Before having a child of my own, I spent 3.5 years working in a home based child abuse prevention program. I would screen new mothers for postpartum depression and help link them to mental health resources, while I was working on my master’s degree in social work to be a therapist myself. I would listen to them talk about “postpartum” when referencing their emotional state after giving birth and constantly heard the phrase, “I have mommy brain” or “I don’t know what’s going on with me, I’m not myself.” Never did I truly understand the weight of these phrases until I gave birth to my daughter earlier this year.
When discussing maternal mental health, most people only know to ask about postpartum depression (PPD), but there are so many more facets of maternal mental health that need to be asked about and talked about in general. Physicians screen for PPD at appointments, but most of the time the screen isn’t discussed with the mother unless she scores in the “high risk” category and no follow-up is made if not. The questions ask about sleep, joy, laughter, and coping. I remember answering these questions three weeks postpartum and at the time thinking, “well, duh, I am not coping as well as before because I am learning a new role.” So I was honest, but I didn’t have a “high” score on the screen, so the physician saw the low score and then didn’t ask me a single additional question about my mental health. If the PPD screen was low, I must be doing fine right?
At this very appointment, I had actually been having intrusive thoughts and fears since being released from the hospital that somehow my child was going to be hurt. I had these scary images of her falling out of my arms when I walked down the stairs, or falling off our balcony, or stopping breathing at night. Some days it took all I had to push these images out of my head. I talked with my husband about these thoughts and he helped me to manage them and checked in to see how my mental health was many times throughout each day. He encouraged me to seek help as needed. Thankfully, these thoughts subsided with each passing day as I became more comfortable in my role as a new mom, but I felt so alone in these thoughts and feelings. Why had no one warned me about this?
Everyone told me I would be bringing home this new person, but they didn’t warn me that I would be a new person too.
I am now doing great with no intrusive thoughts whatsoever and my daughter is 2 months old. My thoughts stopped in what is considered a “normal amount of time” but I know I am lucky in that sense. Thankfully I have a wonderful support system at home and I am educated on mental health topics and warning signs because of my career, so I knew when something was off with me, but all I could think about was, what if I wasn’t educated? What if I had no support and no one to check in? What happens to all the women who aren’t fine but score “low” on the PPD scale? What happens when women are experiencing a different maternal mental health issue that doesn’t fall under the postpartum depression umbrella? What about the dads and partners that are struggling with the transition? The adoptive parents?
So, I started doing my research. Not only can new parents experience postpartum depression (notice I said parents – fathers/partners can experience this too), but they can also experience postpartum anxiety, postpartum OCD, and even postpartum psychosis. 13% of new mothers in the US, 19% in other countries, are reported to experience some type of perinatal mood disorder (World Health Organization). This statistic likely doesn’t include adoptive mothers, and even more likely doesn’t include fathers and partners.
WHY does no one talk about these mental health concerns with pregnant women and new parents? Why is the only image we have of maternal mental health a mom hurting her baby?
We have to do better.
The first way I can contribute to doing better is by sharing my postpartum experience with others. I experienced intrusive, scary thoughts for several weeks postpartum. I wasn’t coping with them well at first, and I was crying and fearful more than ever. I talked about them, shared them, tackled them with support, and it didn’t make me a bad mom.
I now have a “mommy brain” and I am proud of it because that means I care about the safety and wellbeing of myself so that I can care for my daughter and keep her safe as well. I am not the same woman I was before I gave birth to my daughter and I am still getting to know this new woman who came home from the hospital a few months ago. My priorities are different. My self-care needs are different. My worries are ever changing.
But my power and strength and resilience — they are all growing by the day — and I am so incredibly proud of this new person I am becoming.
Now that we’re several months into the COVID-19 pandemic, steps we need to take to effectively control the outbreak have become clear: conscientious prevention measures like handwashing and distancing, widespread testing with quick turnaround times, and contact tracing. None of these is easy to maintain over a prolonged period. But combined, they are our best bets while awaiting better treatments and an effective vaccine.
So, which tests to use?
The many types of tests available are sowing considerable confusion. Unfortunately, because this novel coronavirus is indeed novel, and COVID-19 is a new disease, information about these tests is incomplete and the options for testing keep changing. But here’s what we know now about tests designed to diagnose a current infection, and those that show whether you previously had the virus.
Diagnostic tests for current infection
If you want to know if you are currently infected with the COVID-19 virus, there are two types of tests: molecular tests and antigen testing.
How is it done? Nasal swabs, throat swabs, and tests of saliva or other bodily fluids.
Where can you get this test? At a hospital, in a medical office, in your car, or even at home.
What does the test look for? Molecular tests look for genetic material that comes only from the virus.
How long does it take to get results? It depends on lab capacity. Results may be ready the same day, but usually take at least a day or two. Throughout the pandemic, especially lately, delayed turnaround times of up to a week or two have been reported in many places.
What about accuracy? False negatives — that is, a test that says you don’t have the virus when you actually do have the virus — may occur. The reported rate of false negatives is as low as 2% and as high as 37%. The reported rate of false positives — that is, a test that says you have the virus when you actually do not — is 5% or lower.
A molecular test using a deep nasal swab is usually the best option, because it will have fewer false negative results than other diagnostic tests or samples from throat swabs or saliva. People who are in the hospital, though, may have other types of samples taken.
You may have heard about pooled testing, in which multiple samples are combined and a molecular test is performed on them. This could speed up the testing of large numbers of people and reduce the number of tests needed.
If a pooled test is negative, the people whose samples were combined are told they have a negative test and individual testing is unnecessary. But if the pooled sample tests positive, each of the individual samples that were taken will then be tested to see which person(s) is responsible for the positive pooled result.
This approach may be particularly helpful in settings where the number of infections is low and declining, and most test results are expected to be negative. For example, in a community where the infection seems to be under control and reopenings of schools and businesses are planned, pooled testing of employees and students could be an effective strategy.
How is it done? A nasal or throat swab.
Where can you get these tests? At a hospital or doctor’s office (though it is likely home testing will soon be available).
What does the test look for? This test identifies protein fragments (antigens) from the virus.
How long does it take to get results? The technology involved is similar to a pregnancy test or a rapid strep test, with results available in minutes.
What about accuracy? The reported rate of false negative results is as high as 50%, which is why antigen tests are not favored by the FDA as a single test for active infection. However, because antigen testing is quicker, less expensive, and requires less complex technology to perform than molecular testing, some experts recommend repeated antigen testing as a reasonable strategy. According to one test manufacturer, the false positive rate of antigen testing is near zero. So, the recent experience of Ohio Governor Mike DeWine, who apparently had a false-positive result from an antigen test, is rare.
Tests for past infection
Antibody tests (also called serologic testing)
How is it done? A sample of blood is taken.
Where can you get these tests? At a doctor’s office, blood testing lab, or hospital.
What does the test look for? These blood tests identify antibodies that the body’s immune system has produced in response to the infection. While a serologic test cannot tell you if you have an infection now, it can accurately identify past infection.
How long does it take to get results? Results are usually available within a few days.
What about accuracy? Having an antibody test too early can lead to false negative results. That’s because it takes a week or two after infection for your immune system to produce antibodies. The reported rate of false negatives is 20%. However, the range of false negatives is from 0% to 30% depending on the study and when in the course of infection the test is performed.
Research suggests antibody levels may wane over just a few months. And while a positive antibody test proves you’ve been exposed to the virus, it’s not yet known whether such results indicate a lack of contagiousness or long-lasting, protective immunity.
The true accuracy of tests for COVID-19 is uncertain
Unfortunately, it’s not clear exactly how accurate any of these tests are. There are several reasons for this:
We don’t have precise measures of accuracy for these tests — just some commonly quoted figures for false negatives or false positives, such as those reported above. False negative tests provide false reassurance, and could lead to delayed treatment and relaxed restrictions despite being contagious. False positives, which are much less likely, can cause unwarranted anxiety and require people to quarantine unnecessarily.
How carefully a specimen is collected and stored may affect accuracy.
None of these tests is officially approved by the FDA. They are available because the FDA has granted their makers emergency use authorization. And that means the usual rigorous testing and vetting has not happened, and accuracy results have not been widely published.
A large and growing number of laboratories and companies offer these tests, so accuracy may vary. At the date of this posting, more than 160 molecular tests, two antigen tests, and 37 antibody tests are available.
All of these tests are new because the virus is new. Without a long track record, assessments of accuracy can only be approximate.
We don’t have a definitive “gold standard” test with which to compare them.
The bottom line
Unfortunately, getting a test for COVID-19 can be confusing, because the options are rapidly changing and tests from many companies are being marketed. Despite the current limitations of testing, we’re lucky to have reasonably accurate tests available so early in the course of a newly identified virus. Imagine where we’d be if that was not the case.
Still, we need better tests and better access to them. And all tests should undergo rigorous vetting by the FDA as soon as possible. Lastly, widely available tests and short turnaround times for results are essential for effective contact tracing and getting this virus under control.
Clinical services director Tim Dodd said the “vast majority of people get their results sent out via text very quickly”.
“We’re putting additional resources in the laboratory and also ensuring that we are able to get results out as quickly as possible,” he said.
Labor’s Stephen Mullighan said the Government should provide SA Pathology with more staff to help bring down processing times.
“Now is the time the Government should be providing whatever funding is needed to our health agencies, including SA Pathology, in order to get people’s responses back to them as quickly as possible,” he said.
“Clearly there are improvements that need to be made and those improvements can be made if the Government provides SA Pathology with more staff.”
No new cases in SA today
No new cases of coronavirus were recorded today or over the weekend in South Australia.
SA Health did not include an essential worker in his 30s in its tally yesterday.
The man was tested interstate and received the positive result after entering South Australia from Victoria.
Police have taken legal action against 17 people and one business for non-compliance with COVID-19 Public Health Orders across the weekend.
In total, six people were charged and 11 were issued $1000 Penalty Infringement Notices (PINs), while a Sydney CBD business received a $5000 PIN as part of ongoing operations in response to the pandemic.
The charges include:
Officers from South Sydney Police Area Command were alerted about 6pm on Friday (7 August 2020), after a man absconded from his room in a hotel on Jackson Drive, Mascot. Police began searching for the man and tracked him to Central Railway Station where he had caught a train north. He was tracked to Newcastle Railway Station where he was arrested and taken to Newcastle Police Station about 3am on Saturday (8 August 2020). The 31-year-old man, from Thurgoona, has been charged with not comply with noticed direction re section 7/8/9 – COVID-19 and fail to comply requirement public health order – COVID-19. He was refused bail and appeared at Newcastle Bail Court on Saturday where he was formally refused bail and is next due to appear at Central Local Court on Wednesday (12 August 2020).
About 2.30pm on Saturday (8 August 2020), officers stopped a vehicle on Wood Street, Gol Gol, and spoke with the 26-year-old female driver and two passengers – a 28-year-old woman and 35-year-old man.
In a subsequent search of the car, police seized more than $64,000 cash and 62g of a crystallised substance believed to be prohibited drugs. All three occupants were arrested and taken to Dareton Police Station, where the younger woman was charged with two counts of deal with property proceeds of crime.
The older woman was charged with deal with property proceeds of crime and not comply with noticed direction. Police will allege in court that the older woman hid in the boot of the vehicle to avoid detection by NSW Police Force and Australia Defence Force officers at the George Caffey Bridge checkpoint earlier that day. Both women were granted conditional bail to appear at Wentworth Local Court on Tuesday 6 October 2020. The man was charged with deal with property proceeds of crime. He appeared at Dubbo Bail Court on Sunday (9 August 2020), where he was formally refused bail to appear at Broken Hill Local Court today (Monday 10 August 2020).
Officers from Surry Hills Police Area Command were conducting proactive patrols, when they stopped to speak with a woman who was acting suspiciously on Mary Street just before 7pm on Saturday (8 August 2020). It’s alleged the woman was aggressive toward the officers then attempted to walk away. When the officers attempted to stop her from leaving, she allegedly resisted before being arrested. During a subsequent search of the woman’s handbag, police located and seized methylamphetamine, $500 cash, and tramadol and diazepam, which were not prescribed to her. Checks revealed the woman is a Victorian resident and had been granted a transit permit in July to travel directly to Queensland.
She was taken to Surry Hills Police Station and charged with resist or hinder police officer in the execution of duty, possess prohibited drug, two counts of possess prescribed restricted substance, supply prohibited drug, and not comply with noticed direction re s 7/8/9 – COVID-19. She was refused bail and appeared at Parramatta Bail Court, where she was granted conditional bail to next appear at Downing Centre Local Court on Thursday (13 August 2020).
Just after midnight yesterday (Sunday 9 August 2020), officers from Coffs/Clarence Highway Patrol stopped an unregistered Toyota Kluger outside a hotel on the Pacific Highway, Coffs Harbour, and spoke to the driver – a 29-year-old woman. The driver produced a Victorian driver’s licence and while speaking to her, a 32-year-old man – known to the woman – approached the vehicle. Checks revealed the couple entered NSW on Monday 27 July 2020 on a transit permit, before staying at Port Macquarie on Sunday 2 August 2020. The pair were arrested and taken to Coffs Harbour Police Station where they were both charged with not comply with noticed direction section 7/8/9 – COVID-19. They were refused bail and appeared at Port Macquarie Bail Court yesterday where they were granted conditional bail to appear at Coffs Harbour Local Court today (Monday 10 August 2020).
Officers from Tweed/Byron Police District attended a home on Cecil Street, Nimbin, on Friday (7 August 2020, and spoke to a 31-year-old woman who arrived in NSW from Victoria on Saturday 1 August 2020. The woman was advised to travel direction from Albury to her Nimbin address. Checks revealed the woman had visited a friend in Maitland, stopped at Nabiac and Gosford for mechanical repairs and picked up a patient who had been discharged from Lismore Base Hospital. Following further inquiries, the woman was served a Court Attendance Notice for not comply with noticed direction section 7/8/9 – COVID-19 yesterday (Sunday 9 August 2020). She is due to appear in Lismore Local Court on Monday 21 September 2020.
The PINs include:
While transiting in Sydney, the man was taken to a quarantine hotel at Chippendale before being directed to travel directly to Sydney Airport to board his international flight on Saturday (8 August 2020). It was established the man had attended a nearby building and spoke to a friend before travelling to the airport. Police were informed and attended Sydney Airport, where the man’s connecting flight had been cancelled and he was returned back to the hotel. He was subsequently issued a $1000 infringement for breaching the Public Health Order.
Just before 7pm on Saturday (8 August 2020), officers from Eastern Suburbs Police Area Command attended a North Bondi apartment in response to noise complaints. On arrival, police requested to speak with the resident – noting loud music and noise emanating from the residence. The 30-year-old man subsequently told police he had planned a surprise party for a friend and too many guests turned up – a total of 30. He was issued a $1000 PIN and the party concluded.
After receiving information in relation to a person travelling into NSW under false pretences, police from Operation Border Closure attended a hotel at Albury, about 7pm on Saturday, and spoke with a 32-year-old woman from Melbourne and her partner, who is a NSW resident. It was established that the woman had entered NSW on a carer’s permit but neither she nor he had children with them at the hotel. Further, the woman had been in the Greater Melbourne area in recent days and therefore made a false declaration at check-in to the hotel and was not self-isolating as per permit requirements. The woman was issued a $1000 PIN and directed to return to Victoria.
About 9.30pm on Saturday, police attached to Operation Border Closure stopped a Mercedes Benz while working a checkpoint on Wodonga Place, South Albury. After speaking with the 23-year-old male driver and the 21-year-old female passenger, it was established that neither had a permit to enter NSW, and checks revealed they had attempted to cross the border at the Hume Highway about 30 minutes earlier. Police again explained the processes required for entering NSW, including permits and quarantining. The pair were subsequently issued $1000 PINs and refused entry to NSW.
About 12.50am yesterday (Sunday 9 August 2020), police stopped a vehicle on Wodonga Place, South Albury, and spoke with the 37-year-old male driver. Checks revealed the man was in breach of his permit, which stated he must self-isolate for a period of 14 days. Further inquiries revealed the man had already been turned away by police at two border checkpoints earlier in the evening. He was issued with a $1000 PIN for failing to adhere to border permit requirements.
Just before midday yesterday, police stopped a vehicle on the Newell Highway at Tocumwal and spoke with two men in the vehicle – aged 35 and 58 – who stated they had travelled across the border to pick up a car from Shepparton. The men were in possession of permits which stipulated they were only able to travel into Cobram to obtain essential goods and services. They were both issued $1000 PINs for failing to adhere to conditions of a border exemption permit.
About 9.30pm yesterday, police attached to Operation Border Closure approached a Pantech truck at the Wodonga Place checkpoint and spoke to the driver and passenger – both men aged 63 – who advised they were delivering furniture. After officers advised the men that they had been briefed about two men in a Pantech truck attempting to cross the border without permits twice that afternoon, the men provided other reasons but neither had valid permits. Both men were advised they would each be issued with $1000 PINs before being refused entry and turned around.
About 11pm on Saturday (8 August 2020), licensing police from Sydney City Police Area Command issued the owner of a licensed premises on O’Connell Street, Sydney, with a $5000 PIN for failing to comply with a ministerial direction for alleged breaches on Sunday 2 August 2020. The venue was previously issued a warning.
Anyone who has information regarding individuals or businesses in contravention of a COVID-19-related ministerial direction is urged to contact Crime Stoppers: https://nsw.crimestoppers.com.au Information is treated in strict confidence. The public is reminded not to report crime via NSW Police social media pages.
An emergency physician who spent eight years as an assistant professor at New York University’s School of Medicine, Blackstock is also a Black woman who saw the many ways in which racism and sexism damaged the health of her patients. Determined to make a difference, she started running training sessions about unconscious bias at her medical school and elsewhere, and eventually became the faculty director of recruitment, retention, and inclusion for NYU’s office of diversity affairs. But while the extra work she took on is critical to addressing long-standing problems in medicine—a field that underserves patients of color and includes vanishingly few Black or Latinx doctors—Blackstock says her contributions were undervalued by colleagues and superiors who weren’t personally affected by unconscious—or conscious—bias.
“People think of medicine as innovative and pushing the limits—but it’s probably one of the most conservative environments that I’ve ever been in,” Blackstock says. “It’s very resistant to change.”
By the end of 2019, she decided to walk away from academic medicine, leaving behind a recent promotion to associate professor and a scorching Stat Newsop-ed about “a toxic and oppressive work environment that instilled in me fear of retaliation for being vocal about racism and sexism within the institution.”
A spokesperson for NYU noted that it had promoted Blackstock, and said in an emailed statement that the school has “continued to advance diversity in the workplace and to combat the effects of unconscious and conscious bias in medicine.”
Blackstock now runs her own consulting firm, Advancing Health Equity, and has become an increasinglyvisiblepublicexpert about the impacts of the COVID-19 pandemic and systemic racism on Black patients and other people of color. She’s also holding on to some part-time clinical work and spent the worst of New York’s pandemic surge this spring treating coronavirus patients at an urgent-care clinic.
Earlier this summer, Blackstock was planning to stop seeing patients entirely, to focus more on her health care equity work. She’s since decided to continue practicing at reduced hours, meaning that medicine gets to keep one of the few professionals that it desperately needs more of: the 24,100 Black women who make up only about 2.6% of all active physicians in the United States.
A health care ‘self-reckoning’
“It is a significant problem,” says Laurie Zephyrin, a physician and former director of reproductive health at the U.S. Department of Veterans Affairs, who’s now the vice president of delivery system reform at the Commonwealth Fund.
“Study after study shows the positive benefits of having a diverse workforce in providing health care,” she adds. “Training, recruiting, and retaining diverse providers—providers of color, Black women, Black men—that’s important.”
The need for a more diverse workforce, and many employers’ repeated failures to create one will likely resonate for Black employees and other workers of color across industries, as Fortune’s Working While Black project and RaceAhead newsletter have chronicled. But the stakes are heightened in the “first, do no harm” realm of medicine, a field whose position somewhat outside the for-profit corporate sector—and, as Blackstock points out, whose reputation for innovative, science-based thinking—sometimes obscure just how stark its discrimination and lack of diversity can be.
The low percentage of Black women doctors represents a broad and long-standing problem in medicine. Only 36% of doctors are women of any race, according to the Association of American Medical Colleges. Only 5% of all active physicians are Black, compared with the 13% of the U.S. population that is Black.
The numbers are equally bad, if not worse, for physicians who are Hispanic or Latinx: Only 5.8% of doctors are Hispanic, according to the AAMC, compared with 18% of the overall U.S. population; only 2.4% of active physicians are Hispanic women.
These statistics rival the breathtaking lack of diversity at large tech companies, which have drawn criticism in recent years for the low-single-digitpercentages of Black and Latinx employees they employ. Now, amid a pandemic that has disproportionately killed people from those same communities, and a national reckoning over racism, some doctors and public health experts are drawing new attention to the long-standing racial inequities that damage the health of people of color in America—and that are exacerbated by the low numbers of professionals from these communities who are able to reach the highest positions in medicine.
“On my more optimistic days, I think that the conversation that we’re having now around these systemic issues of race and inequality could potentially be really well utilized by the health care industry,” says Adia Harvey Wingfield, a professor of sociology at Washington University in St. Louis, and the author of Flatlining: Race, Work, and Health Care in the New Economy.
But “there would need to be an industrywide focus on self-reckoning, about how the patterns and practices that are present in health care contribute to the marginalization and exclusion of Black workers,” she adds. “The health care industry would need to institute an explicit and overt focus on racial diversity—and not simply make it something that is expected to happen by happenstance.”
Happenstance hasn’t gotten Black doctors very far in medicine, as the numbers show. The reasons for their low percentage in the workforce include many that are shared across the broader conversation about systemic racism: Black Americans have less access to wealth, housing, education, and health care, meaning that Black students interested in becoming physicians generally have more barriers to overcome to enter and stay in the field.
Some of these socioeconomic disparities start with early childhood education and “access to solid STEM training in K to 12,” and then continue through higher education, Wingfield says.
Nor is it enough just to qualify, and be able to pay, for medical school; applicants also have to fly across the country for interviews, and pay for test prep and fees for the tests themselves, in a process that often costs up to $10,000. That’s just a prelude; the average medical student graduates with around $200,000 in debt. (In 2018, NYU started relieving some of these costs for its medical students by guaranteeing free tuition.)
“We know that Black Americans are disproportionately less resourced when it comes to income and wealth than white communities,” Wingfield says. “For doctors, those sorts of issues span a number of institutions, and make it more difficult to enter and remain in the field.”
Black job candidates also often face structural internal barriers in other areas of health care, aside from either obvious prejudice or unconscious bias. Some nursing programs, for example, require traditional four-year degrees instead of community college degrees, which may “inadvertently weed out Black applicants who are interested in the field,” Wingfield says.
And then there are the obvious instances of racism and systemic bias that Black doctors and other health care workers report in their training or workplaces. “In our education, traditionally, racism in health care hasn’t been addressed at all,” Blackstock says. “It’s more so now—I think medical schools are really trying to include it in their curriculums—but it’s been a hard push that’s really come from Black students and faculty at these institutions.”
There’s also obviously a need for better education about the impact of systemic racism on health long before medical school. It’s something that David R. Williams, a public health expert and Harvard University professor, has spent his career teaching medical students about—and says that many of them arrive completely ignorant of.
Williams blames this ignorance not on his students but on a society that has allowed many white Americans to achieve positions of privilege and power without learning about—or reckoning with—the systemic impacts of racism. Over the course of a career at Yale, University of Michigan, and Harvard, “I have taught some of America’s best and brightest students,” he says. “And many of them—I would arguably say most of them—are clueless about the degree of racial inequities that exist.”
Even before the pandemic that has disproportionately harmed Black and brown people, Black Americans had shorter life spans and were more likely to suffer from a wide range of chronic health conditions. For example, Black women are at particularly high risk of heart disease and strokes, and are much more likely to die from childbirth and breast cancer than white women.
These problems are exacerbated by a workforce dominated by white and male doctors, who often tend to dismiss the health concerns of women and people of color—or to rely on harmful stereotypes when treating them. For example, in the research for her book, Wingfield observed stereotypes that she attributes in part to the lingering influence of the 1980s’ drug epidemic, and the “war on drugs” policies of penalizing rather than treating people with drug addictions.
“Many Black practitioners that I interviewed still see vestiges of that today in their work, where white peers will make racial stereotypes about patient populations,” she says. “They expect that these patients are just simply ‘drug users seeking a fix,’ or that they are people who are too lazy or unintelligent to take care of their health.”
As a result, Black doctors and other health care workers who want to combat those racist assumptions and make sure that Black patients receive fair treatment in the health care system often take on the unpaid work of what Wingfield calls “racial outsourcing.”
That involves “Black workers doing more to make sure that patients felt that they were receiving a fair equitable experience in the health care system,” she explains. “Institutions don’t do the necessary work of making spaces more accessible and available to communities of color, but instead leave that work up to the few Black professionals that are in their employ.”
As a result, these employees often end up feeling “exploited and used by the institutions where they work,” Wingfield says. “For Black health care workers, that disparity means that there’s a lot more work that they have to do for patient care—not only in terms of dealing with patients who may suffer from existing health disparities, but also in dealing with colleagues and in some cases, supervisors, who make their jobs more difficult by mistreating the patients that they’re trying to care for.”
Now, she and other public health experts and doctors say they are cautiously optimistic about the attention that medical schools, hospitals, and other health care organizations are paying to the national protests against racism—and the long-term changes they need to make to address their own systemic issues.
Tina Sacks, an assistant professor at UC–Berkeley’s School of Social Welfare and the author of Invisible Visits: Black Middle-Class Women in the American Healthcare System, says she’s heartened by some medical students she is advising as part of a Berkeley joint program with UC–San Francisco. Most of those students are not Black, but “they have started to interrogate and really push back against how that outdated way of thinking about race actually contributes to health inequities,” Sacks says. “It’s not only about unconscious bias. These medical students are saying, ‘This is overt, and we are being trained to sort people based on their race, when that has nothing to do with their underlying health condition.’ That’s super helpful for me as we start to think about the future of American medicine.”
Back in Brooklyn, Uché Blackstock is hoping that her advocacy, as part of this larger reckoning, can help draw more attention to the many ways that more diversity within medicine’s top ranks can improve health care outcomes for all patients.
“Work needs to be done, and it needs to be a multipronged approach,” she says. “We know that having a diverse workforce is one of the solutions. It’s not the solution, but it’s one of them.”
Donald Trump and others may have argued the cure shouldn’t be worse than the disease but the renewed outbreak in Victoria, whether it’s a “second wave” or an acceleration of the first, underscores the reality that, until there is an effective and widely-distributed vaccine, there is no cure for either the virus or the economy.
The Treasurer, Josh Frydenberg, has said that the six-week Victorian lockdown will cost the national economy about $1 billion a week.
Until Victoria lost control of the virus the national economy was expected to shrink by slightly less than 4 per cent this calendar year, with a horrific June quarter followed by a significant bounce back as the economy reopened.
The numbers – the more visible and calculable economic costs of the pandemic – are now clearly going to be worse, given that Victoria represents about a quarter of the national economy and that its lockdown will have spillover effects even into those states that have, so far, been able to suppress the virus.
The great unknown is whether the virus can actually be suppressed, given how infectious it has shown itself to be.
In the absence of a vaccine, is the Victorian experience likely to be the norm, with economies veering continuously between cautious reopenings and then hard lockdowns and is there an alternative to Victoria’s harsh response to the surge in its infections?
The obvious reference point is the much-discussed Swedish strategy. The Swedes didn’t impose a lockdown, instead advocating voluntary social distancing, bans on large gatherings and table-only service in bars and restaurants.
There have been about 6000 deaths attributable to the coronavirus in Sweden and its economy contracted by 8.6 per cent in the June quarter.
The economic impacts weren’t as severe as those experienced elsewhere in Europe – Germany’s economy, for instance, shrank 10.1 per cent – but they are very similar to those of its Nordic neighbours and the death rate is about four times that of Germany’s, about 10 times Denmark’s and nearly 25 times Norway’s, countries where the restrictions on activity have been far more stringent.
That would suggest there isn’t that much difference in the economic costs of doing little to contain the virus or adopting strong measures but there is, however, a very large disparity in the health outcomes.
Economists are scrambling to put some kind of analytical framework around the “lives versus economic costs” question but there is no conclusive answer because the inputs of data aren’t sufficiently reliable, given the unprecedented nature of the pandemic for modern economies and the novelty of communities’ responses to it.
One of the great unknowns is whether – even if the virus were suppressed – consumers would still behave differently relative to their pre-pandemic norms.
Some studies of mobility, using mobile phone data, have found that even as restrictions eased consumers did behave differently, with less activity, an avoidance of congested areas such as shopping centres and a shift away from non-essential activities.
It’s obviously premature to determine whether that could be a permanent shift in consumer behaviours but, as long as the threat of the virus and fresh outbreaks persist, consumer fear of infection is likely to impact and depress economic activity.
That suggests that even when the hard lockdown of Victoria ends, there will be an ongoing reduction in economic output and not just in Victoria. As the Victorian experience has also demonstrated, at this point in the life cycle of the virus, infections can be contained but not to the point where they are eradicated.
As restrictions are eased, infection rates can rise rapidly and, with some in the community considering themselves relatively immune to anything but mild effects, quickly get out of control. The initial boost to the economy from reopening can evaporate almost overnight.
It is, perhaps, the human and economic costs of continually opening and closing economies – big businesses won’t invest or employ with that kind of prolonged uncertainty and smaller businesses won’t survive it – that says prioritising the health response is also the best economic strategy.
In the absence of a vaccine, that may have to be a long-term strategy, albeit hopefully with fewer restrictions and a reduced economic cost. There are academic papers that, having come to that conclusion, argue for more targeted containment measures once the virus is under control.
They advocate strict quarantines for the infected and the most vulnerable groups in the community but a gradual normalisation of activity for those with some level of immunity or at low risk and argue for a granular approach to different industries and activities, depending on their levels of perceived risk.
Constraints on activity could be dialled up or down, incrementally and tightly-targeted at a local level, in response to infection rates.
It is possible to try to put a value on the lives lost to the pandemic and then try to compare that to the economic cost of the lockdowns but, apart from being a distasteful calculation with significant moral dimensions, the inputs are very rubbery and the concept is simplistic.
Health systems do put a value on lives to decide how much to spend on particular treatments. Comparisons between the value of lives lost and losses of economic output are made in a lot of pandemic-related research.
Containing that side of the health-versus-the-economy equation to the value of lives directly lost to the virus would, however, grossly underestimate the pandemic’s wider health and welfare costs.
On the other side of the equation – the broader economic impacts – the experience of Victoria relative to those states that have reopened their economies will provide better insights into the costs of a harsh lockdown after an economy has started to reopen.
With the threat of renewed infections still affecting the psychology and behaviour of consumers and businesses in the more fortunate states, we’ll also have a better sense of what a post-pandemic normal might look like if the virus is suppressed but not eradicated.
It is unlikely, however, to alter the convictions of politicians and many economists that the best economic strategy for responding to significant outbreaks of the virus is to lock the economy down as tightly as possible for as long as it takes to choke the rate of community transmission.
A six-week or even three-month lockdown appears preferable to the long-term damage done if there were a rolling series of reopenings and closures. The health and economic outcomes don’t appear, from the evidence to date, to be conflicting priorities but rather inter-dependent.
Setting aside the moral questions, sustainable economic growth, even at a pandemic-reduced level, can’t be achieved unless the virus is sustainably contained, whatever the immediate economic cost.
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Stephen is one of Australia’s most respected business journalists. He was most recently co-founder and associate editor of the Business Spectator website and an associate editor and senior columnist at The Australian.
New South Wales has recorded a single-digit rise in coronavirus cases, the first time new infections have dropped below double figures in more than two weeks.
NSW Health says the number of COVID-19 cases under investigation is rising
One of the new cases is at a girls school in north-west Sydney
Two Sydney hotels were issued fines this morning for breaching social distancing rules
The last time the state saw fewer than 10 overnight infections was on July 24, with seven cases — six of them associated with the Thai Rock cluster in Wetherill Park.
Although COVID-19 daily cases numbers have been steadily decreasing over the past week, NSW Health has warned that mystery infections are rising.
“While most of the cases in the past week have been associated with local clusters and close contacts with known cases, nine have not been linked to known cases, indicating COVID-19 is circulating in the community,” NSW Health said in a statement.
“It’s extremely important we all play our part in prevention all the time.”
In the 24 hours leading up to 8:00pm on Friday health authorities recorded nine new infections out of 24,421 COVID-19 tests.
Three cases are under investigation, four are close contacts of known cases, and the remaining two are returned international travellers in hotel quarantine.
One of the cases under investigation is a student of Tangara School for Girls in Cherrybrook, north-west of Sydney.
The school has been closed for cleaning and contact tracing.
The other cases under investigation are close contacts of each other.
The latest figures come after a slew of border restrictions implemented by the NSW Government in light of the large virus outbreak in Victoria.
NSW authorities have vowed to clamp down on social distancing breaches, and today announced they had handed out $5,000 fines to a pair of Sydney hotels.
Liquor and Gaming NSW said its inspectors visited the Unity Hall Hotel in Balmain and The Eastern Hotel in Bondi Junction on Wednesday and found several breaches.
The agency’s director of compliance, Dimitri Argeres, said inspectors found Unity Hall had an out-of-date safety plan, failed to detail the time of entry of patrons, and did not digitise those records within 24 hours.
At the Bondi venue, inspectors viewed CCTV and found patrons at gaming machines were too close to each other.
“The licensee has since advised us that he will turn off every second machine to ensure compliance with the public health order,” Mr Argeres said.
“These latest breaches mean a total of 18 venues across NSW have now been fined for COVID safety breaches in the past month.”
He warned venues who were caught a second time would be shut down.
We’ve credited our guts for so many things over the years. We go on gut feel, tough people show plenty of guts, if you’re no good with a secret you will spill your guts, cowards are gutless — you can even have someone’s guts for garters.
But not matter how many things we’ve claimed our guts can do over the decades, it turns out we’ve still been underselling what scientists now refer to as the body’s second brain. Because these days, we know that our guts are good for so much more than bravery, or the lack of it.
It’s only over the past couple of years that we’ve begun really understanding the true power of the gut when it comes to just about all aspects of our overall wellbeing, be it our mental health, our immune system, our ability to fight infections, and so much more.
“Gut health is so important. Before, we were relying on medications and basically putting bandaids on problems, but we now feel empowered to take control of our bodies by eating well, feeding our gut microbiome, and actually getting control over these diseases. It’s a new and exciting field,” University of Newcastle molecular nutritionist, Dr Emma Beckett told Health Hacker.
“We are learning so much more about it. We have so many more methods of measuring what’s going in the gut, and how it relates to the food we eat, and our health.”
Before we go on, let’s cover off some of the big buzz words. Just what is a microbiome, a probiotic and a prebiotic?
“The gut microbiome is all the microorganisms — that’s bacteria, viruses, fungus, all sorts of weird and wonderful things — that live inside our gut,” Dr Beckett says.
“The probiotics are the good bacteria — the bacteria that we want to add in. And then the prebiotics are that bacteria’s food — what they eat in order to flourish. And we provide both by what we eat.”
You might think it’s just the food you eat that controls the health of your gut, and it definitely does but there are all sorts of external factors that play a role, too.
From a lack of sleep or not enough exercise, or feeling stressed or strung-out, almost everything we do impacts the delicate balance of our gut. But before you start feeling like it’s all too much work, Dr Beckett has a simple tip to make sure you’re doing right by your gut microbiome every day.
“If you’re stressed, that can upset your gut health. Not sleeping well has a knock-on effect. But those are things we sometimes can’t control in our lives,” Dr Beckett says.
“What we can control is our diet, so getting all the right fruits and vegetables and plant-based foods. But you don’t need it to be expensive, you don’t need it to go on Instagram, you don’t need it to be sexy.
“My simple trick to making sure I get everything for my gut every day is to do it at breakfast. Start the day with a high-fibre breakfast, paired with yoghurt, for the probiotics, and fruit, for more fibre, and a little honey, and you’ve literally go everything you need for daily gut health at breakfast.”
FAST FACTS ON … BETTER GUT HEALTH
With accredited dietitian Nicole Dynan
1. Mix it up
“We’ve learned that if we feed our gut bacteria well, particularly with foods high in fibre like fruits, vegetables and legumes, then we can help prebiotics proliferate,” Nicole says.
“And if we’re eating a wide variety of these foods, then we’re feeding a wide variety to that healthy bacteria. The more diverse the bugs in our guts, the healthier we are.”
2. Ditch the diets
“If we go on fad diets and cut out entire food groups, or just focus on one food group, we do run the risk of shrinking the diversity of our microbiome,” Nicole says.
“So we want to make sure we eat a broad range of foods so we can really support it, in addition to other important things like sleep, exercise and hydration.”
3. Carbs are not the enemy
“There has been a lot of discussion over the years about people cutting out carbohydrates to control their weight, but the evidence really isn’t there,” Nicole says.
“And when we do that, we run the risk of not being able to feed our microbiome well. I would include wholegrains in any diet.
* Send your health questions to firstname.lastname@example.org
Adam MacDougall is the creator of The Man Shake. A new, healthy, weight loss shake that is low in sugar, full of protein, fibre, vitamins and minerals that you can have on the run and leaves you feeling full.
Peter Dutton denies his function in protecting Australia from the public well being dangers of COVID-19 – these kinds of as the Ruby Princess debacle —but the Migration Act claims otherwise, writes Abul Rizvi.
‘“The recommendation by you that there is been wrongdoing by the Australian Border Pressure is completely incorrect… [the ABF] does not have a job in relation to clearing people on health and fitness grounds.”
This is extremely deceptive.
The Migration Act has extensive powers in terms of the health and fitness necessity, together with in terms of communicable diseases. His Division does have medical professionals on its staff members, albeit not stationed at airports and seaports.
It has a group of physicians on its staff in Australia. In addition, in 2007, the Department had appointed over 3,600 abroad healthcare health professionals and radiologists to undertake healthcare exams. It is most likely this number these days is substantially larger.
Inside the visa system, health and fitness risks are managed according to the health necessity of the Migration Act 1958 and the Migration Restrictions 1994. The well being needs (also named the well being conditions) is a rather small but critical ingredient of DIAC’s broader remit for border control.
The intent of the wellness prerequisite is to:
guard the community from general public well being risks
incorporate general public expenditure on health care and group expert services and
safeguard Australians’ access to health products and services in brief source.
In phrases of community health, the primary concentrate is on ensuring visa candidates and arrivals are no cost of tuberculosis. But the Auditor-General’s report of 2007 states visa candidates and holders must also be
‘…absolutely free from a ailment or affliction that would result in a danger to general public overall health or a threat to the Australian local community.’
It is open up to the Minister to incorporate any other disorders as remaining a danger to general public health. In the earlier, ailments these as Hepatitis B and HIV have been recognized centered on tips from the Department of Wellbeing.
The extent to which COVID-19 has been provided for this purpose continues to be a thriller, specified Peter Dutton’s deflecting responses to issues on this situation.
Whilst Dutton continues to argue he has no part in guarding Australia from the public overall health challenges of COVID-19, the simple fact he has legal powers and obligations in this regard is there in black and white in the Migration Act and regulations.
It is time Peter Dutton points out why he has not utilised the intensive powers he has to guard Australians from the community health and fitness pitfalls of COVID-19.
Abul Rizvi is an Unbiased Australia columnist and a former Deputy Secretary of the Section of Immigration, presently enterprise a PhD on Australia’s immigration guidelines. You can stick to Abul on Twitter @RizviAbul.