See memo in pdf format here:
TO: Senator ------
FROM: Gwendolyn Lee MPP ’20/MD ‘22 & Christopher Arce JD ‘22 | Published May 5, 2020
This memo compares COVID cases, death rates, and other relevant metrics in MA with those in NY and NJ in Part 1. It also identifies policies implemented in each state that may contribute to differences in tracked metrics. In Part 2, this memo focuses on Springfield, MA and identifies possible factors contributing to its higher death rates and continued growing number of cases. In Part 3, this memo offers recommendations based on the findings in Parts 1 and 2.
Table of Contents
Part 1: Comparing MA with NY and NJ
Part 2: Springfield, MA
Part 1: Comparing MA with NY and NJ
Background: The rate of new cases in MA, the number of deaths, and other measures of COVID-19 seem to suggest that MA is plateauing/still growing. Even six weeks after social distancing began, Massachusetts COVID-associated hospitalizations and cases remain high.
Questions: How do MA’s numbers compare to NY and NJ? Are there differences in policies that contribute to different trends?
MA has the third highest number of COVID-19 cases and deaths, after NY and NJ.
It has been hypothesized that testing rates may be a confounding factor of the high number of reported cases. MA does have the second highest percentage of testing per capita at 4.8%, conducting a total of 333,349 tests (Table 1). The high number of cases may reflect higher testing rates. However, only 21.1% of tests return positive in MA. This is in contrast to NJ, which is the state with the second highest number of COVID-19 cases and deaths, where they have a lower testing rate at 3.24% per capita, but 45.4% of tests return positive.
Of these three states, NY seems to have reached its peak in both cases and deaths (see trends in cases and deaths in Table 1). MA may be able to learn best practices from NY’s response to contain COVID-19. In comparing MA and NY policies (Table 2), NY appears to have implemented social distancing and public health orders at earlier dates and with stricter enforcement measures. For example:
NY prohibited non-essential gatherings of any size, while MA prohibited gatherings of 10 or more people. NY also included an enforcement measure (a $500-1,000 fine) for violating social distancing protocol.
Stay at home policy or policy with another name but similar intent was implemented in NY as an executive order on 3/22/20 while implemented as a DPH public health advisory in MA on 3/24/20.
NY has highlighted new testing facilities in minority communities. While MA has not similarly publicized such initiatives, testing is free regardless of insurance or immigration status, and will not affect "public charge" rule determinations.
MA could follow NY’s lead and implement stricter orders, such as the ones highlighted above. Specific modifications to MA’s existing actions could include stricter enforcement of advisories/recommendations (i.e. through fines) and stricter prohibition on gatherings (i.e. fewer than 10 individuals).
MA should continue to lead in areas such as contact tracing.
As NY begins to reopen, MA should closely follow their plan to learn best practices.
Table 1: Comparison of COVID cases, death rates, & other metrics across MA, NY, NJ (updated 5/5/20)
Table 2: Comparison of MA and NY state policies addressing COVID-19
Of note, Table 2 is not comprehensive. These policies were highlighted on government websites and through press releases.
Part 2: Springfield, MA
Background: The NY Times is tracking the number of new cases and deaths. After the greater NY region, MA (specifically Boston and Springfield) rank among the highest in the number of new deaths in the past two weeks and in cumulative death rate (Appendix 1 and 2, respectively).
Nevertheless, The New York Times also reported that Springfield was one of the metro areas where new deaths decreased the most adjusted for population size (Appendix 3).
While new deaths might be decreasing, cases in Springfield continue to grow. This week, there were 100 new cases identified, bringing the total to 1,992 cases in Springfield (NYT).
Question: Why does western Massachusetts have a higher number of deaths and why do cases continue to rise?
This section examines factors that may contribute to Springfield’s high rate of COVID-19 cases and deaths. Factors include modifiable features such as public health policies, as well as fixed features such as geography, population density, and existing health conditions within Springfield’s population.
Ultimately, the fixed features – especially existing health conditions – may contribute to Springfield’s higher rate of cases. Because these features cannot be changed, changing modifiable features through stricter executive orders, recommendations, and advisories may be necessary to mitigate spread of COVID-19.
Public health policies
Like many cities, the City of Springfield’s COVID-19 response primarily highlights MA state policies (Springfield’s situational timeline). Mayor Sarno and HHS Commissioner Caulton-Harris do issue the following Springfield-specific advisories and/or recommendations:
4/22/20 advisory: Request stores providing essential services (such as grocery stores, pharmacies, large box stores, convenience and retail stores, etc.) to partner with the city and require their patrons to wear face coverings.
4/3/20 advisory/recommendation: Asking residents to wear face coverings when out in public
3/19/20 recommendation: Encouraging barber shops, salons, hairdressers, tattoo and piercing studios, massage parlors and spas, and nail salons to voluntarily discontinue services to adhere to the social distancing guidelines.
This is in contrast to cities like Cambridge that have taken a stricter stance. For example, Cambridge implemented a temporary emergency order on 4/27/20 requiring the wearing of masks or face coverings in public places, businesses, and common areas of residential buildings with violations punishable by a $300 fine.
Transportation impacts the spread of the virus and thus we would expect parts of the country that intersect with major transportation systems would be hardest hit. While several of the cities with the most new deaths in the past two weeks are located along the I-95/I-91, they are also some of the most densely populated cities and locations (Appendix 4). Thus, being along I-95/91 might correlate with being disparately impacted by the virus, and that correlation may be further compounded by population density.
Springfield is the 3rd most populated city in Massachusetts and has a total of 1,317 cases and a rate of 831.79 deaths per 100,000 people as of 4/29/20. Worcester is the 2nd most populated city in Massachusetts, and similarly has 2,284 cases of COVID-19, with a rate of 1190.40 deaths per 100,000 people. To some extent then, we can understand the spread of COVID-19 as correlated with higher population density than most other parts of Massachusetts (Table 3).
Table 3: Comparison of cities’ COVID cases and population densities
Existing health conditions
It is difficult to tease out what might account for such dynamics and what might remedy observed disparities, particularly the high death rates found in Springfield. Relevant aspects of Springfield include:
That it has one of the highest premature mortality rates in Massachusetts when compared to other large communities, even while Massachusetts has one of the highest life expectant rates in the country;
That its residents were admitted to the emergency room for asthma at a rate of 1,502 per 100,000 versus the state’s rate of 559 per 100,000, with Latino/a and Black residents being disproportionately represented;
That in comparison to white residents, Latino/a residents visited the emergency room for asthma complications at a rate approximately five times higher than that of white residents, with Black residents having a right that was approximately twice that of white residents;
That 37% of Springfield are adults are obese, 13% percentage points higher than that of the state;
That Springfield residents have a rate of morbidity from diabetes that is double that of the state, specifically 270 per 100,000 vs 138 per 100,000, with Latino/a and Black residents being hospitalized for diabetes related complications nearly twice as often as white Springfield residents;
That Springfield residents are hospitalized for mental-health related conditions twice as often as the state’s rate.
As has been reiterated by public health officials, people with underlying conditions such as obesity, diabetes, and respiratory problems are at the greatest risk for complications from COVID-19. Thus, to some extent Springfield’s high death rate is likely a consequence of the pandemic compounding existing public health problems confronting the population.
Of note, in a Facebook Live video conversation with Sen. Lesser, CEO of Baystate Health System Mark Keroack noted that the hospital census of COVID patients is consistently decreasing. However, some health officials speculated in April that the reason Western Massachusetts health systems have not been overwhelmed by the pandemic is not because of successful measures but instead because the peak for Western Massachusetts has yet to come and would arrive in May. It is difficult to tease out causality between what accounts for the different trajectories that towns and cities have experienced.
Although there are policy opportunities, it is also important to recognize the inherent health system limitations and the existing health of the population. While we cannot immediately change the health of the population, we can take stricter public health measures to protect vulnerable populations. Ultimately, given the significant public health problems that confront Springfield’s population, the importance of social distancing and having the population stay at home cannot be overstated. Some policies may include:
- Public health measures, such as mandatory cloth face coverings, following Cambridge’s lead, especially in terms of enforcement measures.
- Given Springfield’s higher rates of mental health hospitalizations, consider behavioral health policies such as:
In Minneapolis, IN: “The Division of Race & Equity initiated a process to strengthen the capacity of mental and behavioral health providers and community cultural healers to provide services to community residents who may be experiencing increased stress and trauma related to the outbreak of the Coronavirus. We established a $200,000 COVID-19 Emergency Mental Health Fund to support these efforts. Our goal is to provide short-term relief to those who are experiencing crisis and whose ability to receive in person help is either limited or not existent at this time. Providers were able to apply between $2500 - $7500 to meet these needs. The Division of Race & Equity has contracted with 29 organizations who are providing care to those who live and work in Minneapolis. Services that are being provided include but are not limited to psychotherapy, group healing circles, counseling, mentoring services, resource sharing, and peer support. Many of the organizations who have been funded through the Division of Race & Equity’s COVID-19 Emergency Mental Health Fund are continuing care with existing clients who are no longer able to meet in person as a result of social distancing, and several of them are also expanding their services to reach a larger population.”
- Given that Springfield has such a high rate of families with children who are homeless, consider policies such as:
Cambridge, Food/Nutrition: “Cambridge Mayor Sumbul Siddiqui and City Manager Louis A. DePasquale today announced an innovative new project that will begin Monday, March 23, 2020 and provide food to the City’s homeless community during the COVID-19 public safety crisis. With many shelter programs short staffed and no longer having the capacity to prepare meals on site, the city will begin contracting with local restaurants in Central and Harvard Square to provide bag or boxed meals for lunch and dinner. These meals will then be delivered to shelters and programs that have indicated a strong need for meals.”
Seattle, WA: “In addition to the creation of new 24/7 shelters with access to hygiene services and places for individuals experiencing homelessness to stay who have and are recovering from COVID-19, the City of Seattle announced today the continued expansion of hygiene services for people experiencing homelessness. Building on the previously announced resources, eight new hygiene stations will be deployed and two hygiene trailers will be positioned in areas where individuals experiencing homelessness can be best served.”
Somerville, Housing: “On Saturday, March 28, Mayor Joseph A. Curtatone and the Somerville Board of Health announced an Emergency Order Establishing a Moratorium on Eviction Enforcement in the City of Somerville for the duration of the COVID-19 emergency. The order, which applies to both residential and commercial evictions and goes into effect immediately, prohibits the physical act of eviction within the city limits so as to provide for the health, safety and stability of those who live in and serve our community. It also includes orders that the in-person showing of rental units to prospective new tenants or others, as well as any other non-emergency entry, shall cease during the emergency. In a show of unity, the City Council unanimously passed measures in support of both actions.”
Additional policy measures that do not specifically address gaps highlighted in Parts 1 and 2 of this memo, but are nevertheless informative and derived from the National League of Cities (NIC)'s database can be found in Appendix 5.
Appendix 1 (NYT)
Appendix 2 (NYT)
Appendix 3 (NYT)
Appendix 4 (Google maps)
Appendix 5. Featured policies from the National League of Cities’ database
The National League of Cities' (NIC) database lists many other policies that are worth enacting, and it would be worthwhile to look through the entire database to find as many policies that are worth implementing on a local level. Some examples are provided below.
“The City of New Orleans announced a partnership between World Central Kitchen & Hands On New Orleans to provide free meal delivery service to at-risk residents.”
In New York City, the “Department of Education and DOHMH are partnering with Door Dash to deliver meals to medically fragile students.
“The City of Tampa has arranged for Feeding Tampa Bay and Metropolitan Ministries to collect unused food from local restaurants and redistribute throughout the community.”
Business economic stability:
Boston: “For businesses that serve food, the city of Boston is lifting regulations so that all restaurants and bars are allowed to provide take-out and delivery. This includes facilities without take-out licenses.”
Imperial Beach, CA took a wide range of actions in response to the pandemic: “Senior center/parks closed, banned residential evictions, bridge loans through NGO partner for local restaurants, city staff working remotely…”
The City of Columbus created a Friendly Phone Line to provide older adults in greater Columbus who are looking for social connection and have worked with Community Resource Centers to create a phoneline that older adults can call to have food and necessities delivered to their houses twice a week.
Santa Monica, CA: “The Santa Monica's City Manager and Director of Emergency Services Rick Cole signed additional supplements to his executive order proclaiming a local emergency to prevent the spread of the coronavirus (COVID-19). City emergency orders suspend parking restrictions, big blue bus fares, late penalties on city bills, COVID-19 related commercial and residential evictions…”.
Spokane, WA: “The City is suspending water service shut-offs for non-payment of City utility bills and won’t charge fees for late utility payments until further notice.”
Louisville, KY: “The City of Louisville has created an emergency fund to deploy resources to residents impacted by COVID-19. The fund will provide funding for rental assistance, child care assistance, transportation aid, food access, utility assistance, pharmaceutical assistance. Mayor Fischer announces One Louisville" COVID-19 response fund to help Louisvillians impacted by virus outbreak.”
Appendix 6. New York Times Massachusetts Coronavirus Map and Case Count as of May 3, 2020