POLICY BRIEFING – WEEK IN REVIEW
Navajo Nation continues to disproportionately suffer from covid-19
New Mexico's social distancing and comprehensive testing measures appear to be flattening the curve. The state is "no longer projected to face shortages of hospital beds or ventilators at the peak of the virus outbreak." In contrast, the Navajo Nation, which spans Arizona and New Mexico, ranks third in the United States for covid-19 infection rates. Navajo Nation President Jonathan Nez declared a state of emergency regarding covid-19 on March 11th. New Mexico Governor Michelle Lujan Grisham similarly sounded the alarm in early March regarding concerns for the Navajo Nation where multigenerational households can increase spread. Hot spots in the nation's McKinley, San Juan, and Sandoval counties have emerged. Meanwhile, Bernalillo County, New Mexico's most populous county, is the only county with an infection rate comparable to those rural counties of the Navajo Nation. Meanwhile, relief from the CARES Act has been delayed. Jonathan Nez, president of the Navajo Nation told CNN that "sometimes the first citizens of this country are at the bottom of the list when it comes to federal aid. That's what we have been trying to say for the past several weeks." Mr. Nez also highlighted negotiations to share PPE between the Navajo Nation and New York state, filling the gap left by the federal government. Various. 27 April 2020.
New York City, other cities release updated race data for covid-19 fatality and hospitalization rates
On April 6th, the NYC Department of Health (NYC DOH) released data showing that death rates of African Americans and Hispanic persons with covid-19 were twice their non-Hispanic white counterparts (NHWC). The data were age-adjusted, and based on lab-confirmed cases. As of April 22nd, which included probable deaths as well, these numbers held. Additionally, the data show that African Americans were twice as likely to be hospitalized, compared to their NHWC. As reported previously in Brief19, disproportionate covid-19 hospitalization and fatality rates of African Americans highlight ongoing health and economic disparities. For example, the Bronx borough's population is 43.6 percent African American, and contains the poorest congressional district in the U.S. It also has the highest rate of positive covid-19 cases in NYC. In Richmond, VA, all eight people who have died from covid-19 are African American (the city's African American population is 48 percent). Cases may be undercounted among Black people, as early covid-19 testing criteria appear to have been biased in ways that decreased the number of tests performed for Black people. Various. 27 April 2020.
Remdesivir poised to obtain emergency use authorization despite mixed data
On April 29 President Trump and Dr. Anthony Fauci both celebrated preliminary data from an NIH trial suggesting that remdesivir can shorten recovery time for some covid-19 patients, even as The Lancet published a trial that found no statistically significant clinical benefit for patients with severe covid-19 receiving the drug. Now the FDA is likely to issue an Emergency Use Authorization for remdesivir, an administration official told the New York Times. An EUA is a temporary approval the FDA can grant a drug or device that has not otherwise met the criteria for FDA approval, including rigorous, peer-reviewed clinical trials. Just a few weeks ago the FDA issued an EUA for hydroxychloroquine, another drug President Trump has touted as a game-changer, as a covid-19 therapeutic. There are now allegations that the FDA was responding to political pressure, prompting a Congressional investigation. New York Times. 30 April 2020.
States stockpile hydroxychloroquine (HCQ) despite FDA recommendations
State and local governments have acquired ~30 millions doses of HCQ, despite concerns about dangerous side effects and an FDA warning that doctors should not prescribe it to coronavirus patients outside of hospitals or research settings. Some states and cities have received donations of the drug from pharmaceutical companies or received shipments of it from FEMA. Others have purchased the drug with taxpayer dollars. HCQ has FDA approval for use in treating malaria, lupus, and rheumatoid arthritis, but is known to have serious side effects including abnormal heart rhythms that can result in death. While there have been anecdotal reports and preliminary findings in clinical trials that the drug may be effective against SARS-CoV-2 infection, robust clinical evidence is still lacking. AP. 29 April 2020.
Advanced service payments coming to a halt
In late March, as hospitals, clinics and doctors' offices saw their revenue plummet as a result of the coronavirus pandemic, the Centers for Medicare and Medicaid Services (CMS) expanded its Accelerated Payment Program and Advance Payment Program, programs that allow healthcare entities to apply for payment in advance of anticipated services rendered. On Sunday CMS announced that, after paying out $100 billion through these programs since March 28, it was re-evaluating the amounts that would be paid under the Accelerated Payment Program and would not be accepting any new applications under the Advance Payment Program. CMS said it was making these changes in light of funding for healthcare providers in the subsequent federal stimulus packages. The Centers for Medicare and Medicaid Services. 29 April 2020.
Administration embraces telehealth
To support the expansion of telehealth on a national scale, the Federal Communications Commission (FCC) has released the details of its $200 million incentive program, created as part of the CARES Act. This package provides funding for the purchase of telehealth-related services and devices. A new online application details the steps, requirements and restrictions to apply. Money will be distributed on a rolling basis until the funds are exhausted or the pandemic has ended. Separately, the Department of Health and Human Services (HHS) has launched a telehealth website for patients and providers. The patient portal provides education about the basics of telehealth and different ways to connect, while the provider side focuses on changes to billing, policy, and legal considerations associated with telehealth use. Various. 28 April 2020.