What does ‘back to normal’ mean for people hit hardest by the pandemic?
Even as COVID cases continue to bubble up around North Carolina as the new BA.5 Omicron subvariant spreads, for now, at least, things are moving closer to what "normal" used to look like. People may choose to go to stores and airports unmasked, and with several COVID vaccines available, lockdowns reminiscent of those that occurred in the spring of 2020 seem unlikely.
North Carolina’s state of emergency due to COVID will be lifted next week and even as things get "back to normal," advocates for some of the people most impacted by the pandemic caution against forgetting some of the pandemic’s lessons about inequality.
The pandemic highlighted some broken parts of the U.S. health care and social systems, which affected low-income communities and people with disabilities the most. Many in these communities don’t want to go back to all in-person activities. They also don’t want to return to looming housing evictions and a patchwork of insufficient health care options.
Advocates say these communities need permanent changes.
For some people, pre-pandemic times weren’t any better. And they don’t want to go back, said Shailly Barnes, the policy director at the Kairos Center, a national organization focused on ending poverty.
“They don't want to see all the supports that made life better for a little bit taken away,” she said.
Disproportionate impact on poor people
A recent report from the Poor People’s Campaign, a national organization focused on social justice issues, found that the pandemic exacerbated social and economic disparities across the country that already existed, such as income, race and disability.
“The failure to consider how poverty intersected with race, gender, ability, health
insurance status, and occupation during the pandemic created blind spots in policy and decision-making that wrought unnecessary suffering upon millions of people,” read the report titled A Poor People’s Pandemic.
The report aggregated data from more than 3,200 counties nationwide and found that, except for the first phase of the pandemic in March 2020, death rates were many times higher in poorer counties than in wealthier counties.
During the surge caused by the Delta variant from August to November 2021, people living in poorer counties died at nearly five times the rate of people who lived in richer counties. Again, during the surge caused by the Omicron variant, death rates were nearly three times higher in counties with the lowest median incomes compared to those with the highest median incomes.
One North Carolina county was among the top 300 in the nation with the highest rates of poverty and COVID death. Rutherford County ranked 141 in the nation, with a death rate of 567 per 100,000 people. Meanwhile, 43 percent of people in Rutherford County live below 200 percent of the poverty line.
Barnes said the report shows how poverty played a role in health outcomes. Even though more than half of the population in the poorest counties had received two COVID vaccines, they still died at higher rates.
Barnes pointed out that many of the poorest counties also had higher rates of uninsured residents. This was particularly true across the South, where many states, including North Carolina, have not expanded Medicaid.
Lack of access to health care and insurance coverage in poor rural areas contributes to higher rates of chronic diseases, such as diabetes, hypertension and heart disease. These are also some of the conditions that put people at higher risk of COVID complications.
"If you look at … a list of 300 counties that have the highest poverty and death rates, over half of them are in non-expansion states like Texas and Alabama," Barnes said. "That's a huge factor."
This summer, leaders in both the state House and Senate expressed a willingness to expand Medicaid in North Carolina. However, Medicaid expansion in the state remains unresolved due to distinctly different ideas from the Senate and House about how to implement it.
Pandemic-era measures, such as eviction moratoriums, Medicaid extensions and stimulus checks became safety nets for people who were either at the poverty line or one life event away from poverty, Barnes said.
For example, when the federal government declared COVID-19 a public health emergency, it came with a provision that prohibited states from terminating nearly anyone’s Medicaid coverage, regardless of changes to their income. Since North Carolina has not expanded Medicaid, this has helped many low-income workers who fall into the state’s "Medicaid gap" — meaning they earn too much money to qualify for Medicaid but don’t earn enough to qualify for subsidies to buy an insurance plan on the Affordable Care Act marketplace.
Many fear what will happen in October when the federal COVID public health emergency is scheduled to end and the Medicaid extensions go away. The pandemic shined a light on the struggles many people were already living with.
They don’t want to go back to normal, Barnes said. They want to address those factors, such as inequality in income and insurance, that caused them to feel the brunt of the pandemic.
Not back to normal for people with disabilities
People with disabilities also experienced the pandemic differently. People with intellectual disabilities were six times more likely to die from COVID than other members of the population.
For example, one COVID surge resulted in more than 1,100 cases of infection at North Carolina’s three state-run centers that house people with intellectual and developmental disabilities — a rate of infection higher than similar centers in several other states, according to researchers tracking these outbreaks.
Matthew Potter, who lives in Forsyth County, has largely isolated for the past two and a half years for safety reasons. He has cerebral palsy and lives with his parents — one of which is immunocompromised.
“For me, that time in 2020 for the most part was the most ‘socially typical’ that I had maybe ever felt in my life because I tend to be socially isolated as a result of my disability in general,” Potter said.
“It's harder for me to get out into the community and things like that. When everyone was isolating, to me, that was more like everyone else doing what I typically do, rather than the opposite,” he said. “And now that people are going back to the routines that they used to have, it's making me be more aware again of the way that I was isolated before.”
Going into public and being in unmasked crowds remains uncomfortable for him due to the ongoing COVID infections.
Just because immunocompromised and disabled people are vulnerable does not mean they are disposable, said Corye Dunn, director of public policy at Disability Rights North Carolina.
“I think we hear every day, another public official or another decision-maker saying, that the risk is much lower than it used to be — except for especially vulnerable populations, as if that's an acceptable risk to bear,” Dunn said.
From accommodation to new normal
One silver lining of the pandemic is that it’s forced many institutions to be more flexible and provide remote options, which can be a huge benefit for some people with disabilities. In the past, many people with disabilities were refused accommodations allowing them to do school or work online, Dunn said. Then that became a new normal.
"If I tell people that I want to work remotely, they don't even bat an eye about it, not that they generally would have before," Potter said. "But now it's like literally almost the norm and before it was more of an accommodation."
Dunn encouraged employers and policymakers to embrace some of the lessons learned during the pandemic, including the ability of many people to work remotely and offering telehealth services.
"I want to make sure that people with disabilities are both given all the access that they need and want to telehealth but also not pushed into telehealth in a way that is primarily for the convenience of providers as opposed to the patient," Dunn said at a May webinar on telehealth access.
At its best, Dunn said telehealth can create opportunities that will never be possible in a provider’s office, such as seeing a patient’s home environment.
Potter has used telehealth frequently since the pandemic began for both physical and mental health services and finds it beneficial. For him, it’s cut down on wait times and transportation challenges and still results in effective care.
The pandemic has led to some improvements for people with disabilities and low-income individuals but barriers remain. Potter just hopes the "return to normal" also comes with thought and consideration for vulnerable communities.
"Pretty much one of the only positives of this pandemic is that I feel like, in more than one avenue, it showed our society a better way of doing things or at the very least it showed us ways that we should utilize the resources that we have and the technology that we have that we weren't really using before," Potter said. "I don't think we should go back to ignoring that."
North Carolina Health News is an independent, non-partisan, not-for-profit, statewide news organization dedicated to covering all things health care in North Carolina. Visit NCHN at northcarolinahealthnews.org.