Massachusetts has prioritized golf over human life, but don’t worry, most lives needlessly lost won’t be wealthy, young, or white.
As Massachusetts begins to reopen its economy after more than two months of pandemic shutdowns and a stay-at-home order, it’s important to remember that the state has been a national hotspot throughout the coronavirus outbreak, as well as what this all means for the most vulnerable populations among us.
Among a symphony of comparable charges, Yale epidemiologist Gregg Gonsalves has labeled the federal mishandling of COVID-19 “awfully close to genocide by default.” Here in Mass, Governor Charlie Baker’s four-phase reopening plans could make the situation worse. A recent study out of Harvard found that only nine states are doing enough testing to begin to reopen, with the Commonwealth having the second largest gap between current testing and the number of tests needed to begin to reopen safely. The study suggests Mass, which is doing about 10,500 tests per week, would need to be doing 55,000 to 140,000 more tests each week to begin to open safely. On the same day the study was published, Baker reopened golf courses; four days later, the governor announced that the state would begin reopening on May 18.
More than a month before the reopening parade began, in an acknowledgment of sorts of the problem at hand, on April 7, the Massachusetts Department of Public Health (DPH) published guidelines about whose lives are worth saving. The initial announcement was met with dissent from people with disabilities and their advocates, some of whom sent a letter to Baker informing him that the guidelines violate the Americans With Disabilities Act. Among other issues, the proposed measures would have harshly penalized people for having comorbid conditions like asthma and diabetes.
State officials made some minor tweaks to the guidelines and republished them on April 20. The rules now include more robust language barring discrimination even though the guidelines, if followed, will still do disproportional harm to the elderly, poor, chronically ill or disabled, and communities of color. Federally, President Donald Trump admits that his plan means more Americans will die. In Mass efforts, Baker appears to acknowledge the same, but not as openly. Here, patients are given a priority score on a scale of one to eight, with points “assigned for prospect of short-term survival” and “the presence of underlying conditions.” Patients with the lowest scores go before those with higher scores.
The groups that will endure the most deaths are not openly acknowledged in the state’s plan for withholding medical care, but Massachusetts is explicit when it comes to telling seniors they are expendable. The section of the guidelines detailing how younger people will be prioritized over older folks ends in this rather unbelievable quote: “It is always a misfortune to die . . . it is both a misfortune and a tragedy [for life] to be cut off prematurely.”
Though the state’s revised DPH guidelines are less spectacularly fatal to the chronically ill or disabled, they still appear to lower the chance for even nonterminal chronically ill people and people with disabilities to receive needed medical care. People facing chronic conditions require regular hospital and doctor visits, and in some cases need equipment and may face potential rationing. In other states, we’ve seen resources taken from chronically ill people including one who was told “thanks for your sacrifice.” More directly, many chronic conditions would make patients score higher on the priority scale, leaving them more likely to be denied life saving medical care.
Finally, those who cannot effectively advocate for themselves will be disadvantaged. Hospitals have moved to no-visitor policies everywhere, so a patient has to be their own advocate, which is difficult or even impossible for some people. State guidelines worsen this problem by mandating an appeals protocol in the event that a piece of lifesaving equipment is removed from a patient. This would be extremely hard for anybody to negotiate, but for those with cognitive disabilities or some mental illnesses, or for non-English speakers, this could be a death sentence.
Beyond hospitals, government policies about essential workers and reopening will also disproportionately harm the working poor. The people who will be forced back to work, or are already working essential jobs, who have to travel to physical sites are people who generally earn less. They are the retail employees and service sector workers who are unlikely to have strong health care benefits and sick time policies, and who are more likely to live paycheck to paycheck. Currently, many of these workers are at home safe collecting unemployment, but as the economy reopens, they will be increasingly pushed back into high-risk situations.
There aren’t any easy answers in a pandemic. Still, one would think the state’s response would be geared toward protecting lives, not prioritizing golf and church, as today’s announcement blessed the latter with guidelines in place. As the Commonwealth reopens, it should be remembered that despite the reassuring tone of Governor Baker, every pandemic death is a tragedy, and many have been and will continue to be avoidable.