public health – R&R – Reachout and Rebuild

How We Got Here

David Posnett — Fri, 24 Apr 2020 20:36:44 +0000

How We Got Here

The media has accurately reported how President Trump’s mismanagement of COVID-19 has exacerbated this global health crisis. But Trump’s damage to our public health goes back to the beginning of his administration — and for Congressman Lee Zeldin and the rest of the Republican Party, their culpability starts much earlier.

It begins with the universal Republican vow to eliminate the Affordable Care Act and is compounded by their ideological orthodoxy to starve every federal agency of funding, including those agencies that are charged with public health. Like every Republican, this was the platform Zeldin ran on in 2014, and this is how he has voted as a member of Congress.

But these dual GOP missions — repeal the ACA and reduce the size of government — have directly contributed to the disastrous federal response to this crisis.

The ACA, while primarily concerned with health insurance access and patient protections, also focused on public health issues through the Centers for Disease Control and Prevention. In 2010, the ACA established the Prevention and Public Health Fund (PPHF) at the CDC. It supported a public health mission that included the “early detection of and response to health threats.”

The GOP could not repeal the ACA while Obama was president, but once they took over the House after the 2010 election, largely on the strength of campaigning against the ACA, they worked hard to consistently weaken it, including weakening the PPHF. Then, in 2017, with the inauguration of Trump and complete control of the federal government, they went full-steam ahead to repeal the ACA and reduce the size of all federal agencies. The CDC and the PPHF were no exception.

In early 2018, Trump signed the budget bill that cut the PPHF by $1 billion over 10 years. Later, in 2018, Trump eliminated the global health security office within the National Security Council and made further cuts to public health programs by diverting money from the CDC and the National Institutes of Health for his policy to detain migrant children. Public health experts at the time warned that such drastic moves would harm the country’s ability to respond to and contain outbreaks of disease.

Trump and Zeldin are now working overtime to bury this history. To deflect blame, Trump insists that his name be stamped on the stimulus checks being mailed to desperate Americans. In a similar vein, Zeldin recently announced how he alone got much-needed medical equipment rushed to Suffolk County.

They would like you to forget how we got here.

Barbara Weber-Floyd

Westhampton Beach

South Korea: Aggressive COVID-19 Strategies

David Posnett — Sun, 22 Mar 2020 20:16:43 +0000

S. Korea is one of the few countries that have “flattened the curve”. How did they do it?

South Korea learned its successful Covid-19 strategy from a previous coronavirus outbreak: MERS

By HyunJung Kim, March 20, 2020

This is a fascinating story. Here is an excerpt:

Korea’s response to Covid-19 is highlighting a strong public health approach to reigning in the outbreak, one that provides a lesson for the rest of the world. For the country’s health officials, however, it’s a lesson they learned the hard way. Korea’s traumatic experience with a 2015 outbreak of Middle East Respiratory Syndrome, or MERS, paved the way for many of the successful strategies the government is deploying this time around. Read more about the MERS experience here.

After news of the coronavirus outbreak began to emerge from Wuhan, China, earlier this year, the Korean government activated a 24/7 emergency response system to screen all travelers entering the country from that city. A woman was stopped at Incheon Airport en route for Japan at a fever monitoring station and transferred to a hospital where she was quarantined for 14 days. The Covid-19 diagnosis was confirmed on January 20. As it happens, that’s the same day the first US case was reported.

Since the first cases were confirmed, Korean public health authorities and local governments collaborated to precisely document the movement of infected people down to the minute. Authorities sought testimony, watched closed-circuit television, investigated smartphone GPS data and more, publicizing the so-called moving histories of Covid-19 patients. All local governments share information through websites, text messages, and media. Companies have developed apps that allow users to visualize the information. Koreans can now learn where infected people went, when they were there, and how they got there. If someone learns they might have been exposed, they can quickly visit a doctor and begin self-quarantine if they have similar symptoms.

On February 4, the Korea Centers for Disease Control and Prevention took advantage of the post-MERS reform and authorized an unlicensed Covid-19 test; the government went on to test an extraordinary number of people. By February 26, Korea had tested 46,127 cases, while by that point, Japan had tested just 1,846 cases and the United States only 426.

Stricter Gun Laws Can Reduce Deaths

David Posnett — Tue, 29 May 2018 20:36:51 +0000

Proud to be a Cornell Alumnus! These are my medical students!

As published in the latest issue of Weill Cornell Medicine: and found under the title “Weill Cornell Celebrates 20th Anniversary of Medical College Renaming”, scroll down to “Stricter Gun Laws Could Reduce Deaths”:

More stringent state regulation of firearms could help reduce rates of suicide and homicide, finds a study led by Elinore Kaufman, MD, a surgical resident at NYP/Weill Cornell and Weill Cornell Medicine. The investigators analyzed county-level data to determine whether state firearm laws have interstate spillover effects on firearm-related homicides and suicides. They found that counties located in states with restrictive laws had lower rates of homicide and suicide by firearm, regardless of neighboring states’ laws. Counties located in states with lenient policies had higher firearm death rates, with rates declining if those counties were located in close proximity to states with tougher laws. “We know that most firearm policies in the United States are made at the state level,” Kaufman says, “but states do not exist in a vacuum.” The paper was published in JAMA Internal Medicine.

Question Are state firearm laws associated with increases in interstate firearm deaths from homicide and suicide?

Findings In this cross-sectional study, strong firearm laws in a state were associated with lower firearm suicide rates and lower overall suicide rates in the state regardless of the strength of the laws in other states. Strong firearm laws in a state were associated with lower rates of firearm homicide. Counties in states with weak laws had lower rates of firearm homicide only when surrounding states had strong laws.

Meaning Strengthening firearm policies at the state level could help to reduce the incidence of both firearm suicide and homicide, with benefits that extend across state lines.

ABSTRACT:
Importance Firearm laws in one state may be associated with increased firearm death rates from homicide and suicide in neighboring states.

Objective To determine whether counties located closer to states with lenient firearm policies have higher firearm death rates.

Design, Setting, and Participants This cross-sectional study of firearm death rates by county for January 2010 to December 2014 examined data from the US Centers for Disease Control and Prevention for firearm suicide and homicide decedents for 3108 counties in the 48 contiguous states of the United States.

Exposures Each county was assigned 2 scores, a state policy score (range, 0-12) based on the strength of its state firearm laws, and an interstate policy score (range, −1.33 to 8.31) based on the sum of population-weighted and distance-decayed policy scores for all other states. Counties were divided into those with low, medium, and high home state and interstate policy scores.

Main Outcomes and Measures County-level rates of firearm, nonfirearm, and total homicide and suicide. With multilevel Bayesian spatial Poisson models, we generated incidence rate ratios (IRR) comparing incidence rates between each group of counties and the reference group, counties with high home state and high interstate policy scores.

Results Stronger firearm laws in a state were associated with lower firearm suicide rates and lower overall suicide rates regardless of the strength of the other states’ laws. Counties with low state scores had the highest rates of firearm suicide. Rates were similar across levels of interstate policy score (low: IRR, 1.34; 95% credible interval [CI], 1.11-1.65; medium: IRR, 1.36, (95% CI, 1.15-1.65; and high: IRR, 1.43; 95% CI, 1.20-1.73). Counties with low state and low or medium interstate policy scores had the highest rates of firearm homicide. Counties with low home state and interstate scores had higher firearm homicide rates (IRR, 1.38; 95% CI, 1.02-1.88) and overall homicide rates (IRR, 1.32; 95% CI, 1.03-1.67). Counties in states with low firearm policy scores had lower rates of firearm homicide only if the interstate firearm policy score was high.

Conclusions and Relevance Strong state firearm policies were associated with lower suicide rates regardless of other states’ laws. Strong policies were associated with lower homicide rates, and strong interstate policies were also associated with lower homicide rates, where home state policies were permissive. Strengthening state firearm policies may prevent firearm suicide and homicide, with benefits that may extend beyond state lines.