Nevada Gov. Steve Sisolak has rolled out increasingly strong measures to promote social distancing, close nonessential businesses and cancel events as cases of COVID-19 in the state climb.
But before the pandemic arrived, Nevada’s health care system was already struggling.
In 2019, the Commonwealth Fund ranked Nevada 48th in the nation for health system performance.
According to John Packham, associate dean for the University of Nevada, Reno School of Medicine’s Office of Statewide Initiatives, the shortage of health care professionals is the state’s biggest problem when it comes to access.
Nevadans’ limited care options are “almost like an underlying condition,” he says.
That’s because it puts the state at risk in the same way chronic illnesses like diabetes or emphysema make people more vulnerable to COVID-19.
“We’ve neglected shortages in a variety of ways,” Packham said, adding that “underfunding public education for medicine, nursing and other health professionals” is a major issue.
But for many Nevadans, the problems don’t stop there. For Janet Serial of the Reno-Sparks branch of the National Association for the Advancement of Colored People, the pandemic is a perfect storm.
“I liken it to a tornado. COVID-19 just came at a time when we were already kind of falling into that tornado. And this hits us and it’s like wham! Where are we?” she said.
Serial says that’s because, for minority communities in the state, it’s hard to find a provider — let alone one they trust.
“People of color tend to have lower rates of seeking out screenings and testings and are very distrustful of the system because of historical trauma that’s occurred over the years,” she said. “They’re least likely to seek out testing if they can’t follow up that testing with treatment.”
During an April 16 press conference, Sisolak acknowledged that black, Latinx and tribal communities were being tested for COVID-19 at lower rates than white residents. “For me, that is a big problem and we will have to work to correct that problem,” he said.
In response, Sisolak said he sent several rapid testing units to parts of the state where marginalized populations are concentrated, including Clark County, Washoe County, Carson City, Winnemucca and Elko.
“These rapid tests can go into populations [that] previously may not have had access to testing.”
According to Nevada’s Minority Health Report, which the state publishes every two years, the African-American community faces higher rates of underlying conditions that make COVID-19 worse.
For example, black residents are more than twice as likely to have chronic lower respiratory disease (CLRD) than their white neighbors.
Those disparities can have deadly consequences. For example, in Louisiana, black people make up about a third of the population but are overrepresented in COVID-19’s death toll: over half of reported fatalities related to the virus are African-Americans.
Reno resident Sofía D. Herrera says the state is failing immigrants, too.
“With the hospitals, there’s a tremendous lack of attention, just because you don’t have a social security number,” she told CapRadio in Spanish. “It’s the first obstacle we have here in Nevada. Here, they ask you first: ‘Do you have social security? No? Well, we can’t serve you.’”
Herrera is originally from Mexico, but she’s been living in the greater Reno-Tahoe area for about 20 years and has her residency.
So does her 27-year-old son, José. But she says they have to go to California to get help for his chronic medical issues, which include autism, heart murmurs and a condition that limits the mobility of his hands.
Herrera says California also has something else Nevada doesn’t: public health information widely available in Spanish.
“In California, they give you everything in both languages. And what difference is there between Nevada and California, a desert? That’s the only difference!” she said.
Medical costs can add up, too, especially in marginalized communities where people are more likely to be uninsured or underinsured.
That’s a possibility that deeply troubles Janet Serial. “My greatest fear is that people won’t seek medical care because they don’t have the money,” she said.
John Packham agrees: “That’s untreated cases. Cases less likely to be isolated and monitored.”
He’s worried those obstacles can ultimately put the whole state at risk.
“That will be an enduring problem as long as we have segments of the population that have access barriers or are fearful of accessing health care in these exact times,” Packham said.
He believes if Nevada wants to improve its health care system in the long term, officials need to view the pandemic as a wake-up call and double down on support for medical education — especially in marginalized communities.
“We need to strive — as we are expanding health education programs, as we attempt to increase the supply of health workers in the state of Nevada — to make sure that those grads and those individuals entering the workforce are a reflection of the communities they serve,” he said.
Meanwhile, the economic crisis triggered by COVID-19 could disproportionately impact communities of color, too.
According to Serial, black Nevadans are less likely to have an economic safety net, so the long term effects of business closures and economic downturn could be catastrophic.
“You’re going to see a greater divide between those with and those without,” she said. “You’re going to see, I think, an increase in homelessness. You’re definitely going to see an increased need for food banks.”
Sofía Herrera says the loss of income is already making things harder on Reno’s Latinx community.
“We’re panicking right now,” she said. “We’re going to be the most affected. From top to the bottom, we’re always last.”
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