Biden White House Establishes National Covid-19 Response Priorities

In an effort to better coordinate efforts to respond to a pandemic that has now resulted in more than 400,000 deaths, President Biden, within 24 hours of taking office, set out a broad set of COVID-19 response priorities, signed several Covid-19-related executive orders and released a National Covid-19 Response Strategy.

The Executive Orders include:

• EO 13985, establishing that the policy of the Federal Government will be to “pursue a comprehensive approach to advancing equity for all, including people of color and others who have been historically underserved, marginalized, and adversely affected by persistent poverty and inequality.”
• EO 13987, establishing the positions of Coordinator of the COVID-19 Response and Counselor to the President as a direct report to the President, as well as Deputy Coordinator, whose responsibilities will include, among other broad duties, coordinating government-wide efforts “to reduce disparities in the response, care, and treatment of COVID-19, including racial and ethnic disparities,” increasing production of PPEs, vaccines, and tests.
• EO 13991, requiring that “on-duty or on-site Federal employees, on-site Federal contractors, and other individuals in Federal buildings and on Federal lands should all wear masks, maintain physical distance, and adhere to other public health measures, as provided in CDC guidelines,” and directing that the Department of Health and Human Services engage with state, local, and Tribal and territorial officials as well as other entities “regarding mask-wearing and other public health measures, with the goal of maximizing public compliance with, and addressing any obstacles to, mask-wearing and other public health best practices identified by CDC.”
• An Executive Order requiring mask wearing in compliance with CDC guidelines in or on: airports, commercial aircraft, trains, ferries, and intercity bus services, among other forms of public transportation that facilitate domestic travel.  Travelers coming to the U.S. from a foreign country will be required to show proof of a recent negative COVID-19 test before entry and will be required to comply with self-quarantine and/or self-isolation policies that will soon be developed by the department of Health and Human Services.

The National Pandemic Strategy sets out the following 7 broad goals:

1. Restore trust with the American people.
2. Mount a safe, effective, comprehensive vaccination campaign.
3. Mitigate spread through expanding masking, testing, treatment, data, workforce, and clear public health standards.
4. Immediately expand emergency relief and exercise the Defense Production Act.
5. Safely reopen schools, businesses, and travel, while protecting workers.
6. Protect those most at risk and advance equity, including across racial, ethnic and rural/urban lines. Importantly, this likely will include asking states to update their pandemic plans to more explicitly address equity. According to the report (pp. 97-98), “The Centers for Disease Control and Prevention (CDC) will work with states and localities to update their pandemic plans to describe how they have or will provide equitable access to COVID-19 resources within highly vulnerable communities, including Tribal communities,
   using CDC’s Social Vulnerability Index or other indices as appropriate. HHS will provide additional tools to inform equitable pandemic planning, such as mapping pharmacy deserts across the country, and provide technical assistance as needed.”
7. Restore U.S. leadership globally and build better preparedness for future threats.

Traveler’s Quarantine Upheld by Federal Court of Appeals

Last week, a three-judge panel of the U.S. 1st Circuit Court of Appeals upheld Maine’s decision to require that visitors to the state self-quarantine for 14 days upon arrival in the state as a measure to protect against a Covid-19 surge and hospital overwhelm that might be caused by an influx of millions of out-of-state tourists.  Importantly (for public health lawyers), the Court found it was appropriate to apply strict scrutiny in reviewing the state’s action, a move away from the deferential review standards set out by the 1905 Jacobson v. Massachusetts case. While this higher standard was applied, the court did find that the state’s interests as stated above were compelling and that, at the time the restrictions were put in place, “there were no other effective less-restrictive alternative[]” means of serving Maine’s interests.

Indoor Church Service Limits Upheld by Federal Court of Appeals

For the past month in Southern California, many ICU units have been at near-full capacity. While California has deemed clergy and access to faith-based streaming services “essential,” the state continues to enforce a complex web of limits on congregate indoor activities, including indoor church service attendance. In a ruling late last week, a three-judge panel of the Ninth Circuit Court of Appeals denied an attempt by a Southern California church to overturn these restrictions. The court acknowledged that the church had suffered irreparable harm due to these restrictions; however, the court also found that the regulations as implemented were applied neutrally, not singling out churches for restrictions, and were done in support of the state’s vital interest in protecting the health and safety of its residents.

This decision is notable as it appears to diverge from, if not contradict, a late 2020 ruling by the U.S. Supreme Court striking down rules affecting indoor services at New York churches. That Supreme Court decision has led many religious organizations and 19 state Attorneys General to push for the Supreme Court to make a definitive decision concerning whether there are limits to the state’s ability to regulate church attendance under the state’s public health authority.

Meanwhile, the Bay Area church that was involved in the May 2020 Supreme Court decision upholding California church attendance restrictions is racking up penalties for its continued violation of state Covid-19 restrictions.

Pandemic Fatigue

A research letter in JAMA analyzing responses to a series of national surveys from April-November shows that while the percentage of Americans reporting regularly wearing masks more than doubled to over 80%, lower shares of people report being willing to adhere to other nonpharmaceutical Covid-19 interventions, such as limiting social gatherings, staying home except for essential activities, and avoiding indoor dining.

While the mask wearing news is positive, another study generated from a larger set of these surveys found that while 83% of respondents agreed that mask wearing was protective, there were significant racial and geographic differences in mask wearing. According to the reesarchers,

Two-thirds of Americans reported being in close contact (less than 6 feet) with people outside their household in early December, but only about half (51%) of them said they mostly or always wore a mask while doing so.

• White people were the least likely to consistently (“always” or “most of the time”) wear a mask (46%) while in close contact with people from other households, compared to Blacks (67%), Latinos (63%), and people of other races (65%).
• Only 42% of people in rural areas wore a mask always or most of the time while close to people outside their household, compared to 52% of people in suburban locales and 57% of people in urban locales.

Food Insecurity

The Federal government wants Americans to buy groceries online, but most people receiving SNAP (aka Food Stamp) benefits can not, states a critical investigation in USA Today on policies affecting the 50 million food insecure in the U.S.

Studies have shown the most frequent last stop before contracting Covid-19 is the supermarket. Yet in 47 states, SNAP beneficiaries have no choice but to shop in person for their groceries.  This denies equitable protection against COVID-19 exposure to a population that is disproportionately made up of people of color, who also have higher exposures due to their work and living conditions. According to the piece,  

USDA’s online grocery pilot for SNAP recipients is available only through Amazon, Walmart, Aldi and a few other retailers sprinkled across the country. That does not include smaller community stores, farmers markets or discounters where cents on the dollar usually go further.

Furthermore, with such limited budgets stretched across food, rent, water, power, etc., most of those that do have access to the program cannot afford the online grocery services’ delivery-related costs.