This is the second in a two-part series about what Massachusetts is doing well during the coronavirus pandemic, and what the state could have done — and could still do — differently. Part two looks at what the state could have done differently. Read part one here.
On May 1, Gov. Charlie Baker announced a new statewide policy aimed at curbing COVID-19: If you’re outside your home and can’t social distance, you have to wear a mask.
“Covering our faces when we cannot practice social distancing is an easy, critically important and essential step that everyone can and should take to stop or slow the spread,” Baker said in his announcement. "Everyone doing a small thing all the time ... can go a long way to improving everyone else’s ability to avoid the virus.”
If that announcement came as a surprise, it shouldn’t have. The Centers for Disease Control urged people to start wearing masks in crowded places on April 3, nearly a month earlier. Boston Mayor Marty Walsh made masks mandatory in the city on April 5. Baker issued a mask advisory April 10, but he didn’t make masks mandatory until May 6 — five days after he announced the new rule.
It’s a choice with consequences, experts say. Sam Scarpino, who heads the Emergent Epidemics Lab at Northeastern University, says even that brief, final delay came at a cost.
“That could represent almost two rounds of transmission in some cases, where an individual infects someone, and then the individuals, they infect other people,” Scarpino said. “As soon as it was clear that we needed masks, there should have been every possible effort expended to implement required mask wearing quickly.”
COVID-19 has hit Massachusetts hard — the commonwealth has the third-highest death toll in the country from the disease. And though public health experts laud some aspects of Massachusetts' response to the pandemic — including leaders' emphasis on staying home and residents heeding their calls to social distance — other parts of the state's response have been less successful. Deaths in long-term care facilities make up 60 percent of the state’s COVID-19 fatalities, significantly above the national average. And the state’s COVID-19 rates are especially high in lower-income, immigrant-heavy communities where many people work in service jobs, then return to crowded homes.
Case in point: Chelsea, just north of Boston, has a confirmed-case rate of 6.9 percent, compared to 1.3 percent for the state as a whole. Sixty-seven percent of Chelsea residents are Hispanic or Latino, 46 percent were born outside of the U.S., and nearly 19 percent live in poverty, according to 2010 census data.
Nancy Krieger, a social epidemiologist at the Harvard School of Public Health, argues that we could have predicted that COVID-19 would hit places like Chelsea hard and focused our response accordingly. The state has stepped up its response in Chelsea and other lower-income communities, she said, but it did not focus on these communities enough at the beginning of the crisis.
“It is not a mystery that there are health inequities in this country,” Krieger said. “It is not a mystery that health is socially patterned. It is not a mystery that there’s occupational and residential segregation by race, ethnicity and income. ... There was not testing in communities that were known, and should have been known, to be particularly vulnerable."
Scarpino said the state's COVID-19 response has not sufficiently protected people who work in service the service sector.
“We did not provide enough mandatory protection of those individuals,” Scarpino said. “And as a result, we’re putting them in a position where they have to choose between their own safety and an income that provides food on the table.”
Krieger also says we should have been able to anticipate the impact of COVID-19 on nursing homes — where many staff members come from communities like Chelsea, and physical conditions are ideal for the disease’s spread.
“When you have a virus that is airborne, likes to get spread in small enclosed places, with people that are particularly vulnerable by virtue of great age, with co-morbidities," she said, "from the standpoint, again, of the virus, the nursing home is a great place to be.”
Still, even after a nursing-home outbreak in Washington state in March became a national cautionary tale, COVID-19 went on to ravage nursing homes across Massachusetts.
“I think overall, the state failed miserably when it comes to protecting nursing-home residents,” said Barbara Anthony, the senior fellow in health care at Boston’s Pioneer Institute.
“As far as I know, there was no plan to provide adequate equipment, adequate infection-control training, adequate staffing, social distancing,” Anthony said. “There’s nothing done in nursing homes that obviously was successful in that regard.”
Asked about these criticisms, a spokesperson for the Baker administration noted that the state limited visits to nursing homes in early March, and that the governor deployed the National Guard to conduct on-site testing.
In those cases, the spokesperson added — and in hard-hit communities like Chelsea — the state is relying on data as it responds to an unprecedented situation that is changing by the day.