thenation--2020-04-23--The Heartbreaking Choices Faced by Child Care Providers on the Front Lines

It was early in March that Karen DeVos first started taking measures to prevent the spread of the novel coronavirus at the day care center she runs .
She told the parents at her Little Learners Early Childhood Center in Ada , Minnesota , that there would be a new , lower-contact drop-off protocol , and that anyone with a temperature of 100 degrees would be told to stay home .
Show-and-tell was canceled , as she didn ’ t want children bringing anything into the classroom , and she hired an extra staff person to do even more cleaning @ @ @ @ @ @ @ the scariness of the situation hadn ’ t really set in yet , ” she said .
As the pandemic quickly spread across the country and her governor ordered some businesses to close , she faced a more difficult question : Should she remain open to serve the families who needed her , putting herself , her staff , and the children she cared for at risk ?
Or should she simply close her doors ?
The week of March 20 , she had to make a call .
Governor Tim Walz had @ @ @ @ @ @ @ essential workers .
All but two of the families DeVos serves are essential workers of some form or another .
“ I don ’ t know that I slept at all at night , ” she said .
“ The easy response to this for me at this point would be to close , ” she said .
Weighing on her is not just that she has staff who are worried about being exposed to the virus as they come to work to care for children whose parents go out and work every @ @ @ @ @ @ @ and cents .
She ’ s had to spend more on staff to make sure there ’ s enough capacity to do all the extra cleaning and to keep group sizes small .
At the same time , she ’ s not charging the families who are keeping their children home , so she ’ s bringing in less money in tuition .
She got a $ 3,000 grant from a foundation that allowed her to make last month ’ s payroll , and she can meet her expenses for April—except for her @ @ @ @ @ @ @ But after that , if no other help comes through , “ I don ’ t anticipate we can continue running the same way that we are , ” she said .
Hers is the only child care center in her rural county .
“ I really do feel a huge sense of responsibility to those who work here and to the children that we ’ re serving , ” she said .
But remaining open is something she constantly wrestles with .
“ I would hate to be responsible for somebody getting @ @ @ @ @ @ @ voice becoming nearly a whisper .
“ That ’ s such a weight to carry on one ’ s shoulders.
” As the Covid-19 crisis keeps millions of Americans home , the child care providers that enable working parents to keep their jobs are experiencing massive upheaval .
Half of all child care providers across the country have closed .
Another 15 percent are closed to all but the children of essential workers .
At the same time , states across the country have promised essential workers that child care will be available @ @ @ @ @ @ @ That ’ s forced providers to decide whether or not they can afford to remain open and serve those children .
It ’ s not a simple equation .
Child care providers already operate on razor-thin margins .
Now , those that are still open are almost certainly experiencing lower attendance , which likely means less tuition than normal .
But most fixed costs remain the same : rent or a mortgage , along with utilities and bills like food and supplies .
Staff can ’ t be reduced too far since minimum @ @ @ @ @ @ @ some cases , child care centers need more staff to reduce class sizes for social distancing , to do extra cleaning , or to cover for staff who get sick or need to stay home .
Meanwhile , getting those cleaning supplies has become far harder—and more expensive—as the entire world hoards the Clorox wipes and paper towels that centers normally rely on .
“ Those that are open are struggling , and those that are closed are struggling , ” said Chad Dunkley , president of the Minnesota Child Care Association .
@ @ @ @ @ @ @ single person who isn ’ t. ” According to an analysis by the National Women ’ s Law Center and CLASP shared exclusively with The Nation , it takes $ 6.3 billion a month for centers to remain open for the estimated 6 million children of essential workers who need care during the workday .
They estimate that child care centers ’ costs are 23 percent higher now if they ’ re offering emergency care , while costs are 19 percent higher for home-based providers .
All told , it would take at @ @ @ @ @ @ @ top of what the federal government already provides to ensure that providers who remain open for essential workers are able to meet their extra costs while also keeping closed centers afloat so that they can reopen when the crisis passes .
It ’ s a staggering sum .
But “ we ’ re talking about an entire sector that is holding up our entire economy , ” noted Melissa Boteach , vice president for child care and early learning at the National Women ’ s Law Center .
Child care providers are a @ @ @ @ @ @ @ , grocery stores , pharmacies—open .
About 30 percent of health care workers , who are in short supply right now , have children under the age of 14 .
So far , Congress has included just $ 3.5 billion in extra funding for child care providers in the CARES Act .
The industry “ does get lost sometimes , ” Dunkley said .
“ We ’ re loud and we ’ re important , but we don ’ t have the kind of lobbying dollars other industries have.
” Boeing , for @ @ @ @ @ @ @ for the aerospace manufacturing industry , and has already received a $ 17 billion federal loan program carved out specifically for the company in the CARES Act .
While many states have mandated child care provider closures as part of stay-at-home orders , they have generally exempted child care providers that stay open to serve essential workers .
Seventeen states have mandated that child care providers close unless they ’ re willing to provide care to the children of essential workers .
In some places , such as Delaware , Illinois , and @ @ @ @ @ @ @ apply and receive special licenses or waivers to keep their doors open for essential workers .
In Maryland , they have to report daily on the health of each child in their care , according to an upcoming briefing paper by Valerie Lacarte of the Institute for Women ’ s Policy Research .
But most states are hoping that at least some providers will choose to keep operating , recognizing that they are necessary if essential workers are going to stay at work .
And lawmakers at all levels have made big promises @ @ @ @ @ @ @ they ’ ll keep showing up .
Colorado Governor Jared Police pledged access to emergency child care for frontline workers so that “ people aren ’ t forced to stay home simply because their kid doesn ’ t have a place to go during the day.
” Minnesota and Vermont classified grocery clerks as essential workers so that they could receive child care .
“ Frontline workers—including grocery and pharmacy workers , warehouse workers , medical personnel , farmworkers , food processing workers , truck drivers , postal workers , delivery drivers , @ @ @ @ @ @ @ child care , and safe working conditions , ” Senator Bernie Sanders tweeted .
But few states are offering details about how providers are supposed to provide care , let alone enough extra money to ensure they can do it without going broke .
The decision about whether , and how , to stay open is mostly left up to individual providers .
And while some states have made emergency funding and grants available—Minnesota and Vermont , for example , have backed up their promises to essential workers with new funding for child @ @ @ @ @ @ @ the need .
Others are paying providers less than what they normally receive : According to Lacarte ’ s briefing paper , Maryland has barred providers from charging families of essential workers directly and will pay them a flat rate that may be less than what they normally charge .
“ They ’ re really weighing the health and safety concerns , ” noted Catherine White , director of child care and early learning at the National Women ’ s Law Center , against the financial cost of shuttering .
“ They ’ @ @ @ @ @ @ @ hard place.
” It wasn ’ t clear whether Milagros Carbajal , whose children call her Miss Millie , should keep her in-home day care center in New York City open .
Neither the city nor the state told providers what to do .
“ Initially we were left to figure out things for ourselves , ” she said .
“ We should have gotten an e-mail , should have gotten a text , something.
” Eventually , the state sent them guidance on safety protocols if they decided to stay open and @ @ @ @ @ @ @ wrong .
Even less clear was whether she would get paid if she stayed open .
She cares for a number of children whose parents get subsidies from the city to pay for care , and the city has told her she ’ ll get paid for them , whether they attend or not , for the month of April .
But it also said it will decide what to do moving forward on a month-to-month basis .
“ You ’ re holding your breath every 30 days , ” she noted .
@ @ @ @ @ @ @ to deal with on top of everything else , which his completely unfair.
” If the city stops paying the full voucher amount , she ’ ll have to close her doors .
“ If we ’ re supporting parents , then who ’ s supporting us ?
” How Trump ’ s Foreign Policy Puts Troops at Risk of Covid-19 More in this series In the absence of clear guidance , providers are coming up with their own safety protocols to keep operating while protecting everyone ’ s health .
Every provider @ @ @ @ @ @ @ parents and children alike before they come into the classrooms .
Many aren ’ t even allowing parents to come into the room at all , leading to “ a few more tears at drop off , ” Karen DeVos said .
Cleanliness is a staple of a child care classroom , but all of them have gone into overdrive .
Kids ’ “ poor little hands are just raw because they ’ re constantly washing , ” she noted .
Providers have shrunk class sizes as small as they can and try @ @ @ @ @ @ @ other as possible .
Some have come up with creative solutions .
Carbajal has the children change into a T-shirt that gets left with her every day .
Tonya Holt has closed the sensory table at her center in Minnesota , usually filled with sand or water , and put away any toys that can ’ t be washed and sanitized after every use .
The front desk used to have a drawer full of stickers , and each child could take one out each day .
It ’ s been empty since @ @ @ @ @ @ @ .
“ We ’ re hugging less , ” said Angelique Speight , a provider in Washington , DC .
“ I ’ m so used to loving them and hugging them so tight.
” The day has changed in ways big and small .
For DeVos ’ s school-age children—she takes care of kids as old as fourth grade—her staff now has to do distance learning with them .
It entails “ a whole bunch of different lesson plans and a whole bunch of different iPads , trying to navigate the different @ @ @ @ @ @ @ said .
“ It ’ s a whole other level of crazy thrown into the mix.
” DeVos ’ s center is housed on the same campus as an assisted living facility , and now her kids can ’ t have contact with the residents , whom they call the grandmas and grandpas , and normally see on a daily basis , giving them hugs and doing daily activities together .
So instead the grandmas and grandpas watch them play through their windows , to which the children have taped pictures and messages @ @ @ @ @ @ @ t actually related , but it is still family to us , ” she said .
“ We miss them terribly.
” Lower attendance is also an adjustment .
“ It ’ s so different , ” Carbajal said .
“ On a normal day you will hear the laughter , and some cries and some screaming , of children .
Now when you come in , it ’ s so quiet.
” She misses the children who aren ’ t coming anymore .
“ It ’ s emotional .
Mentally draining , @ @ @ @ @ @ @ Easter , she dressed up in a bunny suit and dropped off baskets at some of their apartments .
Sometimes they wave and call to her out their windows when she walks by on her way to and from work .
Small things have gotten tough , too .
It ’ s been a challenge for her to get cleaning supplies , a staple for a child care provider even without a global pandemic .
Store shelves are wiped clean .
She managed to get some things from Amazon , and her union @ @ @ @ @ @ @ .
Her monthly toilet paper shipment that usually comes on the first of the month didn ’ t arrive until mid April .
It took a month for a box of 100 disposable masks to arrive—and cost $ 100 .
Still , she wants to be open .
“ Even if I had one child , I was going to stay open , ” she said .
She ’ s since taken in two new children whose programs have closed .
Closing wasn ’ t a financial option for Jamila Warfa , either @ @ @ @ @ @ @ guidance from Washington state about what she should do , so she kept going because she needed the money .
Speaking Somali through an interpreter , she explained that her husband , whose job is taking elderly people to appointments , was exposed to a patient who tested positive for Covid-19 , so he had to quarantine himself and hasn ’ t been working .
They need her income .
Meanwhile , she ’ s worried that she ’ s exposing not just herself but also her husband and five children at home @ @ @ @ @ @ @ for the children of essential workers ; she has children coming in whose parents are at home .
It makes her very nervous .
She doesn ’ t have health insurance .
But she can ’ t afford to close .
We Can ’ t Save the Economy Without Universal Child Care The Coronavirus Strike Wave Could Shift Power to Workers—for Good As Low-Income Workers Lose Hours and Jobs , Pressure Mounts to Halt Evictions The only contact she ’ s had with the government was a call three weeks ago from the @ @ @ @ @ @ @ and Families asking what she needed .
She told them she needs cleaning supplies ; so far , nothing has materialized .
She ’ s tried to look into some of the government assistance programs that might be available to her , but her language barrier has made it difficult .
Some states are offering extra assistance immediately .
Texas will distribute $ 40 million to parents and child care providers so they can care for the children of essential workers .
Minnesota has created a $ 30 million emergency child care grant @ @ @ @ @ @ @ .
Vermont has offered families a stabilization payment program so that they can keep paying their providers even if their children aren ’ t attending day care .
North Carolina and New Mexico have both committed to paying child care subsidies , whether or not the children attend programs , as well as offering bonus payments ; in New Mexico , providers who stay open will get an extra $ 250 per enrolled child .
The Minnesota grant is a notable win in a state where child care providers have been trying for @ @ @ @ @ @ @ It goes further than anything we ’ ve been able to win on child care , ” Marte said .
But providers have to apply for it—not everyone will get money—and it ’ s capped at $ 15,500 a month .
That amount won ’ t go far enough for Tonya Holt , who has to pay a mortgage on her 11,000-foot facility and compensate staff .
“ That doesn ’ t offset the loss of tuition , ” she noted .
Normally , she has about 170 children in her 11 classrooms @ @ @ @ @ @ @ every day , and , at least for now , she ’ s not charging tuition for the ones who stay home .
She ’ s had to cut her staff in half , from 40 to 20 .
Those that do come in have a lot more to do—extra cleaning , plus acting as distance-learning tutors .
“ There was a very large learning curve , ” she said .
And , of course , there ’ s the danger of exposure .
“ They put themselves at risk every day.
” @ @ @ @ @ @ @ back on things like supplies and playground maintenance .
But she doesn ’ t think she can continue to operate as is for more than a month .
“ Our fixed costs are our fixed costs , ” she noted .
“ We ’ re depleting our cash reserves every day.… It doesn ’ t take a rocket scientist to figure out the finances just don ’ t work.
” “ There ’ s this almost misunderstanding , misrepresentation , that because the legislature continues to say child care is so essential , @ @ @ @ @ @ @ of , ” she added .
“ That ’ s really not the case.
” Instead , she said , “ We really need some help.
” Some lawmakers want to deliver it .
On April 15 , Senators Elizabeth Warren and Tina Smith put forward a plan to invest $ 50 billion in what they call a “ child care bailout.
” That kind of money “ would go a very long way to sustaining things , ” said Katherine Gallagher Robbins , director of child care and early education at CLASP @ @ @ @ @ @ @ , addressing the fact that the providers who are open are putting their own health on the line .
“ I really think those that are coming to work and putting themselves at higher risk should have…some incentive pay , ” Dunkley said .
“ They deserve a heroes ’ fund .
They ’ re some of the lowest-wage heroes out there.
” Angelique Speight felt called to stay open to make sure society keeps functioning .
“ Who ’ s going to take care of the patients if nobody takes care of @ @ @ @ @ @ @ children ?
How are you going to eat if the grocery stores are closed ?
” she asked .
“ I feel as though I ’ m doing a good service , not just for children but for the community.
” Every parent of the children she ’ s caring for has an essential role : a pharmacist , a lab technician , a nurse , and a home health aide .
She knows how important it is to have someone care for your child every day : Her adult daughter has special @ @ @ @ @ @ @ for her , she told me through tears .
“ I decided if they take care of her , I have to take care of the kids , ” she said .
But she knows that her service comes at a huge personal risk .
“ We put our lives in danger every day , ” she said .
Staying open has created family strife .
The only people working with her right now are her 24-year-old daughter and 79-year-old mother ; the rest of the staff has been furloughed .
But her @ @ @ @ @ @ @ protect her mother .
“ The first two , three weeks was horrible , we argued every day , ” she said .
Her mother is also scared .
But she ’ s determined .
“ Somebody has to stay open to help , ” she said .
All of these providers hope to keep going for as long as they can .
But the future is uncertain for all of them , particularly as the crisis extends into the unknown future .
Without more investment , things won ’ t just get @ @ @ @ @ @ @ leave lasting scars in the child care industry , accelerating the existing provider shortage .
“ We will not have a child care sector to come back to if we do not make significant investments now , ” Boteach said .
“ A lot of people can make it through a few weeks of tough financial circumstances , but how are you going to make it through a few months ?
” Dunkley said .
“ We ’ re going to see some permanent closures when this is all over .
”

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It was early in March that Karen DeVos first started taking measures to prevent the spread of the novel coronavirus at the day care center she runs. She told the parents at her Little Learners Early Childhood Center in Ada, Minnesota, that there would be a new, lower-contact drop-off protocol, and that anyone with a temperature of 100 degrees would be told to stay home. Show-and-tell was canceled, as she didn’t want children bringing anything into the classroom, and she hired an extra staff person to do even more cleaning than normal. Even then, “the scariness of the situation hadn’t really set in yet,” she said. As the pandemic quickly spread across the country and her governor ordered some businesses to close, she faced a more difficult question: Should she remain open to serve the families who needed her, putting herself, her staff, and the children she cared for at risk? Or should she simply close her doors?
The week of March 20, she had to make a call. Governor Tim Walz had asked providers to stay open to serve essential workers. All but two of the families DeVos serves are essential workers of some form or another. “I don’t know that I slept at all at night,” she said.
“The easy response to this for me at this point would be to close,” she said. Weighing on her is not just that she has staff who are worried about being exposed to the virus as they come to work to care for children whose parents go out and work every day. It’s also dollars and cents. She’s had to spend more on staff to make sure there’s enough capacity to do all the extra cleaning and to keep group sizes small. At the same time, she’s not charging the families who are keeping their children home, so she’s bringing in less money in tuition. She got a $3,000 grant from a foundation that allowed her to make last month’s payroll, and she can meet her expenses for April—except for her own paycheck, which she skipped. But after that, if no other help comes through, “I don’t anticipate we can continue running the same way that we are,” she said.
Hers is the only child care center in her rural county. “I really do feel a huge sense of responsibility to those who work here and to the children that we’re serving,” she said. But remaining open is something she constantly wrestles with. “I would hate to be responsible for somebody getting sick,” she said, her voice becoming nearly a whisper. “That’s such a weight to carry on one’s shoulders.”
As the Covid-19 crisis keeps millions of Americans home, the child care providers that enable working parents to keep their jobs are experiencing massive upheaval. Half of all child care providers across the country have closed. Another 15 percent are closed to all but the children of essential workers. At the same time, states across the country have promised essential workers that child care will be available to them if they keep working. That’s forced providers to decide whether or not they can afford to remain open and serve those children.
It’s not a simple equation. Child care providers already operate on razor-thin margins. Now, those that are still open are almost certainly experiencing lower attendance, which likely means less tuition than normal. But most fixed costs remain the same: rent or a mortgage, along with utilities and bills like food and supplies. Staff can’t be reduced too far since minimum teacher-to-child ratios are legally mandated. In some cases, child care centers need more staff to reduce class sizes for social distancing, to do extra cleaning, or to cover for staff who get sick or need to stay home. Meanwhile, getting those cleaning supplies has become far harder—and more expensive—as the entire world hoards the Clorox wipes and paper towels that centers normally rely on. Popular "swipe left below to view more authors"Swipe → The Evisceration of a Public University The Evisceration of a Public University Lisa M. Corrigan The Patronizing Moralism of David Brooks The Patronizing Moralism of David Brooks Chris Lehmann “The Blind Side” Was Always Trash “The Blind Side” Was Always Trash Dave Zirin How the “Brooks Brothers Riot” Set the Stage for Insurrection How the “Brooks Brothers Riot” Set the Stage for Insurrection Chris Lehmann Popular "swipe left below to view more authors"Swipe → The Evisceration of a Public University The Evisceration of a Public University Lisa M. Corrigan The Patronizing Moralism of David Brooks The Patronizing Moralism of David Brooks Chris Lehmann “The Blind Side” Was Always Trash “The Blind Side” Was Always Trash Dave Zirin How the “Brooks Brothers Riot” Set the Stage for Insurrection How the “Brooks Brothers Riot” Set the Stage for Insurrection Chris Lehmann
“Those that are open are struggling, and those that are closed are struggling,” said Chad Dunkley, president of the Minnesota Child Care Association. “I haven’t heard a single person who isn’t.” Current Issue View our current issue
According to an analysis by the National Women’s Law Center and CLASP shared exclusively with The Nation, it takes $6.3 billion a month for centers to remain open for the estimated 6 million children of essential workers who need care during the workday. They estimate that child care centers’ costs are 23 percent higher now if they’re offering emergency care, while costs are 19 percent higher for home-based providers.
All told, it would take at least $9.6 billion a month on top of what the federal government already provides to ensure that providers who remain open for essential workers are able to meet their extra costs while also keeping closed centers afloat so that they can reopen when the crisis passes. It’s a staggering sum. But “we’re talking about an entire sector that is holding up our entire economy,” noted Melissa Boteach, vice president for child care and early learning at the National Women’s Law Center. Child care providers are a key part of keeping other vital services—hospitals, grocery stores, pharmacies—open. About 30 percent of health care workers, who are in short supply right now, have children under the age of 14.
So far, Congress has included just $3.5 billion in extra funding for child care providers in the CARES Act. The industry “does get lost sometimes,” Dunkley said. “We’re loud and we’re important, but we don’t have the kind of lobbying dollars other industries have.” Boeing, for example, has requested $60 billion for the aerospace manufacturing industry, and has already received a $17 billion federal loan program carved out specifically for the company in the CARES Act.
While many states have mandated child care provider closures as part of stay-at-home orders, they have generally exempted child care providers that stay open to serve essential workers. Seventeen states have mandated that child care providers close unless they’re willing to provide care to the children of essential workers. In some places, such as Delaware, Illinois, and Oregon, child care centers have to apply and receive special licenses or waivers to keep their doors open for essential workers. In Maryland, they have to report daily on the health of each child in their care, according to an upcoming briefing paper by Valerie Lacarte of the Institute for Women’s Policy Research.
But most states are hoping that at least some providers will choose to keep operating, recognizing that they are necessary if essential workers are going to stay at work. And lawmakers at all levels have made big promises to essential workers in the hope that they’ll keep showing up. Colorado Governor Jared Police pledged access to emergency child care for frontline workers so that “people aren’t forced to stay home simply because their kid doesn’t have a place to go during the day.” Minnesota and Vermont classified grocery clerks as essential workers so that they could receive child care. “Frontline workers—including grocery and pharmacy workers, warehouse workers, medical personnel, farmworkers, food processing workers, truck drivers, postal workers, delivery drivers, and janitors—must be provided hazard pay, child care, and safe working conditions,” Senator Bernie Sanders tweeted.
Nacole Thrower, an essential worker, makes sure the hands of her three-year-old son, Hudson, are washed while arriving at the emergency child care facility in Washington, D.C., on April 15, 2020. (Astrid Riecken/The Washington Post via Getty Images)
But few states are offering details about how providers are supposed to provide care, let alone enough extra money to ensure they can do it without going broke. The decision about whether, and how, to stay open is mostly left up to individual providers. And while some states have made emergency funding and grants available—Minnesota and Vermont, for example, have backed up their promises to essential workers with new funding for child care—none of it matches the scale of the need. Others are paying providers less than what they normally receive: According to Lacarte’s briefing paper, Maryland has barred providers from charging families of essential workers directly and will pay them a flat rate that may be less than what they normally charge. “They’re really weighing the health and safety concerns,” noted Catherine White, director of child care and early learning at the National Women’s Law Center, against the financial cost of shuttering. “They’re caught between a rock and a hard place.”
It wasn’t clear whether Milagros Carbajal, whose children call her Miss Millie, should keep her in-home day care center in New York City open. Neither the city nor the state told providers what to do. “Initially we were left to figure out things for ourselves,” she said. “We should have gotten an e-mail, should have gotten a text, something.” Eventually, the state sent them guidance on safety protocols if they decided to stay open and what numbers to call if anything went wrong.
Even less clear was whether she would get paid if she stayed open. She cares for a number of children whose parents get subsidies from the city to pay for care, and the city has told her she’ll get paid for them, whether they attend or not, for the month of April. But it also said it will decide what to do moving forward on a month-to-month basis. “You’re holding your breath every 30 days,” she noted. “This is another stress we have to deal with on top of everything else, which his completely unfair.” If the city stops paying the full voucher amount, she’ll have to close her doors. “If we’re supporting parents, then who’s supporting us?” The Coronavirus Crisis How Trump’s Foreign Policy Puts Troops at Risk of Covid-19 Ken Klippenstein These People Aren’t Freedom Fighters—They’re Virus-Spreading Sociopaths Elie Mystal The Devastating Emotional Toll of Suspending Prison Visits Karina Piser
In the absence of clear guidance, providers are coming up with their own safety protocols to keep operating while protecting everyone’s health. Every provider I spoke with takes the temperatures of parents and children alike before they come into the classrooms. Many aren’t even allowing parents to come into the room at all, leading to “a few more tears at drop off,” Karen DeVos said. Cleanliness is a staple of a child care classroom, but all of them have gone into overdrive. Kids’ “poor little hands are just raw because they’re constantly washing,” she noted. Providers have shrunk class sizes as small as they can and try to keep children as separated from each other as possible.
Some have come up with creative solutions. Carbajal has the children change into a T-shirt that gets left with her every day. Tonya Holt has closed the sensory table at her center in Minnesota, usually filled with sand or water, and put away any toys that can’t be washed and sanitized after every use. The front desk used to have a drawer full of stickers, and each child could take one out each day. It’s been empty since March 1.
Other changes are harder. “We’re hugging less,” said Angelique Speight, a provider in Washington, DC. “I’m so used to loving them and hugging them so tight.”
The day has changed in ways big and small. For DeVos’s school-age children—she takes care of kids as old as fourth grade—her staff now has to do distance learning with them. It entails “a whole bunch of different lesson plans and a whole bunch of different iPads, trying to navigate the different expectations for each child,” she said. “It’s a whole other level of crazy thrown into the mix.”
DeVos’s center is housed on the same campus as an assisted living facility, and now her kids can’t have contact with the residents, whom they call the grandmas and grandpas, and normally see on a daily basis, giving them hugs and doing daily activities together. So instead the grandmas and grandpas watch them play through their windows, to which the children have taped pictures and messages. “Most of them aren’t actually related, but it is still family to us,” she said. “We miss them terribly.”
Lower attendance is also an adjustment. “It’s so different,” Carbajal said. “On a normal day you will hear the laughter, and some cries and some screaming, of children. Now when you come in, it’s so quiet.” She misses the children who aren’t coming anymore. “It’s emotional. Mentally draining,” she said. The Tuesday after Easter, she dressed up in a bunny suit and dropped off baskets at some of their apartments. Sometimes they wave and call to her out their windows when she walks by on her way to and from work.
Small things have gotten tough, too. It’s been a challenge for her to get cleaning supplies, a staple for a child care provider even without a global pandemic. Store shelves are wiped clean. She managed to get some things from Amazon, and her union gave her one bottle of hand sanitizer. Her monthly toilet paper shipment that usually comes on the first of the month didn’t arrive until mid April. It took a month for a box of 100 disposable masks to arrive—and cost $100.
Still, she wants to be open. “Even if I had one child, I was going to stay open,” she said. She’s since taken in two new children whose programs have closed.
Closing wasn’t a financial option for Jamila Warfa, either. She didn’t get much guidance from Washington state about what she should do, so she kept going because she needed the money. Speaking Somali through an interpreter, she explained that her husband, whose job is taking elderly people to appointments, was exposed to a patient who tested positive for Covid-19, so he had to quarantine himself and hasn’t been working. They need her income.
April Moskalczyk holds two-year-old Zavaya Bibbs while she has her temperature taken at the YMCA in Erie, Pennsylvania, on April 1, 2020. (Greg Wohlford/Erie Times-News via AP)
Meanwhile, she’s worried that she’s exposing not just herself but also her husband and five children at home. She’s not just caring for the children of essential workers; she has children coming in whose parents are at home. It makes her very nervous. She doesn’t have health insurance. But she can’t afford to close. More From Bryce Covert The New Law to Protect Pregnant Workers Is Already Changing Lives August 14, 2023 Finally, the Biden Administration Will Offer Some Relief for Childcare Costs July 11, 2023 One of #MeToo’s Biggest Wins Is About to Be Tested in Court June 13, 2023
The only contact she’s had with the government was a call three weeks ago from the state Department of Children, Youth, and Families asking what she needed. She told them she needs cleaning supplies; so far, nothing has materialized. She’s tried to look into some of the government assistance programs that might be available to her, but her language barrier has made it difficult.
Some states are offering extra assistance immediately. Texas will distribute $40 million to parents and child care providers so they can care for the children of essential workers. Minnesota has created a $30 million emergency child care grant program for licensed programs serving essential workers. Vermont has offered families a stabilization payment program so that they can keep paying their providers even if their children aren’t attending day care. North Carolina and New Mexico have both committed to paying child care subsidies, whether or not the children attend programs, as well as offering bonus payments; in New Mexico, providers who stay open will get an extra $250 per enrolled child.
The Minnesota grant is a notable win in a state where child care providers have been trying for years to get more funding. “It goes further than anything we’ve been able to win on child care,” Marte said. But providers have to apply for it—not everyone will get money—and it’s capped at $15,500 a month. That amount won’t go far enough for Tonya Holt, who has to pay a mortgage on her 11,000-foot facility and compensate staff. “That doesn’t offset the loss of tuition,” she noted.
Normally, she has about 170 children in her 11 classrooms. Now there are about 30 coming every day, and, at least for now, she’s not charging tuition for the ones who stay home. She’s had to cut her staff in half, from 40 to 20. Those that do come in have a lot more to do—extra cleaning, plus acting as distance-learning tutors. “There was a very large learning curve,” she said. And, of course, there’s the danger of exposure. “They put themselves at risk every day.”
She’s been able to cut back on things like supplies and playground maintenance. But she doesn’t think she can continue to operate as is for more than a month. “Our fixed costs are our fixed costs,” she noted. “We’re depleting our cash reserves every day.… It doesn’t take a rocket scientist to figure out the finances just don’t work.”
“There’s this almost misunderstanding, misrepresentation, that because the legislature continues to say child care is so essential, that we are somehow being taken care of,” she added. “That’s really not the case.” Instead, she said, “We really need some help.”
Some lawmakers want to deliver it. On April 15, Senators Elizabeth Warren and Tina Smith put forward a plan to invest $50 billion in what they call a “child care bailout.” That kind of money “would go a very long way to sustaining things,” said Katherine Gallagher Robbins, director of child care and early education at CLASP. It would also ensure hazard pay, addressing the fact that the providers who are open are putting their own health on the line. “I really think those that are coming to work and putting themselves at higher risk should have…some incentive pay,” Dunkley said. “They deserve a heroes’ fund. They’re some of the lowest-wage heroes out there.”
Angelique Speight felt called to stay open to make sure society keeps functioning. “Who’s going to take care of the patients if nobody takes care of the doctors’ and the nurses’ children? How are you going to eat if the grocery stores are closed?” she asked. “I feel as though I’m doing a good service, not just for children but for the community.” Every parent of the children she’s caring for has an essential role: a pharmacist, a lab technician, a nurse, and a home health aide.
She knows how important it is to have someone care for your child every day: Her adult daughter has special needs and relies on caregivers to care for her, she told me through tears. “I decided if they take care of her, I have to take care of the kids,” she said.
But she knows that her service comes at a huge personal risk. “We put our lives in danger every day,” she said. Staying open has created family strife. The only people working with her right now are her 24-year-old daughter and 79-year-old mother; the rest of the staff has been furloughed. But her daughter wants her to shut down to protect her mother. “The first two, three weeks was horrible, we argued every day,” she said. Her mother is also scared. But she’s determined. “Somebody has to stay open to help,” she said.
All of these providers hope to keep going for as long as they can. But the future is uncertain for all of them, particularly as the crisis extends into the unknown future. Without more investment, things won’t just get messy during the pandemic. It could leave lasting scars in the child care industry, accelerating the existing provider shortage. “We will not have a child care sector to come back to if we do not make significant investments now,” Boteach said.
“A lot of people can make it through a few weeks of tough financial circumstances, but how are you going to make it through a few months?” Dunkley said. “We’re going to see some permanent closures when this is all over.”


thenation--2020-04-23--Beating Covid-19 Will Take Coordination, Experimentation, and Leadership

If you watch the news on television during the age of Covid-19 , you ’ ll see a kind of story often featured on the legacy networks and cable stations .
Heartwarming and filling you with hope , these stories are about a survivor—someone who was in an intensive care unit , on a ventilator , and not expected to live for much longer .
Then , a plucky spouse fights to get his or her partner access to an experimental treatment , and , once it is administered , the near-dead rise up like Lazarus .
Except most of @ @ @ @ @ @ @ not true in the causal sense .
That is , while our valiant couple may vanquish their SARS-CoV2 infection together , their stories do not provide evidence that the new drug was behind these stunning clinical reversals of fortune .
With many diseases , people often just get better—with or without an experimental treatment .
That is why we do randomized clinical trials : to keep from fooling ourselves .
Over the past few months , we ’ ve seen this cycle of hope and disappointment play out with several drugs .
The @ @ @ @ @ @ @ , which were touted by President Donald Trump and even led his China trade adviser Peter Navarro to scold our nation ’ s leading infectious disease researcher , Dr. Anthony Fauci , for not being sufficiently credulous about the “ evidence ” that was out there .
I ’ ve seen these boom-and-bust cycles before—in the 1980s and early 1990s during the age of HIV/AIDS , when , for over a decade , we grasped in desperation for the latest cure .
In the mid-1990s , we developed drugs that finally brought that @ @ @ @ @ @ @ chronic , manageable illness for those who had access to these medications .
There are four classes of treatments currently under study for use against SARS-CoV2 and Covid-19 : antiviral medicines , which are meant to attack SARS-CoV2 itself ; the two quinolines , hydroxychloroquine and chloroquine , which , although used for malaria and lupus , have been tested for indirect antiviral activity as well ; immunomodulatory therapies , often antibodies targeted at disease-fighting molecules in our own body ( these can end up doing more harm than good in what are @ @ @ @ @ @ @ where our immune systems in overdrive starts devouring us ) ; and convalescent plasma , blood products from survivors of Covid-19 , which are thought to be enriched in antibodies that can target the virus through passive transfer to another patient with the same blood type .
All of these have been in the news .
I talked to a few of my colleagues who worked with HIV/AIDS about the landscape of treatments for Covid-19 : Dr. Rochelle Walensky , chief of infectious diseases at Massachusetts General Hospital ; Dr. Robert “ Chip @ @ @ @ @ @ @ diseases and global health at University of California at San Diego ; Dr. Carlos Del Rio , a professor of infectious diseases and global health at Emory ; and James Krellenstein , an AIDS activist with the group PreP4All in New York City .
Each of them is now working on Covid-19 and following the research closely .
Some are treating Covid-19 patients themselves .
All of them agree : None of these therapies have yet been shown to be effective as treatments for SARS-CoV2 or the disease it causes .
We have @ @ @ @ @ @ @ the clinical trials .
Data from those should be forthcoming in the next few weeks or months .
The Science Is Clear on How to Beat This Pandemic We ’ ve Got to ACT UP to Stop Trumpcare Meanwhile , many of these therapies are being used around the country off-label or as part of expanded access programs , in which drug companies offer their experimental treatments to patients with no other options .
However , the impact of these agents on individual patients doesn ’ t signal a breakthrough on Covid-19 ; @ @ @ @ @ @ @ poorly designed studies or preliminary results from clinical studies underway .
Just this week though , the prospects for the quinolines took a hit .
Without evidence for benefit from clinical trials , a panel at the National Institutes of Health issued recommendations against the use of hydroxychloroquine in combination with the antibiotic azithromycin because of toxicities associated with this two-drug cocktail .
In particular , these two drugs in combination can cause a type of irregular heartbeat that can lead to cardiac arrest .
This same panel also warned against the use @ @ @ @ @ @ @ called interferons , outside of the context of clinical trials as well , as they have their own toxicities and haven ’ t been shown to be effective against SARS-COV2 ’ s cousins , severe acute respiratory syndrome ( SARS ) and Middle East respiratory syndrome ( MERS ) .
So where does that leave us ?
First , we have to wait .
Acting without evidence has consequences .
Untested medicines are not uniformly helpful and can , in fact , present dangers to those who try them even as a last @ @ @ @ @ @ @ throughout the history of medical research , where a new drug can shorten life , or make a disease worse .
In what is known as the therapeutic misconception , we wrongly assume if it ’ s being studied in a clinical trial , it must be beneficial to us .
If you have Covid-19 , what do you have to lose ?
Without evidence of clinical benefit from well designed randomized clinical trials , the life you lose could be your own .
We ’ ve also got to beware of policy @ @ @ @ @ @ @ go to waste .
These are groups , like the Goldwater Institute and others , who see this moment as just another reason to suggest that the FDA is standing in the way of access to new treatments and demand rollback of more regulations that protect us from unsafe and ineffective drugs .
Lastly , we have to keep an eye on the state of medical research and drug development .
We ’ ve seen a crisis in leadership throughout the SARS-CoV2 pandemic .
It ’ s absolutely crucial to advocate fa coordinated @ @ @ @ @ @ @ nation ’ s research agencies , academic centers , and drug companies to move us more expeditiously to the goal of an effective treatment for Covid-19 .
James Krellenstein , from PreP4All , which is issuing a report shortly on the state of anti–SARS-CoV2 research , warned me this week that what they ’ re seeing is a lack of leadership of this critical national project .
The problems that PreP4All are documenting run from basic tasks like coordinating high-throughput screening of candidate molecules active against SARS-CoV2 among all the compound libraries in @ @ @ @ @ @ @ or run by the US government , to the management of clinical trials to ensure we have adequately powered , well-designed studies targeting treatments based on the best scientific evidence and preliminary data .
Susan Ellenberg , a professor of biostatistics at the University of Pennsylvania underscored this last point to me in a recent email : “ Many sites , especially those with large numbers of patients , are doing their own trials .
But we will get answers faster if people collaborate… .
As some treatments show evidence of benefit we @ @ @ @ @ @ @ combinations and these trials will require larger sample sizes , meaning in most cases multicenter trials.
” That ’ s what ’ s needed .
Instead .
as this article goes to press there are over 100 studies of hydroxychloroquine underway , listed in the federal clinical trials registry , based on hype , hope , and desperation .

EDITOR’S NOTE: The Nation believes that helping readers stay informed about the impact of the coronavirus crisis is a form of public service. For that reason, this article, and all of our coronavirus coverage, is now free. Please subscribe to support our writers and staff, and stay healthy.
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If you watch the news on television during the age of Covid-19, you’ll see a kind of story often featured on the legacy networks and cable stations. Heartwarming and filling you with hope, these stories are about a survivor—someone who was in an intensive care unit, on a ventilator, and not expected to live for much longer. Then, a plucky spouse fights to get his or her partner access to an experimental treatment, and, once it is administered, the near-dead rises up like Lazarus. Except most of these stirring tales are tall ones, not true in the causal sense. That is, while our valiant couple may vanquish their SARS-CoV2 infection together, their stories do not provide evidence that the new drug was behind these stunning clinical reversals of fortune. With many diseases, people often just get better—with or without an experimental treatment. That is why we do randomized clinical trials: to keep from fooling ourselves.
Over the past few months, we’ve seen this cycle of hope and disappointment play out with several drugs. The most famous couple was hydroxychloroquine and chloroquine, which were touted by President Donald Trump and even led his China trade adviser Peter Navarro to scold our nation’s leading infectious disease researcher, Dr. Anthony Fauci, for not being sufficiently credulous about the “evidence” that was out there. I’ve seen these boom-and-bust cycles before—in the 1980s and early 1990s during the age of HIV/AIDS, when, for over a decade, we grasped in desperation for the latest cure. In the mid-1990s, we developed drugs that finally brought that virus under control, making AIDS a chronic, manageable illness for those who had access to these medications.
There are four classes of treatments currently under study for use against SARS-CoV2 and Covid-19: antiviral medicines, which are meant to attack SARS-CoV2 itself; the two quinolines, hydroxychloroquine and chloroquine, which, although used for malaria and lupus, have been tested for indirect antiviral activity as well; immunomodulatory therapies, often antibodies targeted at disease-fighting molecules in our own body (these can end up doing more harm than good in what are known as “cytokine storms,” where our immune systems in overdrive starts devouring us); and convalescent plasma, blood products from survivors of Covid-19, which are thought to be enriched in antibodies that can target the virus through passive transfer to another patient with the same blood type. All of these have been in the news.
I talked to a few of my colleagues who worked with HIV/AIDS about the landscape of treatments for Covid-19: Dr. Rochelle Walensky, chief of infectious diseases at Massachusetts General Hospital; Dr. Robert “Chip” Schooley, a professor of infectious diseases and global health at University of California at San Diego; Dr. Carlos Del Rio, a professor of infectious diseases and global health at Emory; and James Krellenstein, an AIDS activist with the group PreP4All in New York City. Each of them is now working on Covid-19 and following the research closely. Some are treating Covid-19 patients themselves. All of them agree: None of these therapies have yet been shown to be effective as treatments for SARS-CoV2 or the disease it causes. We have to wait to see what happens in the clinical trials. Data from those should be forthcoming in the next few weeks or months. Popular "swipe left below to view more authors"Swipe → The Evisceration of a Public University The Evisceration of a Public University Lisa M. Corrigan The Patronizing Moralism of David Brooks The Patronizing Moralism of David Brooks Chris Lehmann “The Blind Side” Was Always Trash “The Blind Side” Was Always Trash Dave Zirin How the “Brooks Brothers Riot” Set the Stage for Insurrection How the “Brooks Brothers Riot” Set the Stage for Insurrection Chris Lehmann Popular "swipe left below to view more authors"Swipe → The Evisceration of a Public University The Evisceration of a Public University Lisa M. Corrigan The Patronizing Moralism of David Brooks The Patronizing Moralism of David Brooks Chris Lehmann “The Blind Side” Was Always Trash “The Blind Side” Was Always Trash Dave Zirin How the “Brooks Brothers Riot” Set the Stage for Insurrection How the “Brooks Brothers Riot” Set the Stage for Insurrection Chris Lehmann More From Gregg Gonsalves These New Alzheimer’s Drugs Are a Travesty July 27, 2023 It's Not “Unreasonable” to Want to Change Our Rotten Health Care System June 1, 2023 Now More Than Ever, We Need to Fight, Not Despair May 11, 2023
Meanwhile, many of these therapies are being used around the country off-label or as part of expanded access programs, in which drug companies offer their experimental treatments to patients with no other options. However, the impact of these agents on individual patients doesn’t signal a breakthrough on Covid-19; nor do the results from small, poorly designed studies or preliminary results from clinical studies underway.
Just this week though, the prospects for the quinolines took a hit. Without evidence for benefit from clinical trials, a panel at the National Institutes of Health issued recommendations against the use of hydroxychloroquine in combination with the antibiotic azithromycin because of toxicities associated with this two-drug cocktail. In particular, these two drugs in combination can cause a type of irregular heartbeat that can lead to cardiac arrest. This same panel also warned against the use of a class of immunomodulatory molecules, called interferons, outside of the context of clinical trials as well, as they have their own toxicities and haven’t been shown to be effective against SARS-COV2’s cousins, severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS).
So where does that leave us? First, we have to wait. Acting without evidence has consequences. Untested medicines are not uniformly helpful and can, in fact, present dangers to those who try them even as a last resort. We’ve seen this throughout the history of medical research, where a new drug can shorten life, or make a disease worse. In what is known as the therapeutic misconception, we wrongly assume if it’s being studied in a clinical trial, it must be beneficial to us. Current Issue View our current issue
If you have Covid-19, what do you have to lose? Without evidence of clinical benefit from well-designed randomized clinical trials, the life you lose could be your own. We’ve also got to beware of policy vultures, who never let a crisis go to waste. These are groups, like the Goldwater Institute and others, who see this moment as just another reason to suggest that the FDA is standing in the way of access to new treatments and demand rollback of more regulations that protect us from unsafe and ineffective drugs. Lastly, we have to keep an eye on the state of medical research and drug development.
We’ve seen a crisis in leadership throughout the SARS-CoV2 pandemic. It’s absolutely crucial to advocate a coordinated, fast-tracked effort bringing together all our nation’s research agencies, academic centers, and drug companies to move us more expeditiously to the goal of an effective treatment for Covid-19. James Krellenstein, from PreP4All, which is issuing a report shortly on the state of anti–SARS-CoV2 research, warned me this week that what they’re seeing is a lack of leadership of this critical national project.
The problems that PreP4All are documenting run from basic tasks like coordinating high-throughput screening of candidate molecules active against SARS-CoV2 among all the compound libraries in the United States, in private hands or run by the US government, to the management of clinical trials to ensure we have adequately powered, well-designed studies targeting treatments based on the best scientific evidence and preliminary data. Susan Ellenberg, a professor of biostatistics at the University of Pennsylvania underscored this last point to me in a recent email: “Many sites, especially those with large numbers of patients, are doing their own trials. But we will get answers faster if people collaborate…. As some treatments show evidence of benefit we will be moving to studies of drug combinations and these trials will require larger sample sizes, meaning in most cases multicenter trials.”
That’s what’s needed. Instead. as this article goes to press there are over 100 studies of hydroxychloroquine underway, listed in the federal clinical trials registry, based on hype, hope, and desperation.


thenation--2020-04-23--Trump’s New Immigration ‘Ban’ Is an Evil Attempt at Distraction

Donald Trump is not subtle .
He ’ s not deft .
When he “ speaks in code , ” the code is obvious , even to the low-wattage Michael Cohens of the world .
When he wants people to say something , he tells them what to say .
When he wants people distracted , he effectively jumps up and down , making a fool of himself until people are sufficiently distracted by his histrionics and tantrums .
This week , Trump wants us to talk about immigration .
The pandemic story is bad for him , because his @ @ @ @ @ @ @ The economic story is bad for him , because the economy is shedding workers at depression-like rates .
So Trump decided to unveil his newest immigration ban , this one ostensibly inspired by the coronavirus .
Compared to his bigoted , Supreme Court–approved Muslim ban , or his medieval border wall fantasy , this one feels more like the desperate flailing of a weak president as opposed to the terrifying strikes of an unhinged authoritarian .
With his approval ratings down from their temporary highs and general election polls showing him losing , @ @ @ @ @ @ @ has saved him so many times before—the bigotry and xenophobia of his base .
But this time , Trump ’ s reach exceeds his grasp .
Even to call the executive order he signed yesterday an “ immigration ban ” is to adopt Trump ’ s divisive rhetoric and salesmanship over the legal and practical realities of his order .
Trump isn ’ t banning , stopping , or pausing “ immigration.
” What he ’ s doing is more like xenophobia as performance art as opposed to actual policy-making .
That ’ @ @ @ @ @ @ @ order isn ’ t bad .
It will needlessly hurt a group of would-be new Americans who have done everything to complete the arduous process of immigrating to this country .
It is immigrant bashing for the sole purpose of exciting people who take sick comfort in harassing foreigners they ’ ve never met .
And it is politically distracting‚ just as it is transparently designed to be .
It ’ s just not an immigration restriction that has anywhere near the scope or effect of previous horrors ( which is why it @ @ @ @ @ @ @ .
Trump ’ s ban focuses on people who are applying from outside the United States for permanent residency , better known as “ green cards.
” He ’ s decided to ban the processing of these applications for 60 days , with the promise and threat that he might revisit and extend that decision .
Crucially , though , the order doesn ’ t extend to all nonresident green card applicants .
The order contains exceptions for green card applicants who are sponsored by an American citizen spouse .
It contains exceptions @ @ @ @ @ @ @ who are sponsored by an American parent .
It contains exceptions for doctors , nurses , and health care professionals .
And the order contains exceptions for foreign investors who go through the EB-5 program , which essentially lets anybody with $ 900,000 to spend buy entry into the country .
Only a Republican administration would try to convince their supporters that people with $ 900,000 or more can not transmit an infectious disease .
The people most likely to be affected by this ban are grandparents and siblings and whomever else Melania @ @ @ @ @ @ @ to power .
People who are sponsored by their employers and have already had to show that they have essential skills will also be temporarily banned ; so I guess if you were worried about somebody taking your job at Google , Trump has your back during this crisis—unless Google figures out how to make their videoconferencing hangouts not stink .
Foreign nationals who are anxious to upgrade their status and join their family , friends , and colleagues in the United States should not be singled out and punished like this .
@ @ @ @ @ @ @ , thankfully , not the same as “ banning immigration , ” as Trump ’ s base would no doubt like to believe .
Trump ’ s order does not stop people who already have green cards from applying for citizenship , although the coronavirus shutdowns have put a practical if not legal hold on citizenship applications .
The order does not stop people who are already living here from applying for green cards , because he straight up doesn ’ t have the legal authority to unilaterally prevent people already legally living @ @ @ @ @ @ @ upgrade their status .
The order does not stop people who already have student visas , or travel visas , to the extent that any person who can study or read actually wants to come to our disease riddled , testing challenged , scientifically disobedient “ shithole country ” right now .
And , critically , Trump ’ s order does not ban temporary work visa applications .
In fact , the administration is going in the opposite direction with some of those .
Citizenship and Immigration Services recently announced it was relaxing @ @ @ @ @ @ @ most commonly used by immigrant farm workers , to make it easier for them to switch employers without losing their status .
Here lies the inherent contradiction of the Republican Party .
Wealthy Republicans need cheap immigrant labor in order to make their profits .
Somebody needs to mow the lawns and clean the sheets at Mar-A-Lago .
But non-wealthy Republicans need someone to blame for the record unemployment spikes and joblessness .
So Trump is doing the only thing he knows how to do : He ’ s using the same old @ @ @ @ @ @ @ incompetence and failure , while not actually “ banning immigration ” for fear of pissing off his businessman buddies or further tanking an economy already teetering on the brink of ruin .
Argentina Is Showing the World What a Humane Covid-19 Response Looks Like The Lesson of the Coronavirus ?
There ’ s No One Left to Trust .
More in this series And the base will probably love it , particularly the most extreme anti-immigration elements in the Republican Party .
The executive order reeks of Stephen Miller , Trump ’ s @ @ @ @ @ @ @ It ’ s an order targeting some forms of “ chain migration , ” which has become an increasingly deranged fetish of people like Miller , former Trump whisperer Steve Bannon , and the gang of alt-right nationalists and replacement theory aficionados who have determined that any immigration will lead to an America that is more brown , more diverse , and less good for white people .
Fears about chain migration have little to do with the job security of the American worker , and less than nothing to do with the @ @ @ @ @ @ @ ’ s logic is designed entirely for these armchair eugenicists who view any additional brown people added to the country as a dangerous attack against white supremacy and patriarchy .
Of course , it ’ s also possible that this could be a trap .
Trump could simply be testing the waters on banning green cards , which is generally considered sacred ground to all but the most devout opponents of immigration .
Trump could determine that this ban is not generating enough of a distraction and decide to ratchet it up in @ @ @ @ @ @ @ desires .
The Trump administration has already used the Covid-19 crisis to further restrict immigration : US embassies around the world have suspended the normal processing of tourist visas ; Customs and Border Protection is turning away ever more unauthorized migrants and refugees at the border .
This executive order isn ’ t the first attempt to use the virus to close down immigration , and it likely won ’ t be the last .
This time though , his whack at the immigrant piñata feels more desperate than menacing .
One gets @ @ @ @ @ @ @ of tricks .
Covid-19 did not need a visa to come here , and it does not need a green card to stay here .
All the immigrant bashing in the world won ’ t make it go away .

EDITOR’S NOTE: The Nation believes that helping readers stay informed about the impact of the coronavirus crisis is a form of public service. For that reason, this article, and all of our coronavirus coverage, is now free. Please subscribe to support our writers and staff, and stay healthy.
Subscribe to The Nation Subscribe now for as little as $2 a month! Subscribe now for as little as $2 a month!
Get The Nation’s Weekly Newsletter Fridays. The best of the week. Email By signing up, you confirm that you are over the age of 16 and agree to receive occasional promotional offers for programs that support The Nation’s journalism. You can read our Privacy Policy here. Fridays. The best of the week.
Thank you for signing up for The Nation’s weekly newsletter.
Repro Nation A monthly newsletter on the global fight for reproductive freedom. Email By signing up, you confirm that you are over the age of 16 and agree to receive occasional promotional offers for programs that support The Nation’s journalism. You can read our Privacy Policy here.
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Sign up for our Wine Club today. Did you know you can support The Nation by drinking wine?
Donald Trump is not subtle. He’s not deft. When he “speaks in code,” the code is obvious, even to the low-wattage Michael Cohens of the world. When he wants people to say something, he tells them what to say. When he wants people distracted, he effectively jumps up and down, making a fool of himself until people are sufficiently distracted by his histrionics and tantrums.
This week, Trump wants us to talk about immigration. The pandemic story is bad for him, because his failures have resulted in people dying. The economic story is bad for him, because the economy is shedding workers at depression-like rates. So Trump decided to unveil his newest immigration ban, this one ostensibly inspired by the coronavirus.
Compared to his bigoted, Supreme Court–approved Muslim ban, or his medieval border wall fantasy, this one feels more like the desperate flailing of a weak president as opposed to the terrifying strikes of an unhinged authoritarian. With his approval ratings down from their temporary highs and general election polls showing him losing, Trump now grabs for the lifeline that has saved him so many times before—the bigotry and xenophobia of his base.
But this time, Trump’s reach exceeds his grasp. Even to call the executive order he signed yesterday an “immigration ban” is to adopt Trump’s divisive rhetoric and salesmanship over the legal and practical realities of his order. Trump isn’t banning, stopping, or pausing “immigration.” What he’s doing is more like xenophobia as performance art as opposed to actual policy-making.
That’s not to say Trump’s order isn’t bad. It will needlessly hurt a group of would-be new Americans who have done everything to complete the arduous process of immigrating to this country. It is immigrant bashing for the sole purpose of exciting people who take sick comfort in harassing foreigners they’ve never met. And it is politically distracting‚ just as it is transparently designed to be. Current Issue View our current issue
It’s just not an immigration restriction that has anywhere near the scope or effect of previous horrors (which is why it’s also almost certainly constitutional). Trump’s ban focuses on people who are applying from outside the United States for permanent residency, better known as “green cards.” He’s decided to ban the processing of these applications for 60 days, with the promise and threat that he might revisit and extend that decision.
Crucially, though, the order doesn’t extend to all nonresident green card applicants. The order contains exceptions for green card applicants who are sponsored by an American citizen spouse. It contains exceptions for children under the age of 21 who are sponsored by an American parent. It contains exceptions for doctors, nurses, and health care professionals. And the order contains exceptions for foreign investors who go through the EB-5 program, which essentially lets anybody with $900,000 to spend buy entry into the country. Only a Republican administration would try to convince their supporters that people with $900,000 or more cannot transmit an infectious disease. Popular "swipe left below to view more authors"Swipe → The Evisceration of a Public University The Evisceration of a Public University Lisa M. Corrigan The Patronizing Moralism of David Brooks The Patronizing Moralism of David Brooks Chris Lehmann “The Blind Side” Was Always Trash “The Blind Side” Was Always Trash Dave Zirin How the “Brooks Brothers Riot” Set the Stage for Insurrection How the “Brooks Brothers Riot” Set the Stage for Insurrection Chris Lehmann Popular "swipe left below to view more authors"Swipe → The Evisceration of a Public University The Evisceration of a Public University Lisa M. Corrigan The Patronizing Moralism of David Brooks The Patronizing Moralism of David Brooks Chris Lehmann “The Blind Side” Was Always Trash “The Blind Side” Was Always Trash Dave Zirin How the “Brooks Brothers Riot” Set the Stage for Insurrection How the “Brooks Brothers Riot” Set the Stage for Insurrection Chris Lehmann
The people most likely to be affected by this ban are grandparents and siblings and whomever else Melania Trump brought over before her husband rose to power. People who are sponsored by their employers and have already had to show that they have essential skills will also be temporarily banned; so I guess if you were worried about somebody taking your job at Google, Trump has your back during this crisis—unless Google figures out how to make their videoconferencing hangouts not stink.
Foreign nationals who are anxious to upgrade their status and join their family, friends, and colleagues in the United States should not be singled out and punished like this. But sticking it to these people is, thankfully, not the same as “banning immigration,” as Trump’s base would no doubt like to believe.
Trump’s order does not stop people who already have green cards from applying for citizenship, although the coronavirus shutdowns have put a practical if not legal hold on citizenship applications. The order does not stop people who are already living here from applying for green cards, because he straight up doesn’t have the legal authority to unilaterally prevent people already legally living in the United States from applying to upgrade their status. The order does not stop people who already have student visas, or travel visas, to the extent that any person who can study or read actually wants to come to our disease riddled, testing challenged, scientifically disobedient “shithole country” right now.
And, critically, Trump’s order does not ban temporary work visa applications. In fact, the administration is going in the opposite direction with some of those. Citizenship and Immigration Services recently announced it was relaxing restrictions on H-2A visas, the ones most commonly used by immigrant farm workers, to make it easier for them to switch employers without losing their status.
Here lies the inherent contradiction of the Republican Party. Wealthy Republicans need cheap immigrant labor in order to make their profits. Somebody needs to mow the lawns and clean the sheets at Mar-A-Lago. But non-wealthy Republicans need someone to blame for the record unemployment spikes and joblessness. So Trump is doing the only thing he knows how to do: He’s using the same old con of blaming immigrants for his own incompetence and failure, while not actually “banning immigration” for fear of pissing off his businessman buddies or further tanking an economy already teetering on the brink of ruin. Covid-19 These People Aren’t Freedom Fighters—They’re Virus-Spreading Sociopaths Elie Mystal Argentina Is Showing the World What a Humane Covid-19 Response Looks Like Jacob Sugarman The Lesson of the Coronavirus? There’s No One Left to Trust. Elie Mystal
And the base will probably love it, particularly the most extreme anti-immigration elements in the Republican Party. The executive order reeks of Stephen Miller, Trump’s senior adviser for racism and evil. It’s an order targeting some forms of “chain migration,” which has become an increasingly deranged fetish of people like Miller, former Trump whisperer Steve Bannon, and the gang of alt-right nationalists and replacement theory aficionados who have determined that any immigration will lead to an America that is more brown, more diverse, and less good for white people. Fears about chain migration have little to do with the job security of the American worker, and less than nothing to do with the spread of the coronavirus. The order’s logic is designed entirely for these armchair eugenicists who view any additional brown people added to the country as a dangerous attack against white supremacy and patriarchy.
Of course, it’s also possible that this could be a trap. Trump could simply be testing the waters on banning green cards, which is generally considered sacred ground to all but the most devout opponents of immigration. Trump could determine that this ban is not generating enough of a distraction and decide to ratchet it up in order to produce the howling he so desires. The Trump administration has already used the Covid-19 crisis to further restrict immigration: US embassies around the world have suspended the normal processing of tourist visas; Customs and Border Protection is turning away ever more unauthorized migrants and refugees at the border. This executive order isn’t the first attempt to use the virus to close down immigration, and it likely won’t be the last.
This time though, his whack at the immigrant piñata feels more desperate than menacing. One gets the feeling this clown is running out of tricks. Covid-19 did not need a visa to come here, and it does not need a green card to stay here. All the immigrant bashing in the world won’t make it go away.


thenation--2020-04-23--The Challenge of Treating 2 Epidemics at Once

In mid-March , as the Covid-19 pandemic was accelerating , Shantae Owens found a man unconscious in a public bathroom in Tompkins Square Park , in New York ’ s East Village .
Owens wasn ’ t surprised at his discovery .
He was on street outreach distributing naloxone , which helps reverse opioid overdoses , as well as syringes , condoms , and other health supplies .
He administered naloxone and called 911 .
The ambulance took longer to arrive than usual .
Owens is an outreach worker with the Lower East Side Harm Reduction Center , which has @ @ @ @ @ @ @ safety concerns .
But he still covers the parks , public restrooms , and drug houses of the South Bronx , Washington Heights , and Lower Manhattan as a volunteer with VOCAL-NY , a grassroots organization that grew out of the AIDS epidemic and is staying open during the lockdown .
Many harm reduction programs are still running as essential services , though others , such as those that operate out of county health departments , like Michigan ’ s , are now largely closed because of Covid-19 .
Owens is concerned about @ @ @ @ @ @ @ users—in particular , for people who use opioids and are at high risk of fatal overdose .
“ We fear that overdose is going to rise , ” Owens told me , “ because there ’ s not enough services .
We ’ ve already lost so many people to the overdose crisis.
” Around the country , organizations that work to reduce drug-related harms such as overdose , HIV , and hepatitis C are now facing yet another devastating virus .
And for active drug users , people in drug treatment , @ @ @ @ @ @ @ closures and physical distancing mandates are causing a cascade of economic and practical difficulties that compound health dangers .
“ I worry for my community , ” said Kelly Culbert , who works at NYHRE , an East Harlem harm reduction center that has closed temporarily .
“ They ’ re scared .
They have very little access to equipment [ for safer drug use ] .
And everything has become more problematic—from the ways people were making their money to locating a dealer and that person having an adequate supply .
It @ @ @ @ @ @ @ available.
” Among the harms that advocates like Culbert fear most are a spike in overdoses , increased syringe sharing , and a choice between self-isolation and excruciating drug withdrawal .
There are already reports from across the country of increased overdose rates .
Project SAFE works with women and queer people who use drugs in Philadelphia ’ s Kensington neighborhood , delivering harm reduction supplies and offering a place to take a shower or a nap .
Many program participants are precariously housed and stay up all night to avoid being assaulted @ @ @ @ @ @ @ them escape the cycle of exhaustion .
Board member Jeanette Bowles worries that overdose rates will rise because of fluctuations in the drug market , economic contraction , and self-isolation .
“ Your ability to maintain economic stability affects overdose risk , ” she said .
“ And we ’ ve been telling people for years that they should never use alone—that ’ s one of the biggest risk factors for overdose—but now we ’ re telling them to stay home.
” The national “ Never Use Alone ” hotline offers an operator @ @ @ @ @ @ @ you use , calling 911 if you become unresponsive .
But people are wary about disclosing their drug use and address to a stranger , and many of Project SAFE ’ s participants don ’ t have stable access to a phone .
It ’ s hard to hang onto one when you ’ re homeless .
What ’ s more , many of Project SAFE ’ s participants are sex workers—and sex work is another economic area affected by the recent contraction .
“ Business is really slow , ” said Lulu @ @ @ @ @ @ @ SAFE .
“ People are hustling even harder , but not making enough money for drugs .
We ’ ve gotten more requests for pepper spray , and we ’ ve been preparing for people who are having to work in situations they normally wouldn ’ t , because of scarcity.
” Meanwhile , local harm reduction sites may be the only places left where homeless people can take recommended measures for protecting themselves against Covid-19 .
“ Hearing all the messages of ‘ stay at home , wash your hands ’ —for @ @ @ @ @ @ @ to stay in , that hurts , ” said Alice Bell , the overdose prevention project coordinator at Prevention Point Pittsburgh .
“ What are they supposed to do with that information ?
But they ’ re very relieved to know that Prevention Point is still open.
” Even with drop-in centers closed , harm reduction programs are still letting people in to use the restroom , one by one .
The restrooms of some harm reduction centers also serve as de facto safe injection sites , with staff knocking regularly to check @ @ @ @ @ @ @ And for people who use cocaine , methamphetamine , and other non-opioid drugs , organizations provide clean smoking equipment , to reduce sharing—especially important during a pandemic of respiratory illness .
Staff at these facilities are accustomed to chaos and uncertainty , but they aren ’ t used to feeling that their own lives are at risk , and that they don ’ t have the means to keep themselves safe .
“ It ’ s very easy to forget that we ’ re front-liners , ” said Jose Benetiz , executive director @ @ @ @ @ @ @ services we ’ re providing are essential services to keep people safe .
We ’ d love to have enough protective equipment not just for staff , but to be able to give gloves and masks to people on the street so they can protect themselves.
” How Trump ’ s Foreign Policy Puts Troops at Risk of Covid-19 More in this series When I spoke to Arash Diba , VOCAL-NY ’ s head of harm reduction , his voice was sharp with anxiety .
“ We are literally wearing our last masks @ @ @ @ @ @ @ VOCAL-NY , Prevention Point , and other harm reduction programs , essential staff members have been divided into “ pods ” so that the organizations won ’ t have to shut down entirely if there ’ s a Covid-19 infection or exposure .
People on medication-assisted treatment , or MAT , face a special set of difficulties .
Because of concerns about abuse or diversion of medication , methadone patients are generally required to appear in person at a clinic for their daily , supervised doses .
This makes physical distancing and self-isolation @ @ @ @ @ @ @ staff .
New regulations issued in response to Covid-19 allow for patients to receive two to four weeks ’ worth of methadone at a time .
But clinics have been left to sort out the details themselves , and to make their own decisions about who can have take-home doses .
Some of New York City ’ s 30,000 methadone patients have received two weeks ’ worth of medication , but many others have simply been put on a staggered schedule , still coming in three times a week .
As a result @ @ @ @ @ @ @ to wait in line outside , often for long periods , regardless of the weather .
Many travel to the clinic by bus or by train , potentially exposing them to the novel coronavirus .
If they have to self-isolate or self-quarantine , they ’ ll face the prospect of agonizing drug withdrawal , whose symptoms can resemble those of Covid-19—from headaches and body aches to runny nose and fever .
Jasmine Budnella , VOCAL-NY ’ s drug policy coordinator , told me a dramatic story illustrating the dangerous collision of MAT restrictions @ @ @ @ @ @ @ , a homeless man tested positive for Covid-19 and was assigned a room in a designated Brooklyn isolation shelter .
When he entered , he had enough methadone with him to last five days .
Budnella and others struggled to find a way for him to have his next doses delivered in time , but couldn ’ t manage it .
As a result , he broke quarantine to take the subway to his clinic in Manhattan .
This public health failure prompted the city to develop a system to deliver methadone to @ @ @ @ @ @ @ this week , after several delays .
Meanwhile , there ’ s an urgent need to help people start MAT while physically distancing .
With their usual sources of income drying up , many active users can no longer get the drugs they need to keep them from going into withdrawal , which is in turn leading to increased demand for entry into MAT programs .
Regulations have been loosened to allow for the prescription of buprenorphine ( a less strictly controlled form of MAT ) by telephone ; activists are calling for @ @ @ @ @ @ @ A Tale of Two Cities in the Grips of the Opioid Crisis Like the loosening of restrictions on naloxone access in response to the overdose epidemic , these sudden changes are a tantalizing reminder that rules are more flexible than they may appear .
“ Things that seemed like insurmountable obstacles a few weeks ago suddenly don ’ t seem so hard to do , like hand-washing stations in the homeless encampment , or finding places for people to live , ” Bell told me .
Certain categories of prisoners are being released @ @ @ @ @ @ @ Orleans , Los Angeles , San Francisco , and Philadelphia , have begun renting hotel rooms for homeless people .
VOCAL-NY and other advocacy groups have been pushing hard for New York to follow suit and secure 30,000 hotel rooms for the city ’ s homeless .
On April 11 , Mayor Bill de Blasio announced that the city would relocate 6,000 homeless New Yorkers to hotels .
It will be important that these sites provide for MAT and overdose prevention ; in New York City , overdose is the leading cause of @ @ @ @ @ @ @ temporary improvements made in response to an emergency .
Harm reduction advocates plan to fight to make many of them permanent .
But for Budnella , such small steps forward are not enough to address the “ wave of death ” caused by failed drug policies .
“ We need to decriminalize drugs , ” she said , “ and bring people to the center of this work .
”

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In mid-March, as the Covid-19 pandemic was accelerating, Shantae Owens found a man unconscious in a public bathroom in Tompkins Square Park, in New York’s East Village. Owens wasn’t surprised at his discovery. He was on street outreach distributing naloxone, which helps reverse opioid overdoses, as well as syringes, condoms, and other health supplies. He administered naloxone and called 911. The ambulance took longer to arrive than usual.
Owens is an outreach worker with the Lower East Side Harm Reduction Center, which has temporarily stopped doing outreach due to Covid-19-related safety concerns. But he still covers the parks, public restrooms, and drug houses of the South Bronx, Washington Heights, and Lower Manhattan as a volunteer with VOCAL-NY, a grassroots organization that grew out of the AIDS epidemic and is staying open during the lockdown. Many harm reduction programs are still running as essential services, though others, such as those that operate out of county health departments, like Michigan’s, are now largely closed because of Covid-19. Owens is concerned about what the lockdown will mean for drug users—in particular, for people who use opioids and are at high risk of fatal overdose. “We fear that overdose is going to rise,” Owens told me, “because there’s not enough services. We’ve already lost so many people to the overdose crisis.”
Around the country, organizations that work to reduce drug-related harms such as overdose, HIV, and hepatitis C are now facing yet another devastating virus. And for active drug users, people in drug treatment, and people without stable housing, business closures and physical distancing mandates are causing a cascade of economic and practical difficulties that compound health dangers. “I worry for my community,” said Kelly Culbert, who works at NYHRE, an East Harlem harm reduction center that has closed temporarily. “They’re scared. They have very little access to equipment [for safer drug use]. And everything has become more problematic—from the ways people were making their money to locating a dealer and that person having an adequate supply. It’s all become riskier, less available.”
Among the harms that advocates like Culbert fear most are a spike in overdoses, increased syringe sharing, and a choice between self-isolation and excruciating drug withdrawal. There are already reports from across the country of increased overdose rates.
Project SAFE works with women and queer people who use drugs in Philadelphia’s Kensington neighborhood, delivering harm reduction supplies and offering a place to take a shower or a nap. Many program participants are precariously housed and stay up all night to avoid being assaulted; they need a place to help them escape the cycle of exhaustion. Current Issue View our current issue
Board member Jeanette Bowles worries that overdose rates will rise because of fluctuations in the drug market, economic contraction, and self-isolation. “Your ability to maintain economic stability affects overdose risk,” she said. “And we’ve been telling people for years that they should never use alone—that’s one of the biggest risk factors for overdose—but now we’re telling them to stay home.” Popular "swipe left below to view more authors"Swipe → The Evisceration of a Public University The Evisceration of a Public University Lisa M. Corrigan The Patronizing Moralism of David Brooks The Patronizing Moralism of David Brooks Chris Lehmann “The Blind Side” Was Always Trash “The Blind Side” Was Always Trash Dave Zirin How the “Brooks Brothers Riot” Set the Stage for Insurrection How the “Brooks Brothers Riot” Set the Stage for Insurrection Chris Lehmann Popular "swipe left below to view more authors"Swipe → The Evisceration of a Public University The Evisceration of a Public University Lisa M. Corrigan The Patronizing Moralism of David Brooks The Patronizing Moralism of David Brooks Chris Lehmann “The Blind Side” Was Always Trash “The Blind Side” Was Always Trash Dave Zirin How the “Brooks Brothers Riot” Set the Stage for Insurrection How the “Brooks Brothers Riot” Set the Stage for Insurrection Chris Lehmann
The national “Never Use Alone” hotline offers an operator who will stay on the line while you use, calling 911 if you become unresponsive. But people are wary about disclosing their drug use and address to a stranger, and many of Project SAFE’s participants don’t have stable access to a phone. It’s hard to hang onto one when you’re homeless.
What’s more, many of Project SAFE’s participants are sex workers—and sex work is another economic area affected by the recent contraction. “Business is really slow,” said Lulu Duffy-Tumasz, delivery services coordinator for Project SAFE. “People are hustling even harder, but not making enough money for drugs. We’ve gotten more requests for pepper spray, and we’ve been preparing for people who are having to work in situations they normally wouldn’t, because of scarcity.”
Meanwhile, local harm reduction sites may be the only places left where homeless people can take recommended measures for protecting themselves against Covid-19. “Hearing all the messages of ‘stay at home, wash your hands’—for people who don’t have homes to stay in, that hurts,” said Alice Bell, the overdose prevention project coordinator at Prevention Point Pittsburgh. “What are they supposed to do with that information? But they’re very relieved to know that Prevention Point is still open.”
Even with drop-in centers closed, harm reduction programs are still letting people in to use the restroom, one by one. The restrooms of some harm reduction centers also serve as de facto safe injection sites, with staff knocking regularly to check on users, naloxone on hand. And for people who use cocaine, methamphetamine, and other non-opioid drugs, organizations provide clean smoking equipment, to reduce sharing—especially important during a pandemic of respiratory illness.
Staff at these facilities are accustomed to chaos and uncertainty, but they aren’t used to feeling that their own lives are at risk, and that they don’t have the means to keep themselves safe. “It’s very easy to forget that we’re front-liners,” said Jose Benetiz, executive director of Prevention Point Philadelphia. “The services we’re providing are essential services to keep people safe. We’d love to have enough protective equipment not just for staff, but to be able to give gloves and masks to people on the street so they can protect themselves.” Covid-19 These People Aren’t Freedom Fighters—They’re Virus-Spreading Sociopaths Elie Mystal How Trump’s Foreign Policy Puts Troops at Risk of Covid-19 Ken Klippenstein
When I spoke to Arash Diba, VOCAL-NY’s head of harm reduction, his voice was sharp with anxiety. “We are literally wearing our last masks now,” he said. At VOCAL-NY, Prevention Point, and other harm reduction programs, essential staff members have been divided into “pods” so that the organizations won’t have to shut down entirely if there’s a Covid-19 infection or exposure.
People on medication-assisted treatment, or MAT, face a special set of difficulties. Because of concerns about abuse or diversion of medication, methadone patients are generally required to appear in person at a clinic for their daily, supervised doses. This makes physical distancing and self-isolation almost impossible for methadone patients and clinic staff. New regulations issued in response to Covid-19 allow for patients to receive two to four weeks’ worth of methadone at a time. But clinics have been left to sort out the details themselves, and to make their own decisions about who can have take-home doses.
Some of New York City’s 30,000 methadone patients have received two weeks’ worth of medication, but many others have simply been put on a staggered schedule, still coming in three times a week. As a result of physical distancing guidelines, patients have to wait in line outside, often for long periods, regardless of the weather. Many travel to the clinic by bus or by train, potentially exposing them to the novel coronavirus. If they have to self-isolate or self-quarantine, they’ll face the prospect of agonizing drug withdrawal, whose symptoms can resemble those of Covid-19—from headaches and body aches to runny nose and fever.
Jasmine Budnella, VOCAL-NY’s drug policy coordinator, told me a dramatic story illustrating the dangerous collision of MAT restrictions and public health imperatives. In March, a homeless man tested positive for Covid-19 and was assigned a room in a designated Brooklyn isolation shelter. When he entered, he had enough methadone with him to last five days. Budnella and others struggled to find a way for him to have his next doses delivered in time, but couldn’t manage it. As a result, he broke quarantine to take the subway to his clinic in Manhattan. This public health failure prompted the city to develop a system to deliver methadone to patients in isolation shelters. It launched this week, after several delays.
Meanwhile, there’s an urgent need to help people start MAT while physically distancing. With their usual sources of income drying up, many active users can no longer get the drugs they need to keep them from going into withdrawal, which is in turn leading to increased demand for entry into MAT programs. Regulations have been loosened to allow for the prescription of buprenorphine (a less strictly controlled form of MAT) by telephone; activists are calling for the same changes for methadone programs. The Opioid Epidemic Capitalism Is Killing Us Zachary Siegel A Tale of Two Cities in the Grips of the Opioid Crisis Maia Szalavitz
Like the loosening of restrictions on naloxone access in response to the overdose epidemic, these sudden changes are a tantalizing reminder that rules are more flexible than they may appear. “Things that seemed like insurmountable obstacles a few weeks ago suddenly don’t seem so hard to do, like hand-washing stations in the homeless encampment, or finding places for people to live,” Bell told me. Certain categories of prisoners are being released early. Many cities, including New Orleans, Los Angeles, San Francisco, and Philadelphia, have begun renting hotel rooms for homeless people.
VOCAL-NY and other advocacy groups have been pushing hard for New York to follow suit and secure 30,000 hotel rooms for the city’s homeless. On April 11, Mayor Bill de Blasio announced that the city would relocate 6,000 homeless New Yorkers to hotels. It will be important that these sites provide for MAT and overdose prevention; in New York City, overdose is the leading cause of death among the homeless.
These are temporary improvements made in response to an emergency. Harm reduction advocates plan to fight to make many of them permanent. But for Budnella, such small steps forward are not enough to address the “wave of death” caused by failed drug policies. “We need to decriminalize drugs,” she said, “and bring people to the center of this work.”