Network Report Thursday, May 7, 2020 
Recent demographic data suggests huge racial disparities in COVID-19 infections and death. The pandemic has motivated states to develop Crisis Standards of Care (CSC) plans responsive to possible shortfalls in resources, such as ventilators. The emergence of these two circumstances raises the question of how CSC planning might incorporate growing racial justice concerns about COVID-19 and resource allocation. This issue brief examines evidence of racial disparities with respect to COVID-19 infections and deaths, possible causes, and legal protections against race discrimination. It also provides an overview of CSC planning, including key ethical features that may be utilized to ensure that CSC planning incorporates concerns about racial inequity.
Law and Policy Perspectives Legal Changes to Improve Health Outcomes for Undocumented Patients with End-Stage Renal Disease Absent ongoing dialysis treatment or kidney transplantation, end-stage renal disease is a permanent and fatal loss of kidney function. Insured patients typically receive routine dialysis treatment. However, those who are uninsured do not get access to ongoing treatment and are left to rely on life-saving emergency dialysis when their condition worsens. Among this group are thousands of undocumented immigrants who are excluded from purchasing private coverage through state insurance exchanges and who are ineligible for Medicare and non-emergency Medicaid under federal guidelines. While the Emergency Medical Treatment and Labor Act (EMTALA) requires that hospitals provide emergency dialysis to undocumented immigrants, this system of care is detrimental to public health and fiscally inefficient. 
Feeding America, the nation’s largest domestic hunger-relief organization, estimates that the pandemic will force an additional 17.1 million Americans into food insecurity. Food banks across the country have been valiantly working to feed the vulnerable but they are facing pandemic-related barriers to food distribution, including reduced donations and an inability to obtain excess food production directly from farmers. In response to these challenges, the USDA recently announced the Coronavirus Food Assistance Program to allocate funds for the purchase of produce, meat, and dairy products from America’s farmers for distribution to food banks and other organizations serving food insecure Americans. 
Disappearing Public Toilets, Public Health and the COVID19 Pandemic Frequent hand washing is critical to preventing the spread of COVID-19, yet not everyone has easy access to running water. Lack of toilet facilities contributes to a variety of illnesses and can trigger outbreaks of contagious diseases, like Hepatitis A. Along with the homeless, others, including taxi drivers, utility workers, gas and electric service workers, people doing street repair, and people with certain medical conditions can encounter difficulty accessing toilet facilities. Today, access to public toilet facilities is even more restricted in states that have mandated closure of nearly all businesses. However, there are a variety of ways that cities can increase access to clean and safe public toilets.
Resources Federal E-Rate Program for Broadband Services and Internet Access during COVID-19 School Closures Many schools throughout the nation have moved to distance learning in response to the COVID-19 pandemic. Federal programs can help address the digital divide by increasing capacity for schools to provide broadband service or by providing broadband access to students that lack access at home. This FAQ discusses the federal E-Rate program which provides for discounts on broadband and internet services in support of distance learning. 
Effects of Denial of SNAP Benefits on Convicted Drug Felons Federal law bans convicted drug felons from receiving Supplemental Nutrition Assistance Program (SNAP) benefits, which provide low-income individuals with financial assistance to pay for food. The denial of SNAP benefits to people with drug convictions can promote food insecurity and may negatively affect the health of the ex-offender, their family, and their community. A provision of the law allows states to opt out or modify the ban without any reduction in funding. All but seven states have taken action, resulting in a diverse array of SNAP eligibility standards. The issue brief discusses the public health consequences of rescinding nutritional assistance from people with drug convictions. 
Summary of Authority and Actions Regarding Public Health Emergencies: Indiana Public Health Code Indiana’s Public Health Code and Communicable Disease Rules provide an array of actions that state and local health officers can use to respond to a public health emergency. This issue brief is intended to assist health officers and their attorneys by identifying potential actions and linking to the applicable law. Though the details of this document apply only in Indiana, the legal provisions likely have similar counterparts in all other states.
Webinar COVID-19: Legal and Policy Strategies to Promote Mental Health May 21 | 1 - 2:30 p.m. EST The response to the COVID-19 pandemic involves massive disruptions to daily life in the United States. Large-scale illness and loss of life are producing widespread grief. Social distancing and stay at home orders may lead to social isolation and loneliness along with rapidly reconfigured family roles and responsibilities. Economic disruption generates anxiety and challenges in meeting basic needs. What programs, policies, and laws are available to help those seeking to promote skills in self-care, stress management, coping, and resilience in their own workplaces and the broader community? Join us for an overview of the mental health implications of COVID-19 and the role of laws and policies in the initial stages of the mental health response.
Guidance Disclosure of COVID-19 Information by Domestic Violence Agencies or Shelters The COVID-19 pandemic has raised numerous questions with regard to public health reporting requirements. This guidance addresses whether domestic violence agencies or shelters have an obligation to report cases of COVID-19 to a state or local public health department. 
State Legal Authority to Investigate the Spread of Communicable Disease Many states grant broad legal authority to local health departments to investigate the causes and spread of communicable diseases. These powers are often contained in the state’s public health code and communicable disease rules. This guidance provides information on which provisions of state law a local health department can cite to compel sharing of information needed for a communicable disease investigation.
Worth Sharing: Federal vs. State Powers in Rush to Reopen Amid Coronavirus Pandemic James J. Hodge, director of the Network’s Western Region Office, authored this article in Just Security on how the tension between the state and federal government on whether to open businesses and withdraw stay-home orders has revealed a deep rift in American federalism. The article addresses the question as to what powers the president could use to influence state actions whether to impose or lift mitigation measures, and what zone of decisions are designated for the states alone. Using Law and Policy to Promote Breastfeeding in the United States Healthy People 2020 aims to inform policymakers, community organizations and educators about how policy can impact public health. Their newly released report, The Role of Law and Policy in Assisting Families to Reach Healthy People’s Maternal, Infant, and Child Health Breastfeeding Goals co-authored by Leila Barraza, consultant at the Network's Western Region Office, provides information on how public health laws can help improve breastfeeding rates. Reproductive Rights in the Time of COVID-19: State Directives Exploiting a Public Health Crisis April Shaw, staff attorney with the Network’s Western Region Office, co-authored this article in the Harvard Law & Policy Review on the constitutional issues and health impacts of state directives that include surgical and medical abortions among the “nonessential” surgeries and procedures prohibited during the COVID-19 pandemic. COVID-19 Housing Policy Scorecard To better understand the steps states have taken to prevent homelessness during and after the pandemic, the Eviction Lab and Columbia Law School Professor Emily Benfer have developed a policy scorecard for each state, distilling the contents of thousands of newly-released emergency orders, declarations, and legislation into a clear set of critical measures included in, and left out of, state-level pandemic responses related to eviction and housing. The Network was among the partners who contributed guidance in crafting the methodology of the scorecard.
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Thank you! Your interest in the work of the Network is important. Together, we can advance law as a tool to improve public health. Please forward the Network Report and encourage others to join the Network! The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this document does not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state.
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