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COVID-19, Masks, and the ACA: 7 Takeaways from the Presidential Debate

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President Donald Trump and Joe Biden faced off in a heated debate on September 29. Jim Watson/Getty Images
  • The heated presidential debate between Donald Trump and Joe Biden touched on key health issues.
  • Both candidates talked about the COVID-19 pandemic, vaccines, and the Affordable Care Act.
  • We spoke to experts about seven key health issues brought up during the debate.

The presidential debates kicked off Tuesday night with a heated and at times chaotic discussion between President Donald Trump and Democratic nominee Joe Biden.

The debate, which lasted 90 minutes and was hosted by Fox News anchor Chris Wallace, touched upon six topics, including the handling of the pandemic and the Supreme Court nomination’s potential impact on our healthcare system.

The candidates addressed the effectiveness of masks, when we’ll see a vaccine, a path toward reopening the country, and the future of the Affordable Care Act.

Here are seven key health takeaways from Tuesday’s debate:

The ACA was passed in 2010 with the goal of providing affordable health coverage to millions of Americans, bringing the uninsured rate to a historic low by 2016.

The Trump Administration is suing to overturn the law in the Supreme Court, which could happen if Amy Coney Barrett, a conservative judge who Trump nominated to replace Justice Ruth Bader Ginsberg, is appointed to the court.

Biden, on the other hand, wants to expand and improve upon the ACA. Without the ACA, millions of people, particularly those with preexisting health conditions, would lose coverage.

This would all take place during the pandemic, in which people with underlying health conditions, like diabetes and heart disease, are more at risk for severe illness from COVID-19. Millions of people, too, have lost employer-sponsored insurance during the pandemic.

Without insurance, people often delay care “until they are so sick that they end up in the ICU and require very expensive care,” explains Dr. Dean Winslow, an infectious disease physician at Stanford Health Care.

“This is a totally frightening threat to our public health — that people might not be able to access help when they need it because they become un- or under-insured, or that they go into massive debt to cover the costs of COVID-related hospitalization,” says Dr. Jaimie Meyer, an associate professor of medicine (section of infectious diseases) at Yale School of Medicine.

Biden spoke to the power of masks, citing the statistic that an estimated 100,000 lives could be saved by the end of the year if we all wore masks. Trump said he’s “fine with masks” but that he only wears them when “it makes sense.”

Winslow, a former military officer who teaches a class on moral and ethical leadership at Stanford, says “a good leader ‘leads from the front,’ ‘walks the walk,’ and sets an example for his/her troops.” People look to our leadership for guidance and follow by example.

The truth of the matter is that masks save lives, especially when it comes to a virus we have no vaccine for. Masks protect not just the person wearing it, but those around them too, according to Dr. Howard Forman, a professor of public health (health policy) at Yale School of Public Health.

“We know that many infections are spread by infected individuals who have no symptoms. Mask wearing is not the only way to mitigate this outbreak, but it is one of the simplest ones and something that we all have easy access to,” Forman said.

Trump said he wants to keep the country open and that more people’s lives would be hurt from further lockdowns, whereas Biden said he wants to help support and fund businesses and schools so they can open with the proper personal protective equipment (PPE) and sanitation.

According to Forman, in order to open schools safely, the country needed to lower transmission down to a safe, low level and allocate “dollars so that states and municipalities could afford both the staffing and materials required to maintain social distancing and safety and health,” Forman said.

Meyer says reopenings need to be executed on a local level and take into consideration the test positivity rate, the population-based case rate, the hospitalization rate, and the death rate.

“It would be a mistake to fully reopen schools and businesses in places where levels of community transmission are high and businesses are ill-equipped to implement (and enforce) preventive measures,” Meyer said.

During the debate, Trump took a dig at Biden regarding his handling of the swine (H1N1) flu outbreak in 2009, claiming 14,000 people (in truth, its 12,469) died under his leadership.

Forman says though the swine flu vaccination effort was not well handled, and a number of deaths likely could have been avoided, during the COVID-19 pandemic over 200,000 Americans have died. Additionally, he pointed out that hundreds of thousands of lives could have been saved if the current pandemic was handled better.

It’s worth noting H1N1 was much less contagious than COVID-19. It’s also believed that some older people carried a bit of immunity to the strain. People with swine flu passed it to 1.6 others on average, whereas people infected with COVID-19 may pass it up to five, sometimes 10 others in certain situations, according to Meyer.

Scientists were also able to repurpose the existing flu vaccines for the H1N1 strain and use safe, effective antiviral medications. With COVID-19, there is no vaccine to work off of and there are fewer treatment options available, explains Meyer.

Biden said a vaccine will be distributed sometime around the middle of next year, whereas Trump stated the vaccine’s timing has been politicized and that we can move faster and distribute doses by early November.

The process to test, manufacture, and distribute a vaccine is a lengthy one. Scientists are still waiting on critical information from phase 3 testing about the vaccine before it can go to market such as how long immunity lasts, how effective it is, and what the long-term safety is like.

Winslow expects all of the vaccines being tested in the United States to be safe but vary in efficacy, but we need to complete the ongoing phase 3 trials before confirming those assumptions. More realistically, that looks like a vaccine will be widely available around the middle of next year.

“You can’t hurry the results,” Winslow said.

Trump has held several rallies, indoors and outdoors, and claims there hasn’t been a problem. Biden rebuked, saying it’s very irresponsible to host a rally during the pandemic when distancing and masking is crucial.

When it comes to contracting COVID-19, researchers have found that indoor spaces are much riskier than outdoor environments.

“Most ‘superspreader events’ world-wide have been related to indoor exposure,” Winslow said, noting it’s irresponsible to host indoor events without distancing and masks. We’ve seen how a room full of people can get infected indoors if just one person carries the coronavirus (see: the choir practice in Skagit County, Washington).

“When our elected leaders behave contrary to public health and science, this sends the public mixed and confusing messages about how they should behave,” Meyer said.

COVID-19 has hit communities of color, including Black and Hispanic people, the hardest. During the debate, Biden said 1 in 1,000 Black Americans have died during the pandemic and by the end of the year, 1 in 500 African Americans could have been killed by COVID-19.

The pandemic has exposed the many issues in our healthcare system — Black people are more likely to have an underlying condition increasing their risk for severe COVID-19, and they’re less likely to have access to healthcare.

“Black communities have not been disproportionately infected and affected by COVID-19 because of biology, but rather because of our social and cultural constructions of race that drive health disparities,” Meyer said.

The presidential debates kicked off Tuesday night with a heated discussion with President Donald Trump and Democratic nominee Joe Biden. The candidates addressed the handling of the pandemic, use of masks, future of the Affordable Care Act, and race for a vaccine.