Why the week ahead is crucial for COVID-19 decisions in the US

Covering COVID-19 is a daily Poynter briefing of story ideas about the coronavirus and other timely topics for journalists, written by senior faculty Al Tompkins. Sign up here to have it delivered to your inbox every weekday morning.

The next week will be crucial for decisions about COVID-19 in the United States. For starters, Ali Mokdad, a professor of health metrics sciences at the University of Washington in Seattle, estimates that our national COVID-19 figures do not include about 93 out of 100 positive cases. Keep in mind that his group has been among the most reliable forecasters of COVID-19 trends for a couple of years.

However, Mokdad’s forecasting team currently does not foresee a big increase in hospitalizations or deaths from this wave of COVID-19.

(IHME)

(IHME)

BA.2 is on the decline in Europe. The Institute for Health Metrics and Evaluation reports, “There are some states where we’re seeing hospitalization admissions go up slightly but not seeing the reported cases go up.”

New York City’s case rate is rising weeks after it lifted most restrictions. New York City reports 1,500 new cases a day with a 3% positivity rate, which is twice the rate from March when the city’s restrictions were still in place. New York City just extended its mask mandate for toddlers in day care and public 3-K school programs through this week because of rising cases.

Philadelphia city leaders will decide, probably today, whether to reimpose indoor mask requirements. City government officials released a statement preparing people for the possible move to Level 2, which includes masking. The new case count qualifies for Level 2, but hospitalizations are still fairly low in Philly.

Dr. Anthony Fauci told ABC News “This Week” co-anchor Jonathan Karl, “I think the people who run functions, who run big dinners like the White House Correspondents ball or thinking back to the Gridiron dinner are going to have to make a determination looking at the CDC guidelines and seeing where the trends are.”

NBC News reports:

“I do think we are in the middle of a surge, the magnitude of which I can’t tell you,” Zeke Emanuel, vice provost of global initiatives at the University of Pennsylvania, said.

Emanuel and other experts cite a lack of testing as the primary reason cases are underreported. At the height of the omicron wave in January, the U.S. was administering more than 2 million tests per day. That had dropped to an average of about 530,000 as of Monday, the most recent data from the Centers for Disease Control and Prevention.

“The milder symptoms become, the less likely people are to test or show up in official case counts,” said David Dowdy, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health.

Average Covid cases have risen nearly 80 percent in Nebraska, 75 percent in Arizona, 58 percent in New York and 55 percent in Massachusetts over the last two weeks. Wastewater surveillance similarly suggests that infections are rising in Colorado, Ohio and Washington, among other states.

The number of high-profile government leaders and journalists who have tested positive in recent days grew larger over the weekend. 68 attendees of the Gridiron dinner more than a week ago have been infected. The Washington Post reports:

When the last month is taken into account, President Biden has come in contact with at least four people who tested positive either shortly after, or right before, interacting with him. The White House says that Biden tests regularly and they have said they will disclose a positive test if he has one. Also, they say, anyone who will be meeting with Biden, Vice President Harris or their spouses must test beforehand.

But, experts say, case counts do not matter as much as they did before since so many of us have some level of immunity that will likely keep us out of hospital beds. The immunity from vaccinations and previous infections may make this wave, if there is one, less lethal for people who have some immunity but still dangerous for people who are vulnerable. And keep in mind, children under age 5, while less likely to be infected, are unvaccinated.

The federal government has a big decision to make this week. The Department of Transportation’s mask mandate is set to expire on April 18. That is the mandate that keeps masking requirements on planes, trains, buses and in airports and other terminals. 21 states have sued to end the mask mandate for airlines and airports.

Shanghai has locked down its 25 million residents. The government there reports 130,000 cases since the beginning of March. And, the government says, there have been no deaths and only one serious illness.

School systems nationwide are recording stunningly high levels of school absenteeism including, in some cases, more than 40% of students missing at least 18 days of school a year. Reporting from various cities indicates the real number is higher because some teachers report a student as present even if they briefly check in online. Some examples:

In Los Angeles, 46% of students in Los Angeles Unified have been chronically absent this year or have missed at least 9% of the academic year, according to the Los Angeles Times, which reports:

This more than twofold increase from pre-pandemic years reveals yet another hit to education with widespread learning disruptions even as campuses are open for in-person learning.

In the three years just before the pandemic the district’s chronic absentee rate, already considered high, averaged about 19%. This school year it has been about 46%, according to the data provided to The Times in mid-March.

Like almost all education hardships wrought by the pandemic, the impact of missed school is being borne most heavily by the most vulnerable student groups. For Black students the chronic absence rate is nearly 57%. For Latinos, it is 49%. For homeless students it is 68%.

In New York City, the rate of chronic absenteeism soared to 40% — up from 26% during the 2018-2019 school year, according to the New York Post. That is up from 26% in 2018-19, before the COVID-19 crisis. The story said, “But that number is likely an undercount because students out with COVID or quarantined could be marked present if they logged in online or had minimal contact with a teacher.”

In Ohio, the statewide chronic absenteeism rate rose to 24% in 2020-2021, the most recent school year for which there is data, up from 11% in 2019-2020.

(Ohio Department of Education)

The Milwaukee Journal Sentinel finds:

More Wisconsin students were chronically absent and graduation rates took a slight hit in the 2020-21 school year, according to new data from the state Department of Public Instruction reflecting public schools.

K-12 DIVE reports:

The pandemic created alarming drops in student attendance and enrollment, school system leaders say. An April 2021 survey covering 565 school districts in 46 states from the American Institutes for Research showed 18% of districts reported daily attendance for all students to be substantially lower in fall 2020 than in fall 2019.

Drops in enrollment or attendance can hurt district budgets. A 5% loss in enrollment in Arizona’s Mesa Public Schools in the 2020-21 school year could have caused a loss of $23 million, or about 4% of the district’s total revenue, without state intervention, according to a report from Edunomics Lab at Georgetown University.

This is a new take on an old problem. A Brookings study five years ago found that some school systems like Detroit had more than half of all students “chronically absent,” which is defined as missing 18 or more days in a school year.

An unidentified student rests on his desk as the Mojave Unified School District Superintendent Katherine Aguirre, center rear, addresses students before their spring break at California City Middle School in California City, Calif., on Friday, March 11, 2022. Since the pandemic started, experts have warned of a mental health crisis facing American children that is now visibly playing out at schools across the country. (AP Photo/Damian Dovarganes)

We have seen hints of this before, but nothing quite this stark. The Centers for Disease Control and Prevention recently released a study that says:

More than 1 in 3 high school students experienced poor mental health during the pandemic and nearly half of students felt persistently sad or hopeless.

Female students and those who identify as lesbian, gay, bisexual, other or questioning (LGBQ) are experiencing disproportionate levels of poor mental health and suicide-related behaviors. For example, in 2021, 12% of female students, more than 25% of LGB students, and 17% of other or questioning students attempted suicide during the past year compared to 5% of their male peers and 5% of their heterosexual peers, respectively.

More than half of students experienced emotional abuse in the home and more than 10% reported physical abuse in the home.

Lesbian, gay, and bisexual students were far more likely to report physical abuse, with 20% reporting that they had been physically abused by a parent or other adult in their home, compared to 10% of heterosexual students.

Black students were most likely to report hunger, with nearly a third reporting that there was not enough food in their home during the pandemic.

Los Angeles Unified School District food service worker Marisel Dominguez, left, distributes free school lunches on Friday, July 16, 2021, at the Liechty Middle School in Los Angeles. (AP Photo/Damian Dovarganes)

This item has a direct link to the last point above. Even though one-third of Black students said there was not enough food in their homes during the pandemic, the free lunch programs that the federal government launched during the pandemic went a long way toward feeding millions of children.

More children got meals from pandemic-era school meal programs than they did before the pandemic. Maybe there is something to learn from the way schools allowed food to be picked up when classes were being taught remotely, emergency funds could be added to EBT cards for households with free-lunch eligible children and expanded eligibility allowed millions more children to eat free.

I know how difficult it may seem to put together a local news story about Medicaid. But it is a crucial agency for millions of people … and it is overwhelmed by a backlog of cases. Kaiser Health News focuses on just one state to give you an example:

Missouri had nearly 72,000 pending Medicaid applications at the end of February and was averaging 119 days to process one, more than twice the maximum turnaround time of 45 days allowed by federal rules. Adding people to Medicaid is labor-intensive, and the jobs require training and expertise. The program covers many populations — children, people with disabilities, seniors, adults who are pregnant or have children, and some without children. Different rules dictate who qualifies.

Consider that when the national emergency declaration expires, there will be a flood of new applications seeking Medicaid help in every part of the nation. Again, KHN:

Just about every industry is struggling to find workers now but staffing shortages in state Medicaid agencies around the country come at a challenging time. States will soon need to review the eligibility of tens of millions of people enrolled in the program nationwide — a herculean effort that will kick off once President Joe Biden’s administration lets the covid-19 public health emergency declaration expire. If Missouri’s lengthy application backlogs are any indication, the nation is on course for a mass-scale disruption in people’s benefits — even for those who still qualify for the insurance.

“If you don’t have people actually processing the cases and answering the phone, it doesn’t matter what policies you have in place,” said Jennifer Wagner, director of Medicaid eligibility and enrollment for the Center on Budget and Policy Priorities, a left-leaning think tank in Washington, D.C.

Kaiser found state after state frantically searching for workers, knowing that it takes months for a new hire to become competent in helping clients work through the complexities of Medicaid claims and eligibility. Journalists would learn a lot just walking alongside people like those Kaiser found desperately trying to get help from an overloaded system:

In the suburbs of Kansas City, Missouri, Stacey Whitford, 41, applied in December for Medicaid for herself and her 13-year-old son. Her son needs hearing aids that she said cost $2,500 apiece without insurance. She also lined up a support worker for the boy, who has autism, through the Department of Mental Health but said she was told the worker can begin only once her son is enrolled in Medicaid.

“It’s just like hanging a golden ticket right in front of your face and saying, ‘Here it is, but you can’t touch it,’” she said in early March.

Whitford spent hours on the phone trying to sort out the status of their applications, then on March 31, just shy of four months after applying, they were finally approved.

We’ll be back tomorrow with a new edition of Covering COVID-19. Are you subscribed? Sign up here to get it delivered right to your inbox.

Leave a Comment