COVID-19 Cases and Deaths, Vaccinations, and Treatments by Race/Ethnicity as of Fall 2022

As the United States enters its third holiday season navigating a potential increase in COVID-19 cases as well as other respiratory illnesses, federal data from the Centers for Disease Control and Prevention (CDC) show that as of November 9, 2022, 80% of the total population in the United States have received at least one dose of a COVID-19 vaccine and only 10% of eligible individuals have received the updated, bivalent booster that was authorized for use among individuals 5 years of age and older in early Fall 2022. Individuals who have not received any booster dose are at higher risk of infection from the virus, and people who remain unvaccinated continue to be at particularly high risk for severe illness and death.

Over the course of the pandemic, racial disparities in cases and deaths have widened and narrowed. However, overall, Black, Hispanic, and American Indian and Alaska Native (AIAN) people have borne the heaviest health impacts of the pandemic, particularly when adjusting data to account for differences in age by race and ethnicity. While Black and Hispanic people were less likely than their White counterparts to receive a vaccine during the initial phases of the vaccination rollout, these disparities have narrowed over time and reversed for Hispanic people. Despite this progress, a vaccination gap persists for Black people. COVID-19 outpatient treatments, which can mitigate hospitalization and death from COVID-19, are also available. However, early data suggest racial disparities in access to and receipt of these treatments.

This data note presents an update on the status of COVID-19 cases and deaths, vaccinations, and treatments by race/ethnicity as of Fall 2022, based on federal data reported by the Centers for Disease Control and Prevention (CDC).

What is the status of COVID-19 cases and deaths by race/ethnicity?

Racial disparities in COVID-19 cases and deaths have widened and narrowed over the course of the pandemic, but when data are adjusted to account for differences in age by race/ethnicity, they show that AIAN, Black, and Hispanic people have had higher rates of infection and death than White people over most of the course of the pandemic. Early in the pandemic, there were large racial disparities in COVID-19 cases. Disparities narrowed when overall infection rates fell. However, during the surge associated with the Omicron variant in Winter 2022, disparities in cases once again widened with Hispanic (4,341 per 100,000), AIAN (3,818 per 100,000), Black (2,937 per 100,000), and Asian (2,755 per 100,000) people having higher age-adjusted infection rates than White people (2,693 per 100,000) as of January 2022 (Figure 1). Following that surge, infection rates fell in Spring 2022 and disparities have once again narrowed. However, as of September 2022, the age-adjusted COVID-19 infection rates were still highest for Black and Hispanic people (192 per 100,000 for each group), followed by AIAN people at 188 per 100,000. White and Asian people had the lowest infection rates at 164 per 100,000 and 153 per 100,000, respectively. While death rates for most groups of color were substantially higher compared with White people early on in the pandemic, since late Summer 2020, there have been some periods when death rates for White people have been higher than or similar to some groups of color. However, age-adjusted data show that AIAN, Black, and Hispanic people have had higher rates of death compared with White people over most of the pandemic and particularly during surges. For example, as of January 2022, amid the Omicron surge, age-adjusted death rates were higher for Black (37.4 per 100,000), AIAN (34.7 per 100,000), and Hispanic people (29.9 per 100,000) compared with White people (23.5 per 100,000) (Figure 1). Following that surge, disparities narrowed when death rates fell. As of August 2022, age-adjusted death rates were similar for AIAN (4.9 per 100,000), Black (4.4 per 100,000), and White people (4.2 per 100,000) and lower for Hispanic (3.6 per 100,000) and Asian (2.7 per 100,000) people. Despite these fluctuations over time, total cumulative age-adjusted data continue to show that Black, Hispanic, and AIAN people have been at higher risk for COVID-19 cases, hospitalizations, and deaths compared with White people.

Read the full article from KFF here.

Pediatric Shared Decision-Making: Creating Better Communication for Your Child’s Care

Shared decision-making (SDM) is a set of processes where health care decisions are made through respectful collaboration between doctors, patients, and their parents or guardians. The American Academy of Pediatrics (AAP) and many other medical care groups see SDM as a key part of family-centered care. However, SDM may not be used as often as it should be. There are many reasons for this, such as:

  • Doctors have not learned how to do SDM.
  • There is not enough time.
  • There can be an imbalance of power between the medical care team and the family.
  • There is an existing lack of understanding of what SDM is and how to participate in SDM.

In this month’s Pediatrics, “Pediatric Shared Decision-Making for Simple and Complex Decisions: Findings from a Delphi Panel”, Eaton et al (10.1542/peds.2022-057978) explore the SDM process to look at what SDM is and how it is best implemented.

What did the authors find in the study?
The processes of SDM refer to the activities, in the short and long term, involved in making decisions. For example, an initial process could be to:

  • Establish a relationship with the family
  • Discuss research treatment options
  • Ask if the family understands the clinical issue and the decision that needs to be made.

The main findings of the study show the need to personalize this decision-making process to each family’s unique situation and preferences. Examples of ways to personalize the process can include:

  • Determine information preferences- such as language, amount, type, method and with whom the information is to be shared. For example, how can the information be given in a way that is accessible, useful, and meaningful to the family?
  • Discuss the role of the child and parent/guardian in the SDM process. For example, does the child want to be a part of the process? Are they old enough? Are they mature enough?
  • Explore family values and what matters most to them. For example, is a family willing to discuss these topics with the rest of the care team and/or with the child?
  • Discuss guidance from the medical team about the child’s care. For example, what type of information does the family want from the doctors and nurses providing the care?

The authors introduce a framework that suggests different ways to help with the SDM process. Developed based on learnings from the study, the framework aims to provide a range of strategies to help personalize the process to unique needs of the child, family and clinical situation. The framework provides guidance to be used in all types of decisions, as well as additional guidance for more complex decisions.

The study also highlights areas where the panel did not agree. For example, the panel did not agree on topics such as:

  • Should “personalized” or another word replace “shared” in this process?
  • How do you decide what the child’s role in the process should be?
  • Should a family be asked if they want a recommendation before a doctor gives one?

The full article is available from the American Academy of Pediatrics.

Department of Homeland Security Finalizes “Public Charge” Immigration Rule

The Department of Homeland Security (DHS) has finalized a rule defining the criteria it uses when determining whether a person can be denied a visa and/or legal residency because they are likely to become a “public charge.” The final rule comes on the heels of the proposed rule, published February 24, 2022, and is the latest chapter in a long series of regulatory and legal actions surrounding the public charge policy. It includes several provisions that directly affect older immigrants and immigrants with disabilities, their families and caregivers.

For more information and background on the history of the public charge policy, see ACL’s March 2022 blog post on the Notice of Proposed Rulemaking and the July 2021 blog post on the history of public charge rulemaking as well as resources from the Department of Homeland Security.

What’s most important for older immigrants and immigrants with disabilities to know?

Someone may be considered a “public charge” if they are likely to become primarily dependent on the government for subsistence. This is evaluated by looking at prior and current use of certain public benefits as well as other factors such as age, health, and financial resources.

Participation in most public benefits, including ACL’s programs, will not adversely impact a citizenship or residency determination under the new rule. The ONLY public benefits considered in a public charge determination are:

  • Long-term institutionalization funded by the government (for example, Medicaid-financed care in a nursing facility). Receiving Medicaid Home and Community-Based Services (HCBS) or other Medicaid health care benefits will not affect a public charge determination.
  • Direct cash assistance programs, including Supplemental Security Income (SSI) and Temporary Assistance for Needy Families (TANF).

This is a codification of DHS’ 1999 Field Guidance (the policy that is currently in place). It solidifies DHS’ long-standing position on which public benefits will be considered in a public charge determination and which will not.

What are the major provisions of the final rule?

DHS received 233 comments on the proposed rule, including many from the aging and disability community. The final rule provides responses to many of those comments, explaining why policy changed or remained the same. The final rule closely mirrors the proposed rule with a few exceptions. The major provisions include:

  • Receiving Medicaid Home and Community Based Services (HCBS) will not factor into any public charge determination. Medicaid HCBS, as well as acute care benefits, will not be considered.
  • Long-term institutionalization at government expense will be factored into a public charge determination and while “long-term” is not explicitly defined, the rule includes guardrails. While the rule did not define what constituted “long-term” institutionalization with a hard threshold or day limit, it did specify that short-term residential care for rehabilitation or mental health treatment would not be considered. Long-term institutionalization also does not include imprisonment for conviction of a crime. DHS will collaborate with the Department of Health and Human Services to develop sub-regulatory guidance to help guide DHS agents’ evaluation of past or current institutional stays.
  • Evidence may be presented to show unjustified institutionalization in violation of federal law. DHS recognizes that some people are forced to live in institutions due to the unavailability of HCBS and in violation of their rights under the Americans with Disabilities Act and Section 504 of the Rehabilitation Act (as interpreted by the Supreme Court in Olmstead v. L.C.). As a result, an applicant for admission to the United States or an immigration status change may present evidence to show their institutionalization was in violation of federal law, thus mitigating negative weight that may be put on that period of institutionalization during a public charge determination.
  • No single factor alone is determinative of whether someone may be deemed a “public charge.” DHS will perform a “totality of the circumstances test” considering both past and current use of publicly funded institutional care and cash assistance. The test also includes an evaluation of five statutory factors: health, age, family status, assets/resources/financial status, education/skills to determine likelihood of primary dependence on the government for support. No single factor is determinative, however. Thus, past or current institutionalization, receipt of cash benefits, poor health or advanced age alone is not sufficient to render someone a public charge.
  • Disability alone is not sufficient for a determination that individual is likely to become a public charge. Disability, as defined in Sec. 504 of the Rehabilitation Act of 1973, cannot be the sole basis for a determination that an that individual is in poor health, is likely to require long-term institutionalization at government expense, or is likely to become a public charge due to any other factor.
  • DHS will consider the medical evaluation performed by a physician when evaluating a non-citizens health: In the proposed rule, DHS did not specify evidence it would consider as a part of the statutory minimum factor evaluation. In the final rule, DHS clarifies it will accept information submitted via forms it is already gathering as a part of the admission, citizenship, or naturalization process. The standard medical report and vaccination record  will be considered as evidence for the health factor. This report captures information on a non-citizens chronic health conditions and/or disabilities and will be used by DHS agents in the “totality of the circumstances” analysis. DHS will work with HHS on guidance to agents to ensure disability competency when evaluating medical conditions or disabilities that appear on the medical report.

What does this mean for immigrant communities moving forward?

Non-citizens should apply for and use the public benefits to which they are entitled, with the understanding that:

  • Long-term institutionalization paid for by Medicaid (or another public source) or cash benefits like SSI or TANF may, but will not necessarily, adversely affect immigration decisions under the public charge rule.
  • Using other services – such as Medicaid HCBS, services provided through ACL’s programs, or the Supplemental Nutrition Assistance Program (SNAP) – will not affect immigration decisions under the public charge rule.

The final rule will be effective on December 23, 2022, and will be published in the Federal Register on September 9, 2022.

Read more:

Release from the U.S. Department of Health and Human Services: New Rule Makes Clear that Noncitizens Who Receive Health or Other Benefits to which they are Entitled Will Not Suffer Harmful Immigration

Pandemic Medical Innovations Leave Behind People With Disabilities

Divya Goel, a 35-year-old deaf-blind woman in Orlando, Florida, has had two telemedicine doctors’ appointments during the pandemic. Each time, she was denied an interpreter.

Her doctors told her she would have to get insurance to pay for an interpreter, which is incorrect: Under federal law, it is the physician’s responsibility to provide one.

Goel’s mother stepped in to interpret instead. But her signing is limited, so Goel, who has only some vision, is not sure her mother fully conveyed what the doctors said. Goel worries about the medical ramifications — a wrong medicine or treatment — if something got lost in translation.

“It’s really, really hard to get real information, and so I feel very stuck in my situation,” she signed through an interpreter.

Telemedicine, teleworking, rapid tests, virtual school, and vaccine drive-thrus have become part of Americans’ routines as they enter Year 3 of life amid covid-19. But as innovators have raced to make living in a pandemic world safer, some people with disabilities have been left behind.

Those with a physical disability may find the at-home covid tests that allow reentry into society hard to perform. Those with limited vision may not be able to read the small print on the instructions, while blind people cannot see the results. The American Council of the Blind is engaged in litigation against the two dominant medical testing companies, Labcorp and Quest Diagnostics, over touch-screen check-in kiosks at their testing locations.

Sometimes the obstacles are basic logistics. “If you’re blind or low-vision and you live alone, you don’t have a car,” said Sheila Young, president of the Florida Council of the Blind, pointing to the long lines of cars at drive-thru testing and vaccination sites. “Who can afford an Uber or Lyft to sit in line for three hours?”

Desperate for Cash: Programs for People With Disabilities Still Not Seeing Federal Funds

LILBURN, Ga. — Matthew Southern, 35, who has intellectual and developmental disabilities, is able to stay out of an institution because health aides paid through a Medicaid program assist him and his roommate with ordinary tasks.

But amid a worker shortage worsened by the pandemic, Southern’s father, Dan, has had to step in to fill in gaps in his son’s care by volunteering at their home 45 minutes away from his northwestern Atlanta suburb. He blames the low pay across the industry.

“No one wants to work for $12 an hour,” Dan Southern said. “People can work at Burger King and make more money.”

Last year brought an injection of hope: The federal government, through the American Rescue Plan Act that President Joe Biden signed into law in March 2021, increased funding with a 10-percentage point match that could amount to some $25 billion in federal money for Medicaid home and community-based services, which have long faced staffing crunches. That massive infusion of cash could be used by states to buttress wages, move people off waiting lists for disability services, train more workers, or expand covered services for vulnerable elderly and disabled people, helping to keep them out of nursing homes.

But almost a year later, Indiana, Massachusetts, New York, North Carolina, Ohio, and Washington were among 19 states as of Feb. 17 yet to receive the “conditional approval” needed from the Centers for Medicare & Medicaid Services to fully access the money.

Read the full article from KHN.

Executive Order on White House Initiative on Advancing Educational Equity, Excellence, and Economic Opportunity for Black Americans

The Initiative shall advance educational equity and economic opportunity for Black students, families, and communities by focusing on the following policy goals:
(i)     increasing general understanding of systemic causes of educational challenges faced by many Black students, whether these students are in urban, suburban, rural, or migrant learning environments, and working across executive departments and agencies (agencies) to address these challenges;
(ii)    increasing Black children’s and families’ access to and participation in high-quality early childhood programs and services that promote children’s healthy development and learning, prepare them for success in school, and affirm their cultural identity;
(iii)   addressing the inequitable treatment of Black children, such as eradicating discriminatory referrals to special education and excessive disciplinary actions;
(iv)    supporting and improving data collection related to Black students and the implementation of evidence-based strategies to increase the participation and success of Black students in all levels of education and prepare them for careers and civic engagement;
(v)     ensuring that all Black students have access to excellent teachers, school leaders, and other professionals, including by supporting efforts to improve the recruitment, preparation, development, and retention of qualified, diverse teachers and school leaders and other professionals who understand students’ lived experiences and can effectively meet their learning, social, and emotional needs;
(vi)    enhancing student support services and fostering positive engagement among schools, families, community leaders, and community-based organizations to increase the high school graduation and post-secondary attendance rates and decrease the high school dropout rate for Black students;
(vii)   promoting a positive school climate that supports equitable access to and participation in college-readiness, advanced placement courses, and internship opportunities, as well as innovative dropout prevention and recovery strategies that better engage Black youth in their learning, help them progress academically as needed, and provide those who have left the educational system with pathways to reentry;
(viii)  eliminating discriminatory enrollment, housing, transportation, and other policies that lead to racial and socioeconomic segregation among and within schools;
(ix)    ensuring equitable access to educational resources, professionals, and technology, including by addressing racial disparities in school funding and expenditures;
(x)     breaking down barriers that impede the access of higher education institutions that serve Black students, such as Predominantly Black Institutions (PBIs) and Historically Black Colleges and Universities (HBCUs), to Federal funding, and strengthening the capacity of those institutions to participate in Federal programs and partnerships;
(xi)    advancing racial equity and economic opportunity by connecting education to labor market needs through programs such as dual enrollment, career and technical education, registered apprenticeships, work-based learning, and career advancement, particularly in the fields of science, technology, engineering, and mathematics; and
(xii)   ensuring that Black communities have access to resources for economic success, such as in the areas of financial education, small business development, entrepreneurship, arts, science, technology, engineering, and mathematics.

In working to fulfill its mission and objectives, the Initiative shall, consistent with applicable law:
(i)    identify and promote evidence-based best practices that can provide Black students with a rigorous and well-rounded education in safe and healthy environments, as well as access to support services, that will improve their educational, professional, economic, and civic opportunities;
(ii)   advance and coordinate efforts to ensure equitable opportunities for Black students in the re-opening process for schools across the country, and take steps to ensure that Black students, from early childhood to post-secondary education, can equitably recover from learning losses and other challenges faced during the COVID-19 pandemic;
(iii)  encourage and develop partnerships with a national network of early childhood and early intervention providers, schools, institutions of higher education, and other public, private, philanthropic, and nonprofit stakeholders to improve access to educational equity and economic opportunities for Black Americans;
(iv)   monitor and support the development, implementation, and coordination of Federal Government educational, workforce, research, and business development policies, programs, and technical assistance designed to improve outcomes for historically underserved communities, including Black Americans;
(v)    work closely with the Executive Office of the President on key Administration priorities related to education, equity, and economic opportunity for Black Americans; and
(vi)   advise the Secretary on issues of importance to Black Americans and policies relating to educational equity, excellence, and economic opportunity for Black Americans.


Income-Related Inequalities in Affordability and Access to Primary Care in Eleven High-Income Countries

As COVID-19 continues to ravage the globe, the United States faces renewed scrutiny for the stark disparities in health and economic impacts experienced by people with lower incomes and by Black and Latino communities. In other countries, the crisis has highlighted the need for greater resiliency of national health systems to ensure access to care.

To compare the health experiences of adults with lower income during the pandemic and the effect of income-related disparities, the Commonwealth Fund surveyed adults across 11 high-income countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the U.S. The results of the survey, conducted during the early part of the pandemic between February and May 2020, were published in the December 2020 issue of Health Affairs.

What the Study Found

  • In nearly all countries, adults with lower income were significantly more likely than those with higher income to have multiple chronic health conditions. However, on nearly every measure the study used, income-related disparities were greatest in the U.S.:
    • More than one-third (36%) of U.S. adults with lower income have two or more chronic conditions — significantly more than in other countries.
    • Approximately one-third of adults with lower income in the U.S. (36%), Australia (36%), and Canada (34%) reported having anxiety or depression, the highest rates in the survey. Their counterparts in Germany (14%) and Switzerland (15%) were the least likely to report anxiety or depression.
    • More than one-quarter (28%) of U.S. adults with lower income said that, in the past year, they worried about being able to afford basic necessities such as food or housing, a significantly greater proportion than seen in other countries, where 6 percent to 22 percent reported this.
  • Half of U.S. adults with lower income don’t get needed care because it’s too costly. In the survey, 50 percent reported skipping doctor visits, recommended tests, treatments or follow-up care, or prescription medications in the past year because of the cost. In contrast, just 12 percent to 15 percent of adults with lower income in Germany, the U.K., Norway, and France reported doing the same.

Read the full article from the Commonwealth Fund