Category Archives: Public health

An Inequity Ignored is an Inequity Enabled

The numbers, from the start of the pandemic through 2/10/21. Source: VT Department of Health.

The subject of today’s sermon is racial inequity in health care, and more specifically, racial inequity in access to Covid-19 vaccines. We have two readings. First, a legislative hearing about racial inequity in health care. Second, a racial equity activist’s efforts, apparently ignored, to get answers about Vermont’s vaccination policy.

As you can see above, Black and Hispanic Vermonters are far more likely to contract Covid than their white counterparts. And yet, the state isn’t doing much (if anything) to address the disparity in its vaccine policy.

More on that in a moment, but let’s turn to the hearing. The House Health Care Committee is considering H.210, a bill addressing racial disparities in health care. Wednesday morning, the panel heard from a nationally known expert in the field: Dr. Maria Mercedes Avila, a UVM prof and member of the Governor’s Task Force on Racial Equity.

Dr. Avila spent the better part of two hours unspooling a wide-ranging overview of those disparities. Their roots in history, their scope and persistence, their effects, and what can be done to address and eliminate them. It was a sobering presentation.

Well, it was for most of the committee.

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Three Atonements

Ah, traditional values.

In the same week when a state lawmaker denied the existence of systemic racism in Vermont, there were hearings on three separate bills designed to atone for some of the most racist passages in state history.

Rep. Art Peterson, R-Of Course, opened his yap and revealed the hatred within during a Wednesday hearing on H.210, which would address racial disparities in health care. If you want details, click the link above. I’ll just note that Peterson (also known for opposing the display of a Black Lives Matter flag) entered the Legislature after narrowly defeating one of the most decent men in the Legislature, Dave Potter, last fall. Definitely not an improvement.

Let’s take the three bills one at a time, shall we?

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Any room for expanded opioid treatment in the budget?

Just askin’.

It’s clear that opioid use disorder has gotten more prevalent since the pandemic began, both nationally and in Vermont. The Centers for Disease Control published a report in December that said overdose deaths rose sharply after the onset of the Covid-19 pandemic, due to “a larger supply of illegal drugs, reduced access to addiction and overdose treatment, and the lethality of synthetic fentanyl.” A study published in Population Health Management reports that, while testing for illicit drugs plummeted in the early weeks of the pandemic, positive test results for opioids went through the roof.

The American Medical Association says that “More than 40 states have reported increases in opioid-related mortality as well as ongoing concerns for those with a mental illness or substance use disorder,” and recommended action “to remove barriers to evidence-based treatment for those with a substance use disorder as well as for harm reduction services.”

Which leads me to the question posed above.

Maybe there has been an expansion of treatment, harm reduction and availability of naloxone, buprenorphine and other relevant medications. Maybe the feds’ Covid relief bills brought some funding to the states for such programs. Maybe the state acted on its own to fight this aspect of the pandemic’s impact on society.

But if they have, it’s news to me.

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Dr. Levine Susan Collinses the CovidCruiser

Friday’s Scott-free* Covid briefing featured multiple questions about the CovidCruiser, which took a busload of Vermonters down to Washington for Wednesday’s pro-Trump rally turned riot. And the answers revealed a surprisingly laissez-faire attitude toward the dozens of participants who were clearly shown violating public health guidelines. During a 10-hour one-way trip in an enclosed space, which seemed ideal for superspreading.

*The governor was not present. His absence had been planned for days; it was not an attempt to duck questions about the Trump-encouraged D.C. riots.

Essentially, the state wagged its finger at the travelers.

Health commissioner Dr. Mark Levine labeled the trip as “a high risk enterprise,” and said the state issued very clear guidance on testing, mask wearing, social distancing and quarantining requirements upon returning to Vermont. But, he added, “we don’t really have the regulatory power to enforce somebody being quarantined when they are not yet a [Covid-19] case… But we’ve been very strong with the information about quarantining and testing.”

He didn’t specifically say he was concerned or disappointed, but he was obviously following the Susan Collins approach to non-ideal developments.

Public Safety Commissioner Michael Schirling was asked if the state had obtained a list of travelers, for purposes of communication and possible contact tracing. “We do not have a comprehensive list of the folks that were on the bus,” he replied. He said the state had no intention to get such a list. He added that the state did contact the bus company, which “graciously agreed to make an announcement to all of the folks that were on the bus to reinforce the quarantine guidelines.”

In all, a remarkably passive response to a clear superspreader threat. I mean, you’ve got a busload of people who were clearly shown on video riding in close proximity with nary a mask in sight. I’d think that would warrant a more robust response. Not mandatory quarantining, but getting that list and closely following the occupants for signs of illness. And something more than a mere suggestion to get tested.

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Saluting The Indomitable Heroes Of The Great Covid Counter-Revolution of 2020

The Stamford Selectboard, as they see themselves

The stupid… it burns.

The town fathers in Stamford, Vermont — population 824 — have had it up to here with Gov. Phil Scott’s dictatorial efforts to fight the Covid-19 pandemic. Mad as Hell, not gonna take it anymore.

So, by a vote of 3-2, the town Selectboard has “terminated” the governor’s public-health measures. Talk about the mouse that roared.

The majority’s action was inspired by none other than Vermont Republican Party vice-chair (and former candidate for attorney general, thank God she lost) Deborah Bucknam.

You heard right. A top official of Phil Scott’s own party is peddling this brand of intellectual snake oil. Maybe someone will ask him about this at his next coronavirus presser.

And look who showed up to push this nonsense: Kevin Hoyt, Bennington’s number-one conservative nutcase. In a Facebook post, he said the vote makes Stamford “One of the first conservative autonomous zones in the Nation.” Love the brazen self-aggrandizement there.

Stamford’s action came after Bucknam posted an essay on — wait for it — True North Reports, arguing that Scott’s action violates the state constitution. Trigger Warning: You Might Lose a Few Dozen IQ Points By Reading This.

Vermont Statute Section 13(3) of Title 20 provides that the governor “shall” declare the state of emergency terminated in a municipality when the “majority of the legislative body of a municipality affected no longer desires that the state of emergency continue within its jurisdiction.”

… The terms “shall” mean that the governor has no discretion in this matter. He must terminate the state of emergency in the municipality when the majority of the selectboard or other legislative body no longer “desires” to be under a state of emergency.

Sheesh.

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A Dangerous Journalism FAIL at True North Reports

I don’t usually bother spending any energy chronicling the reportorial misadventures of the Island of Misfit Toys doing business as True North Reports. That’s the conservative “news” outlet funded by Lenore Broughton, the reclusive ultra-right-wing millionaire.

But this one is special. And it’s a threat to our coronavirus response.

TNR’s Mike Bielawski put together a piece alleging that South Dakota has taken the proper course on Covid-19. That would come as a surprise to any credible public health expert — and I don’t include Peter Navarro or Scott Atlas in those ranks.

And it’s entirely based on a mathematical blunder of epic proportions.

Bielawski cites the two states’ similar death tolls — 165 for South Dakota, 58 for Vermont.

The 58 was Vermont’s total death toll as of a couple months ago. Mikey didn’t bother to update it. But the real whopper is the South Dakota figure, which is not total deaths but the death rate per 100,000 residents!

The actual death count in South Dakota is 1,448. That’s far, far worse than Vermont’s. How much worse? Try eight times as bad. According to the Centers for Disease Control, South Dakota’s death rate is 158 per 100,000. Vermont’s is 20.

Again, normally I wouldn’t bother to debunk this kind of nonsense — except the article argues that we should follow South Dakota’s example because Covid isn’t really that bad. That, my friends, is dangerous. And according to the headline, this is one of TNR’s “most read” pieces. So it’s getting traction among the site’s small audience of hard-core conservatives.

After the jump: More whoppers!

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The True Heatmap

Well, looky here. One week after I noted that the state of Vermont’s travel map was “deeply misleading” (text) or “a lie” (headline), the state has issued a new version, reproduced above. And it clearly shows that we’re just as besieged by the pandemic as any of our neighbors.

I’ll take one sentence to crow about feeling vindicated. And then I’ll say that on balance, I’d rather be wrong in this case. Especially since I live in Washington County, which is Ground Zero of our current outbreak. (Thanks, recreational hockey league!)

For those just joining us, the state’s official travel map had made it seem like Vermont was somehow immune from the coronavirus. Other states were assigned green, yellow and red, while Vermont was illustrated in three shades of blue — for the same disease rates. Light blue was the same as green, and dark blue was the same as red. If considered strictly as a “travel map,” one could argue that the coloring was appropriate. But it also sent a signal that Vermont was doing just fine, thank you, and if that led anyone to let down their guard, it helped contribute to the upward spiral in our Covid numbers.

So far, Gov. Phil Scott has received a lot of credit for his coronavirus response. It’s beginning to look like he’s taken a few too many chances as we enter a new and much more severe phase of the pandemic. Throughout, he has listened to his experts and made decisions based partly on their input and party with an eye on the economy — even as he has consistently claimed to be placing science above all.

Did he give his renowned spigot a few too many turns? It’s beginning to look like it. We can’t lay it all at his feet, but he did play a role in the growth of a false sense of confidence among Vermonters. This new map, with its unavoidable and unbroken sea of red, should serve as a wake-up call for himself and his officials and for all of us.

This Map Is A Lie

I’ve been following the state of Vermont’s travel maps for months now, and watching the grim progression of the “red zone” closer and closer to our borders. Through it all, I’ve gotten a bit of visual comfort from Vermont’s apparent exemption from the great red tide.

But, as others have noted this week, that comfort was entirely without foundation. The blue lagoon shouldn’t be blue at all; it should be a mix of red, yellow and green. You don’t get that if you just glance at the map. But if you check the fine print, you see that the three shades of blue correspond to red, yellow and green. By the standards of this map, my county (Washington) is in the red zone, the no-travel zone.

The shades of blue for Vermont are a deliberate choice by the creator of the map — the Department of Financial Regulation. And it’s deeply misleading. It feeds into our innate sense that Vermont is different, better, and at least somewhat immune from the problems that beset all the other states. Like we have an invisible, ineffable moat around our borders.

In truth, if the same color scheme was used throughout, Vermont’s counties would be roughly equally red, yellow and green. And in fact, the situation has already worsened; we learned at the Scott administration’s Friday Covid briefing that roughly one-half of Vermont counties would be colored red if the out-of-state standards were applied.

If I were to ask why Vermont’s counties were colored in blue, the response would probably be, “Well, this is a travel map, and we want to showcase the areas where it’s safe to travel from. Vermont isn’t part of that equation.”

Okay, well, maybe. But at the very least, they should use a different set of much flashier colors instead of three subtly differing shades of the same hue. Maybe orange, purple and blue?

This is the state’s travel map. But it’s also the state’s primary (perhaps only) visual representation of the spread of the coronavirus. The map should be recrafted to accurately impart that message as well.

Finally, those stupid Travel Maps are good for something

Useless Travel Map, June 30 edition

I have previously railed against the state’s Travel Map, which is supposed to let out-of-state visitors know whether they can enter Vermont without self-quarantining. Roll the tape, please.

C’mon, now. Do you really expect out-of-staters to look up and obey this map? Which, by the way, changes weekly — so don’t pre-plan a visit for two or three weeks from now, because your county might turn yellow or red.

That was just one of multiple objections to the map. But finally, I’ve found a way in which it’s legitimately useful: it quantifies our collective feeling of dread.

Looking at multiple maps in sequence shows how the virus is spreading, and illustrates exactly why Gov. Phil Scott finally imposed a mask mandate. The map above was released on June 30; here’s the July 10 version.

As a reminder, each area is a county. “Green” counties have low Covid rates, so their residents can travel to Vermont without restriction. But on July 11, there was already a lot more yellow and red, and a lot less green, than on June 30.

Now here’s the latest version, released on July 31.

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Don’t buy any green bananas

Is anyone feeling confident right now?

You shouldn’t.

Vermont has been spared the worst of the pandemic so far. But even so, we’re dealing with constant uncertainty — and a financial calamity that’s just beginning to be felt.

And every day we’re one step closer to the fall, when coronavirus is likely to hit even harder.

Where do I even begin? Education seems the best place. Educators at all levels, not to mention parents, are furiously trying to develop plans that are subject to change on a moment’s notice. This week, Gov. Phil Scott identified September 8 as the first day of school — but that could mean in-person, online, or most likely a mix of the two. Scott and Health Commissioner Dr. Mark Levine sought to reassure the public that, as Levine put it, “In Vermont, this is the right time to open schools.”

Of course, in the same press conference, Education Secretary Dan French conceded that “This is uncharted territory that acknowledges a considerable amount of uncertainty and anxiety.”

This came a few days after Brigid Nease, superintendent of the Harwood Union Unified School District, posted a letter to her community outlining all the uncertainties and obstacles facing her staff. It’s worth reading, but what struck me was the complete lack of confidence that, even if it was safe to open schools, there may not be enough staff.

Letters of resignation, requests for leaves of absence, Family Medical Leave (FMLA), Emergency Family Medical Leave (EFML), Emergency Paid Sick Leave (EPSL), Exemption status, and leave under the Families First Coronavirus Relief Act (FFCRA) (Which provides up to 12 weeks of leave for employees unable to work because their child’s school is closed) are coming in.

The truth is most school employees are scared to death they will get sick (or worse), bring the virus home to loved ones, have a student in their care become ill, or experience the death of a coworker.

Meanwhile, on the higher education front, colleges and universities are constantly fiddling with their reopening plans — all of which seem to be based on crossed fingers and an unfounded faith in the self-restraint of college students.

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