As an adolescent, she helped her parents — immigrants from Eritrea who spoke little English — navigate the health care system in Oakland, California. She saw physicians who were disrespectful to her family and uncaring about treatment for her mother’s cirrhosis, hypertension and diabetes.

“All of those experiences actually made me really dislike physicians,” Asmerom said. “Particularly in my community, the saying is, ‘You only go to the doctor if you’re about to die.’”

But that changed when she took a course in college about health disparities. It shocked her and made her realize that what her Eritrean family and friends saw was happening to other communities of color, too. Asmerom came to believe that as a doctor she could help turn things around.

Faculty members and student activists around the country have long called for medical schools to increase the number of students and instructors from underrepresented backgrounds to improve treatment and build inclusivity. But to identify racism’s roots and its effects in the health system, they say, fundamental changes must be made in medical school curriculums.

Asmerom is one of many crusaders seeking robust anti-racist education. They are demanding that the schools eliminate the use of race as a diagnostic tool, recognize how systemic racism harms patients and reckon with some of medicine’s racist history.

This activism has been ongoing — (WC4BL), a student-run organization fighting racism in medicine, grew out of the 2014 Black Lives Matter protests. But now, as with countless other U.S. institutions since the killing of George Floyd in Minneapolis in May, medical schools and national medical organizations are under even greater pressure to take concrete action.

Debunking Race as a Diagnostic Tool

For many years, medical students were taught that genetic differences among the races had an effect on health. But in recent years, studies have found race does not reliably reflect that. notes very little genetic variation among races, and more differences among people within each race. Because of this, more physicians are embracing the idea that race is not an intrinsic biological difference but instead a social construct.

Dr. Brooke Cunningham, a physician and sociologist at the University of Minnesota Medical School, said the medical community is conflicted about abandoning the idea of race as biological. It’s baked into the way doctors diagnose and measure illness, she said. Some physicians claim it is useful to take race into account when treating patients; others argue it leads to bias and poor care.

Those views have led to a variety of false beliefs, including that people’s or they feel less pain.

When race is factored into medical calculations, it can lead to less effective treatments and . One such calculation estimates kidney function (eGFR, or the estimated glomerular filtration rate). The eGFR can because the number used to denote Black race in the formula provides a result suggesting kidneys are functioning better than they are, researchers in the New England Journal of Medicine. Among another dozen examples they cite is a formula that obstetricians use to determine the probability of a successful vaginal birth after a cesarean section, which disadvantages Black and Hispanic patients, and an adjustment for measuring lung capacity using a spirometer, which can cause inaccurate estimates of lung function for patients with asthma or chronic obstructive pulmonary disease.

In the face of this research, medical students are urging schools to rethink curricula that treat race as a risk factor for disease. Briana Christophers, a second-year student at Weill Cornell Medical College in New York, said it makes no sense that race would make someone more susceptible to disease, although economic and social factors play a significant role.

Naomi Nkinsi, a third-year student at the University of Washington School of Medicine in Seattle, recalled sitting in a lecture — one of five Black students in the room — and hearing that Black people are inherently more prone to disease.

“It was very personal,” Nkinsi said. “That’s my body, that’s my parents, that’s my siblings. Every time I go into a doctor’s office now, I’ll be reminded that they’re not just considering me as a whole person but as somehow physically different than all other patients just because I have more melanin in my skin.”

Nkinsi helped in a successful campaign to exclude race from the calculation of eGFR at UW Medicine, joining a small number of . She said the achievement —  in late May — was largely due to Black students’ tireless efforts.

Acknowledging Racism’s Adverse Effects on Health

The Liaison Committee on Medical Education, the official accrediting body for medical schools in the U.S. and Canada, said faculty must teach students to recognize bias “in themselves, in others, and in the health care delivery process.” But the LCME does not explicitly require accredited institutions to teach about systemic racism in medicine.

This is what students and some faculty want to change. Dr. David Acosta, the chief diversity and inclusion officer of the American Association of Medical Colleges, said about 80% of medical schools offer either a mandatory or elective course on health disparities. But little data exists on how many schools teach students how to recognize and fight racism, he said.

An anti-racist curriculum should explore ways to mitigate or eliminate racism’s harm, said Rachel Hardeman, a health policy professor at the University of Minnesota.

“It’s thinking about how do you infuse this across all of the learning in medical education, so that it’s not this sort of drop in the bucket, like, one-time thing,” she said. Above all, the courses that delve into systemic racism need to be required, Hardeman said.

Edwin Lindo, a lecturer at the University of Washington School of Medicine, said medicine should embrace an interdisciplinary model, allowing sociologists or historians to lecture on how racism harms health.

Acosta said the AAMC has organized a committee of experts to develop an anti-racism curriculum for every step of medical education. They hope to share their work publicly this month and talk to the LCME about developing and implementing these standards.

“Our next work is how do we persuade and influence the LCME to think about adding anti-racist training in there,” Acosta said.

Recognizing Racism in Medical Education’s Past and Present

Activists especially want to see their institutions recognize their own missteps, as well as the racism that has accompanied past medical achievements. Dereck Paul, a student at the University of California-San Francisco School of Medicine, said he wants every medical school to include lectures on people like , the Black woman who was dying of cancer when cells were taken without her consent and used to develop cell lines that have been instrumental in medical research.

Asmerom said she wants to see faculty acknowledge medicine’s racist past in lessons. She cited an introductory course on anatomy at her school that failed to note that in the past, as scientists sought to study the body, Blacks and other minorities were mistreated. “It’s like, OK, but you’re not going to talk about the fact that Black bodies were taken out of graves in order to have bodies to use for anatomy lab?” she said.

While Asmerom is glad to see her medical school actively listening to students, she feels administrators need to own up to their mistakes in the recent past. “There needs to be an admission of how you perpetuated anti-Black racism at this institution,” Asmerom said.

Asmerom, who is one of the leaders of the UCSD Anti-Racism Coalition, said the administration has responded favorably so far to the to pour time and money into anti-racist initiatives. She’s cautiously hopeful.

“But I’m not going to hold my breath until I see actual changes,” she said.

This article first appeared on Ñî¹óåú´«Ã½Ò•îl Health News and is republished here under a .

It looked and sounded like any normal gym session. Except it wasn’t. Grant’s gym consisted of a few yoga mats and equipment underneath a strip of scaffolding in Carl Schurz Park, which borders the East River in Manhattan. People on their evening quarantine walks strolled by, many glancing with amusement at the signs Grant had taped to the scaffolding: “Get your sexy back … no more cookies!” and “Come for the party, stay for the workout!”

Grant, 57, was despondent for the first few weeks of quarantine last spring. New York City was quickly becoming the of the coronavirus pandemic, and everyone hunkered down at home. As a personal trainer who works for himself, Grant watched his income crumble.

Then, a lightbulb went off. Grant used some savings to buy face shields, disinfectant, hand sanitizer and some additional equipment. He set up shop in the park, which is just a few blocks from his house, and started to attract new clients.

“This is an opportunity to meet people and get prospective clients for the future,” Grant said. “I just talk to people, connect, share and inspire, hopefully.”

One new client is Elizabeth Pompa, a 53-year-old real estate agent living on the Upper East Side. Pompa, who used to teach Lotte Berk Technique dance-based exercise classes, has always valued fitness and personal training. Her husband struck up a conversation with Grant while working out next to him and later suggested Pompa give Grant a try. Since then, she’s seen Grant once a week.

“He pushes me, but in a great way,” Pompa said. “I know I’m not going to get hurt with him. For that hour, I forget everything that’s going on around me.”

Casey Grillo, a 40-year-old nurse practitioner, comes to Grant’s sessions twice a week. At the start of the pandemic, she would not have considered working out with others in person. But she said now that she and others know how to take the appropriate measures to stay safe, she’s comfortable at Grant’s sessions.

Grant holds small classes Sunday through Thursday, charging his clients $25 per session. And he teaches private clients on Fridays for $85. At every session, he wears a face shield and reminds clients to stay 6 feet apart. He disinfects equipment after every use and offers hand sanitizer to those who want it.

Grillo said she’s noticed a larger community of fitness enthusiasts getting their exercise outside. She admires everyone’s creativity.

“I’ve seen people use canned goods and water bottles and gallon jugs for weights,” Grillo said. “It’s really encouraging to see people still staying active.”

Grant is not the only personal trainer using Carl Schurz as gym space. Patrick Narain, a 36-year-old trainer and martial arts instructor, has been teaching classes in Carl Schurz, Astoria Park and Central Park. At the beginning of the pandemic, he mostly did virtual classes from home without charging people. It was tough, he said, staying financially afloat on solely the tips he got from online clients. Now he’s getting $15 from each class participant.

As for many people, Narain said the pandemic and subsequent quarantine have caused him anxiety.

“I find myself worrying too much about others and not really paying attention to taking care of myself,” Narain said. “It really caused me a lot of stress, to the point where I couldn’t really feel my right side.”

His stress slowly improved as he worked with another instructor to teach small classes in the park. He’s enjoying the fresh air and open space, though he’s careful not to push clients too hard in the heat.

Devin Paul, another trainer, also transitioned his business smoothly to the outdoors. He’d worked with a gym until the quarantine started, and now he’s training his own clients in Carl Schurz and in Jackie Robinson Park in Harlem.

Paul, 46, has found that since he’s working for himself, he’s making more money and working fewer hours. He said his minimum fee for a private lesson is $100.

“I’m at a point in my life where I don’t think I’m going to go back when the gyms open,” Paul said. “I can have a better peace of mind just doing everything on my own.”

Paul plans to rent a training studio when the weather turns too cold to work outside.

Grant said the personal trainer community has had one another’s backs through it all. He’s been a part of the industry for 17 years, ever since a fellow fitness enthusiast told him he’d be a “natural.” He’s seeing trainers he’s known for a long time using parks to their advantage, being creative and making things work.

“We just try to help each other out and stand for each other,” Grant said.

Pre-pandemic, Grant had been doing well financially with his model of meeting up with clients at gyms and getting new ones through referrals. Still, he’s taking the pandemic as an opportunity to reevaluate his operation.

“We have to really think about how to create something for the future and see the glass as half full and be optimistic because you’ll never know what you create when you put your mind to it,” he said.

For the foreseeable future, he’s sticking around at his makeshift gym throughout the week, hoping to entice people to “get your sexy back.”

This article first appeared on Ñî¹óåú´«Ã½Ò•îl Health News and is republished here under a .

In late August 2019, Shannon Harness awoke to serious pain in the lower right side of his abdomen — a telltale sign of .

He booked it to the emergency room of the only hospital in the county: Heart of the Rockies Regional Medical Center in Salida, Colorado. After a CT scan, doctors told Harness he had acute appendicitis and required immediate surgery.

A surgeon performed an appendectomy that night and released Harness the next day.

But a couple of days later, Harness felt sharp pains where his appendix had been. The pain grew until he was on the floor screaming.

“It was disturbing,” said Eliza Novick-Smith, his partner. “He has a pretty high pain tolerance,” given previous injuries from military service and mountain biking.

Harness went back to the hospital, where another CT scan revealed a blood clot the size of a brick floating in his pelvic area, a rare complication that most likely came from clipping and stapling the appendix tissue in the first surgery, said his surgeon. He would need another operation to check for the source of bleeding and to remove the clot.

After four more days in the hospital, he went home. It took him a couple of months to fully recover.

Then the bill came.

Patient: Shannon Harness, 39, an operations manager for a company that builds mountain bike trails across the country and a Marine Corps veteran. At the time of this incident, Harness had no insurance.

Total Owed: The original hospital bill was $80,232 for both surgeries — the first surgery cost $35,906 and the clot surgery cost $44,326. These amounts do not include payments to the surgeon, anesthesiologist, pathologist or radiologist.

Service Provider: Heart of the Rockies Regional Medical Center, a nonprofit in Colorado, where the surgeries were performed. Anesthesia, radiology and pathology were performed by other providers.

Medical Services: Laparoscopic appendectomy, followed by a second surgery a few days later, to resolve complications.

What Gives: Uninsured patients are extremely vulnerable to exorbitant hospital bills. It’s difficult to negotiate with a hospital without the leverage and bargaining power of an insurance company. Worse, uninsured patients are often billed three or four times what an insurer or government program would pay for the same service, said Anthony Wright, executive director of Health Access California, an organization advocating for affordable health care in California.

“As somebody who’s uninsured, you are getting an unnegotiated rate,” Wright said, derived from the hospital’s master price list. Insurers typically pay a rate that is a tiny fraction of that cost.

Harness was uninsured for seven years before this incident. His employer didn’t offer insurance, and the Affordable Care Act plan he qualified for cost $350 a month — an amount he didn’t have.

One option for uninsured patients is a hospital’s financial assistance program, a . In Colorado, every hospital is supposed to have a comprehensive charity care program for uninsured patients who earn less than 250% of the federal poverty level.

Heart of the Rockies hospital determines on a sliding scale of family size and income. They also offer a self-pay discount of 15% to uninsured patients. Harness said the hospital’s financial services office initially told him he was ineligible for their assistance program as well as the . Harness had worked overtime the previous month and missed the qualification by around $200. The hospital would use only his past two pay stubs to verify his income, he said.

The hospital wouldn’t answer any questions about Harness’ care or bills, even though he gave it permission to do so.

Another quirk of the U.S. health care system that Harness encountered is that when surgeries don’t go as planned, and need revision with another operation, the patient (or his insurer) typically pays again. Medicare and some insurers have experimented with “bundled payments,” through which the hospital gets a set fee for the surgery and any follow-up care for 90 days thereafter.

Resolution: Harness filed a grievance with the hospital with the help of Novick-Smith, who is a lawyer, to push back on the bills for the two surgeries — $35,906 for the first and $44,326 more for the second —and express concerns with the quality of care.

, which estimates costs based on insurers’ claims data, says a fair price for an appendectomy in Salida is around $12,600. Dr. Gina Adrales, director of minimally invasive surgery at Johns Hopkins Medicine in Baltimore, said the complication Harness experienced is not common. The complication rate for an appendectomy is fairly low, she said.

In November, the hospital decided to give Harness a 30% discount for both surgeries, leaving him with a still hefty bill of $56,162.40.

The couple followed up repeatedly with the hospital for months, often finding representatives “hard to reach.” More than six months later, in March, the hospital told Harness he would have to pay for the second surgery because it was a risk he accepted by agreeing to the appendectomy.

Adam Fox, director of strategic engagement at Colorado Consumer Health Initiative, said it’s “especially important” to push back on bills resulting from surgical complications. “It usually indicates that something didn’t go right in the first surgery and at least that second surgery should be provided at a substantially reduced cost to the individual,” he said.

By May, the hospital gave in. Lesley Fagerberg, Heart of the Rockies’ vice president of financial services, wrote a response to Harness’ grievance, reducing the total bill by roughly the amount charged for the second surgery. But she didn’t explain how the hospital had come to that decision.

“Unfortunately, there was a complication in your appendectomy surgery,” Fagerberg wrote. “As explained in the consent to treat, a surgery/procedure has inherent risk. Your case has been reviewed and the total bill has been reduced by $31,218.60.”

Harness’ final bill from the hospital, Fagerberg wrote, stands at $22,304.17 after adjustments that included a self-pay discount.

Harness and Novick-Smith said that still seemed too high to them, and after some research, offered to pay the hospital $12,000 upfront. The hospital rejected this offer.

Before the appendectomy, I was looking for property and homes to purchase, and that is pretty much completely off the table right now.

Shannon Harness

Now, Harness is working out a payment plan with the hospital. The hospital offers an interest-free payment plan if he can pay it off in two years, but for Harness, those monthly payments would be more than his rent.

“I would not be able to do it by myself, like, I wouldn’t have another choice other than taking out a loan,” Harness said. “Before the appendectomy, I was looking for property and homes to purchase, and that is pretty much completely off the table right now.”

Novick-Smith said she’s glad the hospital ultimately wrote off the bill for the second surgery. But she still feels angry with the hospital.

“What feels particularly hard is that the hospital markets itself in our community as this vital community resource and they provide a lot of jobs,” she said. “Their lack of transparency and lack of communication with us made this all a whole lot worse especially because there’s nowhere else to go.”

The Takeaway: The United States health care system is not forgiving to the uninsured, who, paradoxically, often face the highest bills of all patients. The benefit of having insurance is in part that your plan pays much of the bill, but also that you get the benefit of being charged the plan’s highly discounted rates. If your employer doesn’t provide health insurance, said Wright.

Harness now has health care through the Department of Veterans Affairs. He initially avoided looking into VA health care because he felt “other vets needed it more.”

If you’re uninsured and stuck with a huge bill, Fox said, the first step is to ask for an itemized bill to ensure it reflects the actual service you received. The next step is to check the hospital’s charity care policy. Another resource uninsured patients can turn to are organizations like the Colorado Consumer Health Initiative.

“It’s by no means a perfect solution because there’s only so much that we can do to help consumers advocate for themselves in these cases, but we do our best,” Fox said.

If all else fails, Wright said, it’s best to put pressure on the hospital before they sell the bill to a collections agency. There’s less room for negotiation once a bill goes to collections, Wright said. And if all else really fails, you could try calling the press.

Dan Weissmann, host of “” podcast, reported the radio interview of this story. Jacob Conrad and Joe Neel of NPR produced the Morning Edition interview with KHN Editor-in-Chief Elisabeth Rosenthal.  

Bill of the Month is a crowdsourced investigation by KHN and that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!

This article first appeared on Ñî¹óåú´«Ã½Ò•îl Health News and is republished here under a .

The teenager, of South Brunswick Township, New Jersey, joined her church in commemorating members who had died of COVID-19. But she was driven to try to do more, something personal.

“I thought there could be something more meaningful I could do for the families of the doctors who lost their lives fighting the pandemic,” said Christine, 15.

A gifted artist, Christine resolved to draw the fallen U.S. health care workers in colorful memorial portraits, distribute them to their families and post them on her . She wanted the relatives to know that people appreciated those who were trying to help Americans heal while putting their own lives in jeopardy.

Christine frequently draws portraits for her friends and knew memorial portraits are usually rather expensive. She realized that drawing front-line workers could actually help families and was a better use of her time than drawing her friends — whom she said she’d drawn “like 10 times already.”

According to KHN and The Guardian’s “Lost on the Frontline” project, more than 900 health care workers in the United States have died after helping patients battle the coronavirus. The pandemic overburdened many hospitals and led to shortages in protective equipment such as masks and gowns that endangered many of those assisting patients.

Christine found her subjects through that project. She set up a to upload her portraits and to let families request drawings of their loved ones. Her portraits are free and easily accessible online, Christine said.

She has finished and posted 17 portraits since she started in late April. Each one takes six to eight hours, and Christine spreads that work out over a few days so as not to interfere with her school assignments. Using a close-up image as a reference, she first digitally sketches the proportions of the person’s face with a pencil and then adds unique colors to “really bring life to the portrait.”

Her largest obstacle is getting in touch with the families. She hopes more families will request portraits through her website so she can work with them from the beginning.

One person Christine featured is Sheena Miles, a semiretired nurse from Mississippi who died of COVID-19 on May 1. Christine tracked down her son, Tom Miles, who his gratitude on Facebook.

“When you’re going through a loss like that, like the loss of a mom, to get the email from out of the blue just kind of gives you a profound feeling that there are some good people in this world,” Tom Miles said in an interview. “For her to have such talent at such a young age, and that she really cares about people she doesn’t even know — she is what makes America what it is today.”

This kind of response is exactly what Christine aims for — she wants the families to know that she is thankful for the work of their loved ones.

“Someone they don’t know personally, even a stranger, appreciates what their loved one has done,” she said.

The portraits may be a source of brightness for grieving families, said Christine’s mother, Helen Liu.

“I hope that families who receive these portraits will have a feeling of hope that better times will come,” Liu said. “A memorial is something meaningful and permanent, and I feel her portraits capture the happiness that will forever be with them.”

She hopes to get additional requests for the memorials from families.

In addition to drawing, Christine is a member of the South Brunswick High School’s Science Olympiad team and helps build projects for competitions. She’s interested in exploring engineering or product design as a career. Anything related to building or creating, she said.

She plans to either major or minor in art in college. For now, she wants to continue this project throughout high school — hopefully with help from others who know how to create digital art. She has a on her website where others with art experience can sign up to help out. She said they can also add “other heroes in our society, such as war veterans or firefighters.”

“There are so many people that need to be honored, but I can’t do it by myself,” Christine said.

This article first appeared on Ñî¹óåú´«Ã½Ò•îl Health News and is republished here under a .

A few days before she got the virus, she’d met a volunteer with — one of the many mutual aid groups that have rallied to provide help in the face of the pandemic. Bed-Stuy Strong assembled an army of volunteers to help vulnerable neighbors with food deliveries and basic supplies. While Perez was in isolation, volunteers regularly delivered cooked food for her sons, ages 17 and 20, and her 4-year-old grandson.

“If it wasn’t for them, we wouldn’t have survived my quarantine and any other stuff that’s been going on,” said Perez, who receives disability benefits and scavenges the city for items she can sell to help cover the family’s and others’ expenses.

Perez, who since recovering has been helping deliver food with other volunteers, found herself getting to know neighbors she never would have met before and staying in constant communication with other volunteers.

“I say it so happily that my tears are coming out right now. Because it’s so refreshing,” she said. “There is no age, there is no color, there is no race within Bed-Stuy Strong.”

People are hurting financially and medically from the coronavirus pandemic. Millions of Americans are and 1 in 4 are . The struggle is widespread, in some cases. Many people are looking to their next-door neighbors for help.

New York City has seen an influx of mutual aid groups — a website called Mutual Aid Hub reports 59 operating in the city now. Though the concept is not new, such efforts have gained and during the pandemic. Mutual aid involves ordinary people volunteering their time and resources to help one another, rather than relying solely on the government or large institutions for relief.

Alyssa Dizon, a 26-year-old product manager at an urban technology company, volunteers with Bed-Stuy Strong, helping to manage the online system that coordinates grocery deliveries. She moved to the area from New Orleans less than a year ago and found herself meeting more neighbors in the past couple of months while helping with the mutual aid than in the nine months before that.

“So, I am a gentrifier and I’m new to New York,” Dizon said. “I feel more connected to this neighborhood now than I have before, and I have heard that sentiment even from people who’ve lived here much longer.”

Willie Tolliver, an associate professor of social work at Hunter College, part of the City University of New York, said mutual aid is deeply rooted in African American and immigrant communities. In his research, he’s traced mutual aid among African Americans in New York City to as early as the late 1700s. He noted the mutual aid ideology embodied by the , which coordinated free breakfast programs and errands for the elderly.

Tolliver said these organizations had to exist because the communities “could not depend upon their government to look out for them the way the government did for everyone else.”

In rapidly gentrifying neighborhoods, mutual aid efforts may bring neighbors from different backgrounds closer together. Tolliver said he’s not confident that such bonds will be long-lasting, but people are at their best in moments of disaster.

“Hope lives in the possibility of a collective finding itself in moments like this,” he said.

Bed-Stuy Strong uses from the community and beyond to purchase groceries and essential supplies for neighbors. Those in need can text or call the group with a delivery request, which gets assigned to a volunteer through Bed-Stuy Strong’s online network. The volunteer then picks up the groceries and delivers them to the recipient’s door. Anyone can become a volunteer — though the use of computer messaging excludes those without access to technology.

Long-standing community organizations also have established mutual aid delivery services. Imani Henry, 50, is the executive director of , a community group known locally as E4F that is dedicated to addressing two pressing neighborhood issues: gentrification and police violence.

Henry, a diversity trainer in his day job, started E4F in 2013, as in Brooklyn shrank while higher-income residents streamed in, displacing people who had lived there for years.

“We’re grassroots,” Henry said. “All of our organizing is led by the people directly impacted. We strategize together; that’s how we already were.”

At the start of the pandemic, E4F joined with the to to help residents with groceries and other material needs, and to with services such as child care and other food assistance programs. Volunteers use donated money to buy needed items, and deliver two large bags each month for people who sign up.

Henry said that, as a child of Caribbean immigrants, he grew up in a family that looked out for and supported other people in their community. During the current crisis, he has been amazed by the solidarity of neighbors and the energy of volunteers.

“We’re not doing relief work,” Henry said. “We do not treat people in that way. It’s about love and solidarity. It’s about, do you love this person?”

E4F has also been active in the “Black Lives Matter” protests spurred by the death of George Floyd at the hands of Minneapolis police. Henry said volunteers have effectively split into two groups: One helps lead protests, and the other abstains so members can safely continue delivering aid packages.

Patricia Hall, a resident of another Brooklyn neighborhood, Crown Heights, was watching television one night when she saw a news report about E4F’s delivery program. Hall, who is in her 50s and out of work, called Henry and soon was organizing deliveries for herself and many of her fellow tenants.

Mutual aid work is going on even within her tenant community, Hall said.

“If they give lots of coffee, I don’t drink coffee, but what do I do?” Hall said. “I would give it to my neighbor. So this building here is a community building. Everybody shares in this building. Everybody shares and helps one another.”

Dizon, the Bed-Stuy Strong volunteer, said it’s inevitable you will develop a bond with someone when you take their grocery list and step into their shoes to help them with basic needs. It’s intimate.

“If you’ve never experienced food insecurity before, I think there’s a lot of power in being this close to it and to empathize and hear the struggle of a stranger who is very close to you,” Dizon said.

Perez wants this work to continue so people can make a change.

“We can make a wave at the end, if we have enough ripples,” she said.

This article first appeared on Ñî¹óåú´«Ã½Ò•îl Health News and is republished here under a .

Public health authorities have identified bars as the locus of outbreaks in Louisiana, Florida, Wyoming and Idaho. Last weekend, the Texas alcohol licensing board after undercover agents observed crowds flouting that required patrons to keep a safe distance from one another and limit tavern occupancy.

Adriana Megas found HandleBar Houston so crowded when she went one night two weekends ago that she left. “They weren’t counting who came in and came out,” said Megas, 38, a nursing student. “Nobody was wearing any masks. You would never think COVID happened.”

The owners of HandleBar Houston, one of the bars whose licenses were suspended, did not respond to requests for comment. Megas said she and her friends drove by five other jammed bars on their way home. “The street was insanely busy,” she said. “Every single bar was filled.”

Photo at Handlebar in Houston 2/3

— Texas Alcoholic Beverage Commission (@TexasABC)

In Boise, Idaho, have been diagnosed with COVID-19 in cases that health authorities linked to people who, unaware they were infectious, visited bars and nightclubs, officials said. On Monday, the Central Health District, which oversees four counties, to shutter bars and nightclubs in Boise’s Ada County.

Bars are tailor-made for the spread of the virus, with loud music and a cacophony of conversations that require raised voices. The alcohol can impede judgment about diligently following rules meant to prevent contagion.

“People almost don’t want to social-distance if they go to the bar,” said Dr. Amesh Adalja, a senior scholar at the Johns Hopkins University Center for Health Security in Baltimore. “They’re going to be drinking alcohol, which is a social lubricant. People will often be loud, and if they have forceful speech, that’s going to create more droplets.”

On top of that, the very act of drinking is incompatible with wearing a mask, a primary way of limiting the spread of infection. Public health experts say many patrons are young adults who may think they are impervious to the coronavirus.

It’s certainly less lethal for them: Fewer than 4% of adults in their 20s with COVID-19 have been , compared with 22% of those in their 60s, according to the federal Centers for Disease Control and Prevention. Only 1 in 1,000 COVID-19 patients in their 20s die from the virus.

Nonetheless, as bars and other public places reopen, in younger adults are rising, and bars are a particularly dangerous vector. Several outbreaks have been traced to to college students. In Baton Rouge, Louisiana, health authorities have received reports of of positive COVID-19 tests tied to bar visits and bar employees in Tigerland, a neighborhood frequented by Louisiana State University students.

Reggie Chatman, a 23-year-old LSU graduate and sports reporter at a Baton Rouge television station, said he was surprised at how crowded the Tigerland bars were when he drove past them last weekend.

“It looked like a football weekend. It was unbelievable, just seeing that many people walking around,” he said. “Each bar had a line in front of it. It didn’t look like they were really stopping anybody from going inside. I didn’t see one mask out there at all.”

Jason Nay, the general manager of Fred’s, one of the bars there, said the bar closed two days last week to test all employees after three workers were COVID-positive. The business reopened Friday night but had only five customers.

“This goes to show you how many people know what’s going on,” he said. “Not even the students who thought they were invincible felt comfortable coming out.” He said that Fred’s will check patrons’ temperatures and hand out disposable face masks this weekend.

Nay, 37, said he believed most students had been actively socializing for months by having friends over to their homes. “Don’t think they changed anything until recently, and I think the main reason why they changed is because their parents really tore into them because they could have brought that home for Father’s Day,” he said.

There are about in the country. As many states permit them to reopen, authorities have enacted various measures to mitigate the chances of infection. Earlier this month, Florida Gov. Ron DeSantis allowed bars to open at half capacity with social distancing. This week he risk losing their liquor licenses if “it’s just like mayhem and like ‘Dance Party USA’ and it’s packed to the rafters.”

In Texas, that bars must limit indoor service to half their legal occupancy, keep tables to 10 people or fewer and enforce 6 feet of distancing between groups. “There are certain counties where a majority of the people who are tested positive in that county are under the age of 30, and this typically results from people going to bars,” Abbott earlier this month.

Last weekend, undercover inspectors with the Texas Alcoholic Beverage Commission visited nearly 600 bars and restaurants in Texas’ major urban areas. The commission videotapes of two bar scenes and a photograph of a third bar, all showing patrons standing shoulder to shoulder and chatting face-to-face. Those bars and 14 others had their liquor permits suspended for 30 days, with the threat of a 60-day suspension for a repeat violation.

On , one of the bars sanctioned by the commission, BARge 295 in Seabrook, near Houston, said its license was suspended “for allowing some customers to stand and gather at the bar [S]aturday night (no six foot rule).” The bar, which has been promoting its live music, whole pig roasts and a bikini contest, said it would appeal the action.

“Everyone in the country is aware of the situation and has the ability to think for themselves and decide when and where they want to interact socially,” the bar said in a series of posts. “This BS needs to end now. Come out and support local businesses.”

Other bar owners have found the mandates manageable. Greg Barrineau, who owns a number of bars in the San Antonio area, said he rearranged tables and stools to meet the state’s requirements. “The guidelines are not that hard to follow,” he said. While the state does not require masks, he said the county’s administrative officer and the mayor decided to fine businesses if customers did not wear masks, and most patrons have complied.

“You walk in the door, and you sit down and take your mask off,” Barrineau said, adding he was not sure how big a difference it makes. “If they were waiting in the line outside and the restroom, then they would wear them.”

J.C. Diaz, president of the American Nightlife Association, which represents bars and clubs, said it has been harder for bars to enforce mask-wearing because it has been so politicized. “The problem now is people are not adhering to the mitigation measures,” he said. “We’re doing what we can do to prevent the spread of COVID, but if you are a reckless guest who doesn’t care about the health of others, you shouldn’t be out.”

Masks alone cannot solve the problem, said Dr. Ray Niaura, interim chair of the epidemiology department at New York University’s School of Global Public Health. The risk of contagion is impossible to eliminate at bars, especially since many infected people are asymptomatic. “Even if you distance tables, you’re still going to have groups of people together,” he said.

Megas, the nursing student, said crowds have not deterred her from planning to return to Houston bars despite the continued spread of the coronavirus. “I’ve studied it enough and I think it’s been going on long enough that I’m really comfortable around it,” she said. “There’s a small part of me that is just like ‘I would like to get it now, while I’m not in school.’”

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“I’ve been doing really, really well,” Trondsen said. “I felt like most of it was pretty much — I wouldn’t say ‘cured’ ― but I definitely felt in remission or under control. But this pandemic has been really difficult for me.”

Trondsen, 38, a Costa Mesa, California, therapist who treats those with obsessive-compulsive and anxiety disorders, has found himself excessively washing his hands once again. He’s experiencing tightness in his chest from anxiety — something he hadn’t felt in so long that it frightened him into getting checked out at an urgent care center. And because he also has , he said, he’s finding it difficult to ignore his appearance when he’s looking at himself during his many Zoom appointments with clients each day.

From the early days of the coronavirus outbreak, experts and media have warned of a mounting as people contend with a pandemic that has upended their lives. A recent found that about 4 in 10 adults say stress from the coronavirus negatively affected their mental health. (KHN is an editorially independent program of , the Kaiser Family Foundation.)

But those with and other serious anxieties face uniquely difficult mental health battles, including trying to distinguish concerns brought on by their conditions from general fears shared by the public about COVID-19. People with OCD have discovered one advantage, though: Those who have undergone successful treatment often have increased abilities to .

Dr. Katharine Phillips, a psychiatrist at NewYork-Presbyterian and professor at Weill Cornell Medicine, said it’s possible that patients who have been in consistent, good treatment for their OCD are well protected against the stress of COVID-19.

“Whether it’s excessive fears about the virus, excessive fears about possible repercussions to the virus, whether that’s financial effects ― good treatment protects against relapse in these patients,” Phillips said.

feel compelled to repeatedly perform certain behaviors, such as compulsive cleaning, and they may fixate on routines. OCD can also cause nonstop intrusive thoughts.

Carli, who asked that her last name be withheld because she feared professional repercussions, can trace her OCD to age 6. The coronavirus pandemic has sent Carli, a 43-year-old from Jersey City, New Jersey, into a spiral. She’s afraid of the elevators in her building, so she doesn’t leave her apartment. And she’s having trouble distinguishing an OCD compulsion from an appropriate reaction to a dangerous pandemic, asking those without OCD how they’ve reacted.

“The compulsions in my head have definitely gotten worse, but in terms of wearing a mask and cleaning my groceries and going into stores, it’s really hard to gauge what is a normal reaction and what is my OCD,” Carli said. “I try to ask people, Are you doing this? Are you doing that?”

Elizabeth McIngvale, director of the McLean OCD Institute in Houston, said she has noticed patients struggling to differentiate reactions, as Carli described. Her response is that whereas guidelines such as hand-washing from the Centers for Disease Control and Prevention are generally easily accomplished, OCD compulsions are usually never satisfied.

McIngvale was diagnosed with OCD when she was 12, with behaviors like taking six- to eight-hour showers and washing her hands for so long they bled. McIngvale receives therapy weekly.

“It’s just a part of my life and how I maintain my progress,” McIngvale said.

Lately, she’s found herself consumed with fears of harming or infecting others with the COVID-19 virus — a symptom of her OCD. But, generally, with the tools she’s gained through treatment, she said she’s been handling the pandemic better than some people around her.

“The pandemic, in general, was a new experience for everybody, but for me, feeling anxiety and feeling uncomfortable wasn’t new,” McIngvale said.

“OCD patients are resilient,” she added. Treatment is based on “leaning into uncertainty and so we’ve also seen patients who are far along in their treatment during this time be able to manage really well and actually teach others how to live with uncertainty and with anxiety.”

Wendy Sparrow, 44, an author from Port Orchard, Washington, has OCD, (fear of places or situations that might cause panic) and post-traumatic stress disorder. Sparrow has been in therapy several times but now takes medication and practices mindfulness and meditation.

At the beginning of the pandemic, she wasn’t fazed because she’s used to sanitizing frequently and she doesn’t mind staying home. Instead, she has felt her symptoms worsening as her home no longer felt like a safe space and her fears of fatal contamination heightened.

“The world feels germier than normal and anyone who leaves this house is subjected to a barrage of questions when they return,” Sparrow wrote in an email.

Depending on how long the pandemic lasts, Sparrow said, she may revisit therapy so she can adopt more therapeutic practices. Trondsen, too, is considering therapy again, even though he knows the tools to combat OCD by heart and uses them to help his clients.

“I definitely am needing therapy,” Trondsen said. “I realized that even if it’s not specifically to relearn tools for the disorders … it’s more so for my mental well-being.”

Carli has struggled with finding the right treatment for her OCD.

But a recent change is helping. As the pandemic intensified this spring, many doctors and mental health providers — and insurers agreed to cover them ― to cut down on the risks of spreading the virus. In April, she started using an app that connects people with OCD to licensed therapists. While skeptical at first, she has appreciated the convenience of teletherapy.

“I never want to go back to actually being in a therapist’s office,” Carli said. “Therapy is something that’s really uncomfortable for a lot of people, including me. And to be able to be on my own turf makes me feel a little more powerful.”

Patrick McGrath, a psychologist and head of clinical services at , the telehealth platform Carli uses, said he’s found that teletherapy with his patients is also beneficial because it allows him to better understand “how their OCD is interfering in their day-to-day life.”

Trondsen hopes the pandemic will bring increased awareness of OCD and related disorders. Occasionally, he’s felt that his troubles during this pandemic have been dismissed or looped into the general stress everyone is feeling.

“I think that there needs to be a better understanding of how intense this is for people with OCD,” he said.

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The found that 48% of Americans said they or a family member has skipped or delayed medical care because of the pandemic, and 11% of them said the person’s condition worsened as a result of the delayed care. (KHN is an editorially independent program of the foundation.)

Medical groups have noted a sharp drop-off in emergency patients across the country. Some, including the American College of Emergency Physicians, American College of Cardiology and American Heart Association, have publicly urged people concerned about their health to seek care.

, president of the , said the anecdotes he’s heard of people delaying care have been troubling, with patients suffering heart attacks or strokes at home. He urged people not to skip going to the emergency room, and pointed out the many safety precautions hospitals are taking to curb the spread of the coronavirus.

“Don’t sit at home and have a bad outcome,” Jaquis said. “We’re certainly there and in many ways very safe, and, especially with low volumes in some places, we’re able to see people quickly. Come on in, please.”

According to the poll, nearly 7 in 10 of those who had skipped seeing a medical professional expect to get care in the next three months.

Despite a significant number of adults saying they delayed care, 86% of adults said their physical health has “stayed about the same” since the onset of the outbreak in the U.S.

Nearly 40% of Americans, however, said stress related to the coronavirus has negatively affected their mental health. Women were more likely than men to say the coronavirus has had a negative impact on their mental health, and those living in urban and suburban areas were more likely to say this than those living in rural areas. Nearly half of those living in households that have experienced income or job loss said the pandemic had a negative effect on their mental health.

The poll further reports on some of the economic consequences of the pandemic. It found that about 3 in 10 adults have had trouble paying household expenses, with 13% expressing difficulty paying for food and 11% paying medical bills. Nearly 1 in 4 adults said they or a family member in the next year will likely turn to Medicaid, the federal-state health insurance program for low-income residents.

Medicaid continues to show strong support among Americans. About three-quarters said they would oppose efforts by their states to cut the program as part of cost reductions.

The poll was conducted May 13-18 among 1,189 adults. The margin of sampling error is +/-3 percentage points for the full sample.

This article first appeared on Ñî¹óåú´«Ã½Ò•îl Health News and is republished here under a .