Relaxing shelter-at-home requirements must be done judiciously with health in mind

As Georgia governor Brian Kemp more aggressively lifted restrictions yesterday, joining other states like South Carolina, Oklahoma, etc., a concern that is not getting talked about enough is some of these same states have the worst national health care rankings. More on this below. Per two separate surveys in the past few days, 70% of Americans want the focus to be on health first, before reopening. Americans seem to get where the focus needs to be more so than some leaders.

I understand the desire to reopen more fully, but we must be smart about it. I was pleased to see the North Carolina governor Roy Cooper extend the shelter-at-home requirement for two weeks, but actually announcing a three phased plan to reopen. That is what is needed. It could be postponed if the numbers do not improve, but it is an articulated plan.

This is a state-by-state issue. The relative health of the state is important as it increases the relative risk. The Commonwealth Fund is an organization that measures the relative health of a state based on a number of factors and have been doing so for years. A link below is to the 2019 state rankings. As you think about states that are reopening sooner than others, consider the following:

The worst twelve states (and District of Columbia) for overall healthcare, from worst to twelfth worst, are as follows:
51 – Mississippi
50 – Oklahoma
49 – Texas
48 – Nevada
47 – Arkansas
46 – West Virginia
45 – Louisiana
44 – Florida
43 – Missouri
42 – Georgia
41 – South Carolina
40 – Tennessee
39 – Alabama

The Commonwealth Fund uses a robust number of variables to rank the states and is one of the more comprehensive tools. These states tend to have a higher degree of obesity (BMI greater than or equal to 30), some have a greater degree of child hood obesity, and have a greater degree of people who claim poor health. With the higher degree of obesity comes higher propensity of diabetes, although this data is inconsistently reported. Please click on the link and go through the most recent report.

Obesity and diabetes are critical factors. Data from the COVID-19 reported this week noted diabetics are not faring well when diagnosed. People with breathing difficulties – asthma, COPD, etc. also are at greater risk. It should be noted Florida ranks poorly on childhood asthma. Again, this is an underreported data point in other states.

Another key factor for poor ratings is access to health care providers and insurance. Many of these states did not expand Medicaid. Many of these states have seen more rural hospitals close than others. Many of these states have more food deserts and higher degrees of drug overdoses, alcoholism, and suicides.

I mention all of the above, as the states have varying degrees of preparedness and risk exposure. In fact, many businesses have noted they are ignoring the governor’s orders to reopen their doors. That is also telling.

I get it. I understand the desire to reopen the doors. I also know pandemic diseases spread more readily than other diseases. If we do venture out – please use social distancing and face masks. There are many restaurants who are practicing good procedures to protect the staff and customers through take out and delivery orders. Support their efforts. That is a way to invest in our economy.

And, please listen to the truthtellers, the doctors, nurses and disease scientists. Listen to the folks not patting themselves on the back or making the issue more political. Facts must trump politics. But, we should also be mindful, we are learning more about this virus with increasingly better data. Just because new data sets aside a previous notion, that is not unusual with pandemic risks. AIDs and Ebola revealed this based on their initial discoveries (AIDs was thought to impact only gay men at first, until women and heterosexuals started dying, eg).

These truthtellers understand this is an uphill climb. We must be vigilant and patient. And, judicious and humble.

20 thoughts on “Relaxing shelter-at-home requirements must be done judiciously with health in mind

    • VJ, conservative pundit David Brooks said at least with Trump transferring decisions (and accountability) to the states, he will be less involved. That is sad statement as we missed six weeks to plan and could have made investments and preparations before it got worse. The early naysaying of the president has a lingering echo. Keith

  1. Hello Keith. A great post. People do not understand it is not just the virus that is overwhelming the hospital ICU systems, but all other aspects as well. For example this virus hits the kidneys hard requiring either dialysis or Continuous Renal Replacement Therapy (CRRT) is a 24-hour non-stop dialysis therapy used to support patients with renal (kidney) failure. The country is running low on the fluids needed for CRRT and dialysis companies are stretch very thin trying to keep up with the extra need. Supplies for a lot of things is short, not just PPEs. If the states open too soon with out testing and contact tracing what happened in New York is going to hit every small town and city every where that opens, just a few weeks later. Small town healthcare facilities do not have the resources that large areas so. People seem unaware of the damage Covid-19 can do. It hist your major organs hard with lasting damage, it gunks up your lungs so you can not breath, you drown. So much more, they are fining that younger people are simply having strokes because this virus hits the large arteries.

    I had a woman a few minutes ago call me because she wants to go out and buy a tablet. She got some extra money and so that is how she wants to use it. She is a high risk person. Heat trouble, elderly , breathing issues, bad health, and over weight. She was sure it would be OK to just go to Best Buy and check them out, handle them, see what they could do. I had to spend a half hour explaining that anything she needed she should get online and delivered and anything else could wait. It was not worth her life. I finally got through to her. People are under educated about this and watching the wrong news sources. My husband works in an ICU of a major hospital and they are really struggling. if they get another spike in patients while the staff can not even get tested nor the needed PPEs it will result in a disaster of death. The best therapy to save people is to RotoProne them, but the beds to do it are in seriously short supply. We can not take another spike in this. Please tell everyone to not go out when these states prematurely open back up. All so they don’t have to pay unemployment and face angry ignorant voters. Hugs

    • Scottie, well said. With a two week incubation people, the absence of immediate impact may have an empowering effect making people bolder than they should be. Keith

  2. Note to Readers II: I have written before about The Commonwealth Fund. It is frustrating that citizens of these states do not know of their relative poor ranking. We have too many issues like this where powers that be refuse to change the paradigm. They are too beholden to funders to focus on the needs of the people.

    A statistic I did not mention is these states have led the US down a path where maternal mortality is one of the highest rates in the western world. That is inexcusable.

    • Hugh, thanks. Fortunately, most people are taking this seriously, social distancing, and sheltering-at-home. They are also helping others. I worry about those who pay attention to misinformation and, in some cases, disinformation and run out without a care. The virus will finds its way through these people to those who are being more cautious.

      What I find interesting, some of the misinformation saying how safe it is comes from the same sources who naysayed it and said it was a hoax two months ago. Credibility of sources should come into question. Keith

  3. One can only infer from the numbers, that these states that are frothing at the bit to “return to normal” do not care about health. It is not a top priority and is not budgeted adequately. I suspect that many of the same states also under=prioritize education. But when it comes to “family values” and “freedom to be stupid” they are out front and literally ready to die for what they believe. Obviously, good health is not a family value. (And although Idaho may not rank at the bottom of the health statistics, it ranks 49th in education and I would lump our state in with those mostly southern states you mentioned.)

    • Linda, an easy fix that the president could have done, if he did not make everything about him, is open up the ACA exchanges for those who lost coverage or cannot afford or are not eligible for COBRA. I read eleven states that run their own exchanges have done this.

      I have long said, predating Trump, more than half of the Republican party is voting against their economic interests and have no idea they are. The many financial investments in rural America by the USDA, e.g, have been reduced or threatened to be reduced by Trump’s White House.

      I mentioned Michael Lewis’ book “The Fifth Risk” in a response to your comment on another post. A USDA official that doles out loans through banks tells the story of how a Trump supporter was bragging on how he got this loan on his own with no help from the government. She was standing next to him and introduced herself. He asked what she was doing there and she said the USDA provided the loan you are bragging about. Keith

      • Funny story. And yes, Idaho is the only state that has not re-opened the exchange in response to the pandemic. And of course, the last thing in the world the baby would do is fall back upon the previous administration’s healthcare solution. In 2005, Thomas Frank wrote a book called “What’s the Matter With Kansas?” It attempted to explain the very phenomenon you talk about regarding GOP.

    • Roger, I was thinking a horrible thought today. What if the virus was more deadly? Unfortunately, there is a disconnect with the “reopen” movement and the fact shelter-in-place has kept numbers lower. Keith

      • At the risk of sounding that a character out of the Old Testament. This is not over yet, our Hubris is still to be played out.
        We cannot wish this away. We have to play by Nature’s rules- no option.

      • Roger, that hubris thing will continue to be an obstacle. It has been many a smarter person’s downfall than this one. But, you also may be referring to our collective hubris with our inability to change the paradigm before it is too late. We are better at addressing messes after they happen, but not before. Keith

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