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Strong leadership needed to weather COVID and coming healthcare crises

Strong leadership needed to weather COVID and coming healthcare crises

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In recent weeks, two key political figures — Gov. Ralph Northam and President Donald Trump — have tested positive for COVID-19.

Both cases publicly appear to involve mild symptoms, with the 61-year-old governor staying at home and the 74-year-old president spending time over the weekend at Walter Reed National Military Medical Center in Bethesda, Maryland.

“Feeling really good!” Trump tweeted as he left Walter Reed. “Don’t be afraid of Covid. Don’t let it dominate your life.” Meanwhile, Northam let Virginians know via social media that he also was “feeling good” but developed “some mild cold-like symptoms” over the weekend. “@FirstLadyVA and I are grateful to everyone for continuing to take #COVID19 seriously — let’s keep it up,” he tweeted.

According to a Saturday Washington Post report, through contact tracing efforts, 65 people were identified as close to the governor, and his wife, Pam, who also tested positive. So far, mask-wearing and social distancing have been credited as tamping down any spread by the Northams, who traveled around the state in the days leading up to their diagnosis.

Meanwhile, among Trump’s recent contacts, roughly a dozen people also have tested positive, including First Lady Melania Trump, aide Hope Hicks, Campaign Manager Bill Stepien and White House Press Secretary Kayleigh McEnany.

A lack of personal protective equipment at recent gatherings and rallies across the country publicly has been cited as a factor in the virus’ spread — and who knows how many more will become infected.

While the country was consumed with up-to-the-minute monitoring of Trump’s condition over the weekend, there are plenty of other case studies outside of political bubbles as to why the virus still is spreading.

As much as we want the economy to stay strong, college and pro sports are not immune from COVID-19. Shortly after Northam tested positive, Virginia Tech football had a home game without two coaches and 23 players who contracted the virus.

Point a finger at the White House or the state Capitol, but even local governments are struggling to find unity on COVID-19 precautions.

In Virginia Beach, a September school board meeting turned tense as a member was asked to leave after not wearing a mask. The board took an 8-3 vote that masks must be worn unless paperwork is submitted with a reasonable accommodation.

In Alexandria, the City Council recently voted, 5-2, to add a mask mandate for outdoor public spaces where social distancing is not feasible. The requirement went into effect on Oct. 1 and expanded the state’s executive order that has applied to most indoor areas since late May.

Differences in opinion are healthy. But we all should be on the same page about public health. We are in the midst of a global pandemic. COVID-19 has killed more than 1 million people across the globe and has the ability to hospitalize anyone, including the president of the United States or the governor of Virginia. The coronavirus has claimed the lives of about 210,000 people in this country — roughly the size of Des Moines, Iowa, or Rochester, New York — including more than 3,200 Virginians.

We stand with Northam and Trump as they recover from COVID-19. We also continue to stand with the governor’s COVID-19 message, not the president’s.

Leadership is about vision, integrity, humility and focus. While individuals like the president and governor have access to quality medical treatment to fight off this novel virus, Americans are experiencing disruptions to their continuity of care, including needs other than this disease. There are some concerning health care trends that likely will outlast the pandemic.

First, there is a forthcoming shortage of primary care doctors. A Times-Dispatch piece earlier this week by Eric Kolenich localized the issue in Virginia. Another 1,600 will be needed in the next decade to add to the current pool of 5,700 physicians.

But a recent article in the Journal of the American Medical Association highlights how age might further strain the population of practicing physicians. Roughly 1 in 10 doctors nationally are age 65 or older and another 20% are aged 55 to 64. The population most at risk of COVID-19 is age 60 and older, and Kolenich’s story leads with a phone call that could be just as unsettling as a mild COVID-19 diagnosis — word from your primary care physician that he or she is retiring.

Second, shift from older to younger populations and there’s an area of concern that needs more scrutiny: routine health care for children. A recent study by the Centers for Medicare & Medicaid Services offered a preliminary data snapshot of how treatments were affected during the height of stay-at-home orders.

Several treatments sharply declined for children covered by Medicaid or the Children’s Health Insurance Program. Compared to the 2019 March-May quarter, there were 1.7 million fewer immunizations among 2-year-old children or younger. Cognitive or developmental screenings fell by 3.2 million. Dental visits dropped by 7.6 million and, even with telehealth, outpatient mental health services declined by 6.9 million.

Third, Medicaid is no small investment in state and federal dollars. A Tuesday report by the RTD’s Michael Martz shows roughly 1.7 million Virginians are enrolled in the program, with about 470,000 entering through the expansion provided by the Affordable Care Act.

In the previous fiscal year that ended on June 30, the state paid around one-third of the $13.7 billion Medicaid price tag, but spending on the program was $558 million lower than expected. The factors behind the lower bill: a decline in ER visits and medical services amid Northam’s executive order suspending elective surgeries to prioritize hospital capacity for COVID-19.

Federal aid from the CARES Act also has helped offset costs, but Virginia hospitals continue to be “around a billion dollars in arrears,” a Virginia Hospital & Healthcare Association spokesperson told the RTD. The report added that due to increased enrollment, Medicaid costs will be a sizable piece of the upcoming budget. A forecast is coming later this month and a final estimate is due by Nov. 1. What will the state’s commitment look like in a post-COVID-19 world?

Wearing masks, washing hands and practicing social distancing are ways for Virginians to truly avoid fears over the coronavirus. And we elect leaders to take things seriously — a shortage of doctors, a decline in routine health care for our children, a ballooning Medicaid budget and a pandemic among them. We as ordinary citizens might not have to make tough decisions. But at all levels of government, leaders do. After all, that’s their job — to lead.

Richmond Times-Dispatch

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