Facilities

This virtual presentation hosted by the Jefferson College of Public Health and the Vermont Association of Hospitals and Health Systems addresses data, experiences, challenges, and recommendations related to crisis management in long-term care facilities during the pandemic. There is also an accompanying white paper by Morse et al. addressing these issues. Long-term care facilities, including skilled nursing facilities, continue to be particularly important in the context of COVID-19 due to the overall health status and vulnerabilities of their typical populations, and they have been the source of disproportionate mortality from the infection.

Systems

This Health Affairs blog by Ali & Mangione looks at data systems used to measure and assess health and health care and assesses challenges exposed by COVID-19. Specifically, the authors identify three critical frailties in the systems: 1) the impact of various disparities (social, demographic, economic) that create inequalities in access to and use of health care services; 2) false dichotomies between infectious and non-infectious diseases that fragment the delivery and measurement of care (e.g., the interrelationship between COVID-19 and noncommunicable diseases like diabetes and hypertension); and 3) fragmentation in defining and collecting health data that confuses clinicians and patients and consistently underrepresents the most vulnerable groups that lack insurance and access to preventive services. These challenges and others are built into the existing health care system, but the pandemic has exposed key weaknesses in the interaction between supply, demand, and public health.

This article by Louis-Jean et al. adds even more evidence and analysis to the literature on the disparate impact of the pandemic on minority groups in the U.S., particularly African American communities. These disparities are the result of existing systemic inequities in access to health care, health care quality, and available resources and information, among other challenges. The result has been an extreme disparity in the population effects of COVID-19, including a mortality rate among African Americans that is nearly four times the national average. Exacerbating these challenges, numerous historical abuses of African Americans in government-sponsored medical research contributes to substantial distrust of the health care system in these communities that necessitates sensitivity, research, and outreach efforts.