Testing and treatments for COVID-19 must be free or cheap for those who can’t afford to pay | Opinion

Posted Apr 20, 2020

By Glenn Fennelly

To prevent repeated COVID-19 crisis, we should make sure treatments and the hoped-for vaccine are available to all, regardless of the person's income or immigration status, Glenn Fennelly says.

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Our efforts to counter COVID-19 with therapies, social distancing and eventually vaccination will not succeed unless we ensure these treatments are fully accessible to those on the margins: the homeless, incarcerated and undocumented.

We have seen proof of this before. During the 1980s, high rates of HIV coupled with tuberculosis in New York City’s homeless shelters fueled a resurgence of TB among the general population. Recent outbreaks of hepatitis A in homeless in several US cities have threatened a similar spillover to other communities.

Right now, in the middle of the COVID-19 pandemic, hundreds of homeless New Yorkers with possible COVID-19 have discharged from hospital emergency rooms with no place to go. Their movements in search of basic necessities could thwart the city’s best efforts at social distancing and self-isolation. A recent COVID-19 outbreak at Rikers Island prompted the release of low-risk offenders. But America’s correctional facilities remain frighteningly conducive to disease outbreaks that could spread outside, as corrections officers and returning inmates interact with their families.

Our immigrant detention centers also present alarming risks. Several detainee children have died from influenza during the past year because they were denied vaccination and life-saving treatments. An outbreak of COVID-19 in these crowded facilities would create expanded risks, as American employees and contractors return to their communities, and through the U.S. government’s decision to continue deporting detainees to countries poorly equipped for the pandemic.

There are several steps we can take to prevent the risk of COVID-19 spreading in these marginalized communities and threatening the wider population.

First, we should make sure treatments and the hoped-for vaccine are available to all, regardless of their income or immigration status. Gavi, the Vaccine Alliance, has taken steps to help buttress the preparedness of health systems in lower-income countries, accelerate development of COVID-19 vaccines and get them to where they are needed.

Second, we must ensure that the lifting of stay-at-home restrictions is science-based, includes expanded capacity for testing and for tracking everyone who has contacted an infected individual, and is prepared to accommodate homeless and undocumented individuals without threat or intimidation.

Third, we must expand federally qualified health centers and similar facilities that have the capacity to address health care needs for the most vulnerable, regardless of citizenship status or ability to pay.

Programs such as California’s Health4AllKids that ensure affordable care for all undocumented immigrant children under the age of 19 must be replicated at the federal level, and must extend benefits to undocumented immigrant adults.

Other organizations should step up to provide safe and attractive spaces for homeless individuals who must remain in isolation or quarantine, or spaces to help decompress prisons and detention centers.

COVID-19 can afflict everyone. We are well past the time to extend these treatments to everyone who needs them. Failing to do so will encourage seismic epidemics among the most vulnerable populations, bringing repeated tsunamis of COVID-19 crashing upon us all.

 

Glenn Fennelly, MD, MPH is vice president of the Board of Doctors of the World, USA. He is an expert in pediatric infectious diseases and a Professor of Pediatrics at Rutgers New Jersey Medical School in Newark, New Jersey.

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