While the winter blizzard of Omicron cases may be a fading memory for those who have removed their masks and moved on with their lives, the risk of COVID infection and serious complications for others remains very real. There are still hundreds of new infections reported every day in Massachusetts, with people with chronic health conditions, weakened immune systems, or not fully vaccinated or strengthened being the most vulnerable to serious illness.
Now Gaffney fears the new cuts will mean many low-income patients here and around the country who become seriously ill with COVID could face huge bills they cannot afford. Or worse, they may simply forego care.
“These measures have done a lot and made it fairer for so many people,” said Gaffney, a critical care physician and assistant professor at Harvard Medical School. “The pandemic is not over as much as we would like it to be yet. And until it is, we need to maintain these types of support and coverage.
Or how he summed up his frustrations recently on Twitter: “Rationing of COVID care by ability to pay begins.”
Gaffney’s concerns are echoed by other medical, public health and community leaders, who say state and federal cuts to COVID-19 testing, treatment and vaccination initiatives will widen. already gaping gaps between the haves and the have-nots. Higher infection and death rates among black and brown communities, already a feature of the pandemic, will rise, they say, in the event of another surge.
The Baker administration, citing a sharp drop in reported infections, said March 4 that it would close three-quarters of the state’s Stop the Spread free testing sites by the end of the month. That will leave 11 of 41 in operation, with just two of them in western Massachusetts. The sites have been opened in the communities hardest hit by infections and deaths for much of the pandemic.
Additionally, the Biden administration, blaming Congress’ lack of COVID funding, on March 22 stopped paying for testing and treatment for millions of uninsured patients, including more than 200,000 in Massachusetts.
And on April 5, the federal government will stop reimbursing providers who administer vaccines to uninsured people. Federal rules prohibit providers from passing on the costs of COVID vaccination to patients, forcing those who serve uninsured community health centers to find other ways to cover those costs.
“It feels like we’re going to go back in time and pretend we haven’t learned what we’ve learned in the past two years about what inequality means,” said Carlene Pavlos, executive director of Massachusetts Public Health Association.
“It’s not just about saying there’s not the same level of access and care. This means people will die at different rates,” Pavlos said. “It’s so discouraging.”
The cuts are being made as COVID cases rise in the UK and several other European countries, often an indicator of what is to come in the US. At the same time, the steep decline in new cases in Massachusetts has bottomed out.
A spokeswoman for the Baker administration said that regardless of the cuts, any resident, regardless of insurance status, will still be able to get a free shot at one of the remaining eight state-sponsored facilities. vaccination sites, which are located in Lynn, Danvers, Boston, Brockton, Taunton, Lowell, Barnstable and Springfield, as well as local health departments.
As the Baker administration closes most of its free COVID testing sites, it said it recently distributed 10 million free at-home COVID tests to schools, daycares, shelters, community organizations focused on the immigration and other contexts.
The administration also noted that other states were also reducing their publicly funded testing sites, including Rhode Island, New Hampshire and Vermont.
Traffic through Massachusetts’ Stop the Spread COVID free testing sites continues to decline, and the 11 sites that will remain open now account for more than 70% of traffic on state-funded free sites, the administration said.
There are still hundreds of other locations that do COVID testing in Massachusetts, but most require an appointment, often a roadblock for people in low-wage jobs who can’t easily miss work.
“The Baker-Polito administration is analyzing the impacts of this cut in federal funding, but regardless, the people of Massachusetts have tools to protect themselves and their loved ones from COVID-19, including therapies, widely available vaccines and tests,” the administration said in a statement.
But what is considered widely available to some is not to others.
“Although rapid tests are widely available, it’s not as easy for people to figure out how to use them, and I’m afraid we don’t have the infrastructure to [traditional] PCR testing will be ramped up in a next wave in the fall,” said Phoebe Walker, director of the Franklin County Cooperative Public Health Service, which includes 16 communities.
A new study from a team of researchers from Boston and the US Centers for Disease Control and Prevention confirms growing concerns about the fairness and use of rapid home COVID-19 tests.
In online surveys of more than 400,000 adults nationwide between last August and mid-March, researchers found that white people were about twice as likely to report using home testing as black people. The gap was smaller but still measurable when comparing white respondents with those who are Hispanic, Asian or members of other minority groups.
The researchers also found that people living in households earning $150,000 or more were more than twice as likely to report using the tests as those earning half that amount. Similarly, those with a postgraduate degree were more than twice as likely to have used home testing, compared to those who said they had a high school diploma or less.
Dinanyili Paulino, chief operating officer of La Colaborativa, a social services agency in Chelsea, said many people who seek help from her organization have yet to receive free home tests.
“These are people working under the table… and for $15 or $20, do you think they’re going to buy a test and wait for reimbursement, or buy rice and beans,” he said. she asks. “Either they don’t have insurance, or they don’t have access to technology to get reimbursement.”
Paulino said it’s not uncommon for members of the predominantly Hispanic community to be confused by the complex instructions that come with the tests, even though they’re often written in English and Spanish.
“People come to La Colaborativa with the instructions and see if we can do it for them,” she said. “And they want us to wait with them for the results.”
Jessica Collins, Executive Director of the Public Health Institute of Western Massachusetts, said people aren’t asking for as many tests as they were during the recent Omicron push, prompting its social service agencies to focus their attention on the vaccinating more people.
State data shows more than three-quarters of residents are fully immunized, but disparities still exist between different racial and ethnic groups in many communities. In particular, these shortcomings are important for booster shots. The latest data shows that 60% of white residents received a booster, but only 38% of Hispanics and 42% of blacks received one.
Collins worries that state and federal cuts to COVID services and funding could leave Massachusetts and the country off guard, should infections and hospitalizations rise again.
“What is the recovery plan? Will they use an equity-based model, with people welcome, no questions asked, and no insurance needed? ” she says. “Don’t make us repeat this conversation about fairness.
Community health centers are the safety net for many low-income people, communities of color, and people without insurance who are more likely to feel the impact of state and federal budget cuts.
Data shows centers administered more than 900,000 COVID tests during the pandemic; nearly three-quarters of those tests were for people of color.
And of the one million doses of vaccines administered by the centers, two-thirds have been to people of color.
Michael Curry, chief executive of the Massachusetts League of Community Health Centers, said the state has earmarked about $5 million in COVID reserve funds to health centers for future testing and vaccinations.
He said the centers also recently distributed 271,000 home testing kits to patients, but developed simplified instructions in eight languages to go with them.
“As someone who is very vigilant about how we approach health equity, I know that if we are not prepared, we will see higher rates of hospitalizations and deaths. [again] in some pockets and that absolutely concerns me,” he said.
He said the growing chorus of medical and health leaders expressing concerns about cuts to COVID services and funding is vital.
“It forces us all to recalibrate and think, are we doing the right thing?” said Curry. “I’m grateful they’re beating the drums about testing and access and I’m listening to the drums.”