In the middle of March, while many Americans were panic-buying milk and toilet paper, Michael Redmond had other things on his mind: how to safely house the dozens of people who rely on his organization for a bed to sleep in every night.<\/p>\n
The executive director of the Upper Valley Haven social service agency in White River Junction, Vermont, had read the reports that the new coronavirus could easily circulate among people living in close proximity \u2014 retirement homes, prisons, or homeless shelters like his.<\/p>\n
So he contacted the state to ask for advice. \u201c\u2018Don\u2019t worry,\u2019\u201d he recalls an official telling him. \u2018\u201cWe\u2019ve entered into contracts with local motels. If you feel you can\u2019t operate your shelter, everyone can be given a room in a motel.\u2019\u201d <\/p>\n
Within days, Redmond was able to cut the number of beds in his shelter to reduce crowding and divert additional clientele to state-subsidized motel rooms. His nonprofit also organized outdoor dining and meal deliveries to further support social distancing.<\/p>\n
Eight months into the pandemic, Redmond has seen no Covid-19 cases among his patrons. Overall, there have been fewer than six cases in Vermont\u2019s homeless population, according to the state health department. That\u2019s far less than a 1 percent infection rate \u2014 a stark contrast with the 25 percent infection rate among the homeless across the US. <\/p>\n
Vermont has also remained an island of low coronavirus spread generally. Even with a recent surge \u2014 from fewer than 10 cases per day in September to 57 on November 18 \u2014 it\u2019s consistently had one of the lowest infection rates in the continental US: 14.6 cases per 100,000 in the last seven days compared to 27 in New York, 74 in Georgia, 84 in Colorado, and 185 in North Dakota. Anthony Fauci, the nation\u2019s top infectious disease doctor, has called Vermont \u201ca model for the country.\u201d <\/p>\n
Researchers studying Covid-19 policy say Vermont\u2019s successes are inextricably linked to its approach to helping at-risk groups avoid the virus. \u201cVermont\u2019s prioritization of its vulnerable populations has helped both to protect those [people] from the worst outcomes we\u2019ve seen in other settings but also contributed to the much lower transmission rates in the state,\u201d said Anne Sosin, the program director of Dartmouth College\u2019s Center for Global Health Equity. <\/p>\n
\u201cIf we look globally,\u201d Sosin continued, \u201cthe countries that have done better [with Covid-19] prioritized their vulnerable populations.\u201d <\/p>\n
Vermont\u2019s health leaders recognized this very early in the pandemic. And instead of relying only on stay-at-home orders or curfews \u2014 which tend to benefit people who can work from home or fully isolate if they test positive \u2014 the government designed a response with the needs of high-risk groups in mind. <\/p>\n
The package of measures now includes state-supported housing for the homeless, hazard pay, meal deliveries, and free, pop-up testing in at-risk communities. The state\u2019s Republican governor, Phil Scott, is even proposing $1,000 stipends for people who\u2019ve been asked to self-isolate.<\/p>\n
Most states have \u201cbeen using really blunt public health and policy measures to respond to the pandemic,\u201d Sosin said. Vermont highlights a different way. When governments \u201ctailor responses to the needs of our most vulnerable populations,\u201d she added, \u201cwe can stop the virus and save lives.\u201d <\/p>\n
Covid-19 is not an equal-opportunity disease. Covid-19 policies haven\u2019t reflected that. <\/p>\n
There\u2019s a fatal flaw embedded in the basic Covid-19 test, trace, and isolate trifecta used around the world: It doesn\u2019t account for the fact that the coronavirus is not an equal-opportunity pathogen. The people who are most likely to be tested, and to have the easiest time quarantining or isolating, are also the least likely to get sick and die from the virus. <\/p>\n
From the United Kingdom to Sweden to Canada, we have evidence that the virus preys on people employed in \u201cessential service\u201d jobs (bus drivers, nurses, factory workers), which don\u2019t allow for telecommuting or paid sick leave; people in low-income neighborhoods; and people in \u201ccongregate housing\u201d like shelters, prisons, and retirement homes. <\/p>\n
People of color tend to be overrepresented in these groups \u2014 but there\u2019s no biological reason they\u2019re more likely to get sick and die from the virus. Simply put: They tend to work jobs that bring them outside the home and into close contact with other people, live in crowded environments ideal for coronavirus contagion, or both. <\/p>\n
\u201cMy guess is that the only globally consistent finding about Covid-19,\u201d Stefan Baral, an associate professor at the Johns Hopkins Bloomberg School of Public Health, said, \u201cwill be an inverse relationship between Covid-19 incidence and the square feet per person per household.\u201d <\/p>\n
This means that, even when social distancing orders are in place, because of an individual\u2019s work or living circumstances, they may be less able to physically distance. If they test positive, they may not be able to isolate. <\/p>\n
The Green Mountain State has features that might have helped in this regard: It\u2019s more rural and less dense than many other areas in America. <\/p>\n
But focusing on Vermont\u2019s size or rurality misses important lessons in what the state did right during the pandemic, said Sosin, who has studied the state\u2019s Covid-19 response. Vermont also has attributes that put people there at higher risk. The state borders New York, home to America\u2019s deadliest outbreak, and ranks fourth in the nation for the largest percentage of people age 65 and older, and last when it comes to ICU beds per capita. Other even smaller states, like Wyoming, or more rural places, like the Dakotas or Nebraska, are grappling with some of the worst outbreaks in America. <\/p>\n
So what\u2019s the key to Vermont\u2019s success? It\u2019s pretty simple, Sosin said. Instead of just talking about how \u201csocial distancing is a privilege,\u201d leaders in the state designed programs and policies to overcome barriers to social distancing. <\/p>\n
How Vermont kept its coronavirus rate low <\/p>\n
Vermont\u2019s governor was quick to shut down when the virus began surging in neighboring New York, closing schools in mid-March and issuing a stay-at-home order a week later. But the approach to helping people keep their distance and then reopen was much more nuanced \u2014 and involved everyone from the state and municipal governments to nonprofit workers and volunteer community groups. <\/p>\n