vox--2020-05-11--4 aftershocks of the coronavirus pandemic that will be felt for years

The US health system is enduring a shock during the coronavirus pandemic — and the aftershocks will continue to be felt long after the virus itself has been contained .
Hospitals nationwide have canceled elective surgeries en masse .
Visits to primary care doctors and specialists have dropped off precipitously .
Now the US economy is experiencing levels of unemployment not seen since the Great Depression and millions of people have lost their employer-sponsored health insurance .
I posed a simple question to a few different experts who study population health : Have we ever seen disruption to medical care @ @ @ @ @ @ @ ’ t recall there ever being a disruption to the health system like we ’ re seeing , ” Cheryl Damberg , the director of the RAND Center of Excellence on Health System Performance , told me .
“ We ’ ve had recessions where people have lost insurance and there is more uncompensated care , but nothing like canceling surgeries and declines in ambulatory visits.
” Others concurred .
“ I do not believe there has ever been a similar hiatus , ” Mark Cullen , director of Stanford University ’ s @ @ @ @ @ @ @ me , “ and the short answer is that yes , it will take some time before we will know the total health impact , or even to effectively estimate some ” It is , unfortunately , an unplanned natural experiment .
Rifat Atun , a professor studying global health systems at Harvard University , gave me a useful way of understanding the sprawling effects that a major trauma like the coronavirus pandemic will likely have on Americans ’ health .
You can put them , for starters , into four broad categories @ @ @ @ @ @ @ people dead ( at a minimum ) .
Tens of thousands of people hospitalized — we aren ’ t even sure how many .
At least 86,000 , according to a tracking project at the University of Minnesota .
It may be easy to become numb to them , but those numbers we have been tracking for weeks are the first and most direct impact of the coronavirus .
We should also be bracing ourselves for second , third , fourth waves of the outbreak .
The virus itself won ’ t be @ @ @ @ @ @ @ or treatment .
And those acute effects could , somewhat paradoxically , linger with us for a long time .
Just because people have recovered from Covid-19 doesn ’ t mean their health has gone back to normal .
As Lois Parshley wrote for Vox recently , the long-term health consequences of this disease are just starting to come into focus : Parshley ticks through some of the potential long-term complications : lung scarring , strokes , embolisms , blood clotting , heart damage , mental health , and more .
The point @ @ @ @ @ @ @ this disease and the damage it did to their body for years — and so will our health system .
All those canceled surgeries , delayed doctor appointments , and the rest will also have a lasting effect on people ’ s health .
“ One of the key concerns that practitioners in particular are having is related to the backlog that is piling up , ” Ellen Nolte , professor of health services and systems research at the London School of Hygiene and Tropical Medicine , told me , “ and the @ @ @ @ @ @ @ long-term outcomes , in particular for people with chronic conditions.
” As I reported recently , visits to primary care doctors and other outpatient specialists have fallen off steeply during the Covid-19 pandemic .
Here it is , in one chart : Ateev Mehrotra , a professor at Harvard Medical School who led the study above , told me “ our real concern is those patients who might have deferred a visit and they ’ re going to have a flare-up of their chronic illness.
” In the worst-case scenario , a patient @ @ @ @ @ @ @ able to have a routine check-up .
Dania Palanker , an assistant research professor for the Center on Health Insurance Reforms at Georgetown ’ s Health Policy Institute , said she worries about people recently diagnosed with diabetes or heart disease who won ’ t be able to get that critical first appointment with a new doctor .
“ You can ’ t delay those appointments for a few months.
” And if people do delay care — whether because their surgery was canceled , their doctor ’ s office was closed , @ @ @ @ @ @ @ skip treatment to avoid potential exposure to Covid-19 — their health outcomes are probably going to be worse .
There is also a risk that the decline we ’ ve seen in medical utilization will lead rural hospitals to close or primary care practices to consolidate , which in turn restricts access and drives up costs .
That is another factor that could lead to less timely medical care for Americans in the future , which would in turn lead to more adverse health outcomes .
And there is one other obvious thing @ @ @ @ @ @ @ : a loss of income and/or health insurance .
More staggering numbers : 33 million people have filed for unemployment benefits since the pandemic took hold and the unemployment rate is nearly 15 percent .
Experts project that as many as 7 million people will be left uninsured as a result of the economic crisis precipitated by Covid-19 .
Economic downturns can have countervailing effects on people ’ s health .
We know that losses in income and health insurance can have a negative impact .
Atun has actually studied this question himself @ @ @ @ @ @ @ He and a team of researchers found that in the 2008-2010 recession , there were an estimated 260,000 excess cancer-related deaths in that time , including 40,000 from treatable cancers , in OECD countries .
Those consequences were felt most in countries without universal health coverage — of which , of course , the United States is one .
And now millions of Americans have lost the health insurance they did have .
On the other hand , there is some research suggesting that overall mortality actually falls during economic downturns .
But @ @ @ @ @ @ @ , for people who actually experience joblessness or other financial trouble , there still appears to be higher rates of acute heart problems and overall mortality , according to a 2011 summary of the available research .
Excess mortality is a complicated soup of many different variables , some of which hurt health and some of which may help it ( if , for example , people smoke less and exercise more during a recession ) .
This is one of the reasons why it will take us so long to understand the @ @ @ @ @ @ @ I think the negative effects far outweigh what these positive effects might be , ” Atun told me .
If there is one place where the research on economic turbulence and health outcomes converges , it ’ s that behavioral and psychological well-being is harmed during an economic crisis .
This is perhaps the most speculative category , so I will keep it short .
But Atun pointed out that the various social distancing measures we ’ ve taken to clamp down on Covid-19 will have an effect on our collective mental health @ @ @ @ @ @ @ the simple , painful reality of 100,000 or more people dying of the virus in just a few short months .
There is a medical toll to all that mental pain , though it will again take a long time to reveal itself .
And that is the point .
It will take years for the full impact of the coronavirus to be understood .
“ The effects will be longer-lasting than the immediate figures that we see , ” Atun said .
Or as Cullen put it : “ Bottom line is @ @ @ @ @ @ @ out.
” This story appears in VoxCare , a newsletter from Vox on the latest twists and turns in America ’ s health care debate .
Sign up to get VoxCare in your inbox along with more health care stats and news .
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Join our Facebook community for conversation and updates .

The US health system is enduring a shock during the coronavirus pandemic — and the aftershocks will continue to be felt long after the virus itself has been contained.
Hospitals nationwide have canceled elective surgeries en masse. Visits to primary care doctors and specialists have dropped off precipitously. Now the US economy is experiencing levels of unemployment not seen since the Great Depression and millions of people have lost their employer-sponsored health insurance.
I posed a simple question to a few different experts who study population health: Have we ever seen disruption to medical care like this before?
“I don’t recall there ever being a disruption to the health system like we’re seeing,” Cheryl Damberg, the director of the RAND Center of Excellence on Health System Performance, told me. “We’ve had recessions where people have lost insurance and there is more uncompensated care, but nothing like canceling surgeries and declines in ambulatory visits.”
Others concurred. “I do not believe there has ever been a similar hiatus,” Mark Cullen, director of Stanford University’s Center for Population Health Science, told me, “and the short answer is that yes, it will take some time before we will know the total health impact, or even to effectively estimate some”
It is, unfortunately, an unplanned natural experiment. Rifat Atun, a professor studying global health systems at Harvard University, gave me a useful way of understanding the sprawling effects that a major trauma like the coronavirus pandemic will likely have on Americans’ health. You can put them, for starters, into four broad categories.
1) The direct health effects of Covid-19
1.3 million cases. Nearly 80,000 people dead (at a minimum). Tens of thousands of people hospitalized — we aren’t even sure how many. At least 86,000, according to a tracking project at the University of Minnesota.
It may be easy to become numb to them, but those numbers we have been tracking for weeks are the first and most direct impact of the coronavirus. We should also be bracing ourselves for second, third, fourth waves of the outbreak. The virus itself won’t be fully neutralized until there is a vaccine or treatment.
And those acute effects could, somewhat paradoxically, linger with us for a long time. Just because people have recovered from Covid-19 doesn’t mean their health has gone back to normal.
As Lois Parshley wrote for Vox recently, the long-term health consequences of this disease are just starting to come into focus:
Because Covid-19 is a new disease, there are no studies about its long-term trajectory for those with more severe symptoms; even the earliest patients to recover in China were only infected a few months ago. But doctors say the novel coronavirus can attach to human cells in many parts of the body and penetrate many major organs, including the heart, kidneys, brain, and even blood vessels. “The difficulty is sorting out long-term consequences,” says Joseph Brennan, a cardiologist at the Yale School of Medicine. While some patients may fully recover, he and other experts worry others will suffer long-term damage, including lung scarring, heart damage, and neurological and mental health effects.
Parshley ticks through some of the potential long-term complications: lung scarring, strokes, embolisms, blood clotting, heart damage, mental health, and more. The point is, people will be living with this disease and the damage it did to their body for years — and so will our health system.
2) The indirect health effects of Covid-19
All those canceled surgeries, delayed doctor appointments, and the rest will also have a lasting effect on people’s health.
“One of the key concerns that practitioners in particular are having is related to the backlog that is piling up,” Ellen Nolte, professor of health services and systems research at the London School of Hygiene and Tropical Medicine, told me, “and the impacts this will have on medium- and long-term outcomes, in particular for people with chronic conditions.”
As I reported recently, visits to primary care doctors and other outpatient specialists have fallen off steeply during the Covid-19 pandemic. Here it is, in one chart:
Ateev Mehrotra, a professor at Harvard Medical School who led the study above, told me “our real concern is those patients who might have deferred a visit and they’re going to have a flare-up of their chronic illness.” In the worst-case scenario, a patient could die because they weren’t able to have a routine check-up.
Dania Palanker, an assistant research professor for the Center on Health Insurance Reforms at Georgetown’s Health Policy Institute, said she worries about people recently diagnosed with diabetes or heart disease who won’t be able to get that critical first appointment with a new doctor. “You can’t delay those appointments for a few months.”
And if people do delay care — whether because their surgery was canceled, their doctor’s office was closed, or they chose on their own to skip treatment to avoid potential exposure to Covid-19 — their health outcomes are probably going to be worse.
There is also a risk that the decline we’ve seen in medical utilization will lead rural hospitals to close or primary care practices to consolidate, which in turn restricts access and drives up costs. That is another factor that could lead to less timely medical care for Americans in the future, which would in turn lead to more adverse health outcomes.
And there is one other obvious thing could lead to people postponing medical care: a loss of income and/or health insurance.
3) The economic effects of Covid-19
More staggering numbers: 33 million people have filed for unemployment benefits since the pandemic took hold and the unemployment rate is nearly 15 percent. Experts project that as many as 7 million people will be left uninsured as a result of the economic crisis precipitated by Covid-19.
Economic downturns can have countervailing effects on people’s health. We know that losses in income and health insurance can have a negative impact. Atun has actually studied this question himself, looking specifically at cancer-related mortality. He and a team of researchers found that in the 2008-2010 recession, there were an estimated 260,000 excess cancer-related deaths in that time, including 40,000 from treatable cancers, in OECD countries.
Those consequences were felt most in countries without universal health coverage — of which, of course, the United States is one. And now millions of Americans have lost the health insurance they did have.
On the other hand, there is some research suggesting that overall mortality actually falls during economic downturns. But the reasons are not well understood and, for people who actually experience joblessness or other financial trouble, there still appears to be higher rates of acute heart problems and overall mortality, according to a 2011 summary of the available research.
Excess mortality is a complicated soup of many different variables, some of which hurt health and some of which may help it (if, for example, people smoke less and exercise more during a recession). This is one of the reasons why it will take us so long to understand the full impact of Covid-19.
“But I think the negative effects far outweigh what these positive effects might be,” Atun told me.
If there is one place where the research on economic turbulence and health outcomes converges, it’s that behavioral and psychological well-being is harmed during an economic crisis.
4) The social effects of Covid-19
This is perhaps the most speculative category, so I will keep it short. But Atun pointed out that the various social distancing measures we’ve taken to clamp down on Covid-19 will have an effect on our collective mental health, as will the economic crisis and the simple, painful reality of 100,000 or more people dying of the virus in just a few short months. There is a medical toll to all that mental pain, though it will again take a long time to reveal itself.
And that is the point. It will take years for the full impact of the coronavirus to be understood.
“The effects will be longer-lasting than the immediate figures that we see,” Atun said. Or as Cullen put it: “Bottom line is this will be a beast to sort out.”
This story appears in VoxCare, a newsletter from Vox on the latest twists and turns in America’s health care debate. Sign up to get VoxCare in your inbox along with more health care stats and news.
vox-mark Sign up for the newsletter VoxCare Dylan Scott guides you through the fallout of the Covid-19 pandemic and the health care policies that matter most. Thanks for signing up! Check your inbox for a welcome email. Email (required) Oops. Something went wrong. Please enter a valid email and try again. By submitting your email, you agree to our Terms and Privacy Notice . You can opt out at any time. This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. For more newsletters, check out our newsletters page Subscribe
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vox--2020-05-11--Covid-19 could reverse decades of global progress

The world ’ s attention has been focused on the coronavirus pandemic for the past couple of months , and rightly so .
The global death toll has hit 285,000 , the economy is in shambles , and our day-to-day lives are completely transformed .
It ’ s obviously a huge deal .
But as we all focus on that , what other problems are being neglected and growing worse ?
What sort of collateral damage is the world incurring ?
The secondary impacts of Covid-19 — including a possible “ hunger pandemic ” and “ poverty tsunami ” — @ @ @ @ @ @ @ of deaths they cause , experts caution , could easily outstrip the number of deaths from Covid-19 itself .
That ’ s not an argument for taking Covid-19 less seriously , relaxing social distancing , or reopening the economy ; in the US , epidemiologists emphasize that we are absolutely not ready to do that safely .
Instead , the point is that we ’ d do well to adopt a wider-angle view on human suffering .
When we think about this pandemic , it ’ s not just the direct effects we @ @ @ @ @ @ @ the secondary effects .
In other words , while the coronavirus is a serious problem we need to pay attention to , these other issues are also serious problems that are neglected and that urgently require our attention .
Below are eight examples that are worth highlighting , though this list is by no means exhaustive .
1 ) Routine vaccinations are falling by the wayside People are putting off getting vaccinations for themselves and their children because they ’ re afraid to be exposed to Covid-19 .
In many cases , even @ @ @ @ @ @ @ hospitals and clinics are asking them to stay home .
“ National immunization programs in more than two dozen countries have been suspended , which could also leave more than 100 million children vulnerable , ” the New York Times reported .
If kids don ’ t get their shots , that puts them at risk of preventable life-threatening illnesses like measles , polio , and diphtheria .
Experts predict that we ’ re going to see these illnesses pop up more in coming years because immunization rates are falling during the pandemic @ @ @ @ @ @ @ Organization warns that coronavirus-related disruption to anti-malaria programs in sub-Saharan Africa could cause deaths from malaria there to double this year .
2 ) People are avoiding going to the doctor , even for heart attacks and strokes US doctors are alarmed to see a precipitous drop in the number of patients presenting with symptoms of heart attack and stroke .
“ Where are all of our patients ?
There ’ s nothing we ’ ve done overnight that has cured heart disease , ” Martha Gulati , chief of cardiology at the @ @ @ @ @ @ @ .
“ My worry is some of these people are dying at home because they ’ re too scared to go to the hospital.
” For people experiencing heart attack or stroke symptoms , it ’ s crucial to seek treatment immediately .
The earlier a patient is treated , the better chance there is of mitigating damage to the heart and brain and reducing the risk of paralysis .
Experts are also concerned that we ’ re going to see surging rates of sexually transmitted infection ( STI ) and that the @ @ @ @ @ @ @ hit because people are not going in for testing .
“ We are seeing a complete disruption to STD prevention here in the United States , ” David Harvey , executive director of the National Coalition of STD Directors , told The Hill .
“ We expect to experience even higher STD rates as a result.
” 3 ) “ Elective ” procedures — including cancer surgeries and organ transplants — are being postponed When you think of elective procedures , you probably think of nose jobs or hip replacements — things that @ @ @ @ @ @ @ s life in danger .
But as ProPublica explained , the category extends far beyond that : “ Elective surgery is , by definition , any surgery that is scheduled .
That means cancer surgery , organ transplants , and other lifesaving procedures , all of which are now put on hold.
” That ’ s in part because many hospitals have a shortage of personal protective equipment , and they ’ re trying to preserve it all for doctors and nurses treating Covid-19 .
They ’ re also trying to keep ventilators @ @ @ @ @ @ @ , particularly in areas that have been hit hard by the virus .
The American College of Surgeons has found itself in the position of having to recommend that removal of cancerous colon polyps be delayed for three months and breast cancer surgery be postponed if hormone therapy can help in the meantime .
Many heartbreaking stories have emerged as a result .
To pick just one : Zach Branson is a 33-year-old in Colorado who was born with a rare disease and therefore needed a new liver .
After a long wait @ @ @ @ @ @ @ d get a transplant on March 25 .
But then the coronavirus came along , and the surgery was canceled .
His doctor told him he might only have 30 to 45 days left to live .
And yet the hospital considered the surgery that would get him his liver from his willing donor to be “ elective.
” His family called this “ a death sentence.
” Branson ultimately did receive a new liver in April , after the hospital reversed course .
But many others who need transplants or surgeries haven @ @ @ @ @ @ @ ) A “ hunger pandemic ” and “ poverty tsunami ” may be coming The Covid-19 pandemic may be dragging another disaster behind it — what David Beasley , the executive director of the UN World Food Program , calls “ the looming hunger pandemic.
” He warns that “ we could be looking at famine in about three dozen countries ” and that “ WFP ’ s analysis shows that 300,000 could starve to death every single day for the next three months ” if we don ’ t keep humanitarian aid @ @ @ @ @ @ @ .
What ’ s more , the coronavirus economic crisis will exacerbate global poverty .
According to a new analysis out of King ’ s College London and Australian National University , it could push an additional 8 percent of our planet ’ s population into poverty — some 500 million people .
That would effectively wipe out three decades of economic development .
“ We were surprised at the sheer scale of the potential poverty tsunami that could follow Covid-19 in developing countries , ” said one of the authors .
5 @ @ @ @ @ @ @ is growing Covid-19 may fuel yet another disaster : a potential bacterial pandemic , spurred on by a worsening of the antibiotic resistance crisis .
“ Even though Covid-19 is a viral illness not affected by antibiotics , ” Wired reports , “ early data from hospitals shows that very high proportions of patients — more than 90 percent in some cohorts — are being treated with those drugs to cure or protect against secondary infections during respiratory illnesses or hospitalization.
” In addition , many people are taking antibiotics on their own @ @ @ @ @ @ @ the coronavirus .
This overuse could worsen antibiotic resistance , which is when bacteria evolve and adapt so that our antibiotics can no longer kill them .
It ’ s already a huge crisis : One person in the US dies every 15 minutes because of an infection that antibiotics can no longer treat effectively .
Globally , this accounts for about 700,000 deaths per year .
If we ’ re not careful now , that number will mount .
6 ) The coronavirus crisis is taking a very unfortunate toll on research @ @ @ @ @ @ @ for pretty much everything other than Covid-19 .
To patients who are desperate for new treatments for stubborn or rare illnesses , it ’ s devastating and potentially life-threatening to have this research put on hold .
At the same time , keeping immunocompromised patients enrolled in clinical trials right now could also be life-threatening because it would put them at increased risk of exposure to Covid-19 .
It ’ s not easy to know how to strike the right balance .
Meanwhile , a lot of research is being put on hold @ @ @ @ @ @ @ reason : Women seem to be submitting fewer academic papers during the pandemic than before it because they ’ re saddled with the lion ’ s share of child care duties now that schools and day cares are closed .
Even as the number of submissions from women is decreasing , the number of submissions from men is increasing — more than 50 percent , by some counts .
This reality threatens to derail the careers of brilliant women academics .
When they come up for tenure in a post-pandemic world , it @ @ @ @ @ @ @ will believe them when they say , “ Don ’ t punish me for not publishing as much as you expected — it ’ s just that I suddenly had three kids to take care of full-time !
” 7 ) Vulnerable populations are getting hit even harder than usual Far from being an equalizer , the Covid-19 pandemic has been exposing and amplifying preexisting disparities .
It ’ s precisely the populations that were already worse off — girls and women , LGBTQ people , people experiencing homelessness , and people of @ @ @ @ @ @ @ effects of the current crisis .
We ’ ve all been told to stay at home , but for millions of people , home is dangerous .
“ Every year , more than 10 million Americans experience domestic violence , and experts fear that the pandemic and the isolation necessary to combat it could drive those numbers even higher , ” Anna North wrote for Vox in March .
“ The National Domestic Violence Hotline is getting reports of abusers using the coronavirus as another excuse to isolate and harm family members.
” @ @ @ @ @ @ @ have jumped 30 percent during the pandemic .
Calls to hotlines have increased by 30 percent in Cyprus and 33 percent in Singapore .
And UNHCR , the United Nations ’ refugee agency , warns that refugees , internally displaced people , and stateless people are especially vulnerable to physical and sexual abuse .
Being stuck at home while economies are failing and emotions are running high is a recipe for increased intimate partner violence , the agency says .
LGBTQ people have also suffered under stay-at-home orders .
As Katelyn Burns reported @ @ @ @ @ @ @ luxury of returning to their families ’ homes when , say , their college residences are shut down .
And the trans community is having to grapple with a health care system that marginalizes them to dangerous effect .
And then there are people experiencing homelessness .
As the New York Times explained , they ’ re at higher risk of contracting and dying from Covid-19 .
They often live in cramped quarters in under-resourced shelters , and many have underlying health conditions like chronic respiratory infections .
The lack of accessible and @ @ @ @ @ @ @ lack of handwashing stations on the streets , compounds the risk for the more than half-million homeless people in the US .
This is a global problem , and it ’ s perhaps nowhere more glaring than in India .
When that country suddenly instituted the largest lockdown ever attempted on Earth , the Times reported that “ hundreds of thousands of migrant laborers have begun long journeys on foot to get home , having been rendered homeless and jobless.
” In other words , the homeless population surged precisely as having stable @ @ @ @ @ @ @ .
“ This may have been a good decision for the wealthy , ” one laborer told the Times , “ but not for those of us with no money.
” What ’ s more , there is clear evidence that people of color are bearing the brunt of this pandemic .
Covid-19 is disproportionately taking black lives .
In Louisiana , for example , black people accounted for more than 70 percent of deaths ; the state is only about 33 percent black .
To anyone who understands how systemic oppression works @ @ @ @ @ @ @ a shock .
As Fabiola Cineas wrote for Vox , “ Hundreds of years of slavery , racism , and discrimination have compounded to deliver poor health and economic outcomes for black people — heart disease , diabetes , and poverty , for starters — that are only being magnified under the unforgiving lens of the coronavirus pandemic.
” 8 ) Millions of animals are being killed Even as Americans obsess over the possibility of a meat shortage , millions of animals are being killed on farms and going completely to waste .
@ @ @ @ @ @ @ foam that suffocates them to death .
All these animals are dying for nothing ; the meat will never make it to anyone ’ s plate .
The reason for this horrific mass killing : Many farmers have nowhere to send their animals for slaughter because some major meat processing plants have been forced to close after becoming hot spots for Covid-19 transmission .
“ People might think , ‘ Well , if [ these animals ] go to the slaughterhouse , they ’ re going to die anyway .
Who cares ?
@ @ @ @ @ @ @ difference in terms of the amount they suffer at their death , ” said Leah Garcés , the president of Mercy for Animals .
“ And it ’ s also crazy wasteful — the fact that all these animals went through a factory-farmed , horrible life , only to be foamed to death and then disposed of.
” The pandemic has exposed the flaws in our factory farming system , just as it has exposed the brokenness in our systems for warehousing human beings — such as nursing homes and prisons .
Hopefully @ @ @ @ @ @ @ to change these systems , which were a crisis of their own long before Covid-19 came along .
Every day at Vox , we aim to answer your most important questions and provide you , and our audience around the world , with information that has the power to save lives .
Our mission has never been more vital than it is in this moment : to empower you through understanding .
Vox ’ s work is reaching more people than ever , but our distinctive brand of explanatory journalism takes resources — @ @ @ @ @ @ @ downturn .
Your financial contribution will not constitute a donation , but it will enable our staff to continue to offer free articles , videos , and podcasts at the quality and volume that this moment requires .
Please consider making a contribution to Vox today .

The world’s attention has been focused on the coronavirus pandemic for the past couple of months, and rightly so. The global death toll has hit 285,000, the economy is in shambles, and our day-to-day lives are completely transformed. It’s obviously a huge deal.
But as we all focus on that, what other problems are being neglected and growing worse? What sort of collateral damage is the world incurring?
The secondary impacts of Covid-19 — including a possible “hunger pandemic” and “poverty tsunami” — are worth taking seriously. The number of deaths they cause, experts caution, could easily outstrip the number of deaths from Covid-19 itself.
That’s not an argument for taking Covid-19 less seriously, relaxing social distancing, or reopening the economy; in the US, epidemiologists emphasize that we are absolutely not ready to do that safely.
Instead, the point is that we’d do well to adopt a wider-angle view on human suffering. When we think about this pandemic, it’s not just the direct effects we need to worry about, but also the secondary effects. In other words, while the coronavirus is a serious problem we need to pay attention to, these other issues are also serious problems that are neglected and that urgently require our attention.
Below are eight examples that are worth highlighting, though this list is by no means exhaustive.
1) Routine vaccinations are falling by the wayside
People are putting off getting vaccinations for themselves and their children because they’re afraid to be exposed to Covid-19. In many cases, even if people want to come in, hospitals and clinics are asking them to stay home.
“National immunization programs in more than two dozen countries have been suspended, which could also leave more than 100 million children vulnerable,” the New York Times reported.
If kids don’t get their shots, that puts them at risk of preventable life-threatening illnesses like measles, polio, and diphtheria. Experts predict that we’re going to see these illnesses pop up more in coming years because immunization rates are falling during the pandemic.
In addition, the World Health Organization warns that coronavirus-related disruption to anti-malaria programs in sub-Saharan Africa could cause deaths from malaria there to double this year.
2) People are avoiding going to the doctor, even for heart attacks and strokes
US doctors are alarmed to see a precipitous drop in the number of patients presenting with symptoms of heart attack and stroke. “Where are all of our patients? There’s nothing we’ve done overnight that has cured heart disease,” Martha Gulati, chief of cardiology at the University of Arizona, told STAT News. “My worry is some of these people are dying at home because they’re too scared to go to the hospital.”
For people experiencing heart attack or stroke symptoms, it’s crucial to seek treatment immediately. The earlier a patient is treated, the better chance there is of mitigating damage to the heart and brain and reducing the risk of paralysis.
Experts are also concerned that we’re going to see surging rates of sexually transmitted infection (STI) and that the fight against HIV will probably take a hit because people are not going in for testing. “We are seeing a complete disruption to STD prevention here in the United States,” David Harvey, executive director of the National Coalition of STD Directors, told The Hill. “We expect to experience even higher STD rates as a result.”
3) “Elective” procedures — including cancer surgeries and organ transplants — are being postponed
When you think of elective procedures, you probably think of nose jobs or hip replacements — things that can be deferred without putting anyone’s life in danger. But as ProPublica explained, the category extends far beyond that: “Elective surgery is, by definition, any surgery that is scheduled. That means cancer surgery, organ transplants, and other lifesaving procedures, all of which are now put on hold.”
That’s in part because many hospitals have a shortage of personal protective equipment, and they’re trying to preserve it all for doctors and nurses treating Covid-19. They’re also trying to keep ventilators and ICU beds free for Covid-19 patients, particularly in areas that have been hit hard by the virus.
The American College of Surgeons has found itself in the position of having to recommend that removal of cancerous colon polyps be delayed for three months and breast cancer surgery be postponed if hormone therapy can help in the meantime.
Many heartbreaking stories have emerged as a result. To pick just one: Zach Branson is a 33-year-old in Colorado who was born with a rare disease and therefore needed a new liver. After a long wait, he was finally told he’d get a transplant on March 25. But then the coronavirus came along, and the surgery was canceled. His doctor told him he might only have 30 to 45 days left to live. And yet the hospital considered the surgery that would get him his liver from his willing donor to be “elective.” His family called this “a death sentence.”
Branson ultimately did receive a new liver in April, after the hospital reversed course. But many others who need transplants or surgeries haven’t been as lucky.
4) A “hunger pandemic” and “poverty tsunami” may be coming
The Covid-19 pandemic may be dragging another disaster behind it — what David Beasley, the executive director of the UN World Food Program, calls “the looming hunger pandemic.” He warns that “we could be looking at famine in about three dozen countries” and that “WFP’s analysis shows that 300,000 could starve to death every single day for the next three months” if we don’t keep humanitarian aid flowing in the face of border closures.
What’s more, the coronavirus economic crisis will exacerbate global poverty. According to a new analysis out of King’s College London and Australian National University, it could push an additional 8 percent of our planet’s population into poverty — some 500 million people. That would effectively wipe out three decades of economic development. “We were surprised at the sheer scale of the potential poverty tsunami that could follow Covid-19 in developing countries,” said one of the authors.
5) The risk of a bacterial pandemic is growing
Covid-19 may fuel yet another disaster: a potential bacterial pandemic, spurred on by a worsening of the antibiotic resistance crisis.
“Even though Covid-19 is a viral illness not affected by antibiotics,” Wired reports, “early data from hospitals shows that very high proportions of patients — more than 90 percent in some cohorts — are being treated with those drugs to cure or protect against secondary infections during respiratory illnesses or hospitalization.” In addition, many people are taking antibiotics on their own in a misguided effort to protect against the coronavirus.
This overuse could worsen antibiotic resistance, which is when bacteria evolve and adapt so that our antibiotics can no longer kill them. It’s already a huge crisis: One person in the US dies every 15 minutes because of an infection that antibiotics can no longer treat effectively. Globally, this accounts for about 700,000 deaths per year. If we’re not careful now, that number will mount.
6) The coronavirus crisis is taking a very unfortunate toll on research
The Covid-19 pandemic has stalled clinical trials for pretty much everything other than Covid-19. To patients who are desperate for new treatments for stubborn or rare illnesses, it’s devastating and potentially life-threatening to have this research put on hold.
At the same time, keeping immunocompromised patients enrolled in clinical trials right now could also be life-threatening because it would put them at increased risk of exposure to Covid-19. It’s not easy to know how to strike the right balance.
Meanwhile, a lot of research is being put on hold for an altogether different and very annoying reason: Women seem to be submitting fewer academic papers during the pandemic than before it because they’re saddled with the lion’s share of child care duties now that schools and day cares are closed.
Even as the number of submissions from women is decreasing, the number of submissions from men is increasing — more than 50 percent, by some counts.
This reality threatens to derail the careers of brilliant women academics. When they come up for tenure in a post-pandemic world, it’s not clear whether their evaluators will believe them when they say, “Don’t punish me for not publishing as much as you expected — it’s just that I suddenly had three kids to take care of full-time!”
7) Vulnerable populations are getting hit even harder than usual
Far from being an equalizer, the Covid-19 pandemic has been exposing and amplifying preexisting disparities. It’s precisely the populations that were already worse off — girls and women, LGBTQ people, people experiencing homelessness, and people of color — that are feeling the harshest effects of the current crisis.
We’ve all been told to stay at home, but for millions of people, home is dangerous. “Every year, more than 10 million Americans experience domestic violence, and experts fear that the pandemic and the isolation necessary to combat it could drive those numbers even higher,” Anna North wrote for Vox in March. “The National Domestic Violence Hotline is getting reports of abusers using the coronavirus as another excuse to isolate and harm family members.”
In France, reports of domestic violence have jumped 30 percent during the pandemic. Calls to hotlines have increased by 30 percent in Cyprus and 33 percent in Singapore. And UNHCR, the United Nations’ refugee agency, warns that refugees, internally displaced people, and stateless people are especially vulnerable to physical and sexual abuse. Being stuck at home while economies are failing and emotions are running high is a recipe for increased intimate partner violence, the agency says.
LGBTQ people have also suffered under stay-at-home orders. As Katelyn Burns reported, some don’t have the luxury of returning to their families’ homes when, say, their college residences are shut down. And the trans community is having to grapple with a health care system that marginalizes them to dangerous effect.
And then there are people experiencing homelessness. As the New York Times explained, they’re at higher risk of contracting and dying from Covid-19. They often live in cramped quarters in under-resourced shelters, and many have underlying health conditions like chronic respiratory infections. The lack of accessible and affordable health care, coupled with a lack of handwashing stations on the streets, compounds the risk for the more than half-million homeless people in the US.
This is a global problem, and it’s perhaps nowhere more glaring than in India. When that country suddenly instituted the largest lockdown ever attempted on Earth, the Times reported that “hundreds of thousands of migrant laborers have begun long journeys on foot to get home, having been rendered homeless and jobless.” In other words, the homeless population surged precisely as having stable housing became even more crucial than usual. “This may have been a good decision for the wealthy,” one laborer told the Times, “but not for those of us with no money.”
What’s more, there is clear evidence that people of color are bearing the brunt of this pandemic. Covid-19 is disproportionately taking black lives. In Louisiana, for example, black people accounted for more than 70 percent of deaths; the state is only about 33 percent black. To anyone who understands how systemic oppression works, this won’t come as a shock.
As Fabiola Cineas wrote for Vox, “Hundreds of years of slavery, racism, and discrimination have compounded to deliver poor health and economic outcomes for black people — heart disease, diabetes, and poverty, for starters — that are only being magnified under the unforgiving lens of the coronavirus pandemic.”
8) Millions of animals are being killed
Even as Americans obsess over the possibility of a meat shortage, millions of animals are being killed on farms and going completely to waste. Their barns are being filled with a foam that suffocates them to death. All these animals are dying for nothing; the meat will never make it to anyone’s plate.
The reason for this horrific mass killing: Many farmers have nowhere to send their animals for slaughter because some major meat processing plants have been forced to close after becoming hot spots for Covid-19 transmission.
“People might think, ‘Well, if [these animals] go to the slaughterhouse, they’re going to die anyway. Who cares?’ But it’s a big difference in terms of the amount they suffer at their death,” said Leah Garcés, the president of Mercy for Animals. “And it’s also crazy wasteful — the fact that all these animals went through a factory-farmed, horrible life, only to be foamed to death and then disposed of.”
The pandemic has exposed the flaws in our factory farming system, just as it has exposed the brokenness in our systems for warehousing human beings — such as nursing homes and prisons. Hopefully, the coronavirus crisis will prompt us to change these systems, which were a crisis of their own long before Covid-19 came along.


vox--2020-05-11--A treatment for this toddler’s rare genetic condition was in sight. Then the pandemic hit.

Amber Freed ’ s singular mission is to help scientists develop a treatment for her son .
But the pandemic has put the success of that mission into question .
Freed is a mother to twins Riley and Maxwell , who just turned 3 this year .
Riley is a healthy toddler .
But Maxwell has a rare genetic disease that has led to delays in his development .
He ’ s nonverbal , and he has a movement disorder .
The condition responsible for these symptoms is called SLC6A1 , after the gene that ’ s affected , and @ @ @ @ @ @ @ the world to get this diagnosis .
if left untreated , the disease could soon cause debilitating epilepsy .
When doctors broke the news of the diagnosis to Freed , they told her there was no treatment or cure for her son , and that her family would have to prepare to live with Maxwell ’ s condition .
But Amber didn ’ t accept that .
“ Every instinct in my body said , ‘ You ’ ll have your whole lifetime to cry for yourself , ’ ” Freed said .
@ @ @ @ @ @ @ put your feelings and sadness aside .
This isn ’ t about you .
This is about Maxwell .
And you fight like the third monkey on the loading deck to Noah ’ s Ark , and it ’ s starting to rain.
” This is how Freed ’ s quest began .
She taught herself microbiology , so she could understand her son ’ s condition .
She lobbied scientists to take up the research , which wasn ’ t on their radar given how rare the disease is .
She convinced @ @ @ @ @ @ @ mice that could be sent to the US and act as a model of Maxwell ’ s disease .
And she fundraised — a necessary step given the high cost of the gene therapy research .
All told , she ’ s raised more than $ 1 million .
“ What we ’ re doing will be the building blocks of all gene therapies to come after us , ” Freed told Arielle Duhaime-Ross on an episode of Reset in January .
Even though she was racing against time , she was optimistic @ @ @ @ @ @ @ , as experiments on the genetically modified mice were about to begin .
Covid-19 has brought most non-coronavirus medical research to a halt , and closed labs .
“ I never anticipated or thought something like this could happen , ” Freed said , “ but also it was a state of devastation like I felt when Maxwell was originally diagnosed that lightning hit us .
The unthinkable happened .
And here , lightning has hit again .
A black swan event for the world that no one could have anticipated.
” Freed @ @ @ @ @ @ @ the impact of the pandemic on Maxwell and her family — as well as rare disease research as a whole .
Listen to the full episode below .
The episode also features a conversation with BuzzFeed science reporter Dan Vergano , who first wrote about Amber ’ s story and who talks about how the closure has impacted thousands of other kids with rare diseases , as well as clinical trials for other types of medical research .
Listen to the original Reset story from January Dan Vergano ’ s reporting on this @ @ @ @ @ @ @ Dan ’ s piece on how the mice were being used to develop a treatment

Amber Freed’s singular mission is to help scientists develop a treatment for her son. But the pandemic has put the success of that mission into question.
Freed is a mother to twins Riley and Maxwell, who just turned 3 this year. Riley is a healthy toddler. But Maxwell has a rare genetic disease that has led to delays in his development. He’s nonverbal, and he has a movement disorder. The condition responsible for these symptoms is called SLC6A1, after the gene that’s affected, and Maxwell was only the 34th person in the world to get this diagnosis. if left untreated, the disease could soon cause debilitating epilepsy.
When doctors broke the news of the diagnosis to Freed, they told her there was no treatment or cure for her son, and that her family would have to prepare to live with Maxwell’s condition. But Amber didn’t accept that.
“Every instinct in my body said, ‘You’ll have your whole lifetime to cry for yourself,’” Freed said. “At this exact moment, you put your feelings and sadness aside. This isn’t about you. This is about Maxwell. And you fight like the third monkey on the loading deck to Noah’s Ark, and it’s starting to rain.”
This is how Freed’s quest began. She taught herself microbiology, so she could understand her son’s condition. She lobbied scientists to take up the research, which wasn’t on their radar given how rare the disease is. She convinced scientists in China to make genetically engineered mice that could be sent to the US and act as a model of Maxwell’s disease. And she fundraised — a necessary step given the high cost of the gene therapy research.
All told, she’s raised more than $1 million. “What we’re doing will be the building blocks of all gene therapies to come after us,” Freed told Arielle Duhaime-Ross on an episode of Reset in January.
Even though she was racing against time, she was optimistic that Maxwell would be treated this year, as experiments on the genetically modified mice were about to begin.
Then the pandemic hit.
Covid-19 has brought most non-coronavirus medical research to a halt, and closed labs.
“I never anticipated or thought something like this could happen,” Freed said, “but also it was a state of devastation like I felt when Maxwell was originally diagnosed that lightning hit us. The unthinkable happened. And here, lightning has hit again. A black swan event for the world that no one could have anticipated.”
Freed came back to Reset to talk about the impact of the pandemic on Maxwell and her family — as well as rare disease research as a whole. Listen to the full episode below.
The episode also features a conversation with BuzzFeed science reporter Dan Vergano, who first wrote about Amber’s story and who talks about how the closure has impacted thousands of other kids with rare diseases, as well as clinical trials for other types of medical research.
Listen and read more:
Listen to the original Reset story from January
Dan Vergano’s reporting on this story for BuzzFeed
Back in January, Dan’s piece on how the mice were being used to develop a treatment
Milestones for Maxwell, Amber Freed’s website


vox--2020-05-11--Twitter now labels misleading coronavirus tweets with a misleading label

Amid a surge of misinformation triggered by the Covid-19 pandemic , Twitter has announced yet another update to its policies regarding conspiracy theories and fake news .
Now , Covid-19 tweets that are considered misleading will get labels designed to offer more context about the information therein .
Tweets making potentially harmful claims disputed by experts will now come with a more direct warning message .
Twitter explained in a blog post that its new strategy for dealing with problematic tweets takes a three-pronged approach .
The specific action taken will depend on whether the company deems the claims in @ @ @ @ @ @ @ “ disputed , ” or “ unverified.
” Based on how severe the claims made in the tweet are , the company will apply either a label or a warning .
Here ’ s a handy graphic for which types of content get a label versus a warning — or no action at all : Removal is obviously the most serious consequence outlined here .
A warning is next-most serious .
Content with disputed information that Twitter thinks carries a severe propensity for harm will get one of these warning messages .
In @ @ @ @ @ @ @ be blocked off , with a note that the content shared “ conflicts with guidance from public health experts.
” Twitter said these changes will also be applied to tweets sent before today .
For tweets deemed moderately harmful , Twitter will insert a link underneath the tweet directing users to reliable information .
This strategy mimics the company ’ s approach to deepfakes , which was announced earlier this year .
But it ’ s not quite clear how the note — “ Get the facts about COVID-19 ” — will be @ @ @ @ @ @ @ contradict anything said in a false tweet .
Users must also click through the label to get redirected to a page with related fact-checked content .
For example , here ’ s what you ’ ll see if you click on a label that ’ s been attached to a tweet about 5G and the coronavirus .
Speaking of tweets about 5G and the coronavirus , Recode did a quick search and identified several tweets pushing the conspiracy theory that the cellular technology and the pandemic are related .
Many of those tweets @ @ @ @ @ @ @ new label .
But it appears that simply mentioning 5G and the coronavirus together might automatically generate the label .
For now , it ’ s not hard to find tweets discuss 5G and the pandemic that have nothing to do with the conspiracy but also received the new label .
Twitter ’ s new approach follows a similar one from Facebook involving its own third-party fact-checkers , which was announced in March .
Currently , if you see a false post on Facebook that ’ s been flagged , you ’ ll @ @ @ @ @ @ @ a professional fact-checking organization .
Last month , Facebook announced that it would retroactively provide links to verified Covid-19 information to users who had previously “ Liked , ” reacted , or commented on “ harmful misinformation ” related to the pandemic .
Still , Twitter ’ s update feels late .
As we ’ ve previously reported , misinformation about the novel coronavirus pandemic has become increasingly prevalent since January , and social media platforms are fertile ground for all sorts of wild conspiracy theories , from the idea that 5G cellular @ @ @ @ @ @ @ to the notion that the virus was stolen from Canada .
Fake news isn ’ t the only content moderation challenge weighing down these platforms .
Facebook , Instagram , and Twitter are also battling an influx of posts and ads for products that push fake antibody tests and cures , while working with insufficient staff to chase other harmful and offensive content off their sites .
But this surge in a particular category of misinformation — and the threat it presents to public health in the middle of a pandemic — has @ @ @ @ @ @ @ their approach to content moderation .
Twitter , specifically , has already expanded its definition of “ harm ” on the platform to include tweets that defy recommendations from public health authorities .
The company has also taken down some , but not all , of tweets now deemed “ harmful.
” Rather than just labeling certain types of fake news , as previous policies had allowed , Facebook has been aggressively taking down a whole host of misleading posts and entire quarantine protest groups .
Incorrect health information about the coronavirus threatens @ @ @ @ @ @ @ like Twitter and Facebook are now acting more aggressively .
Still , questions about how fake news and conspiracy theories will continue to threaten the public well-being remain unresolved .
Incremental policy updates are good , but they are no panacea .
Every day at Vox , we aim to answer your most important questions and provide you , and our audience around the world , with information that has the power to save lives .
Our mission has never been more vital than it is in this moment : to empower you @ @ @ @ @ @ @ is reaching more people than ever , but our distinctive brand of explanatory journalism takes resources — particularly during a pandemic and an economic downturn .
Your financial contribution will not constitute a donation , but it will enable our staff to continue to offer free articles , videos , and podcasts at the quality and volume that this moment requires .
Please consider making a contribution to Vox today .

Amid a surge of misinformation triggered by the Covid-19 pandemic, Twitter has announced yet another update to its policies regarding conspiracy theories and fake news. Now, Covid-19 tweets that are considered misleading will get labels designed to offer more context about the information therein. Tweets making potentially harmful claims disputed by experts will now come with a more direct warning message.
Twitter explained in a blog post that its new strategy for dealing with problematic tweets takes a three-pronged approach. The specific action taken will depend on whether the company deems the claims in a tweet as “misleading,” “disputed,” or “unverified.” Based on how severe the claims made in the tweet are, the company will apply either a label or a warning. Here’s a handy graphic for which types of content get a label versus a warning — or no action at all:
Removal is obviously the most serious consequence outlined here. A warning is next-most serious. Content with disputed information that Twitter thinks carries a severe propensity for harm will get one of these warning messages.
In this case, the entire tweet might be blocked off, with a note that the content shared “conflicts with guidance from public health experts.” Twitter said these changes will also be applied to tweets sent before today.
For tweets deemed moderately harmful, Twitter will insert a link underneath the tweet directing users to reliable information. This strategy mimics the company’s approach to deepfakes, which was announced earlier this year. But it’s not quite clear how the note — “Get the facts about COVID-19” — will be interpreted since it doesn’t actually contradict anything said in a false tweet. Users must also click through the label to get redirected to a page with related fact-checked content. For example, here’s what you’ll see if you click on a label that’s been attached to a tweet about 5G and the coronavirus.
Speaking of tweets about 5G and the coronavirus, Recode did a quick search and identified several tweets pushing the conspiracy theory that the cellular technology and the pandemic are related. Many of those tweets — though not all — included the new label. But it appears that simply mentioning 5G and the coronavirus together might automatically generate the label. For now, it’s not hard to find tweets discuss 5G and the pandemic that have nothing to do with the conspiracy but also received the new label.
Twitter’s new approach follows a similar one from Facebook involving its own third-party fact-checkers, which was announced in March. Currently, if you see a false post on Facebook that’s been flagged, you’ll be warned and directed to content from a professional fact-checking organization. Last month, Facebook announced that it would retroactively provide links to verified Covid-19 information to users who had previously “Liked,” reacted, or commented on “harmful misinformation” related to the pandemic.
Still, Twitter’s update feels late. As we’ve previously reported, misinformation about the novel coronavirus pandemic has become increasingly prevalent since January, and social media platforms are fertile ground for all sorts of wild conspiracy theories, from the idea that 5G cellular technology is somehow behind the novel coronavirus to the notion that the virus was stolen from Canada. Fake news isn’t the only content moderation challenge weighing down these platforms. Facebook, Instagram, and Twitter are also battling an influx of posts and ads for products that push fake antibody tests and cures, while working with insufficient staff to chase other harmful and offensive content off their sites.
Related How the 5G coronavirus conspiracy theory went from fringe to mainstream
But this surge in a particular category of misinformation — and the threat it presents to public health in the middle of a pandemic — has forced the social media giants to reconsider their approach to content moderation. Twitter, specifically, has already expanded its definition of “harm” on the platform to include tweets that defy recommendations from public health authorities. The company has also taken down some, but not all, of tweets now deemed “harmful.” Rather than just labeling certain types of fake news, as previous policies had allowed, Facebook has been aggressively taking down a whole host of misleading posts and entire quarantine protest groups.
Incorrect health information about the coronavirus threatens lives, which might explain why companies like Twitter and Facebook are now acting more aggressively. Still, questions about how fake news and conspiracy theories will continue to threaten the public well-being remain unresolved. Incremental policy updates are good, but they are no panacea.


vox--2020-05-11--The Supreme Court seems likely to give religious employers a broad ability to discriminate

The Supreme Court appeared divided along ideological lines on Monday in a pair of cases asking when religious employers can defy state or federal laws banning discrimination .
Our Lady of Guadalupe School v. Morrissey-Berru and St. James School v. Biel , are difficult cases asking whether two Catholic school teachers qualify as “ ministers , ” a designation that effectively strips them of many of their civil rights in the workplace .
Both cases involve Catholic school teachers who claim that they lost their jobs for illegitimate reasons .
Kristen Biel was diagnosed with breast cancer and has since @ @ @ @ @ @ @ teaching contract was not renewed because of her cancer diagnosis , in violation of the Americans With Disabilities Act .
The school claims she was removed because she “ was not strict ” enough in her classroom discipline .
Another teacher , Agnes Morrissey-Berru , says her contract was not renewed due to age discrimination .
The school claims a mix of reasons for removing her , including financial concerns and concerns that her teaching had insufficient “ academic rigor.
” In Hosanna-Tabor v. EEOC ( 2012 ) , the Supreme Court unanimously @ @ @ @ @ @ @ “ ministerial exemption ” to anti-discrimination laws .
As the Court explained , the Constitution ’ s “ Establishment Clause prevents the Government from appointing ministers , and the Free Exercise Clause prevents it from interfering with the freedom of religious groups to select their own.
” Yet , while Hosanna-Tabor established that “ ministers ” are broadly exempt from laws protecting them against discrimination , that case offered only minimal guidance about who qualifies as a minister .
Morrissey-Berru and Biel give the Supreme Court a chance to better define which employees @ @ @ @ @ @ @ least two members of the Supreme Court , Justices Clarence Thomas and Neil Gorsuch , staked out the position that a religious employer should more or less be allowed to determine on its own which employees count as ministers .
Meanwhile , some members of the Court ’ s liberal minority appeared concerned that Hosanna-Tabor went too far in exempting ministers from literally all anti-discrimination laws .
The “ breadth of the exemption is staggering , ” Justice Ruth Bader Ginsburg remarked at one point during Monday ’ s oral argument .
She @ @ @ @ @ @ @ fired for blowing the whistle on a priest engaged in sexual misconduct , or on a school principal who embezzled church funds .
At the very least , it appears fairly likely that the Supreme Court ’ s Republican majority will adopt a broad definition of who qualifies as a minister , which was originally proposed by Justice Samuel Alito in Hosanna-Tabor .
Under this test , employees “ who serve in positions of leadership , those who perform important functions in worship services and in the performance of religious ceremonies and rituals @ @ @ @ @ @ @ teaching and conveying the tenets of the faith to the next generation ” That test could lead to hundreds of thousands of workers being stripped of their civil rights .
Defining who qualifies as a minister is hard Hosanna-Tabor is the Supreme Court ’ s only decision laying out who qualifies as a minister , and that case provides little guidance because there was an overwhelming weight of evidence suggesting that its plaintiff was , indeed , a minister .
In Hosanna-Tabor , the Court laid out several factors that courts should consider @ @ @ @ @ @ @ within the ministerial exception .
Did the employer hold the employee out as a minister , and did the employee do the same ?
Did the employee have significant religious training ?
Did their job duties involve “ important religious functions ” ?
All of these factors pointed in the same direction in Hosanna-Tabor .
The plaintiff was a teacher at a Lutheran school with significant training in Lutheran teachings and ministry .
She taught some religious subjects .
The school gave her the job title of “ Minister of Religion , Commissioned @ @ @ @ @ @ @ benefit that applies to workers who earn their income “ in the exercise of the ministry.
” In Biel and Morrissey-Berru , by contrast , these factors point in different directions .
Both involve teachers who spent some time every week teaching Catholic religion to their students .
But both of these teachers have secular degrees ( although one did take “ catechist courses ” provided by Los Angeles ’ s Catholic archdiocese ) .
Both women were also classified by their schools as “ lay employees.
” Nevertheless , Eric Rassbach , @ @ @ @ @ @ @ , claimed that this mix of factors is enough to qualify both teachers as “ ministers.
” According to Rassbach , it is enough that the teachers performed “ important religious functions ” by spending a couple , or maybe even several , hours a week teaching religious subjects to their students .
But what makes a religious function “ important , ” and who gets to decide that question ?
At least four members of the Court , Chief Justice John Roberts , Thomas , Gorsuch , and Justice Brett Kavanaugh all @ @ @ @ @ @ @ even capable of making that determination .
Thomas and Gorsuch , for their part , answered this question by suggesting that courts should determine who qualifies as a minister by just deferring to religious employers .
As Gorsuch put it , if an employer has a “ sincerely held religious belief about who is a minister ” then that belief “ should control.
” That approach has the advantage of making it easy for judges to decide ministerial exception cases , but it would also give some employers the power to exempt themselves @ @ @ @ @ @ @ several other justices struggled with the question of just how many religious duties an employee must take on before they qualify as a minister .
Justice Elena Kagan , for example , appeared to believe that a full-time religion teacher — one who teaches religion and nothing else — would qualify as a minister .
But what about a teacher who spends half their time teaching religion and the other half teaching math ?
What about a teacher , like the plaintiff in Biel , who spends maybe two hours a week teaching @ @ @ @ @ @ @ time on secular topics ?
Hosanna-Tabor doesn ’ t answer these questions .
And the justices ’ own answers appeared to hinge more on whether they view protecting religious employers or defending anti-discrimination laws as a more important value .
An imprecise test will be easy to game Jeffrey Fisher , the lawyer representing the two teachers , suggests that the Court should apply a fairly formalistic test that places a great deal of weight on factors such as whether the employer held a particular employee out as a “ minister.
” That @ @ @ @ @ @ @ were classified as lay teachers .
But , as Roberts noted at one point , such a test would be fairly easy to game — an employer could just classify all of its employees as ministers .
The same could also be said about a test that emphasizes whether an employee performs “ important religious functions.
” Consider , for example , a manual published by the Southern Baptist Convention and the Alliance Defending Freedom , which advised employers on how to broadly classify their employees as “ ministers ” in order to @ @ @ @ @ @ @ while it is far from clear that most of the justices agree with Thomas and Gorsuch ’ s call for extreme deference to religious employers , both Alito and Kavanaugh rallied behind a test that would still give employers broad leeway to reclassify employees as ministers by assigning religious duties to those employees .
According to Alito , the task of teaching religion to a younger generation is “ central ” to religious faith — a position which seems to suggest that if an employee spends any time teaching religion , then that @ @ @ @ @ @ @ a minister .
A camp counselor who spends maybe half-an-hour a week teaching religion to a group of children could potentially qualify .
Such a test , in other words , gives religious employers a strong incentive to assign religious teaching duties to as many employees as possible .
Morrissey-Berru and Biel are difficult cases .
They involve an area of the law where the Supreme Court has offered little previous guidance .
And they present difficult moral questions about how much we value a religious group ’ s ability to select the @ @ @ @ @ @ @ whether we value that ability so much that we are willing to toss aside very basic civil rights .
On Monday , many of the justices appeared to view these cases as fairly one-sided , and they appeared to view the goal of protecting religious groups as paramount .
That view does not simply have profound implications for the employees in Biel and Morrissey-Berru .
It suggests that religious conservatives are likely to prevail in other cases asking the Court to weigh whether civil rights laws apply to people who object to those @ @ @ @ @

The Supreme Court appeared divided along ideological lines on Monday in a pair of cases asking when religious employers can defy state or federal laws banning discrimination.
Our Lady of Guadalupe School v. Morrissey-Berru and St. James School v. Biel, are difficult cases asking whether two Catholic school teachers qualify as “ministers,” a designation that effectively strips them of many of their civil rights in the workplace.
Both cases involve Catholic school teachers who claim that they lost their jobs for illegitimate reasons. Kristen Biel was diagnosed with breast cancer and has since died. Her estate claims that her teaching contract was not renewed because of her cancer diagnosis, in violation of the Americans With Disabilities Act. The school claims she was removed because she “was not strict” enough in her classroom discipline.
Another teacher, Agnes Morrissey-Berru, says her contract was not renewed due to age discrimination. The school claims a mix of reasons for removing her, including financial concerns and concerns that her teaching had insufficient “academic rigor.”
In Hosanna-Tabor v. EEOC (2012), the Supreme Court unanimously held that the First Amendment enshrines a “ministerial exemption” to anti-discrimination laws. As the Court explained, the Constitution’s “Establishment Clause prevents the Government from appointing ministers, and the Free Exercise Clause prevents it from interfering with the freedom of religious groups to select their own.”
Yet, while Hosanna-Tabor established that “ministers” are broadly exempt from laws protecting them against discrimination, that case offered only minimal guidance about who qualifies as a minister. Morrissey-Berru and Biel give the Supreme Court a chance to better define which employees fit within the ministerial exception.
At least two members of the Supreme Court, Justices Clarence Thomas and Neil Gorsuch, staked out the position that a religious employer should more or less be allowed to determine on its own which employees count as ministers.
Meanwhile, some members of the Court’s liberal minority appeared concerned that Hosanna-Tabor went too far in exempting ministers from literally all anti-discrimination laws. The “breadth of the exemption is staggering,” Justice Ruth Bader Ginsburg remarked at one point during Monday’s oral argument. She worried it would allow someone to be fired for blowing the whistle on a priest engaged in sexual misconduct, or on a school principal who embezzled church funds.
At the very least, it appears fairly likely that the Supreme Court’s Republican majority will adopt a broad definition of who qualifies as a minister, which was originally proposed by Justice Samuel Alito in Hosanna-Tabor. Under this test, employees “who serve in positions of leadership, those who perform important functions in worship services and in the performance of religious ceremonies and rituals, and those who are entrusted with teaching and conveying the tenets of the faith to the next generation”
That test could lead to hundreds of thousands of workers being stripped of their civil rights.
Defining who qualifies as a minister is hard
Hosanna-Tabor is the Supreme Court’s only decision laying out who qualifies as a minister, and that case provides little guidance because there was an overwhelming weight of evidence suggesting that its plaintiff was, indeed, a minister. In Hosanna-Tabor, the Court laid out several factors that courts should consider when determining if a particular employee fits within the ministerial exception. Did the employer hold the employee out as a minister, and did the employee do the same? Did the employee have significant religious training? Did their job duties involve “important religious functions”?
All of these factors pointed in the same direction in Hosanna-Tabor. The plaintiff was a teacher at a Lutheran school with significant training in Lutheran teachings and ministry. She taught some religious subjects. The school gave her the job title of “Minister of Religion, Commissioned,” and she claimed a tax benefit that applies to workers who earn their income “in the exercise of the ministry.”
In Biel and Morrissey-Berru, by contrast, these factors point in different directions. Both involve teachers who spent some time every week teaching Catholic religion to their students. But both of these teachers have secular degrees (although one did take “catechist courses” provided by Los Angeles’s Catholic archdiocese). Both women were also classified by their schools as “lay employees.”
Nevertheless, Eric Rassbach, the lawyer for the two Catholic schools, claimed that this mix of factors is enough to qualify both teachers as “ministers.” According to Rassbach, it is enough that the teachers performed “important religious functions” by spending a couple, or maybe even several, hours a week teaching religious subjects to their students.
But what makes a religious function “important,” and who gets to decide that question? At least four members of the Court, Chief Justice John Roberts, Thomas, Gorsuch, and Justice Brett Kavanaugh all raised concerns about whether secular courts are even capable of making that determination.
Thomas and Gorsuch, for their part, answered this question by suggesting that courts should determine who qualifies as a minister by just deferring to religious employers. As Gorsuch put it, if an employer has a “sincerely held religious belief about who is a minister” then that belief “should control.” That approach has the advantage of making it easy for judges to decide ministerial exception cases, but it would also give some employers the power to exempt themselves entirely from anti-discrimination laws.
Meanwhile, several other justices struggled with the question of just how many religious duties an employee must take on before they qualify as a minister. Justice Elena Kagan, for example, appeared to believe that a full-time religion teacher — one who teaches religion and nothing else — would qualify as a minister. But what about a teacher who spends half their time teaching religion and the other half teaching math? What about a teacher, like the plaintiff in Biel, who spends maybe two hours a week teaching religion, and the rest of their time on secular topics?
Hosanna-Tabor doesn’t answer these questions. And the justices’ own answers appeared to hinge more on whether they view protecting religious employers or defending anti-discrimination laws as a more important value.
An imprecise test will be easy to game
Jeffrey Fisher, the lawyer representing the two teachers, suggests that the Court should apply a fairly formalistic test that places a great deal of weight on factors such as whether the employer held a particular employee out as a “minister.” That test would help his clients, who were classified as lay teachers. But, as Roberts noted at one point, such a test would be fairly easy to game — an employer could just classify all of its employees as ministers.
The same could also be said about a test that emphasizes whether an employee performs “important religious functions.” Consider, for example, a manual published by the Southern Baptist Convention and the Alliance Defending Freedom, which advised employers on how to broadly classify their employees as “ministers” in order to evade civil rights laws.
When feasible, a religious organization should assign its employees duties that involve ministerial teaching, or other spiritual qualifications — duties that directly further the religious mission. For example, if a church receptionist answers the phone, the job description might detail how the receptionist is required to answer basic questions about the church’s faith, provide religious resources, or pray with callers. Consider requiring all employees to participate in devotional or prayer time, or to even lead these on occasion.
Meanwhile, while it is far from clear that most of the justices agree with Thomas and Gorsuch’s call for extreme deference to religious employers, both Alito and Kavanaugh rallied behind a test that would still give employers broad leeway to reclassify employees as ministers by assigning religious duties to those employees.
According to Alito, the task of teaching religion to a younger generation is “central” to religious faith — a position which seems to suggest that if an employee spends any time teaching religion, then that is enough for them to qualify as a minister. A camp counselor who spends maybe half-an-hour a week teaching religion to a group of children could potentially qualify.
Such a test, in other words, gives religious employers a strong incentive to assign religious teaching duties to as many employees as possible.
Morrissey-Berru and Biel are difficult cases. They involve an area of the law where the Supreme Court has offered little previous guidance. And they present difficult moral questions about how much we value a religious group’s ability to select the people who teach its faith, and whether we value that ability so much that we are willing to toss aside very basic civil rights.
On Monday, many of the justices appeared to view these cases as fairly one-sided, and they appeared to view the goal of protecting religious groups as paramount. That view does not simply have profound implications for the employees in Biel and Morrissey-Berru. It suggests that religious conservatives are likely to prevail in other cases asking the Court to weigh whether civil rights laws apply to people who object to those laws on religious grounds.