When COVID19 snared President Trump in early October, he promptly received a dose of Regeneron and an airlift to Walter Reed Army Hospital; physicians dispensed a course of therapeutics – Remdesivir and the steroid dexamethasone, and supplemental oxygen as needed. That extraordinary spell of cutting edge treatment soon put the president back on the campaign trail almost within the week.
The price tag for the president’s helicopter ride and specialized, experimental treatment cost roughly about $1 million say experts, and was free, and funded by taxpayer dollars.
“I would not be surprised if it were to exceed $1m,” said Dr Bruce Y Lee, a healthcare researcher at the City University of New York.
The five star treatment afforded to Trump, however, is beyond the reach of average Americans, even those with insurance. With private insurance to cushion the cost, an average American would have to pony up $520 a vial or $3120 for a course of anti-viral treatment.
At the other end of the healthcare spectrum are the uninsured – people who cannot afford even a single dose of Remdesivir, let alone an entire course of treatment, said Dr. David Hayes-Bautista Director of the Center for the Study of Latino Health and Culture, UCLA Health, at an October 23 Ethnic Media Services briefing.
His study of how the coronavirus impacts populations of color found that low-paid and uninsured workers in underserved communities rarely have health insurance to pay for treatment.
Without any protection, said Bautista, COVID19 finds gaps in care in the social services umbrella and the healthcare maze that marginalized communities have to navigate, and “the coronavirus falls upon them like rain.”
For uninsured workers who forage for healthcare access or have none, treatment is simply out of the question.
Quoting a UC Davis study, Bautista explained that $3120 for farmworkers in California is the equivalent of two month’s salary. What that means for farmworkers – many of whom are at high risk of exposure to COVID19 within the industry that employs them – paying for treatment if they get infected means having to forgo food, rent, and other necessities that two months of income covers.
Disadvantaged populations have far higher case rates and mortality rates than non-Hispanic whites, said Dr. Bautista
When the virus hit, California shut down. People ‘grabbed their laptops’ and went home to work, but essential workers could not. Doctors, nurses and healthcare workers had to make sure they had PPE and equipment to treat COVID19 patients.
Other essential workers said Bautista, included meat packers, truck drivers, shelf stockers, grocery store workers, “folks working to make sure the rest of us can eat”, and check-out clerks who were far more exposed to the virus because “about 300 people pass within an arms-length.”
Those that tend to work in these occupations are mostly people of color, explained Bautista and the industries that expose them to the pandemic offer less access to care, treatment and follow up. As a result, California has high rates of exposure and mortality. The state now has a total of 922,005 positive cases. and a total of 17,626 deaths reports the California Department of Public Health.
In California, farm workers have been especially hard hit by COVID19. During the pandemic, migrant farmworkers continue to work shoulder to shoulder in ‘cuadrillas,’ and packing houses, or ride in crowded buses, putting their lives on the line to put food on our tables.
Vulnerable farmworkers (largely Latino, almost 100% immigrant, and 60-80% undocumented), are left out of the Affordable Care Act (ACA) because of their temporary status and cannot afford private health insurance. And yet, the county gave them letters confirming their essential status to travel, so they could go to work when the pandemic broke out. Workers were urged to see a doctor if they had symptoms, but without health insurance, “how would they pay to see a doctor, asked Bautista. “Some do not even know any doctors!” Their situation was further complicated by a requirement in the first few months of the pandemic, for sick people to get a doctor’s recommendation just to get a test – one they could barely afford.
“You could wind up paying $100 to almost $2000 for one test!” said Bautista. “In a farm worker family that quickly adds up.”
Even if a vaccine becomes available, said Denise Octavia Smith, Exec Director, National Association of Community Health Workers (NACHWA), it may be refused. Among Black and indigenous communities who have endured hundreds of years of medical testing and research on enslaved populations against their will, there exists a longstanding fear of vaccines, “We won’t be used as a guinea pig for white people.’’
Smith, who is tracking the disproportionate impact of Covid19 on under-resourced health systems, suggests supporting more community health workers familiar with barriers to care and wellbeing that marginalized populations experience, as trusted messengers to build bridges within these communities. This way, people who believe in efficacy of vaccine can get it when it becomes available
That moment could come sooner that they think. In a move that could transform life in COVID19 times for marginalized communities, the CDC is considering recommendations by ACIP (Advisory Committee on Immunization Practices ) to “remove unjust and barriers to good health and well-being” in some racial/ethnic minority groups that bear the disproportionate burden of the COVID19 disease.
The recommendations ask the CDC to “commit to fair stewardship in the distribution of a scarce resource.” Under review are outreach strategies that will overcome barriers to access, and reduce health disparities in each phase of vaccine distribution.
The interventions must ensure that all affected groups, populations, and communities are treated fairly and have equal opportunity to access the vaccine and treatment, not just the privileged few.
The coronavirus doesn’t discriminate. Even the President got infected. What’s different is he had access to treatment well beyond the reach of essential workers who work to put food on our table. They are the ones “we forgot about,” said Bautista, and who will fall between the cracks of our healthcare jigsaw puzzle without a safety net.
Meera Kymal is a contributing editor at India Currents