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“It's been a nightmare:” As COVID emergency ends, health equity activists say danger posed to vulnerable patients remains

The main sign outside of Berkshire Medical Center in Pittsfield, Massachusetts
Josh Landes
The main sign outside of Berkshire Medical Center in Pittsfield, Massachusetts- the flagship facility for Berkshire Health Systems.

The COVID-19 public health emergency ended today in Massachusetts and across the country. While healthcare facilities are relaxing infection control guidelines, a coalition of public health experts say it’s premature and dangerous to the most vulnerable.

Berkshire Health Systems, the county’s largest healthcare provider, is dropping many of its COVID-19 precautions in line with the state. Visitation policies have been expanded, pre-procedure testing will be discontinued, and testing centers in North Adams, Pittsfield, and Great Barrington will close at the end of the month. Even one of the most effective means of limiting the spread of the respiratory illness that has killed millions worldwide is being halted.

“Universal masking is not required. However, if people want to mask, absolutely, by all means, continue to do so. And more to the point, if you come into this organization masked and say, for my health, I appreciate if you would mask as well, our answer should always be absolutely, we're glad to,” said Chief Medical Officer Dr. Jim Lederer. “We've been through the COVID pandemic, we've learned a lot. We've been able to educate a lot. And we've been able to provide treatment, which different from the outset, didn't exist then. But now we're so far down the road, and we have such a great impact, certainly with our vaccination and with treating people and getting them through their acute illness, that the public health emergency is over from a public health perspective. It's not an eradicated disease, but the public health impact is so much lessened and so mitigated, that we can now return, I guess the words that everyone using is, return to normal.”

But not all public health professionals think the concept of returning to normal is possible.

“As someone who is both disabled and in public health, it's sort of a unique perspective, to feel it very personally, and also be watching all of it happen from a public health lens,” said Christine Mitchell, who received her doctorate from the Harvard T.H. Chan School of Public Health and has worked in public health for the past 10 years. “With the end of the public health emergency, and with the rolling back of masking policies and access to rapid test vaccines and treatments for a lot of people, it feels like the state is really making disabled people, immunocompromised people choose between death and death. Death if we don't receive the care we need and death if we get the virus and suffer the potentially very real consequences of having COVID.”

A Massachusetts resident, Mitchell signed on to an open letter from the Massachusetts Coalition for Health Equity calling on the commonwealth to maintain masking requirements for health care institutions.

“I have Marfan syndrome, which is a connective tissue disorder. It's genetic, but I'm the only one in my family to have it,” she told WAMC. “And because it's connective tissue, which holds so much of the body together, it impacts a whole bunch of different body systems. For me, that's mostly been my heart and my lungs. So, I've had multiple lung surgeries, multiple open-heart surgeries, I’ve had a valve replaced, all of which just like puts me at higher risk of having severe illness.”

After surviving years of the pandemic in a heightened state of risk, Mitchell says the end of even basic preventative measures has left her more scared than ever.

“It's been a nightmare,” she said. “Especially, I feel like as people have been dropping precautions, I feel like I've had to scale up my own precautions. I have a lot of fear and anxiety about getting it, about what could happen if I get it. I've gotten the flu and ended up in the hospital because the coughing led to a hernia and the fever led to cardiac arrhythmia. So the potential repercussions of me getting COVID – which knock on wood, I still have not had – are pretty severe and pretty scary.”

Given how disproportionately the pandemic impacted the most vulnerable at its height, Mitchell says this new chapter of public health policy underscores already deadly themes of ableism and discrimination against people with disabilities.

“The way that we are shifting as a country, as a world right now, away from it, as if it never happened, this sort of idea of returning to normal when normal was actually never very good for a lot of people and not having that option as a disabled person to return to normal,” she told WAMC. “That's been just hard to see, I think, how little people seem to care about the lives of disabled people, immunocompromised people, of elderly people. It feels very much like we're being treated as disposable.”

While Lederer points to the impact of vaccination and medication on the ongoing spread of the pandemic, critics say those claims actually underscore other public health equity concerns.

“Only 29% of the Massachusetts population have gotten a COVID booster shot,” said Dr. Lara Jirmanus. “And when you take a look at who's gotten it, you actually find that there are huge inequities in terms of people of color, people according to levels of education. People with lower levels of education have also been less likely to get the vaccine, people with lower income. And that suggests to me that this is also an access issue. It's about people who are unable to take the day off work to recover from the vaccine.”

Jirmanus is a primary care physician, Harvard Medical School instructor, and a fellow at the FXB Center for Health and Human Rights at the Harvard T. H. Chan School of Public Health and a co-founding member of the Massachusetts Coalition for Health Equity.

“We keep hearing about, oh, well, we have access to the tools,” Jirmanus told WAMC. “We Paxlovid. Again, Paxlovid is wonderful. Some of the most chronically ill patients are on other medications that interact with Paxlovid and are not able to take it. And when you take a look at the racial and economic breakdowns of the patients who did receive Paxlovid, also there are huge amounts of inequities and who has had access to it across the commonwealth. With the public state of emergency ending, we have heard exactly zero plan from our elected officials on how they intend to ensure that people of color that immigrants, that folks with who are working two and three jobs are going to be able to get access to these tools. And with the state of emergency also goes away, they've already gotten rid of the free and fast PCR testing program.”

Even Lederer worries that reversing BHS’s safety precautions could limit community preparedness for the next public health crisis.

“We have all the community patients, most, the rest of us, even including our staff, who've just gotten tired of three years’ worth of, this is what I have to do,” he told WAMC. “And if something emerged, where we have to go back to that stringency, I think people would- You know, there's going to be a lot of pushback.”

Jirmanus, who is continuing to mask while working, says that it’s perfectly reasonable to continue to fear contracting COVID-19, especially with the virus’s lethality and the mass disabling effect of Long COVID.

“COVID is still a leading cause of death,” she said. “And the very people who are at the greatest risk for COVID are also the ones that need the most frequent medical appointments. They are just going to be now repeatedly potentially exposed to COVID, over and over and over. It is exhausting to have to go through your daily life and ask for people, every step of the way, every second to protect you. At the very least, when people are in our care, when they're going into the doctor and saying, I'm here, I'm vulnerable, please take care of my body and cure me, we shouldn't be giving them a deadly virus. And I just think that these conversations have happened in a way which is all wrong.”

Josh Landes has been WAMC's Berkshire Bureau Chief since February 2018, following stints at WBGO Newark and WFMU East Orange. A passionate advocate for Western Massachusetts, Landes was raised in Pittsfield and attended Hampshire College in Amherst, receiving his bachelor's in Ethnomusicology and Radio Production. His free time is spent with his cat Harry, experimental electronic music, and exploring the woods.
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