Monday, April 13, 2020




The Price of Protecting Rhinos

Conservation has become a war, and park rangers and poachers are the soldiers.

Martin Saavedra

Story by Cathleen O'Grady THE ATLANTIC JANUARY 13, 2020 SCIENCE

“Hsst!” hisses Charles Myeni. “Leave space!” Silently, the men in his anti-poaching unit spread out as they move through the bush in single file, leaving a few feet between them.

Myeni explains his command to me: If a rhinoceros poacher attacks us and we're all neatly squished together in a line, he whispers, they “can take us all out, one-one-one-one. We're all gonna die.”

Is he serious? His sardonic half smile is difficult to read. He may just be trying to scare me, the city-dwelling white girl tagging along on his morning patrol through South Africa’s Somkhanda Game Reserve. But I still stick as closely as I can to him and his automatic rifle.

The three guns between the six men on patrol should be enough to overpower any poachers, Myeni tells me, since a poaching team usually carries just one rifle. The last would-be rhino poachers apprehended on the reserve, in March of last year, were traveling in a pair: One carried a gun, and one carried an ax to hack off the rhino's horn.


Myeni’s patrol moves swiftly, scouring the ground for tracks. The terrain is treacherous: The tawny, knee-high grass disguises ditches, rocks, and tree roots, while vicious thorn trees throw out branches at face height. The dry air on this bright winter morning is hot in the sun and freezing in the shade. Myeni spots rhino tracks and follows them for a while to check that they are not joined by human footprints, which would be a sign that someone had followed the rhino. But the tracks are old, and no rhino—or human—materializes.

South Africa’s most recent rhino-poaching crisis came out of the blue. In 2007, the country lost just 13 rhinos to poaching; the next year, that number jumped to 83, kicking off a nightmarish escalation. Losses peaked at 1,215 in 2014, and deaths are still high: 2018, with 769 rhinos killed, was the first year that losses had dipped under 1,000 since 2013. South Africa is home to 93 percent of Africa’s estimated 20,000 white rhinos and 39 percent of the remaining 5,000 critically endangered black rhinos, making South Africa’s rhino crisis a global rhino crisis.

Demand for rhino horn has skyrocketed in Vietnam, where powdered horn is touted as both a hangover cure and a cancer treatment. Though it has no proven medicinal benefits—of no more value than human fingernails and hair, or horse hooves, which are made from the same material—it is associated with social status. As regional economies have boomed, its use has increased along with ordinary people’s purchasing power.


Read: The rich men who drink rhino horns

As the crisis continues, the job of protecting rhinos has changed dramatically. The South African military has stationed soldiers in the Kruger National Park. Surveillance technology like drones and light aircraft are used to spot signs of trouble. Rangers are trained by ex-military specialists. In 2012, the government body that oversees South Africa’s national parks appointed Johan Jooste, a retired army general, to oversee anti-poaching efforts.

As threats to species and natural resources escalate worldwide, conservation is looking more and more like war. National militaries play a role in conservation in the Congo, Cameroon, Guatemala, Nepal, and Indonesia. British troops have been sent to Malawi to provide ranger training. The U.S.-based nonprofit Veterans Empowered to Protect African Wildlife (VETPAW) sends veterans to “lead the war” against wildlife crime in Africa.

The conservation war is a human war—with human casualties. Myeni’s wife and children live with the knowledge that he is in constant danger, he says. Respect Mathebula, the first ranger in Kruger National Park to be killed by poachers in more than 50 years, was shot in July 2018. The International Ranger Federation reports that 269 rangers were killed across Africa between 2012 and 2018, the majority of them by poachers.


Meanwhile, Joaquim Chissano, the former president of Mozambique, alleges that 476 Mozambican poachers were killed by South African rangers between 2010 and 2015. South African authorities are cagey about releasing official figures, but research on organized crime estimates that between 150 and 200 poachers were killed in the Kruger National Park alone during the same period. In neighboring Botswana, anti-poaching action has reportedly resulted in dozens of deaths, and the country’s controversial “shoot to kill” policy—which gives rangers powers to shoot poachers dead on sight—has drawn allegations of abuse.

Species are swiftly being wiped out by the illegal wildlife trade, and the urgency of the situation provokes a panicked, violent response among those fighting to keep these species alive. But many conservationists are concerned about what the militarization of conservation means—for people, and for the success of conservation itself.

On a cool, cloudy morning, I set out to meet Thulani Mageba, a ranger at Hluhluwe-iMfolozi Park near South Africa’s east coast. (Mageba requested to go by a pseudonym for fear of retaliation by his employers.) The park is about the size of the city of Dallas, but humans are scarce; as I crawl my way through the park, where speeds are limited to 25 mph, I spot a hyena standing hunchbacked a few feet from the roadside, watching me warily.

The ranger outpost is quiet and feels slightly abandoned, but the two-way radio crackles with reports from rangers throughout the reserve. Mageba’s eyes flick nervously toward the radio each time a message comes through. KwaZulu-Natal, the province that is home to Hluhluwe-iMfolozi, has the densest population of rhinos in South Africa, and the park has been hit hard by poaching.

Mageba didn’t sign up to be a soldier. When he started out as a ranger, a decade before the poaching crisis escalated in South Africa, he had no idea what the job entailed. “I liked to see people wearing the uniform in town during shopping days,” he tells me shyly. He fell in love with rhinos on the job.

His story isn’t unusual, says Dave Cooper, a wildlife vet based at Hluhluwe-iMfolozi: “Those same guys that were employed as game rangers, living in the bush, looking after animals, are suddenly employed as special forces.”

“Law enforcement has always been part of a ranger’s job description,” says Chris Galliers, chairman of the Game Rangers Association of Africa. But the balance of responsibilities has changed, he says: Where conservation work once occupied the bulk of rangers’ time, it is now likely overshadowed by enforcement work.


The rangers who face danger on a daily basis often do so in terrible working conditions. “I have seen rangers cry when talking about the difficulties of their job,” says the conservation researcher Francis Massé. He describes rangers in Mozambican parks living in dilapidated camps with no electricity or running water, being paid slightly above minimum wage, and sometimes living out in the bush for months at a time.
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The situation in South Africa’s relatively well-funded parks is generally better, says Massé, but even there, conditions are far from acceptable. Rangers in Hluhluwe-iMfolozi report low pay, appalling housing, unpaid overtime, inadequate vacation time, and high stress. They describe working for 20 hours at a stretch, falling asleep on patrols, and waking up in the middle of the night to respond to gunshots.

Rangers are also separated from their families for long periods, and staff shortages make them reluctant to take time off even when it is permitted. “We don’t want to leave the reserve,” one ranger told a researcher investigating ranger welfare. “What happens if a rhino dies in your absence?”

Mageba tells me that he hasn’t seen his wife in four months. His family, he says, sometimes feels like he cares more about his work than he cares about them. “But they don’t understand the situation,” he says. “Losing a rhino is very painful.”

For rangers and other conservationists, says Galliers, the reserves themselves can become places of horror. Apart from the personal danger they face, they witness nearly constant violence toward the animals they love. Almost half of a rhino’s face can be bludgeoned off by a blunt ax, says Cooper. Calves or even full-grown rhinos may be killed by panga or ax if an initial gunshot fails to kill them.


And time off at home doesn’t always provide respite. In certain communities, rangers are “seen as the bad guy; they’re seen as murderers, for doing their job,” says Massé. Poachers bring wealth into their communities, he explains, and the rangers’ neighbors are often baffled by or angry at their interference with a much-needed source of income.

“If you think of the military operations in Afghanistan and Iraq,” says Andrew Campbell, CEO of the Game Rangers Association of Africa, “there’s a tour of duty and then there’s a period of being removed from that high intensity.” For rangers, though, there is no such reprieve: “You don’t get pulled out of that context. You just keep going.”

“We worry about 10, 15, 20 years from now,” says Campbell. “We want to keep rangers in the profession that are well supported, well looked after, and that have a sustainable career as rangers”—not, he says, people that burn out, succumbing to mental and physical exhaustion after two or three years.

The difficult conditions take a toll not only on the rangers but also on the quality of their work: Their concentration lapses at crucial moments. Resources and time for more mundane conservation duties are scarce. And the poor pay and constant danger make it tempting to play double agent for the poachers.

By the time I leave Mageba, the clouds have descended into a blanket of brownish gray. I see vultures circling and involuntarily picture the carcass they might have spotted. A helicopter hovers over a different section of the park. Could that be a rhino kill? My time with Mageba has left me twitchy. Suddenly, a police car rounds the bend ahead and tears toward me, a ranger vehicle following close behind. Mageba’s radio must have finally delivered the inevitable bad news.


In hluhluwe-imfolozi, the ever-present tension is mostly hidden from visitors. There are hints of the ongoing crisis—a quick search of the car upon entry; a sign forbidding the use of drones; a poster asking for donations to save the rhinos—but even here, rhino poaching mostly feels like something that is happening elsewhere.

The rhinos themselves are elusive. After seven days, I’ve seen countless elephants, zebras, baboons, and giraffes, and gawped at a cluster of orphaned rhinos kept in pens, but I’ve spotted not a single wild rhino. One afternoon, a series of booming, meaty grunts comes drifting into my room at the very edge of Hilltop Camp, along with a strong smell of cow dung. There’s clearly a gigantic herbivore a few feet away, but it is completely concealed by a dense screen of bushes and trees. Elephant? Or rhino? I spend ages peering into the bush, but I can’t see so much as a monkey.

The camp is surrounded by electric fences, making it safe for tourists to leave their cars and enjoy the picnic areas, swimming pool, and spectacular view from the restaurant terrace. At night, the Milky Way stretches across the sky; a small cluster of lights twinkles in the distance, a reminder that the towns dotting the borders of the park are not that far away.

Ordinary people have been kept out of iMfolozi, the southern section of the park, for roughly 200 years. The legendary Zulu king Shaka, who rose to power in 1819, drove out the inhabitants who lived between the two iMfolozi rivers and restricted hunting. In 1824, British settlers initiated ivory trade in the area, and their game hunting drove such a decline in the white-rhino population that five new reserves—including Hluhluwe and iMfolozi—were designated in 1895 by colonial authorities.


These days, the park is open only to the select few who find employment as conservation or tourism staff, and to the tourists who can afford to pay for the experience. My modest room at Hilltop Camp costs $595 for six nights, more than the monthly take-home pay of 93 percent of South Africans.

Conservation has a long history of removing people from their land in the interest of preserving wildlife. It’s a model that sees human occupation as incompatible with conservation, despite evidence that indigenous people can play a crucial role in protecting biodiversity. For many conservationists, tourism in otherwise human-free preserves is both a useful way to fund conservation and an industry to be protected in its own right. “Africa holds the last caches of this wildlife,” says Jooste, the retired general who oversees anti-poaching for South Africa’s national parks. Tourism helps protect wildlife for its own sake, he adds, and “it’s one of the economic engines of our country.”

In South Africa, the conflicts surrounding conservation divide along racial lines. Poachers are often assumed to be black, though this assumption is not always accurate, and news of their violent end is often celebrated by white South Africans. save a rhino, kill a poacher, reads a bumper sticker I used to see growing up in Johannesburg. the testicles of a rhino poacher can cure aids, says another, mocking both traditional medicine and South Africa’s HIV crisis while delivering its implicit threat.

Read: South Africa confronts a legacy of apartheid

There’s a widespread assumption among both black and white South Africans that conservation is a concern of white people. Meanwhile, black people witness a lucrative tourism industry operating on their ancestral lands, and the majority cannot afford to access it. Hostility and poverty combine to create the perfect storm for poacher recruitment. “[Poachers] know what the risk is, and they’re still willing to take it,” Massé says. “There’s a social and economic context that motivates them to do that.”

The poaching crisis is “an urgent situation,” he says, “but the militarization of conservation is having a lot of concerning impacts, both socially and ecologically.” Those impacts are both chronic and acute: In Eswatini, rangers allegedly killed suspected subsistence poachers hunting for meat. Anti-poaching forces in Tanzania have allegedly raped and tortured local villagers and suspected poachers. Anti-poaching units in Africa and Asia supported by the World Wildlife Fund (WWF) have allegedly committed abuses ranging from assault to murder.Martin Saavedra

Not only are these incidents unconscionable in their own right, but they also intensify local opposition to conservation. Treating local people as enemies poses a risk to the sustainability of conservation, Massé says: “It creates tensions and hostilities, and alienates them.”

Concerns about militarization are not limited to researchers like Massé—conservationists working the field are worried, too. Employees of South Africa’s national parks have written about the long-term human and conservation costs of military tactics. The Game Rangers Association of Africa has expressed concern about foreign soldiers, military veterans, and private security experts jetting in to train rangers without any understanding of the ecological or social context.

“The big question is the sustainability of these operations,” says Galliers. “How long can this last? How long can you keep purchasing and flying a helicopter that costs $1,000 an hour?” Military intervention can only be a short-term strategy; in the long term, what’s needed is support from the communities in and around reserves. Otherwise, Massé says, “conservation’s never going to be successful.”

Somkhanda game reserve is only about a 60-mile drive north of Hluhluwe-iMfolozi, but it’s a different world. The small towns surrounding Hluhluwe seem like bustling cities compared to the scattered traditional homesteads around Somkhanda. None of these households have electricity, and most have no running water. Many people have little reason to speak much English, and after a couple of days I begin to curse my pathetic elementary-school isiZulu.

This tiny reserve is trying to do things differently. It’s neither a huge state-owned park like Hluhluwe-iMfolozi nor a private game ranch. It’s a relatively young reserve, stitched together from the cattle and game farms that were restored to their original owners, the Gumbi clan, through South Africa’s post-apartheid land-restitution process. The Gumbi community-owned reserve, run in partnership with the nonprofit Wildlands Conservation Trust, employs around 100 people, offers training and internships, and runs education programs for local children, trying to cultivate a love for the bush.

When I arrive at Somkhanda, the young ranger guarding the gate shoots me a few stern questions. He hasn’t been told to expect me, and seems on high alert. While I wait for him to phone park headquarters to confirm whether he should allow me in, I eye a large sign outside the reserve gate. somkhanda game reserve, it reads. protected by ipss anti-poaching unit. IPSS, a private security company, offers a range of services around the province, including anti-poaching units and residential armed response. Although they help supply Somkhanda’s anti-poaching unit, the rangers themselves are hired from the reserve’s neighboring communities.

Within a few minutes of entering the park, I've seen giraffes, zebras, warthogs, and even a small herd of African buffalo. As I pass them, one wet-nosed bull watches me balefully, a calf sheltering behind him. On this smaller, cozier reserve, I hope my rhino-spotting luck will improve. But the rhinos tantalize me, continually lurking just out of sight. The rhino tracks Myeni spots on patrol with his anti-poaching unit lead to nothing. During an early-morning drive with the wildlife-monitoring team, we hop out of the truck, breath misting as we squint into the bright sunrise, and follow more rhino tracks—nothing.

Sihle Mathe, a tracker who can read the movements of animals in bent grass and what appears to me as entirely normal-looking dirt, suggests that I join him while he tries to track one of the reserve’s notoriously aggressive black rhinos. He chuckles at my trepidation. If she charges me, I ask, what should I do? Climb a tree, he says nonchalantly, but only if she’s more than 50 meters away. And if she’s closer? “Don’t try that. You’ll die.”

My eagerness to see the rhino begins to override my sense of self-preservation, but when I mention the plan to the reserve manager, Meiring Prinsloo, he shuts it down immediately. No rhino tracking for me—from the vantage point of a tree or otherwise.

Still, the reserve staff is scheduled to dehorn a rhino while I’m here, which surely means a sighting. But the day of the dehorning dawns wild and windy, and, to my dismay, the plan is called off—there’s no chance of darting a rhino successfully if wind is pulling the tranquilizer dart off course.

The young black rhino scheduled for dehorning will go through many throughout her life, all intended to protect her from her own dangerously precious cargo. Since rhino horn is made of keratin, like fingernails and hair, horns grow back quickly. To protect a rhino from the poaching that could target even the tiniest stump, dehorning should ideally happen every year or two.

Dehorning is far from an ideal solution: It’s expensive, anesthetizing rhinos can harm them, and it’s not properly understood what long-term effects dehorning could have on a rhino population. Bigger parks, like Hluhluwe-iMfolozi and the Kruger National Park, have held off on the pricey and difficult venture of dehorning their huge rhino populations, although Kruger has recently started dehorning some of its female rhinos.

There’s limited evidence on how much protection dehorning can offer, so it is just one of Somkhanda’s range of anti-poaching measures. The supportive community is another line of defense: Local people, invested in the reserve and its benefits, are less inclined to harbor poachers, and a strong network of informants tips off the reserve if a syndicate is operating in the area. Informers told reserve staff about the poachers they apprehended last year.


Somkhanda hasn’t lost a rhino since May 2018. It’s not clear whether the reserve’s anti-poaching success stems from the regular dehornings, the supportive community, or some other factor—like the fact that it’s easier to keep tabs on a 30,000-acre reserve than one the size of a major city. But they aren’t relying on these advantages to keep their rhinos safe: Like any other reserve, Somkhanda has an armed anti-poaching unit, surveillance, and aerial patrols.

Prinsloo’s 6-year-old daughter often tags along with him on reserve business. A few days later, on the day of the hastily rearranged dehorning, her tiny silver ballet flats jostle alongside the butt of Prinsloo’s rifle in the passenger footwell of his truck. We join the small crowd that has descended on the reserve for the event: two wildlife vets, a helicopter pilot, a WWF representative, a gaggle of trainee vets from Canada, and a team of assorted staff, volunteers, and spectators.

The weather is mercifully calm, but there are more hitches to come—the rhino in question can’t be found. While the trackers keep looking, the crowd lounges in the sun at the reserve’s main camp. The Canadian trainee vets pass around a bottle of sunscreen and solicit restaurant recommendations for their upcoming trip to Cape Town. Two wilderness guides start a spirited discussion on the best South African snacks, while one braids the other’s hair in an elaborate updo.


Finally, after hours of waiting, the call comes: The trackers have temporarily given up on the rhino they were supposed to find—but they have her younger sister in sight, and the vet is primed with his dart gun in the helicopter, ready to pump her full of opioids and tranquilizers. The decision is quickly made to dehorn this young rhino instead of her elusive big sister.

The sleepy mood disappears abruptly. The crowd of staff and spectators sprints for the trucks, and I leap onto the back of a vehicle that is already moving. After a short, wild ride, we spot the helicopter hovering ahead. On foot, we hurtle through the bush to find the rhino already unconscious, the large dart sticking out of her rump.

She seems strangely fragile. She is 8 feet and 3 inches from nose to tail, and the vets put her at around 1,500 pounds—but she is still a juvenile, and she’s incapacitated, surrounded by a swarm of 20 people. Her skin is hot and leathery, but butter-soft near her mouth. She heaves six great sighs per minute. When her blindfold shifts, I see that her eyes are slightly open, and flickering. It feels like she is watching us, helplessly, while we attack her in a way she cannot possibly understand.

Read: The last male northern white rhino is dead

Dehorned rhinos never recover their characteristic silhouette: Regrown horns are lumpy and misshapen, too thick at the top. This juvenile’s horns are still perfect. In seconds, they are gone. As the vet uses the chainsaw, and then an angle grinder to shave down the remaining stump, a stream of white, fingernail-like shavings flies at me.


While the vet is working, someone shoves the horns into my hands, asking me to pass them along to another staff member. They are smooth and surprisingly small, the weight of dense wood. In this crowd, they have no value; they will be unceremoniously thrown into a backpack. Soon, Prinsloo tells me, they will leave Somkhanda and be taken to be stored indefinitely in an off-site vault. Somewhere along the way, they will become valuable enough to kill for, and die for.

The would-be rhino poachers apprehended at Somkhanda in March were not from the area—one was from Mozambique, and the other was South African but not local, according to Prinsloo. But locals do hunt illegally on the reserve. On my patrol with Myeni and his anti-poaching unit, one of the rangers notices a snare, probably intended to catch bushmeat.

One afternoon, the unit calls in a gruesome discovery: a field of critically endangered white-backed vulture corpses, poisoned by feeding on a baited impala carcass. Fifteen vultures are already dead when we arrive, and although the vets frantically try to save the four survivors, two more die within hours. The goal was probably to harvest their heads for use in local traditional medicine, says the senior ranger Nkosinathi Mbhele. Support from locals is strong, but it’s not absolute.

One afternoon, Mbhele takes me to visit some of the families in the surrounding villages. We spend hours in the truck driving from place to place, and Mbhele fills the time by patiently explaining the intricacies of Zulu land ownership, leadership, and family responsibility. He delves into each subject with depth and clarity, illustrating his points by acting out little sketches in which he plays all the roles.

Our first visit is to Voyi Gumbi. Born in 1956, Gumbi has lived here all his life, and witnessed the return of the land to the community and the creation of the reserve. His homestead—a cluster of traditional huts—is bustling with chickens, goats, and grandchildren.

As Mbhele translates, Gumbi tells me that he is ambivalent about the reserve’s benefits. The rhinos, he says, were there long before he was born, and preserving them is an important part of preserving his cultural heritage. His son Vincent, employed by the reserve as a field ranger, is living his dream. But the reserve’s efforts focus mostly on jobs and education for young people, Gumbi says, and communication from the reserve to the people is not good. He has never been inside; he would love to take a game-watching tour.

Additionally, the reserve has hurt the local cattle. Cows are so beloved and so central a part of Zulu culture that the word Nguni refers to the primary cattle breed raised by Zulus, the group of languages to which isiZulu belongs, and the group of peoples that includes Zulus. Research from Somkhanda reports that some people know their dozens of individual cattle by name. These precious cows—each worth more than a year’s income for the vast majority of South Africans—have been killed by diseases transmitted by buffalo grazing along the reserve’s fence line, and the owners have not been compensated, Gumbi says.

Phowa Dlamini, our second stop, is less ambivalent than Gumbi. She sits comfortably on the ground at her homestead, surrounded by babies of all kinds—her grandchildren, kittens, a cluster of baby goats. She doesn’t see the benefits of the reserve, she says. But Dlamini’s daughter Sanele interjects, pointing out that four people from the homestead have worked at the reserve, including Dlamini’s field ranger son Pumlani.

When Mbhele and I arrive back at the reserve gate, I gasp in recognition. Pumlani, the ranger who had greeted me so sternly when I arrived, bounds up to the car beaming, his deep-set eyes and straight eyebrows almost identical to his sister Sanele’s. Mbhele chuckles at my reaction and calls over one of the other rangers milling about near the gate—Vincent Gumbi, who is the spitting image of his father, Voyi.

Pumlani, Vincent, and their families are among the fortunate few. Though the reserve offers jobs, training, and infrastructure, there are thousands of people surrounding the reserve and only a handful find jobs there. And there is discontent with how the community trust that owns the land distributes the benefits among people.

More than a decade into the rhino-poaching crisis, South Africa is still figuring out how to achieve justice for rhinos and people at the same time. Reserves that serve their local communities may be part of the puzzle, but they’re not a panacea—and they don’t necessarily result in total demilitarization.

A couple of days before I leave Somkhanda, I drop in on the reserve’s annual community soccer tournament. It’s held on Youth Day, a national holiday commemorating the anti-apartheid student protests of 1976, in which hundreds of people were killed by police. The sunny field is pumping with loud music and excited spectators. Two teenagers photobomb my selfies; a section ranger, glowing from his soccer game, tells me how happy he is with his job.

By the time the tournament winds down and I catch a ride with Mbhele back to camp, darkness and chill have settled in. We huddle in the cab of the safari truck and bounce over the rough gravel road. Nothing is visible in the gloom beyond the headlights.

As Mbhele talks about his time working at a gold mine near Johannesburg, I realize that the music playing on the radio is oddly appropriate: It’s a famous anti-apartheid struggle song about migrant laborers in the mines, brought from across southern Africa by train to work “16 hours or more a day / for almost no pay / deep, deep, deep down in the belly of the earth.”

The train-like rhythm of the song grows more urgent as the singer’s spoken lyrics begin to reach a fever pitch. “They think about the loved ones they may never see again,” he says. “They think about their lands and their herds / that were taken away from them / with the gun and the bomb and the tear gas.”

Just as the singer screams in imitation of a train horn—WHAA WHAA—and the drums build to a crescendo, a gigantic animal crashes across the path ahead of us and pauses for a moment. My brain takes a second to resolve the shape of its hindquarters in the headlights. Elephant? No, rhino. The first wild, conscious rhino I have ever seen. The living battleground on which countless lives are being lost and destroyed. In an instant, the rhino is gone.


Cathleen O’Grady is a South African science writer based in Scotland. Her writing has appeared in Hakai, Undark, FiveThirtyEight, and Ars Technica.
The coronavirus pandemic is going to trigger a second healthcare crisis

Dan Greenleaf, Opinion Contributor Apr 4, 2020
 
Healthcare professionals take a break awaiting patients as they test for COVID-19 at the ProHEALTH testing site in Jericho, New York, March 24. Steve Pfost/Newsday RM via Getty Images


The American healthcare system is straining under the weight of the coronavirus crisis. 

Hospitals have had to postpone or stop providing medical attention for all but COVID-19 patients. 

But the chronically ill still need treatment. A second healthcare crisis could be on the horizon. 


Dan Greenleaf is the president and CEO of LogistiCare, a medical transportation company.
This is an opinion column. The thoughts expressed are those of the author.


As hospitals are inundated with COVID-19 cases, countless other patients are being asked to stay away. If we're not careful, we will have a second health crisis to face as our most chronically ill populations are unable to access the care they need to manage their conditions.

Multiple states are now restricting hospitals to emergency care. Some are shrinking everyday procedures by as much as 50%. But while limitations on elective surgeries get the most attention, the impact on truly vulnerable patients is largely playing out away from the limelight.

This is a call to public health officials and municipal leaders who are in the hot seat of tough decisions in the face of a crisis: We need to keep a lane clear for chronically ill patients.

They include 34 million diabetics and hundreds of thousands of people with chronic kidney disease, who are being asked to postpone visits. Both are uniquely susceptible to infection. Yet, hospitals can handle only their most pressing, emergency needs.

Then come the canceling of joint surgeries for chronic pain. The delays in treatment for lower-risk cancer, cardiac bypass, and congestive heart failure patients. Even organ donor programs are being put on hold, with recent transplant patients foregoing follow up appointments. One Colorado man had his liver transplant surgery aborted after it was deemed elective. Without it, he's thought to have less than two months to live.

Add in the millions of people losing or seeing limited treatment for things like mental health and opioid addiction. Those most reliant on the healthcare system, who need preventative care most, are being pushed to the sidelines.

And this is at a moment when our economy is also taking a turn for the worse and unemployment is rising.

Federal, state, and local health officials are doing the best they can. But I fear that they may be applying unilateral decisions to attack COVID-19 within a healthcare and economic ecosystem that is complex and multivariate.

It may work for the short-term, as physicians postpone only non-urgent matters. And with a medical system preparing to be overwhelmed, few would argue against an all-hands-on-deck, single-minded approach to assembling ourselves to combat COVID-19 effectively.

But we need to look up for a minute at the larger picture or we will pay a big price down the line. Beyond the economic pain inflicted upon frontline primary care practices, there is also the spectre that four to six months out we will face a second healthcare crisis: The build-up and eventual explosion from all those people now going untreated, whose care can only be delayed so long, some of whom are bound to become emergencies or fatalities of their own.

 


Nurses process a COVID-19 sample at an appointment-only, drive-up clinic in Seattle, Washington, March 17. Karen Ducey/Getty Images
The making of a second crisis

To the healthy, the relatively prosperous, and the socially connected, being barred from the doctor may seem a minor inconvenience. Not so for the perennially sick and isolated.

For them, the term "non-emergency" is a bit of a misnomer. Many might be better described as "chronic emergencies." There's a reason they were receiving continuous treatment in the first place.

Begin with the mentally ill, who struggle during the best of times. Even before the coronavirus hit, most states had nowhere near the beds to handle their needs. Now, with clinics closing and hospitals practicing triage, a good percentage will be left to their own devices — just as a global pandemic and economic pullback delivers spikes of anxiety and paranoia.

Meanwhile, the opioid addicted, who must receive their methadone and suboxone treatment in person, are facing lines as long as five hours. It's only a matter of time before many decide the streets offer a more convenient cure.

Add to this an already short supply of dialysis centers, the elderly who avoid crowded waiting rooms and medical workers without proper protective gear, and the restricting of care for the disabled. Mix it with a shortage of coronavirus tests, forcing these same people to self-diagnose, and so begins a bubble that has no choice but to eventually burst.
How will I get there?

Even if they can get appointments, the most vulnerable will soon find no way of getting there.



To stem COVID-19's spread, hospitals have begun to confine medical transport services and ridesharing operations from delivering patients to their doors. In a sign of things to come, Colorado's Summit County, for example, has suspended ridesharing altogether.

The idea is that relatives and neighbors — who've had less contact with others en masse — will pick up the slack. It sounds prudent in theory. But it's a notion built from a gross misread of those who need care most.

These are people whose conditions often leave them entirely isolated. For the mentally ill or severely addicted, they may be ostracized from any friend at all. Then come patients like the 80-year-old with emphysema, whose social orbit extends little beyond bed, couch, and bathroom.

If crisis strikes, many will be reliant on ambulances. Yet EMS operators I know privately admit they're already at capacity. And that's about to get worse as insurers begin to mandate that coronavirus victims be transported only by emergency vehicle.

The bill for an ambulance ride can mean financial ruin to someone living paycheck-to-paycheck, or who just got laid off. Which means many may choose to avoid getting the care they need, because they simply can't get there.




Telemedicine is no savior

To hear politicians talk, telemedicine will provide the cure. But in reality it's an emerging concept, not a finished product.

Two years ago, a study by Avizia found that four out of five consumers were unaware of telehealth at all, much less using it. That's likely because most US hospitals and private practices are unequipped to handle it. Expecting them to now offer service in a matter of weeks — when all manpower and resources are being hurled elsewhere — is a pipe dream at best.

Telemedicine is simply not a solution for our most vulnerable populations. 40% of the country still uses landlines. In large swaths of rural America, internet service remains at the level of 1990s dial-up, with incessant crashing during peak times.

Worse, telemedicine poses special obstacles for the elderly, the blind, the disabled and others, many of whom rely on a library for internet, or only own flip phones.

All of which leads to a coming crush of vulnerable patients who've missed multiple appointments, and can wait no longer.

The key will be finding creative and strategic ways to extend care to vulnerable patients as the coronavirus ascends to its peak. While formulating crisis policy, public health officials need to be especially mindful about leaving some frictionless pathways open for sick and marginalized patients to connect to care.

If we don't, we'll have inadvertently created a second crisis. And we may find ourselves looking back on the onslaught of today as a calmer, quainter time.





Trump 'IGNORED' National Security Council's coronavirus warning and calls for social distancing in January, called health secretary Alex Azar 'alarmist' and 'WAS told about Navarro's memo' 

The National Security Council office responsible for tracking pandemics received intelligence reports in early January about coronavirus 


The report predicted the devastation the virus would cause to the US once it hit 

Within weeks of receiving the report, NSC officials raised options Trump that would prevent the spread of the virus, including shutting down cities 


Donald Trump ignored the warnings, and instead waited until March to implement such measures, the report reveals 


This comes as the death rate from coronavirus in the Untied States rises to 20,087 fatalities - overtaking Italy's death toll after 2,000 Americans died in one day


By KAYLA BRANTLEY FOR DAILYMAIL.COM 11 April 2020

President Trump ignored advice by the National Security Council back in January to consider shutting down cities and keep Americans home from work, memos reveals.

The NSC office responsible for tracking pandemics received intelligence reports in early January predicting the devastation coronavirus could cause to the US once it hit, according to The New York Times.

Within weeks of receiving the report, NSC officials raised options Trump that would prevent the spread of the virus, including shutting down entire cities the size of Chicago. But Donald Trump ignored the warnings, and instead waited until March to implement such measures, the report reveals.

This comes as the death rate from coronavirus in the Untied States rises to 20,087 fatalities - overtaking Italy's death toll after 2,000 Americans died in one day - as the president celebrates Easter while social distancing in Washington, DC.

Donald Trump ignored the warnings from the NSC, and instead waited until March to implement such measures, the report reveal






President Trump tweeted his outrage at the New York Times' findings Saturday afternoon

This is just one of a dozen reports that reveal the US had ample warning ahead of the devastation the coronavirus could cause, but ignored intelligence reports.


President Trump tweeted his outrage at the New York Times' findings Saturday afternoon, 'When the Failing @nytimes or Amazon @washingtonpost writes a story saying “unnamed sources said”, or any such phrase where a person’s name is not used, don’t believe them. Most of these unnamed sources don’t exist. They are made up to defame & disparage. They have no “source”, the president wrote.

'Does anyone ever notice how few quotes from an actual person are given nowadays by the Lamestream Media. Very seldom. The unnamed or anonymous sources are almost always FAKE NEWS,' he continued.

Just this week it was revealed Donald Trump's trade adviser Peter Navarro issued his first grim warning in a memo dated January 29 - just days after the first COVID-19 cases were reported in the US.

At the time, Trump was publicly downplaying the risk that the novel coronavirus posed to Americans - though weeks later he would assert that no one could have predicted the devastation seen today.

Navarro penned a second memo about a month later on February 23, in which he warned that as many as two million Americans could die from the virus as it tightened its grip on the nation.

The January memo marks the earliest known high-alert to circulate within the West Wing as officials planned their first substantive steps to confront the disease that had already spiraled out of control in China.

It serves as evidence that top officials in the administration had considered the possibility of the outbreak turning into something far more serious than Trump was acknowledging publicly at the time.

'The lack of immune protection or an existing cure or vaccine would leave Americans defenseless in the case of a full-blown coronavirus outbreak on U.S. soil,' Navarro wrote.

'This lack of protection elevates the risk of the coronavirus evolving into a full-blown pandemic, imperiling the lives of millions of Americans.'

Another report shows that Trump dismissed Health Secretary Alex Azar's initial warnings about the deadly coronavirus as 'alarmist' back in January.

Trump's administration continues to be heavily criticized for its delayed reaction to COVID-19 by failing to mobilize upon early warnings, form a chain of command, and organize efficient nation-wide testing - as the US suffers heavy casualties from the virus with over 9,600 deaths.

But the president had time to respond as he was first notified about the coronavirus outbreak in China on January 3.

Azar called Trump on January 18 while the president was at his Mar-a-Lago resort in Florida to brief him about the severity of the novel coronavirus.

During that call the president reportedly cut him off before Azar could explain and instead criticized the health secretary over his handling of the axed federal vaping ban.

At that time the president was reportedly more concerned about his then-ongoing impeachment trial.







Trade adviser Peter Navarro warned top Trump officials in late January and again in February that failing to contain coronavirus could cost the US trillions of dollars and millions of American lives. Trump is seen with Navarro (center) at a March 9 press briefing on coronavirus

Trump voters 'are less likely to practice social distancing' in pandemic, claims analysis of phone data 'scoreboard' that grades states by how effectively they are locked down

A new analysis of nationwide cell phone location data suggests that counties which voted for President Donald Trump in higher proportions are less likely to practice social distancing measures to limit the spread of the coronavirus pandemic.

The analysis, by Princeton sociologist Patrick Sharkey for Vox, also found that attitudes toward climate change are 'one of the strongest and most robust predictors of social distancing behavior.'

In parts of the country, a recalcitrant minority of people continue to openly blow off stay-at-home orders, defiantly congregating for recreational events in the midst of the pandemic that has infected more than 500,000 Americans and killed at least 18,798.

In New Mexico, at least 31 off-road enthusiasts gathered last weekend by the 'Welcome to Las Cruces' sign for a photo, which was posted online with the dismissive remark 'If you got it, you got it,' according to the Las Cruces Sun News.

A 'scorecard' from Unacast shows state and county-level data on how much people have reduced their outdoor movement during the coronavirus pandemic

In New Mexico, at least 31 off-road enthusiasts gathered last weekend by the 'Welcome to Las Cruces' sign for this photo, which drew fury after it was posted to Facebook



Unacast data shows county-level ratings for social distancing in Florida (TOP) and the results of the 2016 presidential elections (BOTTOM)

The Facebook post presenting the photographs read: 'Social Distancing Mtherfkers! And if you don't like (it) ur staying hm ok bye!' with emojis simulating hands raising their middle fingers.

New Mexico has been under a statewide stay-at-home order since March 23, currently scheduled to last until the end of April.

According to Sharkey's analysis of location data, 'politics and civic engagement bear a strong relationship to social distancing behavior.'

Sharkey's analysis relies on aggregate location data complied by Unacast, an advertising company that has recently emerged as one of the top sources of information about how much people continue to move about in the pandemic.

Unacast gives each county in the U.S. a letter score of A through F based on how much people have reduced their movement and non-essential travel during the pandemic, with 'F' representing the least change in outdoor movement.

Sharkey used a statistical analysis of the letter grades from Unacast to compare them with other

'Counties with larger populations, with more educated residents, and with higher percentages of white and Hispanic residents tend to receive higher grades on social distancing, while the age structure, the median income, and the unemployment rate are no longer associated with social distancing behavior,' Sharkey writes.

He continues: 'grades fall with the percentage of the county voters who cast a ballot for Trump in 2016.'




The average score of the counties is broken into three cohorts in a variety of categories


A Unacast chart shows the changed in non-essential visits since the pandemic began, with daily new cases in the US shown in grey bars



Unacast data shows county-level ratings for social distancing in California



Unacast data shows county-level ratings for social distancing in New York



Unacast data shows county-level ratings for social distancing in Texas


'Lastly, even after adjusting for all of these other characteristics, counties within the same state where a greater share of residents do not agree that global warming is happening are substantially less likely to change their behavior in response to Covid-19,' Sharkey writes.


Sharkey says his analysis shows that attitudes toward climate change are 'one of the strongest and most robust predictors of social distancing behavior.'


'In the places where residents don't think global warming is real, where they don't believe humans are responsible, where they don't think citizens have a responsibility to act, residents are also failing to change their behavior during the coronavirus crisis,' he writes.


As the crisis continues, cell phone location data is coming to the forefront as a key tool in the battle -- raising privacy concerns and exposing just how much data is being collected on Americans by private advertising and technology companies.


On Friday, Apple and Google announced a joint effort to help public health agencies worldwide use smartphone data to contain the COVID-19 pandemic.


New software the companies plan to add to phones would make it easier to use Bluetooth wireless technology to track down people who may have been infected by coronavirus carriers.



Signs displaying directions for maintaining social distancing due to COVID-19 concerns are posted on a New York supermarket as customers wait outside on Friday

he idea is to help national, state and local governments roll out apps for so-called 'contact tracing' that will run on iPhones and Android phones alike.

The technology works by harnessing short-range Bluetooth signals. Using the Apple-Google technology, contact-tracing apps would gather a record of other phones with which they came into close proximity.

Such data can be used to alert others who might have been infected by known carriers of the novel coronavirus, typically when the phones' owners have installed the apps and agreed to share data with public-health authorities.

Developers have already created such apps in countries including Singapore and China to try to contain the pandemic.

In Europe, the Czech Republic says it will release an app after Easter. Britain, Germany and Italy are also developing their own tracing tools.

No such apps have yet been announced in the United States, but Governor Gavin Newsom of California said Friday that state officials have been in touch with the companies as they look ahead at how to reopen and lift stay-at-home orders.


Surgeon general under fire for telling African Americans not to smoke, drink or take drugs and 'highly offensive' use of 'big momma' as coronavirus pandemic hits black community hardest

Surgeon General Jerome Adams has been met with outrage by the black community for using phrases like 'abuela', 'big momma' and 'poppop', while pleading for minorities to not drink or smoke and follow the government's guidelines to slow the spread of the coronavirus .
'We need you to do this if not for yourself than for your abuela. Do it for your granddaddy, do it for your big momma, do it for your poppop,' the nation's top doctor said Friday at the daily coronavirus taskforce briefing - while also advising those groups to 'avoid alcohol, tobacco and drugs.'

Adams told Americans of color that they need to 'step up' to stop the spread of coronavirus, and said 'social ills' are likely a contributing factor when looking at the dire statistics that the outbreak has killed twice as many black and Latino people than white Americans.

Now members of the black community are calling out the Surgeon General for 'pandering' to them with his use of slang and also for his 'offensive' instruction that those specific communities to stop drinking and smoking during this pandemic.



Surgeon General Jerome Adams asked members of communities of color in the United States to follow the White House guidelines, imploring them to 'do it for your granddaddy, do it for your big momma, do it for your poppop'


The surgeon general talked about some of the dire statistics that show black and Latino Americans are dying twice as much of coronavirus complications than their white peers

TV host and actress Claudia Jordan took to Twitter to express her outrage at Adams' comments.

'The surgeon general telling black folks not to drink and smoke and do it for ya "paa paa and big momma". Where they get this guy from? How dumb do they think we are with this? How bout suggesting that EVERYONE cut back? Let's not do that ok?' Jordan said.

One man on Twitter, David DeLoatch, said: 'Let me tell a lot of you something, we don't talk the way movies, songs, and the media portrays us. The Surgeon General is trying to relate to a life he never lived, listen to his voice and they way he speaks. He has never called anyone "big momma," and neither have I.'

Other questioned why Adams' word choice, writing: 'As if people wouldn't understand him if he said, "Do it for your grandparents"?'

Some bashed him for using 'stereotypical ethnic names for our relative'.

And activist Blaine Hardaway wrote: 'I really would like to say I'm surprised but of course I'm not. Trump sent the only black guy on his team out to chastise black and Latino people for smoking and drinking, as if that's the reason our communities are predisposed to this virus. Just disgusting.'

Adams was met with immediate push back for his comments later in the briefing when PBS NewsHour's Yamiche Alcindor asked him to respond to those who might have been offended by his colloquialisms.

'We need targeted outreach to the African-American community and I used the language that is used in my family,' Adams said. 'I have a Puerto Rican brother-in-law, I call my granddaddy "granddaddy" I have relatives who call their grandparents big momma.'

'That was not meant to be offensive,' he added. 'That's the language that we use and I use and we need to continue to target our outreach to those communities.'

Alcindor also pressed Adams on why he mentioned drugs and alcohol, when talking specifically about communities of color.

'All Americans need to avoid these substances at all times,' he said.



TV host and actress Claudia Jordan took to Twitter to express her outrage at Adams' comments


Adams was met with immediate push back for his comment later in the briefing by PBS News Hour's Yamiche Alcindor



Activist Blaine Hardaway wrote: 'I really would like to say I'm surprised but of course I'm not




Other questioned why Adams didn't choose the word 'grandparents' instead, writing: 'As if people wouldn't understand him if he said, "Do it for your grandparents"?'



Members of the black community are calling out the Surgeon General for 'pandering' to them and his 'offensive' instruction to stop drinking and smoking during this pandemic



Some bashed him for using 'stereotypical ethnic names for our relative'



One man David Deloatch said the Surgeon General is 'trying to relate to a life he never lived'

On Wednesday, New York released data that showed black and Latino people were twice as likely to die from coronavirus than white residents.

Similar figures are popping up around the country including in Chicago where 70 per cent of the deaths have been black people, who only make up 30 per cent of the population.

In Louisiana, with New Orleans being another hot spot, 70 per cent of the dead have been black. Black people only make up 32 per cent of residents in the state.

'Everywhere we look, the coronavirus is devastating our communities,' said Derrick Johnson, president and CEO of the NAACP.

Johnson and other black leaders, including Rev. Jesse Jackson, were on a call Friday with Vice President Mike Pence, who is leading the White House's coronavirus taskforce, and Adams, who took over the briefing room podium to discuss the call and the numbers.

'So what's going on?' he said. 'Well it's alarming, but it's not surprising that people of color have a greater burden of chronic health conditions.'

Among those are high blood pressure, which Adams said African-Americans and Native Americans see at a much younger age than their white counterparts.

'Puerto Ricans have higher rates of asthma and black boys are three times as likely to die of asthma than their white counterparts,' Adams said.

PBS NewsHour's Yamiche Alcindor asked Adams to respond to those who might have been offended by his colloquialisms during the briefing


Crosses are seen outside of a church, as each cross represents one life lost to coronavirus disease (COVID-19) in the state of Louisiana, in Baton Rouge, Louisiana U.S, April 10

Adams then pulled out his own red inhaler, used to open the airwaves during an asthma attack.

'As a matter of fact, I've been carrying an inhaler in my pocket for 40 years out of fear of having a fatal asthma attack,' said Adams, who is black. 'And I hope that showing you this inhaler shows little kids with asthma all across the country that they can grow up to be Surgeon General one day.'

'But I more immediately share it so that everyone knows it doesn't matter if you look fit, if you look young, you are still at risk for getting and spreading and dying from coronavirus,' he warned.

Adams said the 'chronic burden of medical ills' among Americans of color is making those communities less resilient to the 'ravages' of COVID-19.

'And it's possible, in fact likely that the burden of social ills is also contributing,' he remarked.

He mentioned trends like fewer people of color having jobs where they can work from home. He also pointed to housing trends - where many Americans of color live in urban, and thus more densely-packed, places and have multi-generational living arrangements.

'We tell people to wash their hands, but a study shows that 30 per cent of homes on Navaho nation don't have running water, so how are they going to do that?' he asked.

The takeaway, Adams said, was that 'people of color experience both more likely exposure to COVID-19 and increased complications from it.'

Adams was asked later in the briefing if he should have used language like 'big momma' and brought up alcohol and drug use when speaking about communities of color

'But let me be crystal clear, we do not think people of color are biologically or genetically predisposed to get COVID-19, there is nothing inherently wrong with you,' he said. 'But they are socially pre-disposed to coronavirus exposure and have a higher incidence of the very diseases that put you at risk for severe complications of coronavirus.'

Adams then encouraged members of those communities to follow the guidelines of social distancing, mask-wearing and hand-washing strictly.

'Wash your hands more often than you ever dreamed possible,' he said. 'Avoid alcohol, tobacco and drugs,' he advised.

'And call your friends and family, check in on your mother, she wants to hear from you right now,' Adams said.

And with the mention of mothers, Adams listed nicknames for Spanish grandmothers and black moms.

Read more:
He Could Have Seen What Was Coming: Behind Trump’s Failure on the Virus - The New York Times

Trump IGNORED National Security Council's coronavirus warning and its push for social

Here's why top officials are concerned about the coronavirus' growing racial gap
Anjalee KhemlaniSenior Reporter,Yahoo Finance•April 11, 2020


The coronavirus pandemic hammering the global economy is taking a hefty toll on people of color in the United States — a disturbing trend that’s being addressed more frequently by officials at the highest levels of government.

The world’s largest economy is grappling with over 500,000 diagnosed COVID-19 infections and a death toll over 18,000 — close to Italy’s, the world’s largest cluster of coronavirus-related deaths.

To be certain, the virus has cut an indiscriminate swath across the globe, affecting the working and white-collar classes, politicians and celebrities alike. Yet in recent days, President Donald Trump, U.S. Surgeon General Jerome Adams and National Institute of Allergy and Infectious Disease director Anthony Fauci have all addressed the pandemic’s growing racial disparity.

As Trump vowed this week that the U.S. was “doing everything in our power to address this challenge,” New York Governor Andrew Cuomo also pledged to boost testing for African Americans in the hard-hit Empire State, the nation’s epicenter of COVID-19 diagnoses. Still, it was unclear how officials plan to stem the pandemic’s rising tide of non-white casualties.

In a press conference on Friday, Adams said known health predispositions that have dogged black, Latino and Native American populations historically. Among other ailments, asthma, high blood pressure and obesity all exacerbate COVID-19’s effects.

Adams explained that people of color were not biologically or genetically inclined to be infected by the coronavirus. However, he pointed to Milwaukee County, where blacks are 25% of the population but almost 50% of the cases and 75% of the deaths.

“It’s alarming, but it’s not surprising that people of color have a greater burden of chronic conditions,” the nation’s top medical officer said — holding up his own asthma inhaler as proof.

“People of color are more likely to live in densely packed areas and in multi-generational housing...which create higher risk for spread of a highly contagious disease like COVID-19,” Adams added.

Separately, NIAID’s Fauci also addressed the issue this week, noting that when people of color get infected “their underlying medical conditions — the diabetes, the hypertension, the obesity, the asthma — those are the kind of things that wind them up in the ICU and ultimately give them a higher death rate,” he said

Experts point out that longstanding social disparities are at heart of the virus’ rising casualty count. For example, officials have been pushing citizens to wash their hands frequently — but Adams pointed out that some Native American reservations lack running water.

According to a recent report from the Centers for Disease Control, blacks are being “disproportionately affected by COVID-19.” The data showed that 33% of those hospitalized are black, a rate that outstrips their relative population size.

Those socioeconomic barriers are also exacerbating health care disparities. “Social distancing and tele-work are critical...yet only one in five African-Americans and one in six Hispanic Americans has a job that lets them work from home,” the Surgeon General said on Friday.

It’s what Michellene Davis, executive vice president of RWJBarnabas Health — one of the largest health systems in New Jersey — described to Yahoo Finance as “folks who don’t have the ability to stay home are stocking your shelves and delivering your packages.”

Other health experts like Dr. Michael Williams, a surgeon at University of Virginia Health in Charlottesville, didn’t find the current COVID-19 trends surprising.

Among those dying, the definition of underlying health conditions “describes the vast majority of African Americans, particularly those who live anywhere below wealthy.
The demographics of a troubling trend

 
Photo by: John Nacion/STAR MAX/IPx 2020 4/10/20
 Life amidst the cornonavirus in New York City. Empty subway cars


As the crisis gathers momentum, data show that non-whites are contracting — and dying — from the coronavirus at higher rates than their counterparts, with many of the hardest hit living in poverty.

Recently, Yahoo Finance analyzed several neighborhoods with some of the highest rates of coronavirus in the country, underscoring how race, class and ethnicity are playing a combustible mix in the current outbreak.

In New York City, there are currently over 5,100 coronavirus fatalities, with Queens County being the hardest hit. More than 1,600 residents of the borough have died; in the ironically-named Corona neighborhood, nearly 78% of those tested had the virus. More than 60% of Corona residents are not white, and a fifth live below the poverty line, Census data shows.

Meanwhile, Michigan and Illinois have also taken a battering from the virus. In the Great Lakes State, Wayne (which includes the city of Detroit) and Oakland Counties have the highest COVID-19 cases. numbers have been the hardest hit counties in the state.

And with the highest number of residents testing positive for the coronavirus, Detroit is also 79% black, and more than a third of its residents live in poverty, according to 2018 Census Bureau data.

In neighboring Oakland county, communities of color are suffering from the highest infection rates. Southfield, Michigan has the highest number of positive cases in the county, where more than 70% of the residents are black. Over 10% of the population in Southfield lives in poverty, compared to just 2% for Southfield township.

In Illinois, Cook County — including the city of Chicago — has contributed the most to the state’s growing COVID-19 case count. African Americans there have a rate of 332 positive cases of the virus for every 100,000 people, far greater than just 92 for whites and 108 among Asians. And in Chicago, black residents comprise more than half of all the positive cases — more than double the percentage of positive cases among whites in the city.

Disparities abound


Along with underlying conditions, communities of color have long struggled with disparate levels of access and utilization of care, compared to their white counterparts.

“Disparities in teen birth rates, infant mortality rates, and HIV or AIDS diagnosis and death rates were particularly striking for Blacks, Hispanics, and AIANs [Native Americans],” a study from the Kaiser Family Foundation (KFF) found.

And like African Americans, Hispanics have also been overrepresented in the death toll numbers. In New York City, the Hispanic death rate is 34%, despite making up only 29% of the city’s population. That’s higher than the 27% fatality of whites living in the city.

Only a few states break down coronavirus deaths by race, but in areas where such information is available, black death rates are sometimes well over 100% that of whites.

In both Illinois and Michigan, death rates for blacks were at least 40%, well below that of whites. The trend was most striking in Louisiana, where fatalities among blacks stood at a whopping 70.5% compared to 28.6% of whites, and in Washington, D.C. There, the African-American COVID-19 death rate checked in at 59%, compared to 18% for whites.

In addition, communities of color are more likely to be uninsured than that of their white counterparts, data shows, and suffer from disparities in care. The KFF found that 11% of blacks are uninsured, while just under 20% also lack health insurance. That compared to 8% of whites.




Access problems

Underpinning the racial disparity of the current crisis is the hot-button study of social determinants of health— the idea that a job and income, access to food and zip code all play a role in a person’s health.

In recent years, hospitals and health insurers have rolled out a number of programs to try and address shortfalls in food and housing. Yet as Newark Mayor Ras Baraka recently told Yahoo Finance, the system is frequently overwhelmed by people using emergency rooms “as their primary care physician.”

Minorities without access to a car have to rely on public transportation —where service is now drastically reduced — and are unlikely to be able to afford a ride-sharing service, which is also harder to find amid the outbreak, according to Daniel Dawes, a professor of health law and policy at the Morehouse School of Medicine.

He told Yahoo Finance that over the years, living in industrial or urban zones has resulted in increased exposure to pollution while curbing access to fresh food. In addition, minorities disproportionately have lower-income jobs.

“COVID19 doesn’t discriminate. But our economic and social policies do,” Dawes said. “Folks need to get that into their heads. We know that history has already shown us who is going to go without.”

Those factors also serve as barriers to accessing drive-through testing sites opening up around the country. Mobile testing sites and increased testing for younger African-Americans could have helped in slowing the death rate in the community, RWJ Barnabas’ Davis said.

Additionally, “these individuals have asthma (or other co-morbidities) because they live in higher population density where environmental injustices played a role. We’ve seen it in Flint [Michigan]. The evidence is sound and we’ve seen this play out historically,” Davis added.
           ---30---
Is France’s president fueling the hype over an unproven coronavirus treatment? 

Didier Raoult has complained about the “dictatorship of the methodologists” 
who insist on randomization and control groups in clinical trials.
MOURA/ANDBZ/ABACA/SIPA VIA AP IMAGES


OMG HE LOOKS LIKE TRUMPS DOCTOR WHO GIVE HIM 
A CLEAR BILL OF HEALTH FOR THE 2016 ELECTION



By Yves Sciama Apr. 9, 2020
Science’s COVID-19 reporting is supported by the Pulitzer Center.

The highly politicized debate about the use of chloroquine and hydroxychloroquine, two antimalarial drugs, to treat COVID-19 has reached an extreme in France, where two small trials purporting to show potential benefit were done. French physicians have come under enormous pressure from desperate patients to prescribe hydroxychloroquine, despite scant evidence that it works, and 460,000 people have already signed a petition to make it more widely available. Leading the advocacy is a controversial and politically well-connected figure, microbiologist Didier Raoult.

Today his profile rose even higher, as French President Emmanuel Macron traveled to Marseille to meet Raoult, a hospital director and researcher who led the two trials. Macron did not comment after the meeting, but the rendezvous, initiated by Macron, was a clear sign of Raoult’s newfound political clout. Jean-Paul Hamon, president of the Federation of Doctors of France, one of many scientists and doctors critical of the meeting, called it “showbiz politics.”

A survey released by French polling institute IFOP on 6 April revealed that 59% of the French population believes chloroquine is effective against the new coronavirus. Confidence in the drugs is higher on the far right and far left, and reached 80% among sympathizers of the “yellow vest” movement that staged massive protests against Macron’s economic policy in 2018 and 2019. Support is also very high, at 74%, in the Marseille region.

Karine Lacombe, head of infectious diseases at the Saint Antoine Hospital in Paris, has said on French TV that she and her team have received repeated “physical threats” for refusing to prescribe chloroquine; she said she has also seen many falsified prescriptions for the drug. Other doctors have reported similar experiences. The pressure comes on top of the stress caused by shortages of protective equipment, diagnostic tests, and medical staff.

The popular faith in hydroxychloroquine stands in stark contrast to the weakness of the
data. Several studies of its efficacy against COVID-19 have delivered an equivocal or negative verdict, and it can have significant side effects, including heart arrhythmias. Raoult’s positive studies have been widely criticized for their limitations and methodological issues. The first included only 42 patients, and Raoult chose who received the drug or a placebo, a no-no in clinical research; the International Society of Antimicrobial Chemotherapy has distanced itself from the paper, published in the society’s International Journal of Antimicrobial Agents. The second study, published as a preprint without peer review, didn’t have a control group at all.

Raoult has dismissed the criticism and complained about the “dictatorship of the methodologists” who insist on randomization and control groups in clinical trials. In his hospital, every patient diagnosed with COVID-19 receives hydroxychloroquine combined with azithromycin, an antibiotic. Raoult claims this has resulted in a very low death rate, which he says he will document soon in a publication.

His advocacy has made him a kind of medical prophet whose work is discussed incessantly in news outlets and on social media. His political connections have amplified his influence. Former conservative industry minister and Nice Mayor Christian Estrosi, a personal friend of Raoult’s, recently appeared on TV after recovering from COVID-19 and told viewers he was “convinced” the combination of hydroxychloroquine and azithromycin cured him.

Raoult has also found some high-level support in the medical world. The online petition in support of hydroxychloroquine was started by cardiologist and former Minister of Health Philippe Douste-Blazy—France’s candidate to lead the World Health Organization in 2017—and Christian Perronne, head of infectious diseases at the renowned Raymond Poincaré University Hospital in Garches, near Paris. Ten other prominent figures from the medical community, including two members of the Academy of Medicine, co-signed the petition, which demands hydroxychloroquine be authorized for mild cases in hospital settings. (Current regulations, which Raoult ignores, allow the drug to be used only for severe cases of COVID-19.)

In the conservative newspaper Le Figaro, three prominent retired oncologists argued that “all patients tested positive for COVID-19 and not included in a clinical trial” should receive the hydroxychloroquine-azithromycin combo.

The French Ministry of Health has been “incredibly rigid” and has “diabolized” hydroxychloroquine, Perronne tells ScienceInsider. He says there is considerable—though “imperfect and often unpublished”—evidence that the drug has benefits, and he believes its side effects are rare and easy to avoid. Perronne says he has refused to enroll patients in a randomized trial of hydroxychloroquine because a placebo group would be “unethical” for a fatal disease. Instead, he recently decided to give the drug to all patients except the mildest cases.

But many scientists in France are outraged that a potentially harmful drug can be widely used with so little evidence for its efficacy. The fervor also makes it harder to test the drug in a rigorous fashion.

Discovery, a randomized trial launched in at least seven European countries to study the efficacy of hydroxychloroquine and several other treatments, is struggling to recruit participants in France, says Jean-François Bergmann, a former head of infectious disease at the Saint Louis Hospital in Paris. (Macron has met with Discovery’s leaders as well.) “In some hospitals, four out of five patients are declining to take part and refuse any treatment but hydroxychloroquine,” Bergmann says, adding that France is witnessing a form of “medical populism” that is “slowing the emergence of the truth.”

Correction, 10 April, 8:10 a.m.: A previous version of this story said the Discovery trial is double-blinded; it is not.
doi:10.1126/science.abc1786
Some Patients Really Need the Drug That Trump Keeps
Pushing

When he touts hydroxychloroquine as a COVID-19 treatment, shortages endanger those of us who already take it.


Maya L. Harris Civil-rights advocate and lawyer in San Francisco
THE ATLANTIC APRIL 12, 2020

One morning during my last semester in college, I woke up with a strange rash on my face. When it didn’t go away after exhausting a tube of over-the-counter cortisone, my mother persuaded me to see a doctor. The diagnosis was lupus: a life-changing autoimmune disease in which the body literally attacks itself. The physical effects of the disease are cruel, including excruciating joint pain, organ damage, dramatic hair loss, and debilitating fatigue—most of which I have experienced again and again, often for long stretches, throughout my life. And while lupus can be managed, it has no cure.

For three decades, I kept this private and spoke of my condition only with my family and a handful of close friends. I had no intention of changing that until the coronavirus changed everything.

Millions of Americans find themselves vulnerable to COVID-19 because of underlying health challenges, but this pandemic has unearthed particularly deep fractures along our nation’s racial and gender fault lines. This is especially true of lupus. Roughly 1.5 million Americans live with lupus, and we are overwhelmingly female and disproportionately black or brown. For black women like me, lupus tends to take hold at a younger age with more serious, life-threatening consequences. For us, the coronavirus could very well be a death sentence.

Worse still, the pandemic is amplifying the inequities of the health system in tragic ways. For instance: when the president of the United States decided to hype—as a coronavirus treatment—the primary medication used for controlling lupus, he put an already disadvantaged group of patients in even greater jeopardy.

Not long ago, Donald Trump started talking and tweeting about hydroxychloroquine, which I have taken for most of my adult life, as if it were a miracle drug—a “game changer” for treating COVID-19, the president insists. Immediately, thousands of people began hoarding it, causing shortages that have resulted in lupus patients—and their doctors—struggling to get the supply they need. The more Trump pushed the unproven remedy from the White House podium, the more I wondered: Did he not care that the Food and Drug Administration hadn’t approved the drug for COVID-19? Was he that desperate to contain a crisis of his own making?

Trump has even said that people should consider taking hydroxychloroquine preventively. Talking about the drug during a recent briefing, he asked again and again: “What do you have to lose?” But for a president to casually invite Americans to self-medicate is harmful and potentially deadly. And if the supply shortages continue, those of us whose well-being depends on the drug have plenty to lose.

Even on a good day, lupus extracts a physical and emotional toll. There is always the looming possibility that a flare-up could leave you bedridden and racked with pain, and often the only relief comes from this essential medication. Unnecessary shortages caused by false medical narratives peddled from the nation’s highest office not only create fear and anxiety in those who desperately need hydroxychloroquine, but also engender false hopes in those who hoard the drug but might derive no benefit at all from it.


Experts such as Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, have urged caution, pointing out that hydroxychloroquine is unproven against coronavirus and that there’s “only anecdotal evidence” it can be effective. The experience in other countries has been negative to neutral at best. Yet the U.S. government is stockpiling 29 million doses of the drug anyway—and not out of concern for patients with lupus. 

Having spent my career as a civil-rights advocate, I’m acutely aware that the people most affected by the hydroxychloroquine drug shortages live in communities or belong to demographic groups that are among the most vulnerable, even in the absence of a pandemic. Black Americans suffer higher rates of not only lupus but a host of other chronic conditions such as diabetes, asthma, and hypertension, making them more susceptible to the coronavirus. This is compounded by structural inequalities that have denied too many black people access to adequate health insurance, employment, housing, and transportation—all keys to high-quality health care in this country.

In addition, for years, racial bias has infected the way medical care is delivered to black patients, whether children or adults, from diagnosis to treatment. Research has supported the growing recognition that medical professionals have too often dismissed black patients’ reported symptoms, such as pregnancy complications and pain. The coronavirus is raising questions anew about such bias, amid stories about black women who have been turned away from hospitals despite displaying severe COVID-19 symptoms.

Because of these and other factors, medical professionals have been warning—for weeks—that the coronavirus would hit the black community especially hard. And now the experts’ worst fears are coming true.

One day, generations will recall with shame and outrage how the federal government foresaw but failed to prevent this unfolding human tragedy. While President Trump continues to make unfounded claims about hydroxychloroquine, others in positions of responsibility—doctors, hospital administrators, and state and local officials—can take steps to ensure access to vital medications for those who need them. For example, the Ohio and Nevada Boards of Pharmacy have limited how much hydroxychloroquine can be prescribed for certain cases—and banned pharmacists from selling it for preventive use.

Even if people with lupus can get hydroxychloroquine, the broader injustices revealed—and reinforced—by the pandemic will remain. For that reason, authorities need to collect more and better data about how the coronavirus is affecting communities of color. A range of other steps—from vastly expanding our mobile-clinic capacity, to targeted outreach, education, and testing—would also help overcome years of disinvestment and bias in the medical-delivery systems on which people of color depend.

These measures are not aspirational. They will save lives now—which is more than can be said for Trump’s false narratives about a miracle drug.