Masks and Much More: Public Health in the Time of COVID-19

By Chantele E. Mitchell-Miland & Dara D. Mendez
Special to the Pittsburgh Current

Green is associated with “go,” “all clear,” “nothing to worry about” – but during this pandemic, green could not be further from the truth, especially as businesses and other places reopen. Caution is needed now given the increase in COVID-19 cases across the United State and in Allegheny County. In Allegheny County alone, there was an increase of 521 diagnosed cases over the past week (from June 24 to June 30).

Let’s be honest. We are tired. 

The first case of COVID-19 (caused by infection with the virus SARS-CoV-2) in the United States was reportedly detected on January 19, 2020 in Snohomish County, Washington, however, reports indicate there were probably undetected cases and COVID-19-related deaths prior. By March 19, 2020, Pennsylvanian Governor Tom Wolf initiated stay-at-home orders for many counties, including Allegheny County, where most businesses were closed along with additional restrictions. The purpose of these changes were to protect health and “flatten the curve,” meaning reduce the increase in cases over time. This has been a difficult time – even for us Epidemiologists and Public Health workers – who are dealing with the changes as well. Some Public Health workers have even been admonished and fired for showing the true effects of this pandemic on the health and well-being of Americans, particularly for Black and Brown communities that are disproportionately affected. As many are facing challenges with maintaining employment and adjusting, it can be difficult to know what to do at this time with changing information and guidance.

First, it is important to know how COVID-19 spreads. It primarily spreads through the air meaning that you can contract COVID-19 simply by breathing it in, something more likely to occur in enclosed spaces. The stay-at-home orders were put in place to limit contact between people and reduce exposure and opportunities to contract COVID-19. Now that they have been lifted, there are other things you can do to reduce exposure. One way is to limit physical contact (“social distancing”) with people who do not live in your household (staying at least 6 feet apart). One may not be able or have the choice to physically distance given familial and community circumstances, but it is important to be judicious about how often you go out to reduce contact. Wearing a face mask or face covering is also critical. Not only does wearing the mask over your nose and mouth reduce the potential spread of virus from you to others; those wearing one will reduce the spread to you. Yes, masks can be uncomfortable and can feel restrictive, but they can also save the lives of you and others. Because cases are continuing to rise, additional measures have been put in place by the county health department, and additional measures may be needed if cases continue to rise. The Poor People’s Campaign lays out how states’ decisions to ease social distancing measures have put more people at risk.

Testing and contact tracing are also critical. These methods allow us to know when and where people have been infected. Mass testing gives us the ability to know who is infected early and to isolate infected individuals to prevent continued spread. We know from prior work that early on, Black and Brown communities were less likely to receive testing and plans were put in place led by Black leaders, activists and researchers to increase testing in these areas. Work is ongoing, including plans for expansion of contact tracing that is equitable and community centered. We call for community-centered efforts as a means to track and trace cases of infection while also providing the necessary support and resources where needed. This involves inclusion of community-based organizations and Federally Qualified Health Centers that have expanded testing and have long-standing relationships in local communities. 

Data for Allegheny County indicates differences by race where white individuals have a higher number of total infections, but people of color are disproportionately affected. For example, Black populations in Allegheny County are 2.5 times as likely to be infected with COVID compared to white populations, and people of Asian descent are 1.9 times more likely than white populations. Racial differences in infection rates have exposed systemic racism. Systemic racism plays a role in factors that predispose populations to have less opportunity and access to housing, health care, employment, healthy food options and other needed resources that influence health. Systematic racism also plays a role in the kind of the healthcare that people of color receive once they are sick with COVID-19. There are multiple reports that indicate that people of color are less likely to receive a COVID test when they seek medical care and, once identified as being infected, are less likely to receive adequate treatment. In Allegheny County for example, although 13% of the population is Black, they make up more than 30% of all hospitalizations and admittance to the ICU and approximately 19% of deaths. These are serious equity issues that must be addressed.

The toll COVID-19 has taken on the mental and physical health of the community cannot be understated. Mental health care is critical, including expansion of services and supports in multiple forms, such as telehealth and community-based approaches. Resolve Crisis Services is a local resource available to all, but expansion of mental health care in the continuum of care is needed. Physical activity and movement is important too and is linked to mental health. Whether being physically active in one’s home, community or outside elsewhere, physical distancing and wearing a mask within six feet of someone who doesn’t live with you or in any enclosed space is still critical. 

Finally, policy and action that is equitable, based in science and focused on ensuring the full protection and health of populations is important in the immediate and long-term.  A worker’s ability to reduce becoming infected, for example, is influenced by state and workplace policies, including requirements for store patrons to wear masks when entering businesses. Policies are also needed to protect Black and Brown individuals from harm while wearing a mask and that allow workers to still receive pay and have job security if they stay home when they are sick. These are critically important in stopping the spread of respiratory illnesses. So instead of “green” – “yellow” and possibly “red” should be the color of the times.  

About the authors:

Chantele E. Mitchell-Miland, PhDc, MPH, is a Doctoral Candidate in Epidemiology at the University of Pittsburgh Graduate School of Public Health and a Research Health Scientist at the VA Pittsburgh Healthcare System (VAPHS) in the departments of the Center for Health Equity Research and Promotion (CHERP) and Mental Illness Research, Education, and Clinical Center (MIRECC). 

Dara D. Mendez, PhD, MPH, is an Assistant Professor of Epidemiology at the University of Pittsburgh Graduate School of Public Health and Health Equity Editor for Block Chronicles.  Twitter handle: @DrDaraDMendez

Chantele E. Mitchell-Miland (left) Dr. Dara D. Mendez (right)

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