Public Health and COVID-19

Background

Preparation and planning at the federal, state, and local level are essential for protecting populations through all types of public health emergencies. This can include natural disasters, outbreaks of infectious diseases, and other catastrophic events. The effects of a public health emergency can be felt across all aspects of an individual’s life. It can affect health, financial resilience, and the ability to live well and safely in their communities.

The COVID-19 pandemic is one such public health crisis of unprecedented proportions and complexity not seen in over a century. Much remains unknown about the highly contagious and dangerous virus which has caused hundreds of thousands of deaths in the U.S. and over 1.5 million worldwide. As the COVID-19 pandemic has progressed, it has proved to be both a health crisis and a profound disruptor of social and economic life. The pandemic has highlighted the failures to protect the safety and well-being of people in long-term care facilities, the need for access to adequate and affordable health care, and the challenges facing workers and consumers.

Health impacts on older adults: The impact of COVID-19 on older people has been devastating. Research has shown that adults age 60 and older, especially those with preexisting medical conditions, are more likely to have severe — even deadly — infections than other age groups. According to the Centers for Disease Control and Prevention, eight out of ten COVID-related deaths have been among those age 65 and older.

Long-term care facilities: COVID-19-related mortality is even higher among those living in the nation’s long-term care (LTC) facilities. Data show that 2.1 million Americans, or 0.62 percent of the U.S. population, reside in nursing homes and assisted living facilities. Yet, those residents have accounted for nearly 40 percent of all U.S. deaths due to COVID-19.[1]

LTC facilities do not always take responsible steps to ensure the health, safety, and quality of life of residents. They need to be held accountable for failure to do so (see also LTSS - Emergency Preparedness). It is essential to minimize disease transmission through the use of personal protective equipment, physical distancing requirements, and regular testing of residents, staff, and visitors. Families need greater transparency about COVID-19 cases within the facility and about treatment and discharge decisions. Care facilities must be held accountable when residents are harmed, neglected, or abused.

Social isolation and loneliness are significant problems that contribute to worse health outcomes under normal circumstances, especially for older adults (see also Social Isolation). During periods of required physical distancing and stay-at-home orders brought on by COVID-19, social isolation became a problem or worsened among many older adults. This has been particularly problematic in LTC facilities, many of which closed their doors to all visitors starting in the early spring of 2020. Many experts believe that social isolation in locked-down nursing facilities has been extensive and contributed to worsening dementia, overall decline, and even death. This has made planning how and when to reopen to visitors particularly difficult as facilities balance different types of risk. LTC facilities need to combat social isolation. Social interaction is critical to quality of life and health. At the same time, they must maintain the safety of the facility during a crisis. This can be done by facilitating and supporting virtual visitation between residents and their loved ones.

Outreach efforts to break isolation for older adults living in the community are also important. But perhaps they are most critical in nursing homes, which have become, in many cases, completely closed systems. Some LTC facilities such as nursing homes and assisted living facilities are attempting to combine best practices for infection control with vigorous support of virtual visitation options like video visits and telehealthThe use of electronic telecommunications technologies to deliver health care, health information, or health education at a distance. A related term, Telemedicine, generally indicates physician services. options (see also Quality and Consumer Issues Across All Licensed Residential Care Settings, and Telehealth). This, of course, requires staff who know how to use and clean tablets and other tools, and who are trained in how to facilitate engagement between residents and would-be visitors. In the community, older adults who are isolating or physical distancing can also use virtual visits. But that requires that they have the knowledge, ability, tools, and infrastructure, which is not always the case.

Health system impacts: The collateral impacts of COVID-19 on the U.S. health system as a whole have been enormous. Providers have had to focus on treating those with the virus. And individuals are forgoing medical care to avoid risk of exposure to the virus. The resulting decrease in utilization as well as the supply of health services has caused worsening health outcomes for those with chronic or other more minor conditions. This means an overall weakening of the health system, lack of trust in the quality of services available, and increases in all causes of mortality, not just limited to COVID-19.

Digital access to health care via telehealthThe use of electronic telecommunications technologies to deliver health care, health information, or health education at a distance. A related term, Telemedicine, generally indicates physician services. has become increasingly important as people try to minimize their exposure to possible infection by avoiding in-person visitation (see also Telehealth). High-speed internet access enables connection to telehealthThe use of electronic telecommunications technologies to deliver health care, health information, or health education at a distance. A related term, Telemedicine, generally indicates physician services. medicine. It allows people to interact with their health care team safely from home, improving accessibility and potentially quality of care as well. It can also enable individuals to remain safely in the community (see also High-Speed Internet Services). As access to telehealthThe use of electronic telecommunications technologies to deliver health care, health information, or health education at a distance. A related term, Telemedicine, generally indicates physician services. is expanded, it is important to collect data on its use, cost, and quality. However, some people do not have the internet access necessary to engage in telehealthThe use of electronic telecommunications technologies to deliver health care, health information, or health education at a distance. A related term, Telemedicine, generally indicates physician services.. Internet services may not be available or affordable. In addition, some people do not have the necessary technology (e.g., a tablet, smartphone, or computer) or sufficient ability and comfort in using the technology. Even if they have the necessary technology, they may require assistance to use it.

The weakening of the overall health system also has impacts on the access to and distribution of vaccines to treat and prevent COVID-19 (see also Vaccines). The system faces many challenges in ensuring that the COVID-19 vaccinations that have been authorized are distributed quickly and equitably. The federal government is responsible for overseeing vaccine allocation to the states and assisting in the distribution. States are responsible for funding and organizing the distribution of vaccine doses to providers and creating public service messaging about the vaccine and how to obtain it. All parts of the process have faced challenges, which slowed initial access to the vaccines.

COVID-19 has also caused critical shortages of medical supplies and care (see also Crisis Standards of Care). Under circumstances like these, doctors and hospitals are forced to decide who receives potentially lifesaving treatment and who does not. The pandemic revealed the critical role and responsibility policymakers have in planning and implementing strategies to avoid shortages in supplies and care when there are severe outbreaks of highly contagious diseases such as the COVID-19.

The pandemic has also shone new light on underlying disparities facing low-income individuals and communities, especially those of color. Black, Latino, and Native American people have been more likely than others to experience severe illness and death from COVID. The disproportionate impact on these historically disadvantaged groups is not a coincidence. It is a result of systematic inequality resulting in reduced social and economic opportunities, including access to health care (including treatments and other preventative measures), suitable living conditions, and employment opportunities. These groups also have greater historical mistrust of government interventions due to negative experiences. Thus, they may be wary of newly developed vaccines or treatments. The pandemic has emphasized the need for immediate and meaningful action to address our nation’s health disparities and to ensure equitable access to both COVID-19 treatments and health care more broadly.

Economic impacts of COVID-19: Beyond the profound loss of human life, the virus is causing immense social and economic disruption. This disruption continues to significantly impact the U.S. economy. It also threatens to destabilize the world’s interdependent economy in ways never seen before. The full impact of the crisis on the economy and how long it will last remains unclear. Public health measures required to slow the spread of COVID-19 (social distancing, stay-at-home orders, etc.) have contributed to widespread unemployment. Job losses have hit older workers particularly hard. Unemployment in the U.S. has risen to levels not seen since the Great Depression. And the security of retirement savings has been threatened by the volatility in the stock market (see also Savings and Retirement Security). Currently, only one-third of people out of a job receive unemployment insurance. Benefit calculation formulas leave many people with only a small fraction of their previous earnings. Households with low incomes and low wealth have been especially hard-hit by the pandemic.

In addition, essential workers who are unable to work from home face heightened risk for contracting COVID-19. Displaced workers are attempting to access the unemployment insurance system as well as training and job counseling programs to tide them over during periods of unemployment. Paid sick leave, family leave, and flexible work arrangements have become more important than ever (see also Job-Protected Leave). With the economic downturn, food insecurity has increased, especially among Black and Hispanic/Latino older adults (see also Food and Nutrition Assistance Programs). Widespread job loss is likely one of the largest reasons for this increase. Strengthening the nutrition safety net is critical to meet the rising need.

The pandemic has also called attention to worker safety (see also Protections for Workers). As many as 20 million adults age 55 and older have jobs that require them to leave home. This puts them at risk of exposure to the virus. There are currently no solid guidelines or requirements for employers to provide access to personal protective equipment, implement sanitation strategies to prevent disease spread, facilitate physical distancing, or accommodate remote work where possible.

Impacts on individual rights and protections: Along with impacts on health and the larger economy, COVID-19 has also severely impacted the everyday rights and protections that older adults benefit from daily.

Civic rights and voting: The primaries and general election held in 2019 and 2020 demonstrated that many voters would like options for voting that are not in person and will take advantage of such options when they are provided (see also Voting). Absentee and mail-in voting for that election cycle accounted for just over half of all votes cast in the 37 states and the District of Columbia for which data are available. That is double the number of votes cast that way from each of the previous two election cycles.[2] Voting access and safety issues during the COVID-19 pandemic were especially important for older adults, particularly those from historically disadvantaged groups who were disproportionately affected by the virus. About 46 percent of voters used alternative methods that did not require them to appear in person to cast their ballots for the 2020 general election. Many cited the COVID-19 pandemic as the cause.[3] These elections highlighted the vital importance of supporting the ability of all Americans to exercise their right to vote, including during public health crises, natural disasters, and other emergencies.

Assistance during emergencies: COVID-19 has also once again demonstrated the importance of disaster planning at every government level. It is particularly important that the needs of older adults, people with disabilities, and caregivers are addressed in the disaster planning process (see also Disaster Planning and Recovery). Older adults and others who have trouble navigating systems are often left behind in emergencies. Clear directions to the public about where to access services and assistance are critical during such times.

The safety and reliability of public transportation systems during public health crises such as the COVID-19 pandemic have become an issue of great concern (see also Community Transportation). Many essential workers, those who cannot work from home, or others who have no other means of transport continue to rely on public transportation to get to work. They need to feel safe doing so. Travel more broadly has also become dangerous given COVID-19. The need to ensure the safety of various forms of travel has been heightened. For many older adults, travel is important as a way to encounter new experiences, visit with friends and family, and obtain necessary medical care (see also Travel Protections). Additionally, many people have had to cancel travel plans due to the pandemic, increasing the need for consumer protections regarding refunds or vouchers for missed or canceled plans.

Given the rise in unemployment, many people in the U.S. are experiencing severe financial distress and have lost or are at risk of losing their housing. Housing stability during major emergencies or crises, such as pandemics or other public health emergencies, natural disasters, and severe economic downturns, has come to the fore (see also Housing Finance System Reform). Many people, especially older adults, find themselves in need of financial assistance, assistance with countering evictions and foreclosures, and ways to negotiate a reasonable repayment period for mortgage or rent arrearages (see also Home Mortgage Lending). Many people are also at risk for severe damage to their credit due to an inability to pay bills. Many are seeking ways to restrict or suspend negative credit reporting during major crises for all borrowers when credit may be weakened through no fault of the consumer (see also Consumer Credit). Many are also in need of easy access to credit reporting so that they can monitor changes in their credit rating and take action as needed.

 

[1] https://freopp.org/the-covid-19-nursing-home-crisis-by-the-numbers-3a47433c3f70

[2] https://www.pewresearch.org/fact-tank/2020/10/13/mail-in-voting-became-much-more-common-in-2020-primaries-as-covid-19-spread/

[3] https://www.pewresearch.org/politics/2020/11/20/the-voting-experience-in-2020/