United States as of July 31st, 2020. So where is the vaccine as promised by leaders in the ﬁeld of science and engineering? The Step Ladder of Vaccine Development While many countries may have publicly responded late to the COVID-19 pandemic, enterprises relevant to vaccine development immediately jumped into a worldwide race to produce the ﬁrst vaccine. In fact, The New York Times argued as early as March 19th, 2020 that a global arms race was underway to formulate the coronavirus vaccine. However, now it has been several months since the coronavirus was ﬁrst detected, so it is natural to ask “Where is the vaccine?” However, health and science correspondent, James Gallagher explains that vaccines normally take several years to devise, but currently, vaccine development for COVID-19 has been put on the fast track. Still, he states that even the fast track is quite a bit longer than six months. Many research groups have created potential vaccines, but that is just the beginning. Trials must ﬁrst show that vaccines are safe, and then clinical trials must show that vaccines provoke an immune response to protect people from falling ill. Vaccine production must then be scaled up to develop billions of doses and then the vaccine must prove safety in order to get past regulations. These regu-
One speciﬁc segment of the vaccine development process that especially extends the timeline is the Clinical Development phase. Within this stage of vaccine development are Phases 1, 2, and 3, which we hear about so often in the media. As early as mid-March, the National Institutes of Health (NIH) released that the Kaiser Permanente Washington Health Research Institute (KPWHRI) in Seattle had begun Phase 1 of clinical trials, but what does that exactly entail?According to The Centers for Disease Control and Prevention (CDC), to enter the Clinical Development phase, private vaccine developers submit an application for an Investigational New Drug (IND) to the US Food and Drug Administration, and once the proposal has been approved, the candidate vaccine must begin its journey through the three trial stages of the Clinical Development chapter. In Phase 1, vaccine developers determine the safety of the vaccine using a small group of subjects. Phase 2 includes several hundred test subjects and aims to de- -termine information about the immune response caused by the vaccine. Finally, in Phase 3, several thousands of test subjects continue to measure the safety and immune response of the candidate vaccine, but vaccine developers are now looking to determine the effectiveness of the vaccine as well. Currently, there are many leading candidate vaccines, which are in various stages across all three phases.
The Current Status The New York Times reveals that as of July 24th, 2020, the leading candidate vaccines are being developed in the US, China, Europe, and India. American companies Moderna and Pﬁzer (partnered with German company BioNTech and Chinese company Fosun Pharma) are both entering Phase 3 of clinical trials. Chinese companies CanSino Biologics, Sinopharm, and Sinovac Biotech are also entering or already in Phase 3. The British company AstraZeneca and the Murdoch Children’s Research Institute in Australia have also entered Phase 3. Indian companies Zydus Cadila and Bharat Biotech as well as Japanese company AnGes have entered Phase 2 of clinical development in the search for a COVID-19 vaccine. Many other companies have entered Phase 2 as well, including Morningside Ventures, Arcturus Therapeutics, Johnson & Johnson, Anhui Zhifei Longcom, and Novavax. Jonathan Corum and colleagues with the New York Times also assert that there are 19 other candidate vaccines in Phase 1 trials and over 140 other candidates in the preclinical phase. All of these aforementioned companies are the major players in the worldwide race for an effective COVID-19 vaccine. In fact, NIH Director Francis S. Collins has stated that from the companies currently in Phase 3, including Moderna and Pﬁzer, he hopes to have an effective vaccine ready for manufacturing and distribution by the end of 2020.
and Response, the CDC, the US Food and Drug Administration, and the European Medicines Agency. Together, the group developed an international strategy termed “Accelerating COVID-19 Therapeutic Interventions and Vaccines” or the ACTIV plan. By standardizing and sharing preclinical evaluation methods in an open forum, prioritizing and accelerating clinical evaluation of therapeutic candidates, maximizing clinical trial capacity and effectiveness, and creating a collaborative framework to share insights, the ACTIV plan aims to advance vaccine development in the ﬁght against COVID-19. The government has also aided in COVID-19 vaccine development through direct investment. The federal Biomedical Advanced Research and Development Authority (BARDA) is investing in the leading vaccine developers during clinical trials to ensure enough doses for the American public as well as the quick manufacturing and distribution of these doses. According to a CNBC article from early July, BARDA has distributed $1.2 billion to AstraZeneca to fund research and development and also reserve 400 million doses for the US. BARDA has also awarded $456 million to Johnson & Johnson and $486 million to Moderna. The US government has termed these large investments into a COVID-19 vaccine and the overall fast-track process, “Operation Warp Speed.” Additional beneﬁciaries include Novavax with $1.6 billion of funding and Emergent Biosolutions with $628 million. Pﬁzer and BioNTech also announced that the US government reserved up to 600 million potential doses by awarding the companies $1.95 billion to fund research and clinical development. The US government has made plentiful vaccine dose reservations with multiple leading vaccine developers in order to provide the vaccine at virtually no cost for the American public. However, if a company outside the US develops the vaccine, the cost may rise for the American public and there may also be a delay in when the vaccine doses arrive in the US. Who Receives the First Batch of Vaccines?
The Joint Efforts of the Public and Private Sectors One major reason that the vaccine development process for COVID-19 has been able to speed up to its current extent is public-private partnerships. In mid-April, the NIH launched a public-private partnership to place COVID-19 vaccine and treatment development on the fast-track, and this partnership included more than a dozen leading bio--pharmaceutical companies, the Health and Human Services Ofﬁce of the Assistant Secretary for Preparedness
Still, once a vaccine is available, new questions are posed: How should the distribution of the future vaccine be prioritized? According to Lena H. Sun with the Washington Post, current discussions and plans for prioritizing the distribution of the COVID-19 vaccine have categorized healthcare workers, other essential workers, and high-risk populations as the highest priority groups. High-risk populations speciﬁcally include older adults, residents of long-term care facilities, and people with underlying medical conditions relevant to COVID-19. However, there is much more controversy over who is considered an essential worker. Are cafeteria workers and the cleaning staff at medical facilities considered essential? Are teachers considered essential? Another controversial point is the role that race and
ethnicity should play in prioritizing the distribution of the COVID-19 vaccine due to the disproportionate effect of the virus on certain communities of color. Following the high priority categories, there has been discussion about prioritizing children as well as pregnant women. Prioritizing based on location has also been brought up since some regions of the country have been hit harder by COVID-19. Clearly, the story doesn’t end with just the release of an effective COVID-19 vaccine. With multiple plans in discussion, it is equally important to ask, who gets to decide the prioritization? Statnews writer Helen Branswell stated that in mid-July, the National Academy of Medicine named a panel of US health ofﬁcials tasked with developing the framework to make the critical decision of who gets vaccinated ﬁrst. However, the Advisory Committee on Immunization Practices (ACIP) currently exists and already ﬁlls this niche, including the creation of the vaccination priority list during the 2009 H1N1 ﬂu pandemic. Moreover, the national government’s Operation Warp Speed has also claimed distribution of the COVID-19 vaccines. Including the opinion of the general public, there are now four entities tasked with making the same decision. Considering that only a small portion of the population will have access to the vaccine at the start, assigning the groups atop the priority list is a critical decision that could impact the spread of COVID-19 while manufacturers and distributors are still working to make the vaccine available to the rest of the population. Even before building the vaccine priority list, these various entities must ﬁrst decide who gets the ﬁnal say in prioritization, or they must be in agreement because differing opinions will not succeed in enforcing the priority list.
Edited by Varshini Odayar Artwork and Design by Angela Chen, Saagar Sheth
Handling the Uncertainty While the scientiﬁc community is hunting down a vaccine and the public sector is preparing for mass distribution, what should everyone else do? What should you do? President Trump has stated that the ﬁrst doses of a COVID-19 vaccine could be available by the end of 2020, but according to Sarah Kolinovsky with ABC News, the Trump administration’s own medical and scientiﬁc experts are doubting the possibility of an effective vaccine on such a short timeline. Since vaccines can often take several years to develop, many experts including the Operation Warp Speed lead Moncef Slaoui, Dr. Anthony Fauci, and the former head of BARDA Dr. Rick Bright along with more have stated that even the 12-18 month timeline is formidable. With the current uncertainty on a vaccine any time soon, it is best not to hedge our bets and to play it safe. Social distancing guidelines as well as mask mandates should be thoroughly followed. Avoiding large gatherings and minimizing the number of people we come in contact with will both limit our own chance of being infected and also boost our chances of ﬂattening the COVID-19 curve, at least in our own local community. Like any sporting event, as the audience, we should support the players taking part in the worldwide race for a COVID-19 vaccine in any way that we can. Until there is a COVID-19 vaccine available, all actions to limit the spread of the virus should continue if we want any chance of improving the current state of public health in both the US and the world. It is best to hope for a vaccine, but continue to act as if our own actions are the only vaccine.
S D N E O I Z I T L A A L N U I P G O R A P Articles in this section focus on the pandemicâ&#x20AC;&#x2122;s social impacts on vulnerable populations in America and abroad. Articles take both data-driven and journalistic approaches to document lived experiences. We hope readers will think critically about power systems in place right now and envision a fairer world moving forward.
▲ Yemen 2020 (Source: UNICEF), Misha Jordan (Source: Getty Images), Untitled Source: US News, Waste Pickers Pune, India (Source: UN Foundation)
Gender Inequalities Magniﬁed by the Pandemic BY NEHA DAMARAJU
lthough research suggests that men are more likely to experience the negative symptoms of the novel coronavirus, women disproportionately bear the emotional, social, and economic toll created by the global pandemic. Women make up the majority of front-line health care workers, hold jobs less immune to an economic downturn, are more responsible for caregiving duties, and face a high risk of domestic violence. Due to the pandemic, decades of progress towards gender equality have been wiped away, leaving girls and women in a state of vulnerability when it comes to their homes, their health, their education, and their livelihood.
Women in the economy Around the world, over 740 million women conduct informal work — jobs not regulated by the state or government — with the informal economy making up 70% of female employment in developing nations. In fragile, conﬂict, and violent (FCV) settings, only 2 out of 10 women are formally employed. Unfortunately, during times of economic crisis, it is always the insecure and informal jobs that are the ﬁrst to disappear — leaving women without income and in a state of economic hardship. In addition to women 54
making up the majority of informal workers, women are also more likely to work in the restaurant, travel, and hospitality industries. In the United States alone, 74% of women work jobs that rely on in-person interaction. In this new era of social distancing and lock-down orders, these face-to-face areas of business are seeing the greatest economic losses. Globally, women earn less and are most vulnerable to losing their jobs during times of crisis. We saw this in Liberia during the Ebola outbreak: women suffered much higher levels of unemployment than men, with their economic involvement still not having reached the level it was at before. In a similar manner to the Ebola outbreak's impact on women in West Africa, the COVID-19 pandemic has widened existing inequalities to a point where their impact will long outlast the virus itself. Women’s health & Women in healthcare Young girls and women have a plethora of health needs, yet across the world less than half of all females have proper access to the healthcare services or essential products to cover these needs — especially those relating to reproductive health and maternal care. As more resources are diverted to the coronavirus pandemic, fewer and fewer women have access to these essentials. During the Ebola crisis, the number of women who died during childbirth in West Africa increased by 70% as resources were reserved for patients with Ebola. While current data on this statistic is lacking, overall childbirth related deaths are trending upward. Additionally, it is estimated that in Latin America and the Caribbean, 18 million women will lose access to contraceptives due to the coronavirus pandemic. This is due to the fact that clinics are shutting down to make room for coronavirus patients. The lack of contraceptives may lead to an increase in adolescent pregnancy, HIV, and other sexually transmitted diseases. Despite the lack of resources they face, women continue putting their lives on the line in the ﬁght against COVID-19. 70% of worldwide healthcare workers are women. It has also been noted that women have less access to personal protection equipment that properly ﬁts them, as most equipment is mass produced to the “default male” size, leaving women at a greater risk of viral contraction on the front lines. In the end, the pandemic is putting women at greater risk of coronavirus contraction as well as leaving women without proper defenses for other health disorders. Women and life at home The coronavirus pandemic has grossly exacerbated common problems that women have faced within their homes. Studies have shown that women on average do three times as much housework and caretaking as their male counterparts. These numbers are projected to have grown during quarantine and lock-down periods. As children are forced to stay home from school, women need to spend all day taking care of and occupying young children. Taking care of the sick and elderly also falls upon the women of the household.
Within the US, 21% of all children live with only their mother, as opposed to the 4% that live with only their father. This puts these single mothers in charge of all aspects of family life, including all day childcare. A recent study from Washington University in St. Louis has shown that mothers in the US scaled back their work hours by 5% during quarantine to keep up with family needs, while fathers’ work hours remained stable. In addition to increased maternal responsibility, stay at home orders have caused a spike in domestic violence levels against women. Police reports from China show that domestic violence cases have tripled since March and reports from France show that the number of cases have gone up by 30%. The UN predicts that abusers have been exploiting a woman’s inability to leave the home in fear of having no place to safely shelter. The pandemic has put women in more stressful positions at home while at the same time showing how familial success and normality during these uncertain times is thanks to the labor of women. Women and education As COVID-19 cases rose, schooling across the world was halted or transitioned to online learning. Before the pandemic, an estimated 130 million girls between the ages of 6 and 17 did not attend school worldwide. Post COVID-19, these numbers are projected to skyrocket as the pandemic forces many more girls to drop out of school to provide additional help at home or to earn income for the family. Unfortunately, once a girl drops out of school, the likelihood of her returning are slim to none, creating a permanent decline in her chances of improving her future living standards. The pandemic has also put a great strain on teachers, who are primarily women. Female teachers have historically worked longer hours and taught more classes than male teachers, and the transition to online learning has only made it more difﬁcult for these teachers. Not only is distance learning more time consuming, but it has become a female teacher’s job to work with students during a period of high uncertainty and stress — a task that can be very emotionally consuming. In many cases, we have seen the pandemic further exacerbate pre-existing inequalities. In the case of gender inequality, women are being disproportionately hit harder than men in almost every aspect of life. Societal stigmas and differences that have been built over centuries are deﬁning a “woman’s role” during these uncertain times and have put the world back decades in our ﬁght for gender equity. Edited by Joshua Keller Artwork by Neha Damaraju and Kavya Parekh Design by Kavya Parekh
CORONAVIRUS AND BLACK LIVES MATTER BY MOLLY HAYES
In May, as people avoided leaving their homes in fear of COVID-19, their eyes were opened to another, centuries-old crisis. The murder of George Floyd, an unarmed Black man, by police sparked a wave of Black Lives Matter (BLM) protests across major cities in America and around the world. Police brutality and anti-Black racism are products of centuries of continued systemic oppression against Black people. Black people continue to experience racism in every aspect of their lives: from access to healthcare, fair workplace treatment, access to education, and more. Today, the United States is dealing with two major life-or-death crises at the same time: the Coronavirus pandemic and police brutality fueled by institutionalized racism. The two are inextricably connected. While these crises may seem distinct and unrelated, this is far from accurate. While the most recent BLM protests were sparked by police brutality, protesters are ﬁghting anti-Black racism of all kinds. BIPOC (Black, Indigenous, and People of Color), speciﬁcally Black people, are more likely to work in essential jobs and live in communities with limited access to resources. Furthermore, the CDC reports that when adjusted
Although the BLM movement has mobilized millions of people worldwide, the response from the White House has been dismissive at best and inﬂammatory at worst. President Trump showed disdain for the BLM protesters, calling them “thugs” and tweeting, “when the looting starts, the shooting starts.” Trump took this quote directly from former Miami police chief Walter Headley, who had a long history of anti-Black racism. Headly developed a “get tough” policy that, in his own words, targeted “young hoodlums, from 15 to 21, who have taken advantage of the civil rights campaign.” When referring to this policy, he asserted that he and his colleagues
Today, the United States is dealing with two major life-or-death crises at the same time: the coronavirus pandemic and police brutality fueled by institutionalized racism. The two are inextricably connected.
n early March of 2020, COVID-19 changed nearly every aspect of life across the globe. States closed non-essential businesses; masks and social distancing became the norm. Despite the horrors of COVID-19, many people refused to abide by these precautions and continued to eat out, have parties, and attend large gatherings. By May and June, entire states began reopening in clear deﬁance of warnings from health ofﬁcials. As other countries’ cases have plummeted, the number of cases in the US continues to rise. As of July 12th, the CDC reported that the U.S. had 3,236,130 reported COVID-19 cases and 134,572 reported deaths. Evidently, the United States is failing at ﬂattening the curve and keeping its citizens safe from the Coronavirus.
for age, non-hispanic Black people have a 5 times higher rate of hospitalization from COVID-19 than non-hispanic white people in the U.S. The CDC attributes these disparities to a number of factors, among which include living conditions, work circumstances, and health issues, noting that “Racism, stigma, and systemic inequities undermine prevention efforts, increase levels of chronic and toxic stress, and ultimately sustain health and healthcare inequities.” The ingrained discrimination in these systems inherently places Black people at higher risk of contracting
The tendency to blame an increase in Coronavirus cases on the BLM protests isn’t surprising, but according to current research, it is factually inaccurate.
and dying from COVID-19. BLM protests aim to address these intertwined and equally existential issues as well involved stealing and breaking into stores, the overwhelming majority of the Black Lives Matter protests have been peaceful. Many protesters have demanded justice through lifting their voices, making signs, and painting “BLACK LIVES MATTER” on major roads across the nation. In some cases, police ofﬁcers have even stood with protesters in support of the movement. On the other hand, we have seen, time and time again, videos of peaceful protests turned violent by police using teargas and rubber bullets unprovoked. Concern about the government’s response to the Coronavirus pandemic as well as pre-existing biases against Black people and the BLM movement have caused some public ofﬁcials to blame the protests for the rise in Coronavirus cases. At a press conference in early June, Iowa Governor Kim Reynolds argued that “it would be very hard to identify where someone got COVID-19. I mean look at the protesters.” At the end of June, House Minority Leader Kevin McCarthy implied that the BLM protests were causing an increase in COVID-19 cases. He cited the cause of the increase in cases as “the bars but also compounded on that, the protests.” In early July, Mississippi Governor Tate Reeves tweeted, “Liberal media is trying to claim the increase of Coronavirus was just caused by family BBQ’s on Memorial Day. They completely ignore the fact that our uptick (and other states) began within days of massive protests all over — which they have celebrated.”
BLM protesters aren’t just taking to the streets, but are also ﬁnding creative ways to protest from home. People are putting up posters, organizing through Zoom, contacting elected representatives, and sharing information through social media. These forms of protesting are not only safer than in-person gatherings, but make it more accessible for people of differing strengths and abilities to become involved. This isn’t to say that protesting during the pandemic of a highly contagious disease isn’t risky. Large groups of people in a small space certainly have a greater potential to spread the Coronavirus. While it isn’t the ideal time to protest in terms of public health, it is the necessary time to protest in terms of public attention. The issue of police brutality and the general disregard for Black lives is so severe that people are risking their lives to ﬁght against it. BLM protesters are not ﬁghting to oppose COVID precautions, they are ﬁghting despite them. George Floyd’s murder did not start the BLM movement; it re-catalyzed it during a time of existing unrest. The entire world is ﬁnally listening to the calls of the Black Lives Matter movement. Now is the time. What—and who—should we really be directing our critiques towards? Yes, the public health crisis is extremely serious. However this critique regarding the rise in cases should be directed towards the people going out to brunch, bars, parties and the government ofﬁcials who are opening their states too soon, not the people who are protesting to save the lives of Black people. We, as a nation, are dealing with two major issues right now. People are dying at the hands of the Coronavirus and people are dying at the hands of racism and police brutality. Those who are worried about the Coronavirus and those who support BLM both want to save lives. Let’s not pit the crises against each other.
Edited by Bindu Srinivasa Artwork by Kaitlyn Zhou Design by Nidhi Talasani
The list of claims goes on, yet in reality, the evidence suggests otherwise. In mid June, the National Bureau of Economic Research reported there to be “no evidence that net COVID-19 case growth differentially rose following the onset of Black Lives Matter protests” and “no evidence” that urban protests reignited Covid-19 case growth during the more than three weeks following protest onset.” The tendency to blame an increase in Coronavirus cases on the BLM protests isn’t surprising, but according to current research, it is factually inaccurate. Protesters recognize the seriousness of protesting during a pandemic and they are doing all that they can to keep themselves, their fellow protesters, and their communities safe. Through my experience protesting in my own community, I have witnessed the precautions that protesters have taken: handing out hand sanitizer, requiring masks, and keeping distance. This is certainly more than the police have done—consider the irony of tear gassing citizens during a pandemic that affects the respiratory system. Additionally,
COVID in Cancer Alley
BY ANURIKA KUMAR What is Cancer Alley?
Location of Cancer Alley
The town of St. Gabriel is located in the heart of Cancer Alley. Residents of this town have long suffered from all the adverse effects of the nearby plants, ranging from ﬁnding dead birds in their lawns, to watching yellow rain fall from the sky, and even becoming desensitized to the frequent news of their fellow neighbors suffering from miscarriages and being diagnosed with cancer. Such horrible living conditions should never be acceptable, yet this has been the reality for Americans living in this region for decades. A current hospital receptionist and resident of St. Gabriel, Terry Frazier, told a ProPublica reporter, “Out of every 10 houses, there’s a prospect of one or two people that have died of cancer.” She goes on to recount the long list of family members and friends from St. Gabriel that battled with and lost their ﬁght against cancer. Unfortunately, Frazier’s personal account can be corroborated by some even more astonishing statistics on the region’s cancer rates. Studies have conﬁrmed that the region has signiﬁcantly higher cancer rates, speciﬁcally for stomach and lung cancer, as Louisiana saw an average of 237.4 deaths per 100,000 people, while the national average was 206 deaths per 100,000 people.
Cancer Alley sounds like such a morbid term that it is often mistaken as a ﬁgure of speech or a hyperbole. Unfortunately, that is not the case; the term Cancer Alley does in fact refer to a speciﬁc region within the United States. In the state of Louisiana, along the Mississippi River, there is an approximately 85 mile stretch of land reaching from New Orleans to Baton Rouge that has been dubbed as “Cancer Alley.” According to the EPA, a person living in this region is 95 percent more likely to get cancer from air pollution than the average American. This region has become an industrial juggernaut lined with numerous petrochemical and ethylene plants within close proximity of one another that constantly spurt toxic plumes into the skies and ooze hazardous liquids into the nearby river laced with the stench of rotten eggs. There are as many as 30 of these plants within 10 miles of one another. These unfathomably high concentrations of plants result in a disproportionate amount of illnesses due to all the toxins. One of the most drastic examples is when a Condea Vista plant reported over ninety accidental chemical spills in Lake Charles from 1997 to 2000, discharging somewhere between an estimated 19 to 47 million pounds of ethylene dichloride, a known human carcinogen. In the past decade, the story of Cancer Alley has gained much attention in the media and thus there have been many efforts to mitigate the region’s immense pollution, however the problem still persists and continues to grow today.
We haven’t nearly ﬁnished discussing all the problems found in Cancer Alley. Beneath this title lies an even more horrifying phenomenon: environmental racism. The majority of Cancer Alley residents are Black Americans who disproportionately make up the ill population of the region. In addition, the region has some of the highest unemployment rates in the state, despite there being an abundance of plants nearby. Evidently, Cancer Alley has become a region with a whirlwind of serious issues. The large population with serious pre-existing medical conditions and low income families of color are only exacerbated by the pandemic and makes this region particularly vulnerable. As a new global pandemic hits the world, we can clearly see how Louisiana’s Cancer Alley has taken one of the biggest hits nationwide, and the region’s high cancer rates has everything to do with that. 58
How susceptible are cancer patients to COVID? According to the CDC, cancer patients have been classiﬁed as an “at risk” group to COVID-19, meaning they face an increased risk of serious illness from viruses. Cancer patients are especially susceptible to this virus due to the wide range of treatments they undergo, the two most common being chemotherapy and radiation.
What is being done and what can you do? Currently, organizations such as RISE St.James are working to stop additional plants from being constructed in the region. Working in conjunction with such organizations would be a great way to try and mitigate the air pollution issue that has been a root cause in yielding the population to be so vulnerable.
These treatments result in the patients having extremely weak immune systems, or immunosuppression, and thus they are not able to effectively ﬁght off viruses, especially without proper resources and care. Speciﬁcally, chemotherapy often leads to neutropenia, a condition where patients exhibit very low levels of neutrophils- a type of white blood cell- resulting in the immune system to be extremely deﬁcient. Both targeted radiation therapy and total body irradiation have also been noted to lower the overall white blood cell counts severely in patients, making it difﬁcult to overcome even the ﬂu. In fact, researchers have found that there is a 13-28% mortality rate of cancer patients who contract COVID-19, while the overall mortality rate for a cancer patient is signiﬁcantly lower at about 1%. Clearly, COVID is much more virulent and aggressive in its attack to the immune system of cancer patients compared to the average person.
There are also several Black activists such as Sharon Lavigne, who is standing up against the environmental racism and inequity residents of the region are facing. Last year, Lavigne led a march through St. James, Louisiana calling for action against all the toxic emissions plants were producing. Lavigne told reporters, “They promised us jobs. Instead they pollute us with these plants, like we’re not human beings, like we’re not even people. They’re killing us. And that is why I am ﬁghting.”
These are just the physiological effects the virus directly has on existing cancer patients. However, COVID is even hurting patients who don’t even know they have cancer yet. Cancer doesn’t stop just because COVID ravaged the world. As COVID cases began to rise, more routine and essential procedures, such as cancer screening, were halted. This delays diagnosis, progression check-ups, and effective treatment implementation. A study in the UK found a 15.3-16.6% increase in lung cancer mortality rates alone since this past March due to delays in diagnosis and ultimately treatment. Not only is this pandemic taking a huge hit on the immune system of cancer patients, but it is also jeopardizing their routine diagnosis, treatment, and overall care. How long has COVID been in Cancer Alley? As suspected, COVID-19 has unfortunately inﬁltrated the Cancer Alley region, and is hitting residents hard. In fact, Cancer Alley has been noted to have some of the highest coronavirus death rates in the country. This is unsurprising given the large high-risk population. Ridden with numerous serious pre-existing illnesses, such as cancer, the population of Cancer Alley was too weak to take another hit, and now the community is on the verge of crumbling. There are so many enormous problems that need to be ﬁxed right away before the community diminishes. But where do we start?
Image from Rolling Stone Sharon Lavigne (pictured left) leads protest in Cancer Alley That is what you can do too. Fight. Raise awareness, donate, volunteer, and join the cause. Lowering cancer rates and reducing the medically vulnerable population isn’t a quick or easy task. Start with what we can do at ﬁrst. We can work towards reducing the toxic emissions and pollution in the area, and help to create better paying jobs to uplift the community. In time, this will help create a healthier and safer environment for residents. While lowering the staggeringly high cancer rates and COVID-19 mortality rates may seem like a daunting task at ﬁrst, they too can be eradicated. Edited by Blair Hoeting Artwork and Design by Payton Kim
HOW ONE PANDEMIC HIGHLIGHTED ANOTHER:
DOMESTIC VIOLENCE AS A GLOBAL HEALTH EMERGENCY BY EMILY LEVENTHAL
AT JUST SEVENTEEN, Elise Roberts fell victim to intimate partner violence. Her boyfriend at the time physically, sexually, and emotionally abused her—he manipulated her into believing that he was the only person who could ever love her. Once Elise was able to identify that what was happening was abuse, she opened up to her therapist, contacted assault hotlines, and ﬁnally gained the strength to leave her abusive relationship. But her experience as a victim-survivor did not end there. Instead, that moment marked the beginning of a long, arduous journey of healing. She would have to deal with constant ﬂashbacks in future relationships, perpetual urges to self-harm, and debilitating symptoms of depression. The abuse does not end when a survivor leaves his or her abuser; it comes back in ﬂashbacks, anxiety attacks, waves of depression, and a host of other mental health symptoms. And unfortunately, severe intimate partner violence—as well as its lasting impact on mental health—has become a reality for one in four women. While domestic violence has always been a prevalent global health issue, COVID-19 and stay-at-home-orders have exacerbated the problem world-wide. Following self-isolation measures, domestic abuse rose threefold in China, 32-36% in France, and 25% in the UK. For several reasons, the restrictive measures associated with the virus play into the hands of abusers. Dr. Delanie Woodlock, a sociologist who studies domestic violence and sexual assault, found that perpetrators have been using COVID-19 as an excuse to intensify their control of women and children. “[Perpetrators] are restricting women’s contact with friends and family and monitoring their calls and use of their phone…. [their] reasoning now is that these actions are taken out of care and protection.” Control, surveillance, and coercion become “justiﬁable” by abusers during a pandemic; abusive behavior is hidden behind the illusion of care.
The psychological and economic stressors accompanying the pandemic also intensify and mediate abusive behavior. For example, isolation is a well-known domestic abuse risk factor. In a systematic review conducted by Gerino et al., social support was identiﬁed as a primary protective factor against intimate partner violence. Essential support networks are diminished during self-isolation, and victims are dangerously cut off from their support systems. Because people around the world are now spending more time inside their homes, largely away from the rest of the world, abusers are free from scrutiny and consequence from anyone outside the family unit. Power dynamics thus become distorted inside the home, and the abusers’ intensiﬁed control over victims cannot be checked by others. The stress associated with ﬁnancial strain and economic struggle is another domestic abuse risk factor. As millions and millions become unemployed due to the pandemic and ﬁnancial stress increases globally, people become more likely to abuse their partners. Financial strain due to the pandemic may also keep some women in their abusive relationships, as those who are ﬁnancially unstable on their own ﬁnd it more difﬁcult to leave their partner whom they economically rely on. Additional harmful coping mechanisms for the stressors associated with the pandemic, such as excessive alcohol consumption or substance misuse, further trigger an increase in family violence. The widespread shut-down of non-essential businesses inadvertently shut down many traditional avenues of escape or help-seeking for victim-survivors. Family justice centers and nonproﬁt ofﬁces have shifted their operations online and suspended social worker home visits, proving detrimental to women and children victim to domestic abuse who rely on home visits for support and protection. Victim-survivors often report their abuse to school ofﬁcials 60
or co-workers—as schools and businesses close down, many domestic abuse cases dangerously go unnoticed. Domestic abuse and women’s shelters are a critical option for many women looking to quickly escape their violent living situations. While these shelters have remained open, many victims have decided against going to the shelter due to fear of contracting the virus, forcing them to choose between two options affecting their physical and mental health. The stay-at-home orders have turned into a living nightmare for some: victim-survivors become stuck with their mental, physical, and sexual abuser 24/7 with little means of escape or coping. Not only does domestic violence inﬂict immediate psychological, emotional, and physical pain on millions of women every year, but it also puts victim-survivors at increased risk for a myriad of mental health disorders. The Australian Burden of Disease Study in 2015 found that domestic violence contributes more to the burden of disease—which includes depression, anxiety disorders, suicide, and self-harm — more than any other risk factor in women aged 18 to 44. The suicide rate is drastically higher among survivors compared to other women: 17.9% of intimate partner violence victims have attempted to commit suicide. Studies have found that experiencing violence changes an individual’s biological susceptibility to developing mental illness through epigenetic modiﬁcations. Epigenetic changes provide the process by which the environment changes gene expression without changing the DNA sequence. A study by Serpeloni et al. found that lifetime exposure to violence caused epige- netic changes that led to an increased susceptibility to the devel- opment of PTSD, depression, and anxiety. These biological modiﬁca- tions are also heritable. In a study published in Nature by Radtke et al., researchers found that experiencing violence during pregnancy caused epigenetic modiﬁcations in the child that led to an increased susceptibility to psychopathology. The impact of domestic violence thus stretches far beyond the immediate violence; the consequences of intimate partner violence bleed throughout lifetimes and cross over generations. Treating mental health speciﬁcally for the trauma endured by domestic violence survivors remains an underresearched area in academia. This lack of research translates to lack of training and expertise in treating victim-survivors, contributing to the high prevalence of these mental health disorders among those who have experienced domestic abuse. In one study, researchers found that more than half of mental health provider participants believed they lacked the necessary skills to identify instances of intimate partner violence. Another barrier to effective mental health
treatment for victim-survivors is the media’s stigmatization of domestically violent relationships. The stigma leads women to view their abuse as a personal problem which public services cannot help and increases their own debilitating self-blame for the violence they endured. Funding more research in treating victim-survivors struggling with their mental health, as well as actively mitigating the stigma around domestic abuse in the media, is essential to bettering and increasing their access to mental health treatment. While there are many theories about what drives abusers to abuse, one theory conceptualizes domestic violence against women as a pattern of domination by a male partner to undermine the victim’s autonomy and dignity. Dr. Shula Ramon, a psychology professor at the University of Hertfordshire, cites that an underlying reason for abuse is that society “continue[s] to believe that women are a group that has to be controlled because they are perceived as both impure and seductive.” The passive construal of women in society, the continuous election of leaders who have committed violence against women, and the over-sexualization of women in media contribute to these cultural factors mediating male abuse against female victims. According to Dr. Delanie Woodlock, male violence against women and children is also at the root of our oppression as women. Domestic violence is there- fore simultaneously a byproduct and a contributing factor to female oppression. We have to call it what it is. Domestic violence is a pandemic, harming more than 5 million new women around the world every year, detrimentally affecting the longterm mental and physical health of victim-survivors as well as exacerbating gender inequality. A reversal of responsibility is necessary: it should not be regarded as an individualized problem blamable on victims but, rather, a societal public health issue. Elise, like other victim-survivors, believes communities should confront physical and sexual violence head on, rather than treating it as a taboo subject in order to spread awareness about the warning signs of abuse. Combating the taboo nature of the important issue, increasing general education about domestic violence, investing in research for mental health services treating victim-survivors, and rejecting those society members who continue to abuse women are all important steps in ﬁghting this raging pandemic. But the ﬁrst step that governments, policy-makers, and higher education institutions have yet to take is simply recognizing it exists. Edited by Sophia Blyth Artwork by Emily Leventhal Design by Kavya Parekh 61
How Systematic Racism has Led to Deteriorating Black Health in Columbus, Ohio
he year 2020 is undoubtedly going down in history as one of the most tragic and uncertain times for not just America but the entire world. As the COVID-19 pandemic causes chaos and the Black Lives Matter protests highlight the injustices sought by Black people, a new light has been shone on human rights issues, especially in the area of healthcare. This light has revealed how marginalized groups have a disproportionate access to various social determinants of health, such as quality education, nutrient-rich food, and adequate income which leads to the inability to access proper healthcare. With respect to current events, the lack of these evidently inaccessible amenities puts Black populations at a much higher risk of contracting COVID-19. Thus, the concept of health equity in which everyone has a fair opportunity to live a healthy life is currently an unattainable dream. Unfortunately, this issue is so systemic that it starts in our very own community. According to a Columbus report, there is an eight year difference in the life expectancy between residents of Hilltop, a Black majority neighborhood, and Upper Arlington, a White majority neighborhood. Having been to both neighborhoods, this is not a shocking statistic. Instead, what is shocking is that these neighborhoods are segregated by race, as depicted in the ﬁgure below. As a direct result of the demographics of Hilltop, the available resources and ultimately, the quality of life are compromised and diminished, leading to a lower life expectancy. This is a direct example of how redlining negatively impacts Black health. Although this is just one example of a small neighborhood within a small suburb in Columbus, it illustrates exactly what is happening across our entire country. Redlining, the direct and indirect segregation of minorities, is caused by historically racist policies and the continued stigmas within predominantly white neighborhoods against minority groups. Unfortunately, while redlining continues to play a very debilitating role in every aspect of our Black brothers’ and sisters’ lives, the issue is largely ignored. Although the concept may explain statistics such as why 55% of vulnerable youth in Columbus are people of color, we should never feel okay knowing that Black neighborhoods are more vulnerable to health issues solely because of this historical segregation. Highlighting these issues is the initial step towards ﬁghting systemic racism in the world of healthcare.
BY ISHA LODHAWALA AND EMMA BOLKOVAC
▲This map illustrates how the Columbus suburbs are segregated by the race of its youth’s population. The racial distribution of the city is quite evidently “Black and White.” Image retrieved from the Kirwan Institute. 62
ability neighborhoods is 73 percent, compared to 94 percent in very low vulnerability neighborhoods.” The lack of educational opportunities which inturn leads to lower graduation rates makes it extremely difﬁcult for these individuals to make healthy lifestyle decisions in the present and future. Furthermore, these educational hardships prevent upward mobility in employment and ﬁnancial stability, directly inﬂuencing accessibility to healthcare.
LACK OF QUALITY EDUCATION: Studying health disparities begins with understanding one of the most fundamental components of a community: education. Lower income neighborhoods, often composed of large Black populations, have a lack of educational opportunities. This is primarily because a school’s funding is dependent on the property taxes it receives from its surrounding area. As a result, a lower income area would have schools that are less funded, leading to less resources for students, such as lack of new technology and textbooks and decreased availability of academic and mental support services. Additionally, low income areas are more likely to have children participate in gang activity and violence. This is largely due to the fact that these children, often minorities, are subject to unique hardships such as poverty, educational setbacks, immigration, drug usage, and an overall lack of resources. These conditions enable gang activity to thrive in these areas and it thus increases victimization rates causing students to avoid going to school entirely, in the fear that doing so may compromise their safety. Thus, this constant fear which students begin to associate with school decreases their likelihood to attend classes, perform well, and eventually graduate. INSUFFICIENT INCOME: The combination of the lack of educational resources and high gang violence rates contributes to a lower graduation rate for Black children. In fact, according to the, in Columbus “… the graduation rate in very high vulner-
These educational setbacks are related to the amount of Black families that live on the poverty line. In fact, according to the Ohio Poverty Report, “At every age, poverty rates are lower – usually much lower – for the majority than for minorities,” This is especially true for zero to ﬁve year olds where poverty rates are 42% for minority males and and 15% for non-Hispanic White males, respectively. As a result, these poverty -ridden communities, which have decreased educational and employment opportunities, do not possess jobs which can sustain a family. This requires individuals to travel farther distances to work although transportation is often inaccessible. Furthermore, at these workplaces, Black individuals are likely to suffer economic hardships based on racist hiring practices and their lower qualiﬁcations due to predisposed educational disadvantages. As a combination of all of these difﬁculties, Black individuals cannot leave to earn money. Instead, they are ‘stuck’ in their situations. THE UNAVAILABILITY OF HEALTHY FOOD: These low income areas are also impacted by environmental racism, leading to the formation of food deserts. Food deserts are areas within neighborhoods which have limited access to nutritious food and resources. These areas have increased fast food restaurants and a decreased availability of grocery stores. For example, in Columbus, Franklin county has 92 grocery stores but 588 fast food locations. Because marginalized communities have a lower accessibility to transportation and cannot afford more costly, but healthy groceries, they resort to purchasing the most affordable and conveniently located food options. Unfortunately, these avai-
lable options are higher in calories and preservatives. Consistently consuming them increases the risk of developing certain health conditions such as diabetes, certain cancers, kidney disease, and hypertension. It is speculated that these health complications may be intensiﬁed by the “Slavery Hypertension Hypothesis,” which suggests that African Americans developed an enhanced ability to conserve salts due to the treacherous Atlantic passage. Although the physical concept of slavery has technically been abolished, its impacts are long lived and continue to take major physical tolls on the lives of our Black brothers and sisters. INABILITY TO ACCESS HEALTHCARE: The ﬁnancial barrier created by the lack of educational and employment opportunities has had signiﬁcant impacts in Black communities’ accessibility to healthcare. Additionally, certain situational issues such as food deserts have increased the need for certain types of preventative care and treatment such as for Hypertension. However, this is unattainable for a large proportion of Black individuals because treatments, prescriptions and check-ups are expensive and therefore, inaccessible. This causes numerous health conditions to go undiagnosed and untreated. Additionally, similar to how schools in underfunded areas have a lack of resources, hospitals work the same way. When patients do not have health insurance or when they are on Medicare, hospitals are reimbursed to only cover the minimal cost of providing care, which is actually not an adequate amount. However, when private payers are covering the costs, hospitals are reimbursed much thoroughly. Unfortunately, Black populations are subject to higher rates of poverty which increase their likelihood of being on government -provided healthcare assistance, if any at all. This decreases the funding of hospitals in high vulnerability areas. As a result, these hospitals may be understaffed, have low quality techn- ology and surgery equipment, and may hold a lower capacity. Read the rest at healthrighters.com Edited by Sumayyah Farooq Designed by Kavya Parekh 63
Pandemic Exposes Crucial Flaws in Healthcare Systems of U.S. Correctional Facilities BY NICOLE FREEMAN
AS A RESULT of the COVID-19 pandemic, the American people are facing one of the most signiﬁcant public health crises in United States history. However, the effects of COVID-19 transcend clinical healthcare, as they threaten to undermine our social, political and economic institutions. Although it is difﬁcult to see beyond the limelight of pain and devastation, the pandemic’s exposure of inherent human rights violations toward underrepresented communities within American healthcare may offer hope for revolutionary changes to a corrupt and discriminatory system. The COVID-19 pandemic has disproportionately inﬂicted major devastation on marginalized communities. Among these are the socioeconomically disadvantaged, racial minority groups and the incarcerated population — which is notably composed of ﬁve times more African American individuals than white individuals. Incarcerated people have been unjustly exposed to the threat of COVID-19. Many of the United States’ largest outbreaks thus far have occurred within the walls of correctional facilities such as jails and prisons. As reported by Johns Hopkins Bloomberg School of Public Health, COVID-19 cases in United States prisons and jails were ﬁve and a half times higher and death rates were three times higher than the general population between March 31 and June 6. The lives of the incarcerated are just as important as any other human life; thus, their health must be taken equally as June 6. The lives of the incarcerated are just as important as any other
Isman, G. and Park, K., COVID-19 Cases in prison. Graph from The Marshall Project (updated on July 30, 2020) Massive disease outbreaks in jails and prisons are nothing new, however. Historically, such facilities have been epicenters of disease transmission. During the 1918 spanish ﬂu epidemic, an account from the San Quentin State Prison in California estimated that over half of the prison’s inmates contracted the ﬂu during the ﬁrst wave, and the number of inmates reporting sick rose from 150 to 700 each day. Similarly, according to Human Rights Watch, Ohio’s Marion Correctional Institution experienced one of the worst COVID-19 outbreaks in the United States with over 80% of inmates testing positive as of April 29. Inmates described living in dormitories with over 100 inmates in one — double the recommended capacity. They reported that stacked bunks were positioned only about three feet apart from each other. Additionally, inmates claimed that staff members often ignored the inmates’ reports of symptoms indicating infection. Although communities across the United States have undeniably faced signiﬁcant difﬁculties with preventing the spread of COVID-19, the conditions and practices within jails and prisons have put incarcerated individuals at an increased risk for contracting and spreading the virus that could be minimized through respect of the basic human rights of inmates.
At this very moment, I can reach out and touch somebody. We’ve got a reason to be scared for our lives. - PRISONER IN INDIANA’S PLAINFIELD CORRECTIONAL FACILITY
COVID-19 Outbreaks Among the Incarcerated
human life; thus, their health must be taken equally as seriously during these threatening and unprecedented times.
The CDC has recently released thorough documentation of recommendations regarding sanitation, hygiene practices, prevention and testing of COVID-19. U.S. prisons and jails have made efforts to reduce outbreaks by attempting to adhere to these recommendations as well as increasing the number of inmates in solitary conﬁnement and enforcing the use of masks by guards and other workers. However, inmates of the Marion Correctional Institution claim that, at the time of the outbreak, prison staff were not adequately wearing masks, and their facilities lacked clean clothes, soap, and masks for inmates to
protect themselves. Inmates also reported that COVID-19 testing was insufﬁcient, as those who reported symptoms would often be moved to solitary conﬁnement and disregarded rather than being tested and provided with proper treatment. In order to decrease the transmission of COVID-19, a major global focus has been social distancing, which is often a physical impossibility within the prison system. Guards are often required to come in contact with inmates when transporting them, and overcrowding prevents inmates from being able to distance themselves from each other, as they are forced into tight sleeping quarters. Whereas the majority of the American population is able to make the personal decision to stay home to protect themselves and others, inmates are robbed of the ability to safeguard their physical health. In addition, COVID-19 poses a signiﬁcant threat to the incarcerated population due to high vulnerability among many inmates. According to a study published by JAMA Internal Medicine, inmates often have poorer health than they would have if they were not incarcerated due to the generally sedentary lifestyles, poor nourishment and unsanitary living conditions. Additionally, the elderly population within jails and prisons has grown recently due to longer sentences. Thus, the vulnerability
accessing their previous workforce healthcare beneﬁts and are also ineligible for Medicaid. In addition, inmates in 35 U.S. states must pay additional copayments that go directly towards prison revenue. While the intention of such copayments is to mitigate abuse of medical care, it places an undue ﬁnancial strain on most inmates whose meager hourly earnings — as low as 12 cents per hour — may not be able to provide for chronic illnesses or other signiﬁcant health issues. Though COVID-19 outbreaks within the U.S. prison system — as in any American community — would likely have been unavoidable regardless of proper healthcare and living conditions due to the infection rates of the virus, the scale of such outbreaks has exposed signiﬁcant violations of human rights within the U.S. prison healthcare system. In order to combat such inequalities, the prison healthcare system could become a non-proﬁt institution separate from the for-proﬁt prison system. Particularly, the co-payments that often deter inmates from seeking treatment ought to be reduced or eliminated entirely, because they do not make up for the spending on healthcare and thus are virtually unnecessary. For example, as of 2017, Virginia facilities spent almost $160 million on healthcare yet only collected about $500,000 from copayments. Such obstacles to care must be eliminated, as they put not only the individual but the entire prison population at risk, especially with regards to a highly infectious virus such as COVID-19. However, realistically speaking, the current U.S. economy is not in a place that allows such ﬂexibility in monetary proﬁts due to the impact of COVID-19 on employment and government revenue. Therefore, experts have suggested that the optimal solution to mitigate disease outbreaks in U.S. prisons and provide sufﬁcient healthcare to inmates is to reduce overcrowding. The prison population in the U.S. has quadrupled over the past four decades, forcing many prisons to greatly exceed maximum capacity. Methods for prison population reduction include replacing unnecessary prosecutions of jail time with monetary ﬁnes for misdemeanor crimes such as petty theft and possession of marijuana. Additionally, the length of sentences for non-violent crimes should be reduced, because elderly inmates are statistically much less likely to repeat offenses; therefore, reducing a sentence would not pose a signiﬁcant threat to public safety.
Saloner B, Parish K, Ward JA, DiLaura G, Dolovich S. COVID-19 Cases and Deaths in Federal and State Prisons. JAMA. Published online July 08, 2020. of incarcerated populations as a result of poor health makes it much more important for additional precautions to be taken to mitigate the impact of the global pandemic. Those serving vulnerable populations outside the prison system — such as within retirement homes — have been taking great efforts to protect the medically fragile individuals. Incarcerated individuals deserve the same respect as all other vulnerable populations during the COVID-19 pandemic. Access to healthcare is a constitutional right for all inmates under the Eighth Amendment’s prohibition of cruel and unusual punishment; however, despite this right, inmates often have limited access to examinations and pharmaceuticals when needed. Incarcerated individuals are unable to continue
Ultimately, the return to adequate occupancy levels would allow incarcerated individuals to execute their right to protect their health by properly distancing from each other. When the COVID-19 infection curve has ﬂattened and the U.S. economy stabilizes, a transition to non-proﬁt prison healthcare systems would help guarantee proper care for inmates and allow professionals to address the threat of an infectious virus before the situation becomes uncontrollable. As a vulnerable population whose wellbeing is in the hands of the prison system, the incarcerated must be better protected and better served by the healthcare system. Edited by Sophia Blyth Design by Nidhi Talasani
Voices of Homelessness: The Untold Stories of America BY VARSHINI ODAYAR
“I am not a homeless person,” Mary said. “Now, that’s where they’ve read me all wrong. They know I’m here. They know I exist, but they just look past me as if I’m not even worth seeing. I know they know how to smile. I see them on the streets smiling at each other, at these strangers, but not at me. I may not have a home, but I am not homeless. I am a human just like them.”
▲ Mary, a woman experiencing homelessness in downtown Cincinnati, tells her story about getting evicted from her own home as she holds a heartfelt sign. “This can happen to anyone,” she said.
▲ Poster captured in downtown Cincinnati I met Mary, an individual experiencing homelessness, when I was walking down Vine Street in Cincinnati. Every two weeks since I was nine years old, my family and I would visit ShelterHouse, formerly known as the Drop Inn Center, a public shelter near downtown Cincinnati which provides housing, healthcare services, and career support for people experiencing homelessness. I would cook and serve meals, heartened by their smiles, hearing glimpses of their stories. For years, as I walked back from the shelter, I passed by individuals like Mary, experiencing homelessness, which inadvertently contributes to their social isolation. But during one of my visits, I decided to stop and talk to Mary. I asked her about her day, and her story slowly unraveled. Mary was a teacher. She was a model. She is a survivor of domestic violence. “Look at my injuries. He did this to me. But look at me. I’m still here,” Mary said. Mary battled depression for years, causing her to struggle ﬁnancially, as she was evicted from her home.
Like Mary, there are more than half a million individuals in the United States who do not have a home. People are forced on the streets due to eviction and subjected to the cruel ignorance of onlookers. Villanized at the hands of mainstream media, they are portrayed as lazy, poverty-stricken individuals with ragged clothes. The media continues to perpetuate these stereotypes through its failure to explore the root of the problem: how homelessness affects individuals rather than societies and cities at large. First introduced in the 1870s, the word homeless was relatively harmless, simply used to describe people wandering around the country in search of jobs. The word served to critique the aimless nature of these individuals who prioritized travel over domestic responsibilities. The original deﬁnition was further motivated by the construction of national railroads and industrialization, allowing for individuals to travel across the country. During World War II, the word homeless took on another meaning entirely as it described individuals living in small, crowded hotels and single room occupancy hotels (SROs). Yet today, the word homeless includes neither of the two aforementioned deﬁnitions. With gentriﬁcation and the rapid rise of unemployment rates, the deﬁnition has taken a rather different form. Today, the public perception of homelessness is marred with stigma and negative portrayals from the media. To be homeless has become a derogatory label, but the negative connotations surrounding this word have made life more difﬁcult for homeless populations in ways that research has not measured.
In an effort to better understand the true impacts of this word, several activists have moved the discussion forwards, suggesting why the world homeless, although seemingly harmless, welds a destructive power. Dr. Mark Mussman, The Director of the Greater Cincinnati Homeless Coalition, describes that “when we label people as homeless, we are in fact, erasing their faces completely. Rather, we must move towards the language of “people experiencing homelessness.” Dr. Mussman works with these individuals daily, providing career resources and empowering individuals to use their passions to achieve economic success. That day, Mark’s words came to life when I photographed Mary, walking down Vine Street, carrying a heart-felt sign about eviction.
“Homelessness does not deﬁne me, but it pains me that the only thing you see written on my face is homeless, black and white just like that”, -MARY
It is important to evaluate the many factors which can lead someone to homelessness. It was Mary’s experience with domestic violence and her battles against depression which caused her to feel stuck in an endless cycle of isolation with no mental support or helplines. A lack of support systems eventually caused her to be evicted. As she spoke, Mary explained her battles against depression, and how she felt stuck in an endless cycle. Her mental health suffered due to domestic violence and the lack of resources and support. Mary’s case illustrates that mental health and illness is attached with social stigma. This social stigma is further ampliﬁed when combined with the stigma surrounding homelessness in the eyes of the public. Reports from the Substance Abuse and Mental Health Services Administration found that nearly 20 to 25% of the homeless population in the United States suffers from mental illnesses. Often, homelessness leads to social isolation and thus takes a toll on one’s mental health. During a pandemic, this social isolation only increases as individuals are forced to socially distance, and shelters are forced to take fewer people due to social distancing guidelines
Through an analysis of current support systems in place for people experiencing homelessness in the United States, Social Security as well as other public shelters and respite care centers are the primary sources of support for individuals experiencing homelessness. However, these shelters are overcrowded and lack an environment conducive for recovery from mental illness as volunteers are typically not trained or well-equipped to support individuals with mental health needs. Since the current systems fail to support the physical and mental well-being of the homeless, we must focus on prioritizing programs which place emphasis on mental health support. For instance, The Housing First Program offers permanent housing without any predetermined conditions of obtaining treatment for mental health or substance abuse issues. Through prioritization of such programs, more attention can be placed towards building advanced systems of support. Permanent supportive housing, systems which offer combined housing and extensive services, can also be advanced. These systems are beneﬁcial because they do not perform screenings which would otherwise penalize those with criminal records or substance abuse issues. . As I walked further along Vine Street that day, I spoke with another man experiencing homelessness. He explained how he lived in a car for several months, providing much needed shelter during Cincinnati’s harsh winters. Yet, he eventually sold his car, his only possession and source of shelter, in order to afford food and water. He explained that he had been denied housing time and time again due to strict predetermined conditions. If permanent housing programs such as the Housing First Model were prioritized, he would be placed in a more stable housing situation. Read the rest at healthrigthers.com. Edited by Ria Parikh and Akila Muthukumar Photography from Varshini Odayar Designed by Kaitlyn Zhou
THE CONVERGENCE OF TWO DISASTERS IN EAST INDIA BY KAVYA PAREKH
yclone Amphan touched down in late May as one of the most powerful recorded storms in India’s history, causing devastation in the Indian states of West Bengal and Orissa as well as parts of Bangladesh. “Thousands of electric poles were broken down, leaving most of Kolkata without power for at least a day. In some areas, I heard that power didn’t come back for weeks. Mine was only gone for one day, but some people suffered enormously in this city.” said Gautam Prasad Barua, resident of Kolkata, one of the biggest cities in West Bengal.
“Amphan maybe landed for only forty-ﬁve minutes to an hour here. But its devastation was wide and deadly,” Barua continued. The cities of East India were faced with a unique challenge – responding to Amphan as well as the COVID-19 pandemic. Amphan left 14 million people without power, and another 2.5 million were evacuated. When the cyclone hit, India had more active COVID-19 cases than any other Asian country. India also reported its largest spike in new COVID cases the Friday before Amphan landed. And the whole country had gone into complete lockdown two months before, shutting down all nonessential services, domestic and international travel, and heavily restricting transit within cities.
These restrictions left one population far more vulnerable than the rest – informal workers, or workers who lack formal job contracts, job security, and are often from rural areas. Largely made up of agricultural, service, and migrant workers, who travelled hundreds of miles from their home states to ﬁnd work in a city like Kolkata, the sudden lockdown left most informal workers unemployed. Living paycheck to paycheck, mig-rant workers have had no way to reach their “Amphan maybe home states where they landed for only might still ﬁnd security forty-ﬁve minutes to from the COVID-19 an hour here. But its pandemic, leaving many devastation was wide homeless and at a higher and deadly.” risk of exposure to – GAUTAM PRASAD BARUA, COVID-19. KOLKATA RESIDENT
As the effort to combat the pandemic ramped up, Amphan began to approach West Bengal and Orissa, and the government switched gears to evacuate agrarian and migrant populations, who live in low-lying farms, partially concrete homes in the city, or simply on the streets. Yet, one crisis doesn’t simply pause for the rest – in order to keep the villagers safe from the long-term issue of COVID infection, evacuation teams tried to maintain social distancing norms as they evacuated door to door, slowing down 68
their response rate. Limited evacuation efforts “It is for the ﬁrst time that we are having to face two disasters simultaneously. We are facing a dual challenge of cyclone in the time of coronavirus,” said the head of India’s National Disaster Response Force.
“It is for the ﬁrst time that we are having to face two disasters simultaneously. We are facing a dual challenge of cyclone in the time of coronavirus.” – INDIA’S NATIONAL DISASTER RESPONSE FORCE
Authorities in West Bengal reported that some rural residents had to be forcefully evacuated from their homes, with many of them citing fears of contracting COVID-19 in the storm shelters. Unfortunately, those fears were justiﬁed. Many of West Bengal and Orissa’s storm shelters were being used to quarantine migrant workers returning from their areas of work to their hometowns. A multi-purpose cyclone shelter in Panchayat, one of West Bengal’s worst-hit cyclone areas, is just one example of a previous cyclone shelter turned quarantine center. As Amphan approached, evacuees had to be crammed into the Panchayat shelter along with the quarantined migrant workers, and social distancing norms were ignored. In the state of Orissa, there was a similar situation – with 250 of the 800 existing shelters used up to house the quarantined. Instead of housing the evacuees with potential COVID-19 carriers, villagers were crammed into the remaining empty storm shelters. Ofﬁcials told Reuters that they feared the crowded shelters could be breeding grounds for the virus, but there was no other option. Most evacuated villagers in both Bengal and Orissa returned home after the storm, untested, and perhaps bringing COVID-19 back with them. After the storm Bapi Ghosh, a doorman for a residential building in Kolkata, says he hasn’t seen his family, who lives on their family farm in the West Bengal village of Murshad, since the start of the COVID-19 lockdown.
As a migrant worker, Ghosh says he is sustaining his family by sending his wages to them. Fortunately, he still has a job, as the apartment building has not completely shut down. “We were very lucky that at least some walls in our family house are still upright. In Murshad, a lot of homes have been damaged and farming is the only way of living [the villagers] have, which is gone too” he continues. Many farmers hoped to sell more produce after the government loosened COVID-19 related restrictions, but Amphan has left them devastated to an even greater degree than Ghosh’s family. Around 1.5 million sharecroppers in West Bengal lost their entire produce for the season. With no money to rebuild what they have lost, the only other option after such a natural disaster is to become migrant worker and ﬁnd a job in the city – which isn’t feasible anymore due to the nationwide shutdown. Where do they go from here? The economic impact of these two disasters compounded has left informal workers reeling – they remain at high risk of poverty with many of their jobs in the cities lost due to COVID-19, and their family’s houses and farms destroyed in their villages due to Amphan. And the evacuated populations, again mostly agrarian, were at a higher risk for COVID-19 exposure during Amphan. Ghosh says he applied for government aid under both the COVID-19 and Amphan crises, but hasn’t heard back for either. It’s been over a month since Amphan struck. He continues to remain the only breadwinner for his family. It seems the overlap of the two disasters made it impossible for the government to adequately address either.
“We were very lucky that at least some walls in our family house are still upright. In Murshad, a lot of homes have been damaged and farming is the only way of living [the villagers] have, which is gone too.” – BAPI GHOSH, DOORMAN FOR RESIDENTIAL BUILDING IN KOLKATA
Edited by Harnoor Mann Artwork and Design by Kavya Parekh
“We have three farm dwellings, and then a month ago my family called and said the main one had been completely destroyed by Amphan. The crops are very sickly after the cyclone, and we probably will not get any money from farming this season.” 69
Seattle’s Most Susceptible: Unique Challenges for the Homeless Population
BY VY TRINH
n March, when coronavirus swept through the United States, each state began to implement a “stay-at-home” order. But what about the unhoused population? Homelessness is not foreign to the US. In 2019, a White House executive summary reported that 0.2% of the US population (17 in 100,000 people) experience homelessness every night. The CDC states, “People who are homeless are a particularly vulnerable group” due to congregate living spaces and possibly other underlying medical conditions. The “stay-at-home” order is a massive challenge for the homeless, especially since shelters have slowed their intake to meet social distancing requirements. Shelters and housing are at capacity, resulting in crowded facilities with increased viral transmission. Homeless shelters have turned into “outbreak hotspots” in Washington DC, Nashville, and San Francisco.
The state of Washington has been working to ﬁx the homelessness crisis since 2015, but has its efforts to protect the vulnerable population during this pandemic been active enough? Yes and no.
Sheltering facilities are only short-term solutions. Emergency homeless shelters often operate on a nightly basis, and temporary housing may accommodate homeless individuals for as little as two weeks. When business shut down, public bathrooms are also closed, making sanitary and hygiene products more inaccessible to the homeless population. Beyond these immediate concerns, life during the pandemic is mentally and emotionally challenging.
As our country explores different ways to address homelessness, we can turn to Seattle / King County, Washington, one of the ﬁrst three communities in the United States that declared homelessness as a state of emergency in 2015. Seattle is also one of the 5 top cities (along with Los Angeles, San Jose, Oakland, and San Francisco) with the highest homelessness rates in the United States. The state of Washington has been working to ﬁx the homelessness crisis since 2015, but has its efforts to protect the vulnerable population during this pandemic been active enough? Yes and no. Washington has been adamant about its “housing ﬁrst” philosophy when responding to the homelessness crisis. Housing First is an approach to quickly place homeless individuals or families into permanent housing. The model is low-barrier, meaning that applicants do not need to meet any state-mandated requirements. Washington’s low-barrier model supports the state’s belief that housing should be a human right. It abandons the linear model in which homeless people have to meet certain criteria to become “ready” and “awarded” housing. Although Seattle City allocated $80 million to support its homeless population, it is important to examine whether the budget is used toward the homeless. The Human Service Department’s (HSD) mission is to invest in community-based programs and “support the city’s most vulnerable.” A part of HSD is the City of Seattle’s Navigational Team, an outreach program, their primary service is to refer homeless individuals to shelters within the city. However,the referral program’s efﬁcacy is unimpressive. According to HSD’s performance report, out of the total 664 referrals made, only 28% of the individuals enrolled into sheltering facilities. The Navigational team is also responsible for removing multiple campsites in March and May, despite CDC’s explicit advisory against the removal of encampments as “clearing encampments can cause people to disperse throughout the community.” As several campsites were allegedly removed for public safety, who exactly is the city trying to protect?
Moving people from campsites to other housing options, Tiny Home is an initiative that Seattle has piloted since 2018 to shelter those experiencing homelessness. Tiny homes are temporary housing and are much safer than tents , and provide access to electricity, heat, and light. Tiny homes are often grouped together to form Tiny Villages, with communal kitchens, bathrooms and access to counseling and social services. The Low Income Housing Initiative (LIHI) also suggests that this initiative is a cost-effective and efﬁcient method to bridge individuals, couples, and even families from temporary to permanent housing. This year, Seattle built 40 tiny homes in February, and due to the pandemic expanded to another 50 homes. This is an example of an effective and sustainable response to the city’s homelessness crisis. Comparing Seattle’s pandemic response to another metropolitan hub: Los Angeles, yields interesting insights. LA’s priority was to get the homeless population into shelter spaces by mobilizing them into motels and hotels while Seattle was reluctant to do so. In April, King County only moved 400 (compared to LA’s 4200) sheltered and unsheltered homeless people into hotels and motels. Seattle wanted to ensure that they move unhoused people into shelters with accessible social services. In March, when the Coronavirus Aid, Relief, and Economic Security (CARES) Act passed in congress, Seattle city received $14.1 million to support and expand its emergency services for the homeless population. The city used the money to expand shelter operations for daytime housing, provide social services and to pay for rent and utility to reduce evictions. Despite these advantages, the CARES Act potentially poses a barrier for health clinics and services like the International Community Health Services (ICHS) to provide care to the homeless population in the long-term. ICHS reports that the CARES package funding is only short-term and would only support health centers until November 30, 2020.
Health centers that provide health services for the underserved communities rely heavily on federal funding and operate on skim margins. The stimulus package also prevents health centers from billing at its standard Medicare rates. With high operating expenses and foreseeably lower reimbursement rates, lack of long-term federal funding means health clinics must be wary of their ﬁnancial future. These health clinics are not alone when they grow weary of the future. As society begins to reimagine the “new normal,” the challenges that the homeless population face continues to exacerbate. To protect the vulnerable population, it is important to advocate for and discuss the issues they are facing and will continue to face, especially within healthcare. Although the United States has quickly adapted technology like Zoom+Care and adjusted insurance policies to accommodate for virtual healthcare, the telehealth model is not entirely accessible for homeless patients. Some barriers to telehealth are smart-technology ownership and reliable internet. A USC study suggests that although homeless adults do not lack the devices, older adults with underlying health conditions may limit their ability to use and understand new technology. It may also be challenging for unsheltered homeless individuals to access a private space to call their healthcare provider. Due to COVID, most states have allowed a teleconsultation to replace the in-person evaluation in psychiatry. However, some states continue to require an in-person evaluation to prescribe certain medications (like opioids). Mental health and psychiatry are essential, especially for homeless populations. This barrier in telehealth needs to be removed so that medical services become accessible to those in need.
As the city explores various temporary housing and healthcare options during the pandemic, their long term goal remains constant: to move as much of the homeless population into permanent housing as possible.
We must make speciďŹ c changes looking into the future of healthcare for the homeless. For example, we can expand street medicine if teleconsultations are not readily accessible to homeless individuals. Street medicine involves social workers and healthcare providers going to campsites or wherever homeless patients are to provide care. Although this will not replace the primary care visit, it provides temporary care and encourages the patient to seek continued care. HSD currently receives ample funding from the city of Seattle to institute street medicine. Additionally, its Navigation Team could consider extending its partnership to the cityâ&#x20AC;&#x2122;s social workers to build trust and its relationship with the homeless communities. Seattle needs to make housing and healthcare affordable for the homeless. As the city explores various temporary housing and healthcare options during the pandemic, their long term goal remains constant: to move as much of the homeless population into permanent housing as possible. The city needs to continue to work with landlords, subsidize utility bills, and invest into affordable housing projects like Tiny Homes. Ensuring available, accessible, affordable housing is the primary solution to prevent homelessness. Furthermore, the city needs to share the cost burden with health clinics to ensure that healthcare services are accessible to the homeless. Seattle could also use its ample funding to pilot street medical teams to provide care at campsites. The pandemic is forcing many to live in uncertainty. However, itâ&#x20AC;&#x2122;s certain that Seattle needs to be much more assertive in protecting its susceptible homeless population.
Edited by Julia Bulova, Akila Muthukumar Artwork and Design by Annie Liu
THE POLICY MIGHT BE GONE — BUT THE FEAR ISN’T: INTERNATIONAL STUDENT’S REFLECTIONS ON ICE’S RESPONSE TO COVID-19 BY CHARLIE CROMWELL-PINDER, NEHA DAMARAJU, AND COURTNEY LASSERE On July 6, 2020, the Immigration and Customs Enforcement Agency (ICE) issued a policy that aﬀected international students’ ability to reside within the U.S. and continue their education at American universities and vocational schools. Under certain circumstances, this policy puts students in jeopardy of being unable to continue enrollment at their institution or deportation from the United States. On July 14 — just eight days later — this policy was rescinded during a hearing of the lawsuit brought against ICE and the Department of Homeland Security (DHS) by Harvard University and the Massachusetts Institute of Technology. While students are currently safe from the aforementioned threats, the fear and anxiety provoked by the policy still linger. The ever-worsening COVID-19 pandemic has exacerbated international students’ worries as the federal government threatens changes to visa programs under the guise of health, safety, and national security. Many say these same anxieties existed long before the coronavirus outbreak, as ICE gained strength and expanded its reach under the current administration. We asked 15 international students about how ICE’s newest policies would have aﬀected them and how the initiation of these policies made them feel. We invite you to read these students’ stories. Edited by Joshua Keller and Tyler Schutt Artwork by Riya Damaraju Design by Kavya Parekh
Read Tina, Melissa, Sara, Helen, Ahlaam, Amy, Stuti, Saksham, Ellie, Charlie, Yousuf, Weiying, Aren, & two anonymous students’ stories at healthrighters.com
COVER AND TABLE OF CONTENTS BY PAYTON KIM AND ANNIE LIU