The COVID-19 pandemic has highlighted long-standing health inequities that have resulted in an increased risk of sickness and death for people of color. The crisis has also propelled a nationwide focus on understanding and addressing health inequities. As compared to white, non-Hispanic individuals, American Indians or Alaska Natives are over five times as likely to be hospitalized, and black or African-American individuals are over twice as likely to die from COVID-19.

While COVID-19 and the reckoning on racial justice have mobilized some state officials working in Medicaid, public health, insurance departments and Marketplaces alike, states are at different places on their journeys to confront systemic racism and inequities in healthcare, and each faces unique and challenging barriers. As early as August of this year, over one-third of states had launched task forces to take a closer look at health disparities (or differences in health based on population group) in response to the pandemic. These new task force efforts stand in contrast to decades of siloed and often poorly funded work to advance health equity by state offices of minority health or health equity. The new wave of state health equity activities aims to mitigate structural, institutional, political, financial and analytical barriers to ensure everyone has a fair opportunity to be as healthy as possible.

In a new issue brief for the Robert Wood Johnson Foundation’s State Health and Value Strategies program, Manatt Health explores impediments and accelerants to advancing health equity as states are increasingly being called upon to drive change.

To read the full issue brief, click here.

Stricter COVID-19 mitigation efforts, announced Thursday by Gov. Tom Wolf and Secretary of Health Dr. Rachel Levine, aim to put Pennsylvania “on pause” for the next three weeks.

The limited-time mitigation orders place restrictions on in-person dining and alcohol sales, gatherings and events, businesses and K-12 sports. Wolf — who tested positive for the coronavirus earlier this week — and Levine announced the new measures during a virtual press conference Thursday.

“This is a bridge to that better future we all know that we can get to in Pennsylvania,” Wolf said. “We know that COVID-19 thrives in places where people gather together. Therefore, these mitigation measures target high-risk environments and activities and aim to reduce the spread of this devastating virus.”

In the last two days, Pennsylvania has reported the highest number of COVID-19 deaths since the beginning of the pandemic.

“The virus continues to strain our health care systems and the dramatic rise in cases among all age groups, including among school-age children, is alarming,” Levine said. “Since the start of the pandemic, there have been more than 37,500 cases among children age 5 to 18, yet 9,500 of those cases occurred in the past two weeks.”

The new order takes effect 12:01 a.m. on Saturday and will remain in effect until 8 a.m. on Jan. 4, 2021.

“We will be saving lives, but we have to do it together,” Wolf said.

Here’s what to know about the guidelines:

In-person dining and alcohol sales

• All in-person indoor dining at restaurants, bars and other food service establishments is prohibited.
• Outdoor dining, take-out food service and take-out alcohol sales are permitted and may continue.

Gatherings and events

• Indoor gatherings and events of more than 10 people are prohibited.
• Religious services and worship are specifically excluded from the limitations set forth above during religious services, but faith leaders are “strongly encouraged” to find alternative ways to gather.
• Outdoor gatherings and events of more than 50 people are prohibited.

Business closures, capacity limits

• All in-person businesses may operate at up to 50% of the maximum capacity stated on the applicable certificate of occupancy, except as limited by existing orders to a smaller capacity limit.
• In-person businesses in the entertainment industry — theaters, concert venues, museums, movie theaters, arcades, casinos, bowling alleys and private clubs — are prohibited from operating.

Gyms and fitness facilities

• Indoor operations at gyms and fitness facilities are prohibited, but outdoor facilities and classes may continue.
• All participants are required to wear a mask and social distance during outdoor activities.

K-12 sports, extracurricular activities

• Voluntary, school-sponsored activities are suspended, but participants may gather virtually. This includes, but is not limited to, attendance at or participation in activities such musical ensembles, school plays, student council, clubs and school dances.
• All K-12 sports are paused. This includes all competition at public, nonpublic and private schools as well as all club, travel, recreational, intermural and intramural sports.
• The Pennsylvania Principals Association is recommending a delay to the start of the winter sports season. The surge in cases among school-age children increases the risk that asymptomatic participants will spread the virus at a game or practice, in the locker room, while traveling to and from events, or at team meals, parties or other gatherings.

Professional, collegiate sports

• Professional and collegiate sports activities may continue in accordance with guidance from the Centers for Disease Control and Prevention and the Department of Health.
• Spectators are prohibited from attending events.

On Friday, December 4, 2020, the cumulative number of COVID cases in Appalachia surpassed 1 million. New cases have risen considerably since Thanksgiving.

The Region set a new record high for the seven-day rolling average of daily new cases with 17,331 on Sunday, December 6. The seven-day average of daily new cases was 13,077 a week ago and 13,113 two weeks ago.

The number of deaths has also risen considerably in the past few weeks. A new record high for the seven-day rolling average of daily new deaths was also set on Sunday, December 6 at 231. The rate was 139 deaths per day a week ago and 173 two weeks ago.

As of 11:30am December 10, 2020, there were 1,118,068 cumulative cases throughout Appalachia and 18,011 cumulative deaths.

There were 65,188 new cases and 979 new deaths since 12am Monday, December 7, 2020. The total number of COVID-related deaths are 18,011 in 407 of Appalachia’s 420 counties.

The Appalachia Nonprofit Resource Center (ANRC) was established during COVID-19 to assist regional nonprofit organizations by offering free online access to curated resources. Information is updated regularly. Check out recent additions about:

• Online Marketing
• Online Engagement and Fundraising
• Building a Diverse Board

Other topics including financial management, mission and operations, and fundraising are also available. Register now!

The number of new rural deaths climbed by more than 30% last week, topping 3,000 in a one-week period for the first time. New infections last week remained just below the record number of new cases set three weeks ago.

The number of people from rural counties who died from Covid-19-related causes in a one-week period topped 3,000 for the first time last week, marking the fifth consecutive week of a record-setting number of fatalities.

Rural counties broke another record last week for the number of counties in the red zone, defined as 100 new cases per week per 100,000 residents. Ninety-four percent of rural counties (1,857 out of 1,976) exceeded that threshold last week. The red-zone definition comes from the White House Coronavirus Task Force and indicates that localities have lost control of the spread of the virus.

See examples of reports from the White House Coronavirus Task Force for and the nation.

The Daily Yonder’s weekly report on the coronavirus in rural America covers the period of Sunday, November 29, through Saturday, December 5.

• Rural counties reported 3,613 Covid-related deaths last week, an increase of 34% from the previous week, which also set a record for fatalities.
• Cumulatively, 38,172 rural Americans have died from the virus, representing just under 14% of all Covid-related deaths in the U.S. Rural residents (defined here as people living in nonmetropolitan counties) represents just over 14% of the U.S. population.
• The number of new infections was 211,960 last week, an increase of about 7% from the previous week. The record for new cases in rural counties (216,045) was set three weeks ago, just before Thanksgiving.
• Cumulatively, more than 2.2 million rural residents have tested positive for the coronavirus, representing 15.6% of all infections in the U.S.
• Although the rate of new infections continued to be worst in the Midwest, Great Plains, and Mountain West, all but a handful of U.S. counties (urban and rural) are in the red zone.
• About 4 out of every 10 rural counties had “very high” rates of new infections, defined as more than 500 per 100,000 in a week. These counties are shown in black on the map.
• About 3 out of 10 metropolitan counties had infection rates of more than 500 per 100,000 for the week. These counties are shown in dark blue on the map.
• Minnesota and Indiana each had more than 90% of their counties in the “very high” category.
• Illinois, Kansas, and South Dakota had more than 70% of all counties in the “very high” category.
• The rural rate of new infections and deaths remained higher in rural counties than in urban ones (see graphs below).

On December 9, CMS posted updates to FAQs and an infographic about coverage and payment for monoclonal antibodies to treat COVID-19. The FAQs include general payment and billing guidance for these products, including questions on different setting types. The infographic has key facts about expected Medicare payment to providers and information about how Medicare beneficiaries can receive these innovative COVID-19 treatments with no cost-sharing during the public health emergency (PHE). CMS’ November 10, 2020 announcement about coverage of monoclonal antibody therapies allows a broad range of providers and suppliers, including freestanding and hospital-based infusion centers, home health agencies, nursing homes, and entities with whom nursing homes contract, to administer this treatment in accordance with the Food & Drug Administration’s Emergency Use Authorization (EUA), and bill Medicare to administer these infusions. Currently, two monoclonal antibody therapies have received EUA’s for treatment of COVID-19.

For More Information:

• Therapeutics Coverage Infographic
• Section BB of the FAQs: billing and payment for COVID-19 monoclonal antibody treatments
• Monoclonal toolkit and program guidance

The Centers for Disease Control and Prevention (CDC) has updated their Strategies for Optimizing the Supply of Facemasks to include added considerations for returning to conventional capacity. It discusses conventional capacity strategies, contingency capacity strategies and crisis capacity strategies.