DeWine: 70% of Ohioans in counties with increased COVID-19 spread

 By Jake Zuckerman

A surgical mask and an N95 mask hang on display for sale at a pharmacy. Photo by Sean Gallup/Getty Images.

About 70 percent of Ohioans are living in a county with increased levels of COVID-19 exposure and spread, according to the state’s Public Health Advisory System.

While a few counties have receded from “red” status (“very high exposure and spread”), the system — based on a series of inputs like infection rates, emergency room and outpatient health visits — shows a virus slowly making its way into Ohio’s rural counties.

More than an abrupt boiling over, the PHAS depicts Ohio as a pot, gradually rising to a simmer.

“We just can’t seem to get the number of new cases down,” Gov. Mike DeWine said Thursday. “Really, what you’re seeing is the spread of the virus over the state.”

Over the past week, the Ohio Department of Health has reported an average of about 1,000 residents newly infected per day and about 28 dying from those infections per day.

That’s about on par with early-July levels of spread. However, a newly resumed K-12 and college school year, a looming return of Big Ten football, and fall weather driving residents indoors could all swing the epidemic curves.

Nearly 144,000 Ohioans have contracted COVID-19, according to Sunday state data. Nearly 15,000 have been hospitalized with the disease, and 4,600 have died.

Nationally, about 7 million Americans have been infected as the death toll landed just shy of 200,000, according to Johns Hopkins University data accessed Sunday.

Ohio’s test positivity rate — the proportion of tests taken that return with positive results — continues to trend downward this week. As of Friday, it averaged out at 3%, well below July highs toward 6%.

The heaviest caseloads remain in Ohio’s most populous counties.

However, population adjusted data shows in the last two weeks, Ohio’s hardest hit counties are Putnam, Mercer, Athens, Harrison and Shelby.

State-by-state data from The New York Times shows Ohio is, comparatively, faring well. It has avoided categorization as a hotspot state to date.

At Ohio State University, more than 2,600 students have contracted COVID-19 between Aug. 14 and Sept. 7, according to university data.

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This story is provided by Ohio Capital Journal, a part of States Newsroom, a national 501 (c)(3) nonprofit. See the original story here.

DeWine’s health director pick withdraws hours after selection

HEALTH

By Ohio Capital Journal Staff

Ohio Gov. Mike DeWine named his choice for a new health director Thursday afternoon in a release at 3:30 p.m. By 8:30 p.m., DeWine had announced she had withdrawn from consideration.

“This evening, Dr. Joan Duwve withdrew her name from consideration for the position of Director of the Ohio Department of Health, citing personal reasons,” a news release Thursday evening announced. “The Governor’s administration will continue its search for a full-time Director of the Ohio Department of Health.”

Dr. Joan Duwve

DeWine had selected Duwve to fill the position after the resignation of Dr. Amy Acton in June. Acton became a household name in Ohio this past spring, appearing regularly with DeWine during his press conferences. While Acton enjoyed significant support and popularity, she was also the focus of intense criticism, including from Statehouse lawmakers. Protesters of coronavirus-related Ohio Department of Health orders repeatedly demonstrated outside her Bexley home.

Other news reports indicate that Duwve, an Ohio native and graduate of North Olmsted HS and The Ohio State University, was once a volunteer coordinator for Planned Parenthood. This tenuous connection to women’s choice, dating to 1984, was enough to galvanize the mobilization of abortion foes, making it questionable whether the appointment would have received confirmation from the Ohio Senate.

A spokesman for the Governor said that he was aware of the Planned Parenthood connection at the time of the appointment and that Duwve’s withdrawal  was for unrelated “personal reasons”.

Since Acton’s resignation, the department has been helmed in the interim by Lance Himes.

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This story is provided by Ohio Capital Journal, a part of States Newsroom, a national 501 (c)(3) nonprofit. Additional reporting by The Real Deal Press.See the original story here.

Lead tests for children plummet in Cleveland

Advocates worry about long-term fallout 

This story is provided by ideastream as part of special community coverage of COVID-19 and funded by Third Federal Foundation and University Settlement.

By Rachel Dissell

CLEVELAND, Ohio — State shutdown orders meant to prevent the spread of the novel coronavirus have created a double-whammy of lead poisoning risk for young children in Cleveland. 

Many of these children are spending more time in homes with potential lead hazards, and fewer are getting tested to see if they’ve been exposed to the toxin. 

Tests for lead have plummeted by almost half compared with previous years in Cleveland and across Ohio, driven mostly by a dip in March, when most pediatricians’ offices and labs were closed to non-emergency visits because of the pandemic. 

State health data shows a slight uptick in the percentage of Cleveland children tested who have elevated levels of lead in their blood.

The setback couldn’t have come at a worse time, local lead-safety advocates say. For the past year, they have been working to prevent children from being poisoned in their homes, rolling out a new strategy that includes city-mandated lead inspections in rentals and new grants and loans for hazard cleanup. 

Testing children for lead is the main way to identify lead hazards that can continue to do damage. The tests also allow parents to get help recognizing developmental delays or behavioral issues linked to exposure to the toxin, which can cause irreversible damage to a child’s brain. 

The pandemic-related drop in testing means that fewer lead-exposed children will receive help from state-supported early intervention programs, which are now offered automatically when a child’s blood test shows exposure.

It also means that public health authorities won’t receive as many referrals to investigate potential lead hazards in homes, which are triggered by a high lead test. That could result in prolonged exposure for children to lead dust or paint chips. 

“I worry about children who are at home, playing on porches full of lead paint or in the dirt nearby,” said Patricia Barnes, executive director of the Ohio Healthy Homes Network and co-chair of the Ohio Lead Free Kids Coalition, which advocates statewide for policies to eliminate childhood lead poisoning. 

An Ohio Department of Health spokeswoman said that while test rates have dipped across Ohio during the pandemic, other “lead belt” states fared even worse. 

Tests in Ohio have picked up in recent weeks as more parents schedule routine well-child visits, said state lead poisoning prevention advocates. 

“There is nothing we are doing to make up on the missed testing,” ODH spokeswoman Rachel Feeley wrote in an email.

“This is something the (Centers for Disease Control and Prevention) is tracking, as it is a national occurrence,” she wrote. “We will continue to monitor the situation and follow CDC guidance on the matter.”

Testing setback

“I feel like we’re almost starting over again,” Kathy Schoch, nurse case manager for Cuyahoga County’s lead-poisoning prevention program, said about the interruption in testing. 

Schoch and others have wrestled with improving lead testing for years. 

Only one in five Medicaid-eligible children entering kindergarten in Cleveland public schools from 2011 to 2016 had federally recommended tests for lead poisoning at both ages 1 and 2, according to research released last year by Case Western Reserve University and Invest in Children, a county early childhood initiative. 

The study also showed that even a “high dose” of 18 months or more of high-quality preschool education failed to help most lead-poisoned children catch up with their peers. 

As lead testing stalled in the spring, so did new referrals to Ohio’s Early Intervention program, said Karen Mintzer, director of Bright Beginnings, formerly known as Help Me Grow. 

The Early Intervention program, run through the Ohio Department of Developmental Disabilities, can assess children for developmental delays linked to lead exposure.

Referrals to the program from Cuyahoga County also dropped to zero at one point, but have since rebounded, Mintzer said. 

Any child younger than 3 with lead in their blood at levels of five micrograms per deciliter or higher is automatically referred.

Safer than the grocery store

When the MetroHealth System resumed well-child visits in late April, many parents were reluctant to bring their children to the doctor’s office or a lab because of fears about the virus, said Dr. Abdulla Ghori, vice chair of Pediatrics at MetroHealth Medical Center.

There has been a slight uptick in visits in the past few weeks, he said. 

In terms of risk, “coming to the hospital is better than going to the grocery store,” Ghori said. “And certainly much safer than [attending] a birthday party.”

Ghori, also a professor of pediatrics at Case Western Reserve University, said it is difficult to increase the rate of lead testing in part because testing practices vary by location and even by facility within a single health system. 

Sometimes blood can be drawn in the doctor’s office. Other times, parents have to wait at a lab at a different location, which can be impractical for families with limited time and resources. 

At MetroHealth, Ghori said, about a quarter of lab orders for lead tests aren’t ever completed. 

While long-term solutions continue to be debated, Ghori said MetroHealth took the step of “bulk ordering” lead tests for any children who need them, rather than having doctors order the test individually during visits.

The orders will automatically show up in the mail or on electronic medical records for parents, he said. 

Ghori said that’s good, but even better would be free, accessible blood-drawing locations in the city. 

Ghori said he understands the focus on catching up on immunizations for children under 2, especially immunizations against highly contagious and dangerous diseases such as measles. Immunizations are often needed to enroll in day care or school. 

That doesn’t mean lead testing should be an afterthought, though.

Both are important, Ghori said, but he worries people will de-emphasize lead testing. That, he said, would have dangerous long-term consequences. 

“People should not be forgetting this silent disease, which could be getting worse during this lockdown, and the consequences that it could have,” he said.

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Ways to limit exposure to lead dust in your home

·    Much of the lead dust that enters homes comes in from outside via the dirt on shoes and feet and on pets’ paws. Remove shoes when entering the home and clean your pets’ paws if they spend time in bare dirt outside.

·    Put a stiff, outdoor door mat outside the door to trap dust and dirt before it gets in the house.

·    If you have any bare patches of dirt around the edges of your home or driveway, cover it with at least six inches of mulch.

·    Check window sills and doorways for chipped and peeling paint, especially at the level where your child’s hands reach, and in areas of high friction. Wipe or vacuum out window sills and doorways. If you can’t repaint chipped areas, cover with contact paper or duct tape.

·    Mop hard-surface floors frequently using the two-bucket method, if possible. Fill bucket #1 with warm water and a household cleaner. Fill bucket #2 with clean water. Dip the mop into bucket #1 and clean the floor. Then dip the mop into bucket #2 to rinse and squeeze before returning it to the cleaning solution. Dispose of the dirty water by pouring it down the toilet.

·    Vacuum carpeted surfaces at least once a week. Use a HEPA-filter vacuum followed by a steam cleaner, if possible.

·    Wear gloves when cleaning to avoid getting lead dust or paint under fingernails and transferring it to children.

·    Wash your children’s hands frequently with soap and water, especially before meals. Hand sanitizer will not remove lead from hands.

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Faulty COVID-19 Data Collection increases risks for Cleveland’s Latino community

Culturally competent awareness, action are critical for control of virus

By Juan Molina Crespo

SPECIAL TO THE REAL DEAL

                          

The Coronavirus pandemic has exacerbated the precarious daily struggle among Latinos for basic necessities. Latinos are at high risk of contracting Coronavirus, yet, they are noticeably absent from testing, hospitalization, ICU treatment, death rate and recovery. Unless we address the realities presently compounding the virus’ effect upon the Latino community, the pandemic will create a destiny of deaths of despair.

According to the Ohio Department of Health, Latinos comprise 8% of Cuyahoga County residents, yet they account for over 15% of the Covid-19 deaths, based on my analysis of the available data. These data do not include City of Cleveland numbers.

Accurate data collection is elusive. Much of what is reported by Ohio Department of Health and the Cuyahoga County Board of Health does not include the number nor the rate per 1000,000 of Latino/Hispanics in the Coronavirus protocols.

The underlying factors contributing to this overrepresentation of Latinos in COVID-19 mortality rates are vast and complicated. The following is a partial list of deeply rooted socio-economic inequities that contribute to the dismal compliance on stay at home and quarantine orders. 

Housing

Affordable housing is in short supply. The gentrification of the Clark/Fulton area where most Latinos live has decreased affordable housing and created a rise in rents of the existing housing stock that is often beyond the financial scope of many Latinos. With limited options, many families find themselves in crowded conditions with three or even four generations of children and adults living together in overcrowded apartments. Lack of adequate air conditioning in most rental units in the Clark/Fulton community will make compliance with stay-at-home and quarantine orders impossible for many. Forced to venture outside for relief from stifling overcrowded quarters, they become likely targets for citations or arrest by overzealous police officers.

Job loss

For most Latinos COVID-19 is not just a public health issue with genocidal implications, it is also an economic catastrophe. Latinos are overrepresented as health care workers. This includes behavioral health providers, home health workers, nursing home facilities and assisted living employees, emergency medical technicians (EMTs), housekeeping and others who work in healthcare and congregate living settings. Latinos are also widely employed as frontline workers in other essential fields, including childcare, public transportation, food industry and landscaping, where they cannot work from home.

Many of these jobs pay low wages [sometimes “under the table], lack sick day benefits and limited if access to preventative primary healthcare and health insurance. Employees must report to work or risk termination. But they are critical both to society and to the breadwinners who must pay rent and utilities, buy groceries, and other basic necessities. Any job loss or income reduction produces immediate and long term financial effects; increasing stress because of pending evictions, utility shutoffs, food insecurity and the erosion of interpersonal relations between parents, spouses/partners and children. Lack of money increases desperation and social isolation, along with negative mental health symptoms and their repercussions. 

Underlying health conditions

Latinos suffer from many existing underlying health conditions identified as high risk factors to contracting COVID-19. Moreover, Latino people are less likely to have access to quality health care, have higher rates of poverty and are concentrated in high risk jobs. We know that those who struggle with high blood pressure, cancer, diabetes, obesity,  and are over 65 years of age are at higher risk of contracting COVID-19. Latinos suffer from higher rates in all of these categories.

According to Covid-Net, CDC’s weekly publication of the characteristics of hospitalization of U.S. Covid-19 patients, for the week ending May 16, 2020, Latinos comprised 42% of U.S. patients ages 0-17, and 37% of ages 18-49. These data illustrate how COVID-19 has the potential to spread among the most vulnerable among marginalized communities. 

Messaging, awareness and education

Very little Spanish language COVID-19 awareness and educational information exists. MetroHealth Systems has a dedicated page on its website.

The Cleveland Department of Public Health [CDPH] has a Spanish flyer on its website and offers a COVID-19 package to those who have tested positive. CDPH reporting of COVID-19 positive cases does not identify any Latino/Hispanic cases, which complicates any efforts to get accurate numbers from the Latino community.

Ward 14 Council representative Jasmin Santana has organized several food and grocery distributions aimed at reducing food insecurity among mostly Spanish language-dominant Latino residents throughout Cleveland. The success of these efforts comes primarily because information is shared through word of mouth. This brings attention to Cleveland’s large digital divide. The lack of reliable internet service, affordability and access to computers will complicate the creation of a local messaging campaign to reach into the heart of Clark/Fulton Latino neighborhoods and surrounding city wards.

Testing

While testing is currently being offered at limited CVS and Rite Aid stores, neither chain provides testing at stores in Clark/Fulton. The chain’s stores closest that offer testing the Clark Fulton community are both in Parma, five to seven miles away.

Getting to Parma would only be a first step. To secure a test, residents must make an advance online appointment; bring the confirmation notice; obtain a physician’s eligibility notice; provide identification; be at least 18 years old; and drive up — no walk ups allowed.

Instructions with the test packages for the self-administered tests are provided in English at the drive up windows, a further challenge for Spanish dominant residents.

MetroHealth Systems on West 25^th Street offers testing according to their website, it does not provide instructions on where to go once on its formidable campus.

Cleveland Clinic Lutheran Hospital on 25^th Street offers COVID-19 testing only to existing patients with a Cleveland Clinic doctor’s order. Testing is typically scheduled within 24 hours. All emergency department walk-ins are evaluated, those experiencing symptoms are isolated and triaged by the COVID nurse.

The testing landscape changes rapidly. Testing sites are added and or deleted regularly. Suffice it to say that the current testing infrastructure is confusing and rife with barriers to adequate access.

           

Seroprevalence

Seroprevalence surveys  are a testing tool to identify people in a population or community that have antibodies against an infectious disease.

Presently, there is a lack of standardized and coordinated COVID-19 testing and protocols. There is an  inability of  government health officials to  obtain accurate data on ethnicity and race of those tested.  These factors, combined with the  failure to create a uniform multi-language messaging campaign, do not allow for the development of a model to obtain accurate and reliable seroprevalence rates among Latinos. As summer approaches and lockdowns are lifted, and self-quarantine and social distancing compliance wanes,  the lack of coordination, will make it increasingly difficult for an accurate count of Latino COVID-19 patients.  Any efforts to measure new occurrences of COVID-19 on individual and community transmissions, and intensity of the virus will be compromised.

Contact tracing

Generations of marginalized communities have had horrific experiences with appointed and elected government officials. Empty promises, discriminatory and racist interactions, and condescending and disrespectful communication have taken a toll.  This will make the creation of a contact tracing model very difficult to achieve. To a large degree, inquiries to obtain private information of everyone an infected person may have had physical contact with can be seen as intrusive. This natural wariness will be magnified in Latino communities where immigration status of individuals is closely guarded. Moreover, residents with outstanding warrants,  heavily in debt, or  family members, friends, or acquaintances with questionable experiences and behavior will most likely not appreciate being called out to authorities.

Contact tracing is in essence an investigation into one’s privacy, viewed by many as government overreach, and interpreted as another means of control and oppression.

Recommendations

This discussion is meant to highlight the developing crisis in the Latino community and to reinforce the understanding that in a pandemic, no group can be left outside.

In light of the challenges and needs of the Latino community, here are some specific recommendations that local governments, health care providers, and civic leaders should implement:

Testing:

• Engage businesses and employers to provide or facilitate testing at work sites. This will allow for health care providers, community service organizations and businesses to gather more accurate data to contribute to the establishment of seroprevalence rates among Latinos.

• Free testing for those with or without Medicaid, Medicare or other insurance.

• Promote comprehensive testing day at or immediately after summer festivals, outings, events to measure spikes in contagion.

Messaging:

• Messaging campaign must have a long-term tagline that is relevant to Latinos.

• Spanish (Spanglish) language materials should be at fourth grade reading levels, and include succinct copy, and visuals and sketches that reflect the community [e.g., faith-based, schools, homes, shopping].

• Messaging campaign must be done in phases that correspond with external social norms, events and holidays.

• Study and replicate the ingredients that have been used in previous successful targeted campaigns. According to the Ohio Department of Health, 69.5% of Latinos in Cuyahoga County, reported receiving the Flu vaccination in 2019 — the only group in Cuyahoga County to achieve the national benchmark of 70%.

• Lobby state health officials to elevate and include racial and ethnic minorities to underlying health conditions to Priority 1.

• Conduct workshops with contact tracing imagery and flow charts to explain the seriousness of communication with friends and family.

Conclusion

It is imperative that public health institutions, hospitals, community health centers, faith-based organizations and all others who service Latinx residents insist on the collection and reporting of accurate data on race, ethnicity, gender and age. Although most public health officials believed that this first wave of COVID-19 would begin to wane in July and August, this is no longer the prevalent thought. The demonstrations across the country in response to the murder of George Floyd by Minneapolis police officers will mostly cause an expansion and extension of the first wave.  The second wave of COVID-19, which was expected to hit in upcoming Fall months, will be felt throughout winter, 2021.

The availability, amount, and process to access government funding and economic resources for our communities will be driven by data. If Latinos are not part of the science, we will find ourselves once again fighting for the leftover crumbs, not an equitable share.

Juan Molina Crespo is a social worker who served as director of The Hispanic Alliance until his retirement last year.

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