Blacks and Hispanics are unlikely to have fair access to Paxlovid
This doesn’t justify the NYDH guidance.
In a recent post, I criticized the New York Department of Health for using race/ethnicity as risk factors when determining eligibility for Paxlovid without providing evidence that Black/Hispanic people are more likely to die if they get Covid-19 than similar White people.
My criticism is not based on a Panglossian view of racial/ethnic equality. I think it is quite unlikely that Blacks/Hispanics will have equal access to Paxlovid during the current omicron wave. Unfortunately, the NYDH policy seem unlikely to do much to fix this problem, it will lead to a backlash that will benefit Republicans, and there are other policies that might be more effective and would certainly be less controversial and vulnerable to legal attack.
Why Blacks and Hispanics are unlikely to have fair access to Paxlovid
If you get Covid-19, whether you get Paxlovid depends on
1) whether you go to a doctor within 5 days of symptom onset and before your symptoms become serious,
2) whether you qualify for Paxlovid based on your risk factors and your doctor prescribes it,
3) whether the pharmacy in your neighborhood has Paxlovid in stock, and, if not,
4) whether you have the knowledge and resources to search out other pharmacies not in your neighborhood that have Paxlovid in stock.
In the real world, I suspect that these factors will all work against Black and Hispanic people, especially if they are low income.
Whites (especially upper-class Whites) are more likely to have primary care doctors and to be aware of the need to get tested immediately to get Paxlovid. They are therefore more likely than Blacks and Hispanics to be eligible for Paxlovid when they get diagnosed (within 5 days of symptom onset, symptoms not serious). Consistent with this, the CDC reports that Blacks appear to be sicker at the time they are hospitalized for Covid-19, which suggests less/later access to medical care, and less eligibility for Paxlovid. I suspect that testing capacity is higher in White neighborhoods (especially upper income neighborhoods), which will be critical to getting diagnosed in time to qualify for Paxlovid.
The NYDH guidance does not address this problem.
Once patients get a Covid-19 diagnosis, their doctors will have discretion in deciding whether to prescribe Paxlovid, for example by fudging diagnosis codes and risk factors. It seems likely that White patients will be more likely to get Paxlovid prescriptions in borderline cases than Black or Hispanic patients, due to a combination of factors (prejudice, patient sense of entitlement and lobbying, longer and stronger personal relationships with doctors, better insurance, etc.).
Perhaps the NYDH emphasis on race/ethnicity as a risk factor will counteract this to some extent. If this is the real rationale for the policy, it would be helpful to state it clearly and present the evidence that supports it. There are also alternative policy approaches NYDH could have used to prevent unequal prescribing. They could have warned doctors that they tend to under-diagnose Black/Hispanic people. They could have set up an automatic audit process that kicks in whenever an unvaccinated Black/Hispanic person over 65 is denied Paxlovid. This might have been too difficult to implement administratively, but it would have the considerable political advantage of fighting discrimination rather than creating the appearance of a racial/ethnic preference.
After they get a prescription, patients will need to find a pharmacy with Paxlovid in stock. I would personally be surprised if Paxlovid is as plentiful in Black/Hispanic neighborhoods as in White neighborhoods, but perhaps the NYDH has addressed this issue. (In NYC, it appears that allocation is centralized, which might help.)
Finally, it seems likely that Whites – especially upper-class Whites – will be resourceful in finding pharmacies with Paxlovid in stock, possibly at the expense of people in Black and Hispanic neighborhoods. Again, it is possible that the NYDH has addressed this (and the NYC allocation process may prevent it).
An alternative way to avoid Black/Hispanic deaths
Here is an alternative way NYDH could have responded to legitimate concerns about unequal access to Paxlovid.
First, NYDH could have made a big push to vaccinate Black/Hispanics as soon as it was clear that an omicron surge was coming. They could have enlisted the governor to lead the charge. This might well have saved more Black/Hispanic lives than the NYDH guidelines on Paxlovid will, with little if any political or legal cost. Donald Trump is unlikely to complain to his rally-goers that New York state spent money on public service announcements aimed at persuading Black New Yorkers to get vaccinated.
Second, NYDH could launch a campaign to educate vulnerable Black/Hispanic people about the need to get tested immediately if they have any Covid-19 symptoms. They could have made sure PCR testing with rapid turnaround is available in Black/Hispanic neighborhoods. Widespread lags in getting PCR test results means that many people will get a positive result when they no longer qualify for Paxlovid. This will continue to be relevant even when supplies of Paxlovid increase.
Third, as I noted above, rather than using race/ethnicity as risk factors, the NYDH could have tried to educate doctors about biases in diagnosing and prescribing, and implemented an audit process to protect Blacks/Hispanics from unfair denials of care.
Racial disparities in health are real and important. This doesn’t justify the NYDH guidance, which will benefit Republicans in their efforts to win elections by stoking racial animus, and may well do less to save Black and Hispanic lives than alternative policies.
https://www.nytimes.com/2022/01/19/business/covid-pill-treatment-pfizer.html
January 19, 2022
When My Mom Got Covid, I Went Searching for Pfizer’s Pills
The experience showed how hard it is for many people to get potentially lifesaving treatments.
By Rebecca Robbins
Just after 1 p.m. on Tuesday last week, my phone buzzed with a text message from my mother: “Well, came down with cold, aches, cough etc over wknd.” She had taken an at-home coronavirus test. It was positive.
Having spent the past year writing about Covid-19 vaccines and treatments for The New York Times, I knew a lot about the options available to people like my mother. Yet I was about to go on a seven-hour odyssey that would show me there was a lot I didn’t grasp.
My mother, Mary Ann Neilsen, is fully vaccinated, including a booster shot, which sharply reduced the odds that she would become seriously ill from the virus. But she has several risk factors that worried me. She’s 73. She has twice beaten breast cancer.
Her age and cancer history made her eligible to receive the latest treatments that have been shown to stave off the worst outcomes from Covid. The trouble, as I knew from my reporting, was that these treatments — including monoclonal antibody infusions and antiviral pills — are hard to come by.
Demand for the drugs is surging as the Omicron variant of the coronavirus infects record numbers of Americans. But supplies are scarce. The two most widely used antibody brands don’t appear to work against Omicron, and the antiviral pills are so new and were developed so quickly that not many have reached hospitals and pharmacies….
Eric:
Minorities typically may not have primary care doctors. In which case they rely on ERs and Urgent Care for healthcare. I would venture to guess, minorities are less likely to go to either facility unless they are really sick. Once past five days, the effectiveness of known drugs to combat Covid is far lower for everyone. Whether you given HCQ + AZT, Remdesivir, dexamethasone, etc. , the Covid storm in your lungs has progressed beyond their ability to block it.
Asians are more likely than white Americans to be admitted to hospitals. Black and Hispanic Americans are less likely to be admitted than white Americans. Minorities are less likely to have healthcare insurance even with the ACA being passed and the availability of Medicaid.
In states which discriminate and did not pass the expansion of Medicaid, you are more likely to die from Covid. If you are poor, minority, and without healthcare; you will wait to long. Five days is a brief amount of time. Trends of Racial/Ethnic Differences in ER Department Care.
January 18, 2022
Coronavirus
New York
Cases ( 4,699,690)
Deaths ( 62,869)
Deaths per million ( 3,232)
Massachusetts
Cases ( 1,487,277)
Deaths ( 20,999)
Deaths per million ( 3,047)
https://news.cgtn.com/news/2022-01-19/Chinese-mainland-records-87-confirmed-COVID-19-cases-16WsqlFxiGA/index.html
January 19, 2022
Chinese mainland reports 87 new COVID-19 cases
The Chinese mainland recorded 87 confirmed COVID-19 cases on Tuesday, with 55 linked to local transmissions and 32 from overseas, data from the National Health Commission showed on Wednesday.
A total of 37 new asymptomatic cases were also recorded, and 767 asymptomatic patients remain under medical observation.
Confirmed cases on the Chinese mainland now total 105,345, with the death toll remaining unchanged at 4,636 since January last year.
Chinese mainland new locally transmitted cases
https://news.cgtn.com/news/2022-01-19/Chinese-mainland-records-87-confirmed-COVID-19-cases-16WsqlFxiGA/img/d53244c845234721854a7e1e1a0f6d59/d53244c845234721854a7e1e1a0f6d59.jpeg
Chinese mainland new imported cases
https://news.cgtn.com/news/2022-01-19/Chinese-mainland-records-87-confirmed-COVID-19-cases-16WsqlFxiGA/img/31620b4e32724d7db25f5f27cb81e723/31620b4e32724d7db25f5f27cb81e723.jpeg
Chinese mainland new asymptomatic cases
https://news.cgtn.com/news/2022-01-19/Chinese-mainland-records-87-confirmed-COVID-19-cases-16WsqlFxiGA/img/7f3aaa3eb5c9447b8476df648c1969c7/7f3aaa3eb5c9447b8476df648c1969c7.jpeg
January 18, 2022
Coronavirus
United States
Cases ( 68,766,247)
Deaths ( 877,240)
Deaths per million ( 2,626)
China
Cases ( 105,258)
Deaths ( 4,636)
Deaths per million ( 3)
[ The need has been country healthcare institutions to work as partners through this pandemic. ]
https://news.cgtn.com/news/2022-01-20/Chinese-mainland-records-66-confirmed-COVID-19-cases-16Y7HmnNZ6M/index.html
January 20, 2022
Chinese mainland reports 66 new COVID-19 cases
The Chinese mainland recorded 66 confirmed COVID-19 cases on Wednesday, with 43 linked to local transmissions and 23 from overseas, data from the National Health Commission showed on Thursday.
A total of 28 new asymptomatic cases were also recorded, and 755 asymptomatic patients remain under medical observation.
Confirmed cases on the Chinese mainland now total 105,411, with the death toll remaining unchanged at 4,636 since January last year.
Chinese mainland new locally transmitted cases
https://news.cgtn.com/news/2022-01-20/Chinese-mainland-records-66-confirmed-COVID-19-cases-16Y7HmnNZ6M/img/c97ca5ef76334cec82f21afceb4e5221/c97ca5ef76334cec82f21afceb4e5221.jpeg
Chinese mainland new imported cases
https://news.cgtn.com/news/2022-01-20/Chinese-mainland-records-66-confirmed-COVID-19-cases-16Y7HmnNZ6M/img/d1d84df167d04850b9202aaa7db0b7e4/d1d84df167d04850b9202aaa7db0b7e4.jpeg
Chinese mainland new asymptomatic cases
https://news.cgtn.com/news/2022-01-20/Chinese-mainland-records-66-confirmed-COVID-19-cases-16Y7HmnNZ6M/img/69093869aad345cc802d1302ae7cf4e3/69093869aad345cc802d1302ae7cf4e3.jpeg
http://www.chinadaily.com.cn/a/202201/20/WS61e91439a310cdd39bc824bd.html
January 20, 2022
Over 2.95b COVID-19 vaccine doses administered on Chinese mainland
More than 2.95 billion COVID-19 vaccine doses had been administered on the Chinese mainland as of Wednesday, data from the National Health Commission showed Thursday.
[ January 15, 2022
Over 1.22 billion fully vaccinated against COVID-19 on Chinese mainland. ]
January 19, 2022
Coronavirus
United States
Cases ( 69,769,486)
Deaths ( 880,751)
Deaths per million ( 2,638)
China
Cases ( 105,345)
Deaths ( 4,636)
Deaths per million ( 3)