VT Health Commissioner on COVID response, racial disparities


During the Annual Meeting of the Vermont Association of Hospitals and Health Systems (VAHHS), held virtually last month, Vermont Health Commissioner Mark Levine addressed the topic of the night: achieving health equity. 

VAHHS CEO Jeff Tieman introduced as Levine as Vermont’s Dr. Fauci, and Levine also discussed the state’s response to COVID and the effect it has had on several populations.

Levine began with a visual about the state’s early effort to “flatten the curve” of COVID cases to prevent the health care system from being overwhelmed.  

“We were looking at the anxious faces of Italian citizens and doctors, and we would soon see in New York City families devastated by losses and not allowed to see their loved ones as they lay dying,” Levine said. “Inpatient care was being delivered in hallways. There was a debilitating lack of personal protective equipment and refrigeration trucks were compensating for overfilled morgues.

“Thanks goodness, we … collaborated and creatively financed our response so that the surge was an outcome that never came to be.”

Levine enumerated the hardships hospitals had to endure to create that eventuality, listing sacrifices such as empty hospital beds awaiting COVID patients, teaching hospitals that had to reimagine medical school, rigorous testing protocols and the fear that many health care professionals faced.

“You wondered what would happen to all the other medical problems that weren’t being taken care of because of people choosing to ignore them or consciously delaying seeking attention for them,” said Levine. “And when re-opening would occur, what if no one came?

“Though it wasn’t terrible, the health care workforce did suffer out of proportion to the rest of the population, leading to abundant concerns about staffing.”

He noted that hospitals and other health care workers have provided assistance with targeted pop-up testing efforts at the early signs of outbreaks, bailing out nursing homes with staff coverage when these facilities were at desperation’s doorstep, helping to craft a new rulebook for re-opening the health care sector and partnering with the health department to have a diverse and comprehensive testing protocol statewide.

“Setting the table” for keynote speaker Dr. Mercedes Avila and the meeting’s theme, Levine stressed that health care providers are not the only Vermonters to be disproportionately affected by COVID.

“The rate of infection is four times higher for our black, indigenous and people of color (BIPOC) than white Vermonters,” he said, adding that the disparity appears not only in the case rate, but in higher hospitalization rates as well.

One in four Vermonters with COVID are BIPOC. Levine explained that while we are unsure how most white Vermonters are infected with the virus, we are more likely to be able to trace how BIPOC individuals got it.

“BIPOC are more likely to be part of an outbreak, more likely to have come into contact with someone else who has COVID and more likely to have had household contact with a case, as we saw during our largest outbreak in Winooski,” he said.

BIPOC Vermonters are also more likely to have underlying conditions that can make COVID more serious, which Levine attributed to the circumstances people are living in.

“Even if you have one of these underlying conditions, the circumstances you’re living in are what is predisposing you for the worse outcome with COVID — not necessarily your genetic background,” he said. “And if you happen to be in a community that’s predisposed to it, it may be that you’re working in a much more public job — you can’t do telework — and to get to that job, you may be using public transportation. You may live in a multi-generational household where people are very close together. And you may have had less access to some of the things we use to protect ourselves.”

Levine is looking into discharge reports from the VAHHS to inform racial equity in health care, to understand what’s going on with disparities with COVID and how Vermont can manage them.