Twice-weekly COVID-19 testing of residential students = effective infection mitigation strategy at colleges and universities

 Question  What is the association between COVID-19 testing and case rates on residential college campuses?

Findings  In this cohort study of 18 Connecticut colleges and universities, infrequent COVID-19 testing of residential students was not associated with decreased transmission, whereas testing of residential students twice per week was associated with decreased transmission during the 2020-2021 academic year.

Meaning  Findings suggest that twice-weekly COVID-19 testing of residential students may serve as an effective infection mitigation strategy at colleges and universities.

One year on, Republicans still don’t consider Biden the rightful winner

 

IMAGE: A YEAR ON, MORE THAN TWO THIRDS OF REPUBLICAN VOTERS STILL DO NOT CONSIDER PRESIDENT BIDEN THE RIGHTFUL ELECTION WINNER. view more 

CREDIT: BRIGHT LINE WATCH

A year later, a large majority of Republican voters still refuses to acknowledge President Biden's 2020 election victory, which doesn’t bode well for US democracy. The most recent Bright Line Watch survey finds that just 27 percent of Republicans believe Biden is the rightful presidential winner, compared to 94 percent of Democrats.

Bright Line Watch, a nonpartisan watchdog group of leading political scientists who has been monitoring US democratic practices since 2017, was cofounded by Gretchen Helmke, a professor of political science at the University of Rochester, and her colleagues at the University of Chicago and Dartmouth College. Bright Line Watch conducts regular surveys designed to gauge the overall stability and performance of American democracy.

“For a democracy to survive, parties must be willing to lose elections and politicians must be willing to acknowledge when they have lost,” warns Helmke. “The fact that the Republican Party is unwilling to acknowledge the 2020 loss fundamentally undermines the most basic principle of our democracy.”

The group’s latest survey finds that voters’ confidence in next year’s midterm elections has already been affected: only 62 percent of Americans said they were “very” or “somewhat confident” that votes nationwide would be counted correctly. Divisions along partisan lines have notably deepened. While 80 percent of Democrats generally expressed confidence in fair elections, only 42 percent of Republicans felt that way.

Among the key findings

• Partisan divisions over the legitimacy of the 2020 election remain profound.
• Democrats underestimate the commitment of Republican supporters to democratic norms and principles, and Republicans underestimate the commitment of Democrats.
• While support for political violence had been overstated in prior surveys, millions of Americans still explicitly endorse political violence directed against the other party.
• Experts and the public believe that fundamental changes are needed to make the American government work for current times. Most needed are policy and rule changes that don’t require constitutional amendments.
• Experts strongly prefer Senate seats to be apportioned to states by population numbers rather than equally. This preference is shared by Democrats, but opposed by Republicans and Independents. Overall, the public prefers the status quo.
• Experts are relatively evenly divided about which of numerous problems facing American democracy is most severe, though they rank economic inequality, unrepresentative political institutions, and racial inequality generally highest.
• Experts see a number of reforms to campaign and legislative rules and practices as beneficial to democracy. With few exceptions, however, they think these reforms are quite unlikely to be enacted.
• Expert and public perceptions of the performance of US democracy have changed little since June 2021.

 

Nearly one-third (30%) of Americans skipped needed medical care in the past three months due to cost

 Nearly one-third (30%) of Americans skipped needed medical care in the past three months due to cost, the highest reported number since the COVID-19 pandemic began and a threefold increase from March to October, according to the latest survey from the nonprofit, nonpartisan organization West Health and Gallup, the global analytics and advice firm. Even about 20% of the nation’s highest-income households — those earning more than $120,000 per year — blame cost as the reason for not seeking care, up from 3% over the same timeframe.

The survey, the largest conducted on healthcare since the pandemic began, also found that the COVID-19 experience has significantly shaped public opinion of the U.S. healthcare system, which an estimated 100 million Americans would self-describe as either “expensive” or “broken.” Nearly half (48%) of Americans say their view of healthcare in America has decidedly worsened due to the pandemic. An estimated 150 million Americans (59%) say they are now more worried about the cost of healthcare services and 45% are more worried about the cost of prescription drugs. It is no wonder more than half the country reports that the high cost of healthcare contributes some (36%) or a lot (15%) of stress to their daily lives.

Another 60% report higher concern over growing healthcare inequities, a concern that rises to nearly 75% of Black Americans and more than two-thirds of Hispanic Americans. An estimated 12.7 million people, or one in 20 American adults, report that a friend or family member died this year after not receiving treatment because they could not afford it, with Black Americans twice as likely to know someone who died as White Americans.

“Americans have reached their breaking point,” said Shelley Lyford, president and CEO of West Health, a family of nonprofit, nonpartisan organizations dedicated to lowering healthcare costs to enable successful aging. “Between March and October, the percentage of people reporting trouble paying for healthcare, skipping treatments and not filling their prescriptions spiked to their highest levels since the pandemic began, exacerbating another public health threat borne out of cost rather than illness.”

This nationally representative survey of more than 6,600 American adults (18+) comes as a new COVID-19 variant emerges and the death toll from COVID-19 nears 800,000. The full findings of this latest survey and comparative findings from a series of previous surveys conducted over the last year were published today in the West Health-Gallup 2021 Healthcare in America Report.

Despite attempts in Washington to address high healthcare prices through Build Back Better legislation, more than two-thirds of Americans, regardless of party affiliation, are pessimistic that policies that reduce costs will emerge. In fact, nine in 10 expect their costs to continue to rise and 42% are concerned they will be unable to pay for healthcare services in the coming year.

“This negative public sentiment did not form overnight or begin with COVID-19. It’s been decades in the making after failed promises by elected officials to do something to help Americans suffering at the hand of high prices for healthcare and prescription drugs,” said Tim Lash, chief strategy officer for West Health. “However, public opinion plays an important role in the policy process, and if policymakers are listening, they have no choice but to act.”

National health spending is nearly $4 trillion in this country — approximately 20% of GDP— making it the most expensive healthcare system in the world.

“The sharp worsening in public opinion regarding the affordability of care and medicine is startling, and likely a result of myriad factors related directly and indirectly to the COVID-19 pandemic,” said Dan Witters, a senior researcher for Gallup. “From rapidly rising inflation, to deferred care pushed into 2021, to more people having to pay for COVID-19 care itself, the U.S. healthcare cost crisis is now coming to a head.”

Methodology

The results are based on a nationally representative survey conducted by web over successive field periods of Sept. 27-30 and Oct. 18-21 of 6,663 American adults aged 18 and older, living in all 50 U.S. states and the District of Columbia, as a part of the Gallup Panel. For results based on these monthly samples of national adults, the margin of sampling error at the 95% confidence level is +1.5 percentage points. For reported subgroups, such as by age, political identity, household income or race/ethnicity, the margin of error is larger, typically ranging from ±3 to ±5 percentage points.

We need to reduce use of road salt in winter

 Across the U.S. road crews dump around 25 million metric tons of sodium chloride -- much like table salt -- to unfreeze roads each year and make them safe for travel.

Usage varies by state, but the amount of salt applied to icy roads annually in some regions can vary between approximately 3 and 18 pounds of salt per square meter, which is only about the size of a small kitchen table.

As the use of deicing salts has tripled over the past 45 years, salt concentrations are increasing dramatically in streams, rivers, lakes and other sources of freshwater.

Overuse of road salts to melt away snow and ice is threatening human health and the environment as they wash into drinking water sources, and new research from The University of Toledo spotlights the urgent need for policy makers and environmental managers to adopt a variety of solutions.

The study titled "Road Salts, Human Safety and the Rising Salinity of Our Fresh Waters" is published in the journal Frontiers in Ecology and the Environment and presents how road salts hurt ecology, contaminate drinking water supplies and mobilize harmful chemicals, such as radon, mercury and lead, and then lays out suggested best management practices.

"The magnitude of the road salt contamination issue is substantial and requires immediate attention," said Dr. Bill Hintz, assistant professor of ecology at UToledo and lead author of the research based out of the UToledo Lake Erie Center. "Given that road deicers reduce car accidents by more than 78%, we worked to strike a careful balance between human safety and mitigating the negative environmental and health impacts triggered by dumping salt on our streets and highways to keep people safe and traffic moving."

In one major example, the researchers say overuse of road salts likely contributed to higher levels of corrosive chloride in the water supply in Flint, Mich., in 2014, leading to the release of lead from water distribution pipes.

Another example shows that high concentrations of deicing salt typically occur in private wells located near roads in lower elevations or downhill from highways.

The most common deicers are the inorganic salts sodium chloride, calcium chloride and magnesium chloride, all used both in solid and liquid or brine form.

The study examines how current federal safety limits for salt concentrations established by the U.S. Environmental Protection Agency in 1988 to protect fish, plants and other aquatic life in freshwater ecosystems are commonly surpassed.

Particularly alarming is the number of salinized streams. The research highlights recent studies that show urban streams with salt concentrations that are more than 20 to 30 times higher than the EPA chronic chloride threshold of 230 milligrams per liter.

"Current EPA thresholds are clearly not enough," Hintz said. "The impacts of deicing salts can be sublethal or lethal at current thresholds and recent research suggests that negative effects can occur at levels far below these thresholds."

The research suggests several solutions, including:

• Proper storage facilities -- covered structures with a concrete base;
• Anti-icing, the application of liquids such as salt brines to road surfaces prior to winter storm events, which prevents ice from bonding to surfaces and aids removal operations;
• Live-edge snowplows composed of multiple smaller plows on springs, which better conform to road surfaces compared to conventional plows with a single fixed edge, to increase the efficiency of snow and ice removal and reduce the need for deicing salt; and
• Post-storm performance assessments to determine whether the treatment used was appropriate for the weather system and if it should be modified in the future.

"Given the lack of ecologically friendly and cost-effective alternatives, broad-scale adoption of best management practices is necessary to curb the increasing salinization of freshwater ecosystems resulting from the use of deicing salts," Hintz said.

It’s time to clean up the US Clean Water Act

 In 1969, the Cuyahoga River near Cleveland was so polluted that it caught fire, helping to launch the modern environmental movement and prompting Congress to pass the Clean Water Act three years later. It was one of the first laws to safeguard waterways and set national water quality standards.

While the Clean Water Act successfully regulated many obvious causes of pollution, such as the dumping of wastewater, it's done less to limit more diffuse types of pollution, such as "nonpoint source pollution" that includes agricultural runoff from fields and urban stormwater from buildings, paved surfaces and yards -- says a new study from University of Missouri researchers.

Though hard to see, nonpoint source pollution has become one of the main environmental threats to drinking water across the country, said MU researchers who are offering strategies to address the problem.

"Large amounts of nitrates and nitrites, such as those found in fertilizer, can cause negative health effects such as blue baby syndrome," said Robin Rotman, assistant professor in the MU School of Natural Resources, who led the study. Rotman also holds courtesy appointments in the MU School of Law and the MU College of Engineering. "Nonpoint source pollution can lead to toxic algae blooms; pesticides and herbicides also contain carcinogens that can threaten human health," she said.

To mark the upcoming 50th anniversary of the Clean Water Act, researchers studied the existing legislation and regulation and identified critical gaps. As a result of their findings, they are urging expanded or new policies to limit nonpoint source pollution. Without quick action, they said many municipalities will need to invest in sophisticated drinking water treatment systems to remove contaminants. Those systems can come with price tags in the millions of dollars, and the cost would likely be passed on to ratepayers in the form of higher drinking water bills.

Researchers propose three ways to tackle nonpoint source pollution:

• Amend the Clean Water Act to require states to control nonpoint source pollution, and offer federal funding for state and local initiatives to address it, including engineered solutions (such as filtration systems) and environmental solutions (such as planting vegetation next to bodies of water).
• Extend the Safe Drinking Water Act (which established contaminant limits for public water systems) to protect more rural water sources from nonpoint source pollution.
• Encourage citizens to understand nonpoint source pollution and better care for their local water sources.

Kathleen Trauth, associate professor in the College of Engineering and a co-author of the study, said it is important to control pollution even before it reaches public water treatment facilities. She said one way to accomplish this would be to apply standards from the Safe Drinking Water Act, which places maximum contaminant levels for 87 potentially dangerous substances, to rivers, lakes and other bodies of water regulated by the Clean Water Act. Trauth said regulators also need the authority to place limits on nonpoint source pollution.

"As the sources are many and they involve so many contributors, it can be hard to say how we should work on these problems," said Trauth. "But the difficulty cannot deter us from addressing them. To reorient our thinking, let's focus on where we want to go. Because if we really want to ensure clean water, we need to think about nonpoint source pollution."

There have been attempts to litigate the Clean Water Act into addressing nonpoint source pollution, but researchers said their proposals offer direct ways of facing the issue and ensuring the nation's drinking water is safe for years to come.

"Since the Clean Water Act was written, there was always a recognition that nonpoint pollution is a problem," said Rotman. "This issue is particularly important in the Great Plains states where agriculture is a leading industry. We want to see that industry continue to thrive, and at the same time ensure that people have access to safe drinking water."

Closing indoor dining = 61% decline in new COVID-19 cases

 Closing indoor dining during the first two waves of the pandemic was associated with a 61% decline in new COVID-19 cases over a six-week span, preventing an estimated 142 daily cases per city, compared with cities that reopened indoor dining during that period, according to recently published data from experts at the Dornsife School of Public Health. The team looked at data from March to October 2020 in 11 U.S. cities, including Philadelphia, Atlanta and Dallas. The results were published last month in the journal Epidemiology.

The authors are not suggesting that any specific U.S. cities should close indoor dining at this time but suggest it could be a tool worth employing down the road – in addition to social distancing, improved ventilation, vaccination and other measures – to curb the spread of new variants around the globe.  

“This clear association between indoor dining and COVID infections can help inform policies that limit indoor dining to slow the transmission of this disease,” said study lead author Alina S. Schnake-Mahl, ScD, a postdoctoral research fellow at the Dornsife School of Public Health’s Urban Health Collaborative. “We must learn from what worked in the early months of the pandemic, especially with the Omicron variant now in the United States and Delta rapidly causing more COVID-19 cases in countries around the globe.”

The Drexel study is among the first to isolate the role of indoor dining in transmission of this coronavirus. This contrasts with previous studies on “on-premises” dining (that included both indoor and outdoor dining together and COVID).

“Reducing transmission is key to saving lives and preventing serious illness, and of course helps prevent long -term financial and social costs,” said Schnake-Mahl. “Effective policy must be met with a public willing to work together and help us all get through this time and build stronger, more innovative cities for this and the next public health crisis.”

Philadelphia’s City Council passed a bill this month that aims to help those in Philadelphia dine out at less risk – by making outdoor dining structures indefinite fixtures in some areas of the city. 

The street-based three-walled boxes that hug the sidewalk in front of many of center city’s popular restaurants, often replete with hanging flowers, strong lights and heat lamps or fans – are one of the more publicly noticeable innovations by the restaurant industry to help keep businesses open during the pandemic and allow diners to feel more comfortable dining out during more months of the year.

Indoor dining may also contribute to racial disparities in coronavirus cases, as higher rates of occupational exposure are experienced disproportionately by Black and Hispanic populations working in those settings, researchers say.

“Our data suggests that closing indoor dining can help prevent transmission and may also send a message to the broader public about the severity of the pandemic,” said senior author Usama Bilal, PhD, MD, an assistant professor in the Dornsife School of Public Health. “It might also encourage other policies and regulations aimed at ensuring social distancing and improving indoor air ventilation and filtration that we know can help reduce transmission.”

The authors add that the challenge of protecting public health while preventing layoffs and restaurant closures is especially difficult considering this data, and the inherent limitations of the data available.

For example, the current study measures associations between cases and indoor dining policies, but it’s possible that opening indoor dining sent a message of reduced risk to city residents, thus leading to additional higher-risk behavior overall (such as not social distancing, not wearing masks in large indoor gatherings, etc.) in those cities. If future studies look at data pertaining to closing indoor dining from December-February, that might yield additional context as well.

Overall, the researchers report that closing indoor dining is not a substitute for other public health measures, such as masking and vaccination, but may be another way to help stem the spread of COVID-19 and prevent more widespread closures and lockdowns.

A third of US kids lack good and consistent health insurance

 In a concerning trend for the health of U.S. children, the rate of underinsured youngsters rose from 30.6% to 34%—an additional 2.4 million kids—from 2016 to 2019, according to an analysis led by University of Pittsburgh School of Medicine researchers.  

In the study, published today in Pediatrics, the researchers found that underinsurance of children was mainly driven by increased rates of inadequate insurance rather than a rise in absent or inconsistent insurance. Notably, they found families who have children with special health care needs and private insurance were hit particularly hard.  

“The main takeaway is that the insurance landscape is getting bleaker, and it’s hurting millions of families, specifically those who are the most vulnerable,” said Justin Yu, M.D., lead author of the study and assistant professor of pediatrics in Pitt’s School of Medicine. “We need pediatric organizations and politicians to bring child health insurance to the forefront and make it a priority issue.” 

To understand pediatric insurance trends, Yu and his team analyzed data from the National Survey of Children’s Health, an annual survey about the physical and mental health of newborns through 17-year-olds. They defined underinsured children as those who lack continuous and adequate health insurance, with “adequate” meaning that insurance usually or always met a child’s needs, allowed children to see needed providers and protected against what parents felt were unreasonable out-of-pocket expenses. 

The increase in underinsured children was driven by rising insurance inadequacy, mainly experienced as high out-of-pocket expenses for health services. According to the researchers, this is concerning because high fees may force families to delay or forgo care for their child. 

“Access to health care helps children be as healthy as possible so they can live full and complete lives,” said senior author Amy Houtrow, M.D., Ph.D., M.P.H., professor and vice chair of physical medicine and rehabilitation and pediatrics in Pitt’s School of Medicine, and chief of pediatric rehabilitation medicine services at UPMC Children’s Hospital of Pittsburgh. “I don’t believe that any family should have to choose between paying for medical care for their child or putting food on the table or paying their electric bills.” 

The researchers suspect that the rise in unreasonable out-of-pocket expenses reflect broad trends in the insurance landscape: Insurers are increasingly transferring costs to individuals and families through higher copays and premiums and, increasingly, through high-deductible plans. These trends may help explain the finding that children with private health insurance were more likely to be underinsured than those on public plans, such as Medicaid or Children’s Health Insurance Program (CHIP).  

Another notable finding was an increase in the rate of underinsurance in kids considered to be more socioeconomically advantaged: white children from middle-income, highly educated families.  

“We have this idea that if you have a full-time job with health insurance from your employer that your health care needs will be met,” said Houtrow. “But our data show that, increasingly, that’s not the case, especially for families who may be enrolled in lower premium, high-deductible plans.”  

The researchers also examined underinsurance rates in children with chronic health conditions. They found that kids with more complex special health care needs were more likely to be underinsured than those with less complex or no special health needs. 

“This is worrisome because, by definition, these children need the most health care,” said Yu.  

According to the researchers, tackling the problem of child underinsurance may require large-scale policy reforms such as broadening eligibility for Medicaid or creating a universal health insurance program for all U.S. kids. But smaller policy changes—such as making it easier to apply for and stay on Medicaid or cash assistance programs to help cover out-of-pocket expenses—also could help.  

“Rather than providing a clear policy prescription, the goal of this study is to bring the issue of child underinsurance to the forefront of national conversation,” said Yu. “Once people are talking about this issue, we can start thinking about policies to address it.”  

“We know there are many possible paths to improving the adequacy of health insurance coverage for children, and this study tells us that the time is now to move forward on that journey,” added Houtrow. 

The expanded monthly Child Tax Credit must be extended before the end of the year

 

Color Of Change Community 

Change Action Economic Security Project Action 

The Leadership Conference 

NAACP National Urban League 

UnidosUS

Senator Charles E. Schumer Majority Leader of the United States Senate Washington, D.C. 

Monday, December 6, 2021 

Dear Senator Schumer, 

Now that the House has passed the Build Back Better Act, including a robust Child Tax Credit, it is time for the Senate to take this up. The Senate should pass this legislation as-is, without amendments that would weaken provisions key to the racial equity impact of the Child Tax Credit. The expanded monthly Child Tax Credit must be extended before the end of the year to give families the certainty that the payments will keep coming. If the bill does not pass by the end of the year, we risk throwing millions of children back into poverty in 2022. Passing the Build Back Better Act provides a historic opportunity to reduce childhood poverty and continued support to the most vulnerable children, particularly in Black and Latino families.