Daily Archives: July 3, 2020

Drive-Through Naturalizations Make New U.S. Citizens In The COVID-19 Era – NPR

Posted: July 3, 2020 at 5:45 am

An immigration officer administers the oath of allegiance at a drive-through naturalization ceremony in El Cajon, Calif. Max Rivlin-Nadler/KPBS hide caption

An immigration officer administers the oath of allegiance at a drive-through naturalization ceremony in El Cajon, Calif.

In El Cajon, Calif., a procession of cars carrying 600 soon-to-be U.S. citizens from 68 countries passed through a series of stations behind a local community center earlier this week, where they were asked a series of final questions: "Any coronavirus symptoms? Have you been arrested since your interview? No tickets, nothing like that?"

After that, they were asked to surrender their green card and given a small U.S. flag. Driving a little farther forward, an immigration officer wearing a face cover administered the oath of allegiance 6 feet from the car's window. And in a matter of minutes, years of uncertainty were over hundreds of people became U.S. citizens over the course of the day.

When the coronavirus pandemic put a hold on naturalization ceremonies in March, it left a backlog of thousands of people who had qualified to become citizens but hadn't been able to officially swear an oath of allegiance the final step in the often years-long process.

To try to clear the backlog as quickly and safely as possible, U.S. Citizenship and Immigration Services put together a series of naturalization drive-throughs, where prospective citizens could take the final step toward citizenship without leaving their cars.

Prior to the shutdown, the greater San Diego area held its monthly naturalization ceremonies at Golden Hall, a giant venue in downtown San Diego that fits thousands of people. During the coronavirus pandemic, it has been converted to a homeless shelter.

"Whoo-whoo!" Belinda Rodriguez shouted from a parking spot, just moments after becoming a citizen.

Rodriguez had been working toward naturalization for 20 years. She brought her sister and niece along with her for the drive-through ceremony. She was relieved to finally be able to take her final step toward citizenship before she had to renew her residency permit.

"I was thinking my card was going to expire," Rodriguez said. "I was going to have to do it again and maybe have a longer time than this, pay more money, more fees."

Immigration officers in El Cajon held drive-through ceremonies every weekday since early June to play catch-up for the three months that there were no ceremonies in Golden Hall.

"Golden Hall is a great ceremony, but this makes it a lot more personal almost," said Madeline Kristoff, the USCIS field officer for San Diego. "The officers get to participate in ways they normally don't get to in Golden Hall. And it's really fun to talk to people who are driving through and get to hear a little of their stories."

Instead of greeting an auditorium full of faces, immigration officers administering the oath are often doing so for just one or two people at a time.

"I wish we could get a cheeseburger or like a milkshake for you guys too," said one immigration officer, making conversation with driver Niru Reinier.

Reinier, from India, was naturalized 10 years ago. On Monday, she chauffeured her mother, who was becoming a citizen.

"I called my sister and I said, 'I feel like this is so SoCal.' Everything happens quickly," she said.

Ready to vote

Many of the new citizens said what they were looking forward to most was voting in elections this November.

"We got our interview right before the shutdown, and I didn't know if I was going to be able to vote, which ultimately is an important part of why I want to become a citizen," said Raphael Declercq, who was born in France. He appreciated that the drive-through was able to make that happen. "I'm glad they're making those efforts."

Outside of a regular naturalization ceremony, voter registration tables greet people as they exit. At the drive-through, there were no booths to be found. But, along with their small U.S. flags, new citizens were given packets that included instructions on how to register to vote.

USCIS, currently facing a massive budget shortfall due to a reduction of visa applications, is looking to transition back to larger naturalization events later this summer.

"All right, congratulations to you, give her a big round of applause. You are now our newest United States citizens," said an immigration officer after administering the oath for the third consecutive hour.

The new citizen responded with a short honk of her car horn.

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Communities around Alaska canceled Fourth of July celebrations to slow COVID-19. Now unsanctioned events are replacing them. – Anchorage Daily News

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As Alaskas COVID-19 case counts soared, Anchorage and almost every community around the state canceled Independence Day celebrations to stem the spread of the coronavirus.

Now popping up are alternative celebrations such as parades, but also a sing-along and a pie-eating contest just the type of close-up activities officials wanted to avoid to minimize the potential spread of infection.

An organizer urged people in Homer to come out to a Fourth of July march with a Facebook post: I say we bring our flags our drums and our guns out. In Juneau, where local officials discouraged large social gatherings, plans included an unpermitted parade.

And in Palmer, hundreds are expected to celebrate the holiday with the two-day Valley Freedom Festival that features vendors, a pie-eating contest and a parade down Palmers main street with full support of the citys mayor despite local concerns.

There are a lot of people that want to get out and celebrate the Fourth of July, Palmer Mayor Edna DeVries said Monday. There will be plenty of social distancing. People will be able to wear masks if they want to.

DeVries said she supported the event for the same reason she supported a Black Lives Matter rally in early June with a large crowd that included Second Amendment supporters.

People have a right to freely assemble, she said. So Im standing with that.

Palmers weekly Friday Flings are still happening, a summer tradition with food trucks, vendor booths and music that draw crowds to a fairly restricted area. Health officials do say that outdoor events are preferable to people packed together indoors.

But some Palmer residents are worried that crowds at the Valley Freedom Festival on Friday and Saturday could bring more COVID-19 that eventually spreads to people who dont even choose to attend.

Someone posted a question on a popular local Facebook group on Wednesday: Is anyone else worried that the crowds coming to Palmer from other communities might exacerbate the situation here in our little town?

The sites administrator shut off comments, saying the almost 40 responses generated within 20 minutes violated guidelines banning snarky language.

Alaskas COVID-19 cases rose after Memorial Day weekend gatherings, state health officials say. Now case counts are surging again and the active infection rate hits new highs daily.

Mat-Su this week was experiencing a spike in cases, especially in the cities of Palmer and Wasilla. The reported count in Mat-Su residents rose to 102 by Thursday an increase of 20 cases in two days.

State officials said the rising cases will eventually lead to more hospitalizations and implored safe practices as Alaskans geared up for the holiday weekend ahead.

Gov. Mike Dunleavy, when asked about the alternative Fourth of July events, urged participants to practice social distancing and wear masks, a step his administration has not required.

For folks that are going to be in large congregations, groups, its just a fact when you get closer together, you increase the risk of spreading this virus, Dunleavy said Tuesday.

The top emergency doctor at the only hospital in Mat-Su issued a grim warning this week about the importance of wearing masks, citing a large study showing 8% weekly growth of infections in countries with widespread masking compared to 54% in those without.

Dr. Thomas Quimby saw a middle-aged COVID-19 patient recently. The patient had been sick for a week yet was still getting sicker.

Quimby, the emergency department director at Mat-Su Regional Medical Center, said the patient was having trouble breathing. An X-ray revealed telltale spots on their lungs.

At that point the person didnt need oxygen, he said. But there was nothing else the doctor could do. He feared the patient would need to be admitted in the future.

That was a really awful feeling to look at this person and see how they were suffering and to just be helpless as a clinician, Quimby said at a community briefing Wednesday. I just want to remind everyone: thats still this disease that were dealing with.

The Valley Freedom Festival arose after Wasilla canceled its traditional Fourth of July celebration, organizers say.

Valley residents rose up and demanded something be done, the event website says. The Valley is an independent place, made up of people who are smart, caring, resilient, and FREE. The Valley Freedom Festival is a testament to the people of the Valley and our demand to Let Freedom Ring.

Organizer Haylee Kurka, a local business owner, said shes one of numerous businesspeople putting on the event with their own money.

Kurka on Wednesday said shes expecting attendance numbers anywhere from the high hundreds to a couple thousand, given the public event cancellations around Southcentral.

The Freedom Festival will station food trucks and vendors in the parking lot of the MTA Events Center near Palmers middle school. The schedule includes a pie-eating contest, sing-along, national cloggers and the big parade down Palmers main street on Saturday.

There are more than 20 floats signed up to take part in the parade.

Attendees are encouraged to bring lawn chairs, picnic blankets, good attitude, and cheerful heart, the event site says.

They are not required to wear masks nor follow other COVID-19 mandates, restrictions or dictates.

Asked how organizers are dealing with surging numbers of coronavirus cases, Kurka said the event is entirely outdoors, and it has a mitigation plan based on guidance from the federal Centers for Disease Control and Prevention. Many of the states new cases are associated with bars and other indoor spaces, health officials say.

Were also recognizing you do have a personal responsibility, Kurka said. If you dont want to be potentially exposed to the virus, we would think that people wouldnt attend. Theres not going to be much other than that ... its definitely based on what people feel comfortable with.

Palmer issued a special-events permit on June 12 but is not planning to provide additional personnel, according to Palmer City Manager John Moosey. Organizers met with public works officials and the police chief.

Palmer falls within the Mat-Su Borough, but the borough lacks authority to order masks at an event like this, Borough Mayor Vern Halter said. Thats up to the mayor of Palmer, who has the authority to require masks or restrict events.

Halter said hed highly recommend people attending wear masks.

A big parade, people close together its probably the exact opposite of what we should be doing, he said.

Palmers neighboring city of Wasilla canceled Fourth of July plans two months ago. That decision was made as much over the unknowns surrounding this years fire danger as the threat of the pandemic, Wasilla Mayor Bert Cottle said this week.

But given the resurgence of the novel coronavirus, Cottle said he wouldnt be comfortable approving a parade in the narrow confines of the citys 1-mile route.

With the outbreaks that were having now, you cant put 7,000 to 10,000 people on Main Street shoulder to shoulder and have to worry about social distancing, stuff like that, Cottle said Monday. I cant do that. Thats too big of a risk.

Anchorage and most other communities canceled Independence Day celebrations ahead of the weekend.

Lawmakers in Juneau this week voted against an emergency ordinance that would have allowed fireworks to go ahead this weekend.

Officials in Seward this week canceled Fourth of July events entirely and implemented a series of measures on mask-wearing, gathering sizes and business capacity amid a growing coronavirus outbreak in that Kenai Peninsula city.

Homers Chamber of Commerce canceled that communitys parade fairly early on in this whole COVID situation, said chamber director Brad Anderson, adding the decision seemed right this week given the recent uptick in case numbers,

The parade can draw more than a thousand people. But a number of participants didnt feel comfortable even getting close together enough to build the floats, Anderson said.

The chamber also planned to celebrate first responders and health care workers with the parade, he said. They were the ones that said, Hey look, in bringing people together, this probably isnt the right direction for us this year.

An Anchor Point man is proposing an alternate parade Saturday from the elementary school to the Homer Spit, according to a widely viewed post on a local Facebook group that had attracted hundreds of comments. Organizer Matthew Mitchell recommended that route so people could spread out but still watch the bikes, cars, trucks, jeeps, tractors or other parade vehicle go by.

This call out is to all Veterans, Patriots and pure-blooded Americans, Mitchell posted Sunday. This parade is for the people by the people of Free men and women. Who are ready to get off the sidelines and show we will not stand for or tolerate dictatorship or tyranny over our Freedom. We are Free People.

[Because of a high volume of comments requiring moderation, we are temporarily disabling comments on many of our articles so editors can focus on the coronavirus crisis and other coverage. We invite you to write a letter to the editor or reach out directly if youd like to communicate with us about a particular article. Thanks.]

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Communities around Alaska canceled Fourth of July celebrations to slow COVID-19. Now unsanctioned events are replacing them. - Anchorage Daily News

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COVID-19 Daily Update 7-1-2020 – 10 AM – West Virginia Department of Health and Human Resources

Posted: at 5:45 am

TheWest Virginia Department of Health and Human Resources (DHHR)reports as of 10:00 a.m., on July 1, 2020, there have been 173,251 totalconfirmatory laboratory results receivedfor COVID-19, with 2,932 total cases and 93 deaths.

In alignment with updated definitions fromthe Centers for Disease Control and Prevention, the dashboard includes probablecases which are individuals that have symptoms and either serologic (antibody)or epidemiologic (e.g., a link to a confirmed case) evidence of disease, but noconfirmatory test.

CASES PER COUNTY (Case confirmed by lab test/Probable case):Barbour (15/0), Berkeley (440/18), Boone(22/0), Braxton (3/0), Brooke (8/1), Cabell (120/4), Calhoun (2/0), Clay(10/0), Fayette (66/0), Gilmer (13/0), Grant (15/1), Greenbrier (58/0),Hampshire (42/0), Hancock (20/3), Hardy (43/1), Harrison (61/0), Jackson(143/0), Jefferson (226/5), Kanawha (314/9), Lewis (18/1), Lincoln (8/0), Logan(24/0), Marion (56/3), Marshall (40/1), Mason (18/0), McDowell (6/0), Mercer(40/0), Mineral (54/2), Mingo (17/3), Monongalia (161/14), Monroe (11/1),Morgan (19/1), Nicholas (9/1), Ohio (95/0), Pendleton (12/1), Pleasants (4/1),Pocahontas (24/1), Preston (64/15), Putnam (54/1), Raleigh (51/1), Randolph(157/1), Ritchie (2/0), Roane (11/0), Summers (2/0), Taylor (15/1), Tucker(6/0), Tyler (4/0), Upshur (18/1), Wayne (110/1), Webster (1/0), Wetzel (10/0),Wirt (4/0), Wood (78/8), Wyoming (7/0).

As case surveillance continues at thelocal health department level, it may reveal that those tested in a certaincounty may not be a resident of that county, or even the state as an individualin question may have crossed the state border to be tested.

Please visit thedashboard at http://www.coronavirus.wv.gov for more information.

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Under Trump, Covid-19 Spreads While the Economy Stalls – The New York Times

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The thing is, Covid-19s resurgence was utterly predictable and predicted. When Donald Trump declared that we would transition to greatness which is to say, rush to reopen the economy despite a still-rampant pandemic epidemiologists warned that this could set off a new wave of infections. They were right.

And economists warned that while relaxing social distancing would lead to a brief period of job growth, these gains would be short-lived, that premature reopening would be self-defeating even in economic terms. They were also right.

Dont be fooled by the big jobs number in Thursdays employment report a number that still left us down almost 15 million jobs from February. The report was a snapshot of the economy during the reference period, basically the second week of June. So its telling us what was happening before the Covid-19 surge became apparent.

We dont have official data for what has happened since then, but a variety of real-time indicators suggest that the recovery has stalled or even gone backward. Indeed, things started falling apart even before states began reversing some of their previous moves to reopen. Fear of infection will do that: Many people will avoid going out whatever their governors may say.

As a result, unemployment, still in double digits, probably wont get much better for a long time.

Now, there isnt a one-to-one correspondence between jobs and the spread of the pandemic. If we had all worn masks and avoided stupid policies like reopening bars and resuming large indoor gatherings, we probably could have had substantial job gains without surging infections. But we didnt, largely because Trump and Republican governors refused to take sensible actions (and in many cases prevented mayors and other local officials from acting sensibly on their own).

Nor can we simply hit the reset button. Activities we could have safely resumed two months ago, when infection rates were low, arent safe to continue given todays much higher Covid-19 prevalence. That is, were in worse shape, even economically, than we would have been if Trump and his allies had taken the pandemic seriously early on.

The really frightening aspect about where we are is that Trump and his people dont seem to have learned anything from their coronavirus debacle. On Wednesday Wednesday! Trump insisted, as he has at every stage of the pandemic, that the coronavirus will sort of just disappear.

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Under Trump, Covid-19 Spreads While the Economy Stalls - The New York Times

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COVID-19 Daily Update 7-2-2020 – 10 AM – West Virginia Department of Health and Human Resources

Posted: at 5:45 am

TheWest Virginia Department of Health and Human Resources (DHHR)reports as of 10:00 a.m., on July 2, 2020, there have been 177,287 totalconfirmatory laboratory results receivedfor COVID-19, with 3,006 total cases and 93 deaths.

In alignment with updated definitions fromthe Centers for Disease Control and Prevention, the dashboard includes probablecases which are individuals that have symptoms and either serologic (antibody)or epidemiologic (e.g., a link to a confirmed case) evidence of disease, but noconfirmatory test.

CASES PER COUNTY (Case confirmed by lab test/Probable case):Barbour (15/0), Berkeley (441/18), Boone(21/0), Braxton (3/0), Brooke (8/1), Cabell (128/6), Calhoun (2/0), Clay(10/0), Fayette (66/0), Gilmer (13/0), Grant (15/1), Greenbrier (61/0),Hampshire (42/0), Hancock (20/3), Hardy (43/1), Harrison (65/0), Jackson(143/0), Jefferson (228/5), Kanawha (318/9), Lewis (18/1), Lincoln (8/0), Logan(25/0), Marion (58/3), Marshall (40/1), Mason (19/0), McDowell (6/0), Mercer(45/0), Mineral (55/2), Mingo (20/3), Monongalia (166/14), Monroe (12/1),Morgan (19/1), Nicholas (10/1), Ohio (97/1), Pendleton (12/1), Pleasants (4/1),Pocahontas (26/1), Preston (64/15), Putnam (58/1), Raleigh (53/1), Randolph(161/1), Ritchie (2/0), Roane (11/0), Summers (2/0), Taylor (15/1), Tucker(6/0), Tyler (4/0), Upshur (20/1), Wayne (111/1), Wetzel (10/0), Wirt (4/0),Wood (92/8), Wyoming (7/0).

As case surveillance continues at thelocal health department level, it may reveal that those tested in a certaincounty may not be a resident of that county, or even the state as an individualin question may have crossed the state border to be tested.Such is the case of Berkeley County in this report.

Please visit thedashboard at http://www.coronavirus.wv.gov for more information.

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Social Divisions Drive Astronomical COVID-19 Rate In Chile : Goats and Soda – NPR

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A nurse protests Chile's handling of the coronavirus pandemic. The country now has the highest per capita infection rate of any major country 13,000 cases for every 1 million people. Marcelo Hernandez/Getty Images hide caption

A nurse protests Chile's handling of the coronavirus pandemic. The country now has the highest per capita infection rate of any major country 13,000 cases for every 1 million people.

Chile looked as if it were well prepared to deal with the new coronavirus.

It's a rich country classified as high income by the World Bank. Life expectancy is roughly 80 years better than the United States'. It has a solid, modern health care system, and when the outbreak began spreading, officials made sure they had plenty of ventilators and intensive care beds at the ready.

But the virus exploited the cracks in Chilean society. The country now has the highest per capita infection rate of any major country 13,000 cases for every 1 million people. That's more than 10 times the rate in neighboring Argentina and twice the rate in Brazil.

Like many well-to-do countries, Chile saw its first cases of COVID-19 among its elite people who'd recently traveled to Europe and the United States. That was in April. The government quickly rolled out a plan to provide testing and treatment. Health officials quarantined hard-hit neighborhoods. Residents had to apply for a pass online before they could go out of their homes even to buy groceries. In late April, things were going so well that Chile was starting to talk about reopening.

"And then May started bringing more cases and more cases. Currently we have, in my opinion, more cases than we are able to handle," says Thomas Leisewitz, a physician in Santiago. Leisewitz is a professor at Pontificia Universidad Catlica de Chile and heads up strategic development at Red de Salud UC Christus, a nonprofit Catholic health care network.

Since May, the number of cases has been rising steadily, with the country recording at one time 5,000 to 6,000 new cases a day in June. The virus spread out of the affluent parts of Santiago to low-income neighborhoods where many residents don't have the luxury of being able to work from home.

And the high numbers are not just a reflection of an efficient testing infrastructure. Chile's per capita testing rate is lower than most European nations' and almost half the rate in the United States.

So how did this particular virus come to spread incredibly rapidly in wealthy, well-prepared Chile?

Andrea Insunza, a journalist in Santiago, says the reason is something unrelated to the virus itself. That something is social inequity.

"In Chile, there are two countries," says Insunza, who runs the center for investigative journalism at Universidad Diego Portales. "There's a country for people like me. I have a good education. I have a good salary, and all my social security is privatized."

By this she means she has access to high-quality private hospitals and clinics.

But there's another Chile.

"And that Chile is poor and you depend on the public health [system]," says Insunza.

Last October, violent street protests erupted in Santiago over a fare hike on the subway of 30 pesos, or less than 5 U.S. cents.

The protests became about far more than the price of a subway ride. Chile is one of the most unequal countries in Latin America, according to the World Bank. The elite, the top 10%, controls more than half the country's wealth. And while extreme poverty has been driven down significantly over the last decade, the social unrest in October centered on the frustrations of lower- and middle-class Chileans who view their economic opportunities as unfairly limited.

Insunza says part of the frustration is driven by the elite often not even seeming to recognize their privileged lifestyles.

"Santiago, it's a very segregated place," Insunza says. "You can actually live your whole life and don't see poverty. Never."

Chile's initial plan to deal with the coronavirus outbreak which at first affected mainly the elite in Santiago failed to recognize that the affluent have maids, gardeners and cooks who might also get infected.

The country's response went well in those early weeks. Case numbers were holding steady. The fatality rate was low.

Then the virus started spreading in lower-income neighborhoods and quickly got out of control.

"One thing that's interesting about Chile is that it probably has more state capacity in a technical way than any place in Latin America," says James Robinson, a professor at the University of Chicago and co-author of Why Nations Fail. He has written extensively about Latin America and, in particular, Chile.

"It's good at raising taxes and building roads and infrastructure," he says. "And there's not much corruption and things like that, but it's also a very polarized place."

Robinson says large segments of the public don't trust the state. They are wary of cooperating with government, which may be part of what has hindered Chile's response to the coronavirus outbreak.

In June, the health minister stepped down over his handling of the crisis and discrepancies over the case numbers he reported domestically, which were lower than the counts given to the World Health Organization.

President Sebastin Piera caused an uproar last week when he attended the funeral of his uncle along with more than 30 other people, while the government's coronavirus rules allow only 20 people at funerals.

Despite the government offering cash support and food to people who've lost work because of the lockdowns, Robinson says many Chileans feel that the system is stacked against them. And that's impeding the country's ability to tackle this virus.

"There's a real problem with the social contract in Chile," he says. "And the way they tried to manage this thing just seems to have sort of exacerbated a lot of those problems."

Chile has now extended lockdowns to more areas and put in tougher limits on movement to try to rein in the surging outbreak. In Santiago, residents who are not deemed essential workers are only being allowed to leave their houses twice a week, including trips for grocery shopping.

The regional office of the World Health Organization, the Pan American Health Organization, predicts that cases will continue to rise in Chile at least into the middle of July.

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She Tried To Get A Coronavirus Test. Now She Owes $1,840 : Shots – Health News – NPR

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Insurers must cover coronavirus testing, according to federal law, but medical visits to discuss symptoms may not be covered, unless a test is ordered at that time. ER Productions Limited/Getty Images hide caption

Insurers must cover coronavirus testing, according to federal law, but medical visits to discuss symptoms may not be covered, unless a test is ordered at that time.

Carmen Quintero works an early shift at a distribution warehouse that ships N95 masks and other products to a nation under siege from the coronavirus. On March 23, she had developed a severe cough, and her voice, usually quick and enthusiastic, was barely a whisper.

A human resources staff member told Quintero she needed to go home.

"They told me I couldn't come back until I was tested," said Quintero, who was also told that she would need to document that she didn't have the virus.

Her primary care doctor directed her to the nearest emergency room for testing because the practice had no coronavirus tests.

The Corona Regional Medical Center is just around the corner from her house in Corona, Calif. They didn't have any tests either, but there a nurse tested her breathing and gave her a chest X-ray. For testing, the nurse told her to go to Riverside County's public health department. There, a public health worker gave her an 800 number to call to schedule a test. The earliest the county could test her was April 7, more than two weeks later.

Carmen Quintero works at a distribution center that ships N95 masks and other products. She owes $1,840 for other care she received when she tried to get a coronavirus test. Heidi de Marco/KHN hide caption

Carmen Quintero works at a distribution center that ships N95 masks and other products. She owes $1,840 for other care she received when she tried to get a coronavirus test.

At the hospital, Quintero got a doctor's note saying she should stay home from work for a week and she was told to behave as if she had COVID-19, the disease caused by the coronavirus, and to isolate herself from vulnerable household members. That was difficult Quintero lives with her grandmother and her girlfriend's parents but she managed. No one else in her home got sick, and by the time April 7 came, she felt better and decided not to get the coronavirus test.

Then the bill for the ER visit came.

The patient: Carmen Quintero, 35, who works at a warehouse that distributes N95 masks and other products, and lives in Corona, Calif. She has an Anthem Blue Cross health insurance plan through her job with a $3,500 annual deductible.

Total bill: Corona Regional Medical Center billed Quintero $1,010, and Corona Regional Emergency Medical Associates billed an additional $830 for physician services for her visit attempting to get a test. She also paid $50 at Walgreens to fill a prescription for an inhaler.

Service provider: Corona Regional Medical Center, a for-profit hospital owned by Universal Health Services, a company based in King of Prussia, Pa., which is one of the largest health care management companies in the nation. The hospital contracts with Corona Regional Emergency Medical Associates, part of Emergent Medical Associates.

Medical service: Quintero was evaluated in the emergency room for symptoms consistent with COVID-19: a wracking cough and difficulty breathing. She had a chest X-ray and a breathing treatment and was prescribed an inhaler.

What gives: Quintero knew she had a high-deductible plan yet felt she had no choice but to follow her doctor's advice and go to the nearest emergency room to get tested. She assumed she would get the test and not have to pay. Congress had passed the CARES Act just the week before, with its headlines saying coronavirus testing would be free.

That legislation turned out to be riddled with loopholes, especially for people like Quintero who needed and wanted a coronavirus test but couldn't get one early in the pandemic.

Insurers do have to cover tests, but when a patient goes to see a doctor to be checked out for COVID-19 symptoms, if no test is ordered or administered, insurers aren't required to cover the appointment without cost sharing.

So Quintero was on the hook for the copay.

"I just didn't think it was fair because I went in there to get tested," she said.

Some insurance companies are voluntarily reducing copayments for coronavirus-related emergency room visits. But Quintero said her insurer, Anthem Blue Cross, would not reduce her bill. Anthem would not discuss the case until Quintero signed its own privacy waiver; it would not accept a signed standard waiver KHN uses. The hospital would not discuss the bill with a reporter unless Quintero could also be on the phone, something that has yet to be arranged around Quintero's work hours.

Three states have gone further than Congress to waive cost sharing for testing and diagnosis of pneumonia and influenza, given these illnesses are often mistaken for COVID-19. California is not one of them, and because Quintero's employer is self-insured the company pays for health services directly from its own funds it is exempt from state directives anyway. The U.S. Department of Labor regulates all self-funded insurance plans. In 2019, nearly 2 in 3 covered workers were in these types of plans.

Related health care hurdle: On that day in late March when her body shook from coughing, Quintero's immediate worry was infecting her family, especially her girlfriend's parents, both older than 65, and her 84-year-old grandmother.

"If something was to happen to them, I don't know if I would have been able to live with it," said Quintero.

Quintero wanted to isolate in a hotel, but she could hardly afford to for the week that she stayed home. She had only three paid sick days and was forced to take vacation time until her symptoms subsided and she was allowed back at work. At the time, few places provided publicly funded hotel rooms for sick people to isolate, and Quintero was not offered any help.

As lockdown restrictions ease and coronavirus cases rise around the country, public health officials say quickly isolating sick people before the virus spreads through families is essential.

But isolation efforts have gotten little attention in the U.S. Nearly all local health departments, including Riverside County where Quintero lives, now have these programs, according to the National Association of County and City Health Officials. Many were designed to shelter people experiencing homelessness but can be used to isolate others.

Raymond Niaura, interim chairman of the Department of Epidemiology at New York University, said these programs are used inconsistently and have been poorly promoted to the public.

"No one has done this before and a lot of what's happening is that people are making it up as they go along," said Niaura. "We've just never been in a circumstance like this."

Resolution:

The bills have been a constant worry. Quintero called the hospital and her insurance company and complained that she should not have to pay since she was seeking a test on her doctor's orders. Neither budged, and the bills labeled "payment reminders" soon became "final notices." She reluctantly agreed to pay $100 a month toward her balance $50 to the hospital and $50 to the doctors.

"None of them wanted to work with me," Quintero said. "I just have to give the first payment on each bill so they wouldn't send me to collections."

On top of that, Quintero still worries about bringing the virus home to her family and fears being in the same room with her grandmother. Quintero works at a warehouse that distributes 3M products including personal protective equipment and other companies' products. When she returns from work every day now, she puts her clothes in a separate hamper and diligently washes her hands before she interacts with anyone.

The takeaways:

At this point in the pandemic, tests are more widely available and federal law is very clearly on your side: You should not be charged any cost sharing for a coronavirus test.

Be wary, though, if your doctor directs you to the emergency room for a test, because any additional care you get there could come at a high price. Ask if there are any other testing sites available.

If you do find yourself with a big bill related to suspected coronavirus, push beyond a telephone call with your insurance company and file a formal appeal. If you feel comfortable, ask your employer's human resources staff to argue on your behalf. Then, call the help line for your state insurance commissioner and file a separate appeal. Press insurers and big companies that offer self-insured plans to follow the spirit of the law, even if the letter of the law seems to let them off the hook.

If you suspect you have COVID-19 and need to isolate to protect vulnerable members of your household, call your local public health department. Most counties have isolation and quarantine programs, but these resources are not well known. You may be placed in a hotel, recreational vehicle or other type of housing while you wait out the infection period. You do not need to have a positive coronavirus test to qualify for these programs and can use these programs while you await your test result. But this is an area in which public health officials repeatedly offer clear guidance 14 days of isolation which most people find impossible to follow.

Bill of the Month is a crowdsourced investigation by Kaiser Health News and NPR that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!

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In the Covid-19 Economy, You Can Have a Kid or a Job. You Cant Have Both. – The New York Times

Posted: at 5:45 am

But my family, as a social and economic unit, cannot operate forever in the framework authorities envision for the fall. There are so many ways that the situation weve been thrust into, in which businesses are planning to reopen without any conversation about the repercussions on families with school-age children, is even more untenable for others.

Updated June 30, 2020

Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.

A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise comes with issues of potential breathing restriction and discomfort and requires balancing benefits versus possible adverse events. Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. In my personal experience, he says, heart rates are higher at the same relative intensity when you wear a mask. Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.

The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.

The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who dont typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the countrys largest employers, and gives small employers significant leeway to deny leave.

So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was very rare, but she later walked back that statement.

Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus whether its surface transmission or close human contact is still social distancing, washing your hands, not touching your face and wearing masks.

A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.

The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nations job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.

If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)

If youve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.

Under the best of circumstances, the impact on children will still be significant. Students will lose most of a year of learning as parents their new untrained teachers cannot supervise in any meaningful way while Zooming into the office. At best, the kids will be crabby and stir-crazy as they dont get enough physical activity because theyre now tethered to their parents work spaces all day, running around the living room in lieu of fresh air. Without social interactions with other children, they constantly seek parental attention in bad ways, further straining the mood at home. And these are ideal scenarios.

But what about kids who cannot learn remotely? What about kids who need services that are tied to schools? Or those who are at higher risk for complications if they get the virus and might not be able to go back even one week out of the three?

When learning plans for children with special needs could not be followed appropriately this year, academic gains for many students were quickly wiped out. Remote learning has already widened racial and socioeconomic achievement gaps because of disparities in access to technology tutors. As parents are crushed by the Covid economy, so are the children who need the most support. Its no wonder the American Academy of Pediatrics released a statement this weekend urging that students be physically present in school as much as possible this fall.

The long-term losses for professional adults will be incalculable, too, and will disproportionately affect mothers. Working mothers all over the country feel that theyre being pushed out of the labor force or into part-time jobs as their responsibilities at home have increased tenfold.

Even those who found a short-term solution because they had the luxury to hit the pause button on their projects and careers this spring to manage the effects of the pandemic predicated on the assumption that the fall would bring a return to school and child care may now have no choice but to leave the work force. A friend just applied for a job and tells me she cannot even imagine how she would be able to take it if her children arent truly back in school. Theres an idea that people can walk away from careers and just pick them up where they left off, even though we know that women who drop out of the work force to take care of children often have trouble getting back in.

And lest you think its everyone vs. teachers, I cannot imagine a group this situation is less fair to. Teachers are supposed to teach in the classroom full-time but simultaneously manage remote learning? Even in non-pandemic times, teachers would tell you that they already work unpaid overtime on nights and weekends, just planning and grading. Where, exactly, will the extra hours come from? For teachers with their own school-age children, the situation isnt just untenable, its impossible.

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Just 50% of Americans plan to get a COVID-19 vaccine. Here’s how to win over the rest – Science Magazine

Posted: at 5:45 am

Even before a coronavirus vaccine becomes available, some activists are ready to attack it; this woman attended a Reopen Virginia protest in Richmond in April.

By Warren CornwallJun. 30, 2020 , 4:25 PM

Sciences COVID-19 reporting is supported by the Pulitzer Center.

Within days of the first confirmed novel coronavirus case in the United States on 20 January, antivaccine activists were already hinting on Twitter that the virus was a scampart of a plot to profit from an eventual vaccine.

Nearly half a year later, scientists around the world are rushing to create a COVID-19 vaccine. An approved product is still months, if not years, away and public health agencies have not yet mounted campaigns to promote it. But health communication experts say they need to start to lay the groundwork for acceptance now, because the flood of misinformation from antivaccine activists has surged.

Such activists have kicked into overdrive, says Neil Johnson, a physicist at George Washington University who studies the dynamics of antivaccine groups on social networks. He estimates that in recent months, 10% of the Facebook pages run by people asking questions about vaccines have already switched to antivaccine views.

Recent polls have found as few as 50% of people in the United States are committed to receiving a vaccine, with another quarter wavering. Some of the communities most at risk from the virus are also the most leery: Among Black people, who account for nearly one-quarter of U.S. COVID-19 deaths, 40% said they wouldnt get a vaccine in a mid-May poll by the Associated Press and the University of Chicago. In France, 26% said they wouldnt get a coronavirus vaccine.

The Centers for Disease Control and Prevention (CDC) is now working on a plan to boost vaccine confidence as part of the federal effort to develop a vaccine, Director Robert Redfield told a Senate committee this week. Advocates urge campaigns that include personal messages and storytelling. We better use every minute we have between now and when that vaccine or vaccines are ready, because its real fragile ground right now, says Heidi Larson, an anthropologist and head of the Vaccine Confidence Project at the London School of Hygiene & Tropical Medicine (LSHTM).

Even before the pandemic, public health agencies around the world were struggling to counter increasingly sophisticated efforts to turn people against vaccines. With vaccination rates against measles and other infectious diseases falling in some locations, the World Health Organization (WHO) in 2019 listed vaccine hesitancy as one of 10 major global health threats.

Any coronavirus vaccine will face additional hurdles, especially the lack of a long-term safety record, Johnson says. The frenetic pace of vaccine development may play into that concern. Even advocates have worried that the rush for a vaccine raises the risk it could be ineffective or have harmful side effects. Consider the very name for the U.S. vaccine initiative, Operation Warp Speed, says Bruce Gellin, president of the nonprofit Sabin Vaccine Institute. What is a worse name for something thats supposed to give you trust in a product that you want everybody to take?

For some in the United States, the answer is no, according to a survey of 1056 people in mid-May.

OverallUnder age 60Age 60 and olderWhiteBlackHispanic493120403523672112562716253240373723YesNot sureNoDid not answer

(GRAPHIC) V. ALTOUNIAN/SCIENCE; (DATA) Associated PressNORC Center for Public Affairs Research at the University of Chicago

Del Bigtree, a U.S.-based vaccine critic, claims scientists are pursuing one of the most dangerous vaccines ever attempted, for a virus that poses little risk to most people. He says he spreads his message through an online talk show, Twitter, and presentations, and that we have seen incredible growth since the pandemic started.

In addition to safety concerns, activists have embraced a plethora of other antivaccine messages. In May, a documentary-style video, Plandemic, purporting that COVID-19 related deaths were exaggerated and a vaccine could kill millions, got more than 7 million views on YouTube before it was removed because of its unsubstantiated claims. U.S. activists in late April hosted an online Freedom Health Summit featuring antivaccine leaders and railing against medical tyranny during shutdowns. Other outlandish claims include that vitamin C can cure COVID-19 and that the disease is a conspiracy involving philanthropist Bill Gates. Statements by French doctors that coronavirus vaccines might be tested in Africa led to fears of Africans being exploited in trials.

Social media posts that create the impression of a real debate over vaccine safety can tap into psychological habits that make people think doing nothing is safer than taking action, says Damon Centola, a sociologist at the University of Pennsylvania. He fears such concerns could spread more easily among people already suspicious of medical authority, including minority communities. For example, many Black people are keenly aware of the history of medical experiments such as the infamous federal Tuskegee Study, which failed to treat Black men with syphilis. That, to me, is the major issue of the day that Im very worried about, Centola says.

Accuracy and authority are at a disadvantage in a media environment that favors speed, emotion, and memorable stories, says Peter Sheridan Dodds, a complex systems scientist at the University of Vermont who studies how ideas move through social media. Antivaccine activists have used those factors to attract followers, Dodds says. In the end, its story wars.

Vaccine promoters say they need to start now to counter all this, because epidemiologists estimate that to break the pandemic, 70% of the population may need to develop immunity, either by getting a vaccine or becoming infected. Health communication experts suggest taking some pages from the antivaccine playbook. When more than40 experts from around the world gathered online for a strategy session organized by experts with the City University of New York and LSHTM, a top recommendation was to develop faster, more creative ways to communicate with the public that speak more directly to the emotions.

Traditional messages promoting vaccinationauthoritative and fact-filledjust dont cut it with people worried about vaccine safety, says Larson, who helped organize the 20 May meeting. We dont have enough flavors of messages, adds Larson, whose book about vaccine rumors is about to be released. Ive had people say to me, All these social media platforms can send us to WHO or CDC. Weve been there, but it doesnt have the answers to the questions we have.

Some current initiatives have pioneered a more story-based approach. The National HPV Vaccination Roundtable, which promotes vaccination against the human papillomavirus, a leading cause of cervical cancer, uses YouTube videos of women who survived cervical cancer. We need to get better at storytelling, says Noel Brewer, a behavioral scientist at the University of North Carolina, Chapel Hill, and chair of the HPV roundtable. We need to carry positive stories and also negative stories about the harms of not vaccinating. The downsides of refusing a coronavirus vaccine might include not visiting grandparents and continuing to traverse the produce aisle as if it were a minefield.

In West Africa, officials are deploying the same tools that spread rumors about vaccines to counter them, says Thabani Maphosa, who oversees operations in 73 countries for Gavi, the Vaccine Alliance, which supplies and promotes vaccines around the world. In Liberia, for example, officials are using Facebooks WhatsApp messaging app to survey people and to address the rumors behind a drop in routine vaccinations. We need to use this as a teachable moment, Maphosa says.

In the United States, the nonprofit Public Good Projects plans to recruit volunteers to swarm outbreaks of vaccine misinformation online and eventually develop memes and videos, says CEO Joe Smyser.

But the most effective tools may lie outside the digital realm. Real-world nudges and infrastructure, such as phone call reminders to come in for a shot, may be more powerful than any social media campaign, Brewer says. Social media doesnt have as much of an effect as you would imagine from the noise its generating, he adds.

Public health agencies should consider taking vaccinations out of medical settings and into places where people work or shop, adds Monica Schoch-Spana, a medical anthropologist at Johns Hopkins University. That also means talking to leaders in various communities to understand their views. Such outreach could prove particularly important with minority communities. You really do have to meet people where they are both figuratively and literally, she says.

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How COVID-19 in Jails and Prisons Threatens Nearby Communities – The Pew Charitable Trusts

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Read Stateline coverage of the latest state action on coronavirus.

COVID-19 has raged throughout U.S. jails and prisons, where people live together in close quarters and there is little opportunity for social distancing, a lack of basic sanitary supplies and high rates of chronic disease.

While inmates mostly stay behind concrete walls and barbed wire, those barriers cant contain an infectious disease like COVID-19. Not only can the virus be brought into jails and prisons, but it also can leave those facilities and spread widely into surrounding communities and beyond.

The effect may be most pronounced in jails, which mainly house those who are awaiting trial or inmates serving short sentences. Those facilities tend to have more churn than state and federal penitentiaries, with greater numbers of people entering and leaving, thereby increasing opportunities for the disease to disseminate.

Two new studies show that jails can contribute enormously to coronavirus case totals outside their walls. While COVID-19s spread inside the facilities has been widely reported, the research demonstrates just how great an impact it can have in communities outside.

Depending on the social distancing measures put in place, community spread from infections in jails could add between 99,000 and 188,000 people to the virus U.S. death toll, according to a modeling study recently published by the American Civil Liberties Union in conjunction with researchers from the University of Pennsylvania, the University of Tennessee and Washington State University.

The report was released in April, when some experts were predicting that the U.S. death toll would remain below 100,000. As of June 30, more than 125,800 people have died of COVID-19 in the United States.

A peer-reviewed study set to appear in the health policy journal Health Affairsechoes that finding. The researchers found that cycling through Cook County Jail was associated with 15.9% of COVID-19 cases in Chicago and 15.7% in Illinois as of late April.

Although currently available data are inadequate to establish a clear causal relation, the studys authors write, these provisional findings are consistent with the hypothesis that arrest and jailing practices are augmenting infection rates in highly policed neighborhoods.

Cook County officials, including officials from the Chicago Department of Public Health, have pushed back hard on the report, calling it a fantasy filled with assumptions bordering on lies. They say it is based on old data that did not account for changes the jail had made to stop the spread of the virus, including testing and allowing for quarantining.

According to the county sheriffs office, as of last week, 778 inmates at the county jail and 362 of its workers tested positive for the virus. Seven inmates and three employees have died.

The authors of the Health Affairs paper said they stand by their conclusions.

COVID-19 already has infected about 60,000 prisoners and correctional staff and killed more than 600 of them, according to the Marshall Project, which tracks the virus toll in correctional facilities. Many jails and prisons have reduced their inmate populations to reduce exposures.

The results of the ACLU and Health Affairs studies underline a point that many in public health have long advanced: Public health in the wider world is tethered to the health of those who are incarcerated.

This is why public health officials say correctional health is public health, said Dr. Brie Williams, a professor and researcher at the University of California San Francisco School of Medicine and director of Amend, a group that works to improve inmate health.

Stateline Story June 29, 2020

Its not only released inmates, many of whom end up in crowded homeless shelters, who might carry the virus into communities. There are also risks of infection from inmates making court appearances or receiving medical care at hospitals in the community.

Infectious diseases move back and forth between communities and prisons. That was the case with tuberculosis in the 19th and 20th centuries and with HIV/AIDS in the 1980s and beyond.

In recent years, that point was made again in relation to hepatitis C, a communicable disease with high rates of infection in prisons because of the large numbers of incarcerated intravenous drug users. Sharing needles is one of the primary means of hepatitis C transmission.

One of the arguments public health experts used to urge local, state and federal governments to treat inmates with hepatitis Cwith highly effective but expensive medications was that knocking out the infection in prisons would prevent its spread beyond those walls. The difference between this pandemic and those other diseases, epidemiologists say, is that because COVID-19 is transmitted through respiratory droplets in the air, it spreads much more easily.

The United States is particularly vulnerable to diseases spreading near correctional institutions. Its incarceration rate is the highest in the world, at 655 people out of every 100,000, according to World Prison Brief. With 2.1 million inmates, the United States also imprisons more people than any other country, nearly 412,000 more than China, which ranks second.

About 738,000 of those prisoners are in local jails, according to the federal Bureau of Justice Statistics. But that number is just a point-in-time snapshot. During the course of a year, 4.9 million people cycle through local jails, according to the Prison Policy Initiative, a Massachusetts think tank.

Additionally, federal labor statistics show that jails employ about 151,000 correctional officers who can bring infections into facilities or take them home.

Stateline Story September 25, 2018

Most cases in jails have not originated with inmates, said Dr. Alysse Wurcel, an infectious disease physician at Tufts Medical Center who sees patients at six area jails and is a consultant to the Massachusetts Sheriffs Association. Weve discussed with the sheriffs association that early on, clusters were initiated by people working in the jails, not by those newly incarcerated.

There is a racial component to the concern about prisons and the pandemic. Disproportionate numbers of inmates are people of color, and the coronavirus is killing Blackand Hispanic people at higher rates than their shares of the overall population. Those two data points have not escaped the notice of public health experts.

Were in an epidemic of mass incarceration of Black people at the same time as a disease epidemic that is disproportionately affecting minorities, said Dr. Liz Barnert, an assistant professor of pediatrics at the UCLA David Geffen School of Medicine, who studies correctional health.

The pandemic has lent impetus to the growing movement to depopulate jails and prisons. Since the pandemic began, many states and local jurisdictions have taken steps to reduce inmate populations, releasing nonviolent offenders, granting more compassionate-releases and issuing citations rather than arresting alleged offenders.

Jails in California, Michigan, Massachusetts and North Dakota have released hundreds of prisoners. So have state prisons in those and other states. Many jurisdictions report large decreases in arrests.

Other states have done relatively little. Just last week, the Omaha World-Herald reported that the Nebraska prison system is 51% above capacity.

Public health experts insist that reducing jail and prison populations must continue, for the greater good of all.

Decreasing the risk of spread of COVID-19 in jails and prisons decreases the risk of spread out in communities, Williams said. And increasing the spread in jails and prisons increases the risk of spread in communities.

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