The U.S. coronavirus outbreak continues with over 3 million confirmed cases as more states reported record numbers of new infections, and Florida faced an impending shortage of intensive care unit hospital beds. Additional hospitalizations could strain healthcare systems in many areas, leading to an uptick in deaths from the respiratory illness that has killed more than 131,000 Americans since the pandemic began and many survivors are grappling with long-term complications. Authorities have reported alarming increases of daily caseloads in roughly two dozen states over the past two weeks, a sign that efforts to control transmission of the novel coronavirus have failed in large swaths of the country.
Last week, the country averaged just under 50,000 new cases daily — the highest rate recorded, and twice as high as a month ago. An influential coronavirus model has increased its projections for US deaths and it’s now forecasting more than 208,000 deaths by November. Experts say that face masks could save as many as 45,000 US lives by November if 95% of the population wears a covering in public, according to the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, which built the model.
California, Hawaii, Missouri, Montana, Oklahoma and Texas shattered their previous daily record highs for new cases. California reported more than 10,000 coronavirus cases in one day, a record rise for a single day that also surpassed the number of contact tracers recently trained by the state to detect and prevent potential outbreaks. About 24 states have also reported disturbingly high infection rates as a percentage of diagnostic tests conducted over the past week. New COVID-19 infections have risen in 42 states in the past two weeks. Only three other U.S. states have reported more than 10,000 cases in a day. Florida reported 11,458 new cases on July 4 and Texas reported 10,028 on July 7.
At least 56 intensive care units in Florida hospitals had reached capacity on July 7, state officials said. Another 35 hospitals show ICU bed availability of 10% or less, according to the Agency for Health Care Administration in that state. Georgia surpassed 100,000 reported coronavirus cases, becoming the ninth state to pass the mark. In California, the number of hospitalizations across the state were at an all-time high and the virus positivity rate jumped more than 2% in Los Angeles.
New York recorded 12,847 new infections on April 10, three weeks after the state implemented a strict lockdown that closed most businesses. Once the epicenter of the U.S. epidemic, New York saw cases rise by about 6% in June – the lowest rate in the entire country. In Texas, the number of hospitalized patients has more than doubled in just two weeks. The U.S. Department of Health and Human Services said it was adding short-term “surge” testing sites in three metropolitan areas in Florida, Louisiana and Texas.
Affecting nearly one of every 100 Americans, the surge has forced authorities to backpedal on moves to reopen businesses, such as restaurants and bars, after mandatory lockdowns in March and April reduced economic activity to a virtual standstill and put millions of Americans out of work.
Governors and mayors in many states have ordered people in hotspot counties to wear face coverings in public. Recently published research found that on average, the time from exposure to symptom onset (known as the incubation period) is about five to six days. However, studies have shown that symptoms could appear as soon as three days after exposure to as long as 13 days later. That is why contact tracing is so important in controlling the spread of the coronavirus although in parts of the south and southwest, cases are now rising so quickly that experts are warning contact tracing isn’t possible any more.
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Several thousand cars flooded the streets around the state Capitol in Lansing, Mich. to protest the governor’s extended stay-at-home order. Operation Gridlock, as the protest was named, was conceived as a drive-in protest that would block Lansing streets. Organizers said they support some coronavirus restrictions around social distancing, but believed Whitmer has gone too far. As such, they say they planned a protest that would still maintain social distancing guidelines — without contributing to the spread of infection.
At least 200 people broke from the instructions of organizers, getting out of their vehicles to congregate around the steps of the Capitol building, flouting social-distancing guidelines to remain 6 feet apart, and not wearing masks. Many mask-less protesters, some of whom flew Confederate flags and open-carried AR-15 and AK-47 variants, gathered to demand an end to outbreak-reduction efforts and a premature return to normalcy.
The state of Michigan has the third-highest number of COVID-19 cases, 32,000 and over 2,400 deaths. Gov. Gretchen Whitmer has faced a steady drumbeat of criticism for issuing one of the most stringent stay-at-home orders. Among other things, it bars landscapers from working and shutters many greenhouses and nurseries. She extended her original order last week to now end April 30th. The new version of the order banned travel between homes. As of Monday, more than a quarter of the state’s workforce had filed for unemployment benefits. Southeast Michigan and Detroit remain a hot spot — claiming the lion’s share of COVID-19 cases and deaths. Detroit has more than 7,700 positive cases.
Over the past 10 days, the number of patients hospitalized with COVID-19 dropped 6.7%, to 3,374. During the same period, the number of patients on a ventilator decreased from 1,441 to 1,102, a 24% decline, according to data from the Michigan Department of Health and Human Services. Dr. Joneigh Khaldun, the state’s chief medical officer, attributed the progress to the governor’s March 24 stay-at-home order that was previously extended to April 13.
Whitmer is expected to extend her stay-at-home order, which expires at the end of the month, until there is a larger testing capacity and a significant decline in the number of new cases and deaths. Although the numbers are declining, dozens of people are still dying each day. Some counties that have been hard hit are seeing a decline in new cases but the number of deaths continue to rise.
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The U.S. Coast Guard has recovered all but one body after a commercial diving boat named the Conception, caught fire in the early hours of Monday morning off the coast of Santa Cruz Island in Southern California. The only survivors were five crew members of the 75-foot vessel who were sleeping on or above deck. All 33 passengers and one crew member sleeping below deck at the time of the fire were killed in horrific disaster. Authorities have yet to determine the cause of the fire.
The boat and company, Truth Aquatics Inc., are well-known in the tight-knit Southern California diving community, which is now reeling from the horrific maritime tragedy that killed teenagers, families, veteran divers, and one crew member, who were wrapping up a three-day scuba diving trip. Divers were inspecting the ship’s wreckage with plans to raise it from the ocean floor, but that process may be complicated by forecast high winds in the coming days.
The surviving crew members told a harrowing story of their frantic attempts to save the passengers trapped below deck in a bunk room already engulfed in flames. One member of the crew told of hearing a noise from his bunk on the wheelhouse deck of the Conception and that when he opened the door of the wheelhouse, he saw flames erupting from the galley area but never heard smoke alarms. He told investigators he tried to get down a ladder but flames had engulfed the ladder.
Scrambling, the other crew members jumped from the bridge of the boat to the main deck. One person broke their leg doing so. They then rushed to the galley’s double doors to try and reach the passengers below, but the fire was already too intense.
At around 3:15 a.m., the captain made a frantic mayday call to authorities, telling them that the boat was engulfed, 33 people couldn’t escape, and “there’s no escape hatch for any of the people on board.” At that point, due to heat, flames, and smoke, the crew had to jump from the boat. Two crew members swam to the back of the Conception to get the inflatable skiff, then collected the others and made it to a nearby fishing boat, the Grape Escape.
Shirley Hansen, owner of the Grape Escape, said that she and her husband awoke at 3:30 a.m. to “horrific pounding” and a group of distraught, wet men, some injured and just in their underwear. Once on the Hansen’s boat, the men tried to call 911 for rescue and two crew members then took the dinghy boat back to the Conception to try and rescue any survivors but there were none. The Hansen’s said you could hear explosions from the engulfed diving boat every couple of minutes.
Officials have been looking at the dive boat’s maintenance and inspection records, which the Coast Guard said were up to date, and trying to understand if the 34 victims who had been sleeping in rows of narrow bunks even had a chance to escape. Officials are using advanced DNA technology to identify the victims. None of the names of the dead, who ranged in age from 17 to 60, have been publicly released by authorities but friends and family have confirmed who was on the boat. Among the victims were a family of five, a teacher and his daughter, and a diving instructor and marine biologist.
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Louisiana investigators say confessed serial killer Samuel Little from Lorain, may be linked to two more unidentified cold case victims in the state. Little has drawn haunting portraits from memory of women the FBI believes he murdered. The FBI has released the pictures in hopes some of the victims can be identified. Little, 78, says he killed 94 women from 1970 to 2005. Police have confirmed more than 36 cases so far, a tally that puts Little among the deadliest serial killers. He pled guilty to a Texas woman’s death in January and has been convicted in the deaths of three women from California.
Little was arrested on September 5, 2012, at a homeless shelter in Louisville, Kentucky, after authorities used DNA testing to establish that he was involved in the murder of Carol Elford, killed on July 13, 1987; Guadalupe Apodaca, killed on September 3, 1987; and Audrey Nelson, killed on August 14, 1989. All three of their bodies were found dumped in the streets of LA. He was extradited to Los Angeles, where he was charged on January 7, 2013. He was sentenced to life in prison without the possibility of parole in September 2014.
Months later, police said that Little was being investigated for involvement in dozens of murders committed across 14 states between 1970 and 2005. On November 9, 2018, Little confessed to the 1996 fatal strangulation of Melissa Thomas. In December 2018, Little pled guilty to the 1994 murder of Denise Christie. confessed to the 1979 murder of 23-year-old Brenda Alexander whose body was found in Phenix City. Little also confessed to the 1977 murder of an unidentified woman and the 1982 strangling murder of 18-year-old Fredonia Smith.
According to authorities, he also confessed to the 1982 murder of 55-year-old Dorothy Richards, the 1996 murder of 40-year-old Daisy McGuire, the 1978 murder of 36-year-old Julia Critchfield, the 1978 murder of 19-year-old Evelyn Weston, the 1982 murder of 20-year-old Rosie Hill and the 2005 murder of 46-year-old Nancy Carol Stevens. Police have linked him to the 1981 murder of 23 year old Linda Sue Boards. He has also been linked to two murder victims who remain unidentified.
Little confessed to strangling all his victims and dumping their bodies in wooded areas. Without a gunshot or knife wound, many of the deaths were blamed on overdoses or accidents and murder investigations were never opened. The victims were often involved in prostitution or addicted to drugs and their bodies sometimes went unidentified. According to the FBI, Little remembers his victims and the killings in great detail. He remembers where he was and what car he was driving but is less reliable with remembering dates.
Little began making the confessions in exchange for a transfer out of the Los Angeles County prison in which he was being held. The FBI says Little is in very poor health and will stay in prison until his death. He uses a wheelchair, and suffers from diabetes and a heart condition. Little has confessed to dozens of murders and has drawn 26 portraits of some of his alleged victims. One of his victims has been identified from the portraits so far. Martha Cunningham of Knox County, Tennessee who was 34 years old when Little murdered her in 1975. The agency is releasing these photos now to identify his victims and provide closure and justice in unsolved cases. If you have any information that can help, call 800-634-4097.
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A Tennessee woman who was convicted as a teenager for killing a man while she said she was a sex trafficking victim, was granted clemency. Cyntoia Brown, now 30, was granted a full commutation to parole by Governor Bill Haslam and will be eligible for release Aug. 7 after serving 15 years in prison. She will remain on parole for 10 years. Brown was tried as an adult and convicted of first-degree murder and aggravated robbery. In 2006, she was sentenced to life for the death of Johnny Mitchell Allen, who paid Brown for sex.
Her case gained national attention and awareness about the toll of human trafficking. At the time, Brown had run away from home and was living with her 24-year-old boyfriend, a pimp known as “Kut Throat,” who Brown said raped her and forced her into prostitution. According to Brown, on the night of August 6, 2004, Brown, then 16-years-old, met Johnny Mitchell Allen, a 43-year-old real estate broker and US Army veteran, in the parking lot of a Sonic Drive-In in Nashville. Brown agreed to have sex with Allen for $150. The two then ordered dinner and Allen drove them to his home.
At some point during the evening, Brown shot Allen in the back of the head with a .40-caliber handgun. Brown said she feared for her life and shot Allen, 43, while in bed with him because she believed he was reaching for a gun. She then stole $172 in cash, several firearms, and a vehicle, a Ford F150. She drove the stolen truck to InTowne Suites where she was living with her pimp.
During her trial, prosecutors argued the motive was robbery and say Allen was shot as he slept. Brown’s supporters and lawyer have argued her sentence was too extreme, given her age and circumstances. Nashville police detective Charles Robinson testified that she told investigators she shot Allen because she feared for her life. In a letter dated Dec. 12, 2017, Robinson urged Haslam not to grant clemency to Brown. “First and foremost, Cyntoia Brown did not commit this murder because she was a child sex slave as her advocates would like you to believe. Cyntoia Brown’s motive for murdering Johnny Allen in his sleep was robbery.” Among the evidence cited by Robinson, was how Allen’s “arms were folded underneath his head and his fingers were interlocked together,” which was inconsistent with Brown telling investigators he was reaching for a gun.
Haslam said in a statement that the decision comes after careful consideration of “what is a tragic and complex case. Cyntoia Brown committed, by her own admission, a horrific crime at the age of 16. Yet, imposing a life sentence on a juvenile that would require her to serve at least 51 years before even being eligible for parole consideration is too harsh, especially in light of the extraordinary steps Ms. Brown has taken to rebuild her life.”
While in prison, Brown has earned a GED and an associate degree in 2015 through the Lipscomb Initiative for Education Program with a 4.0 GPA, Haslam said. Brown said she is scheduled to earn her bachelor’s degree in May. Brown said she is committed to live the rest of her life helping others, especially young people. “My hope is to help other young girls avoid ending up where I have been,” she said.
Brown thanked the governor and her supporters in a statement released by her attorneys. “Thank you, Governor Haslam, for your act of mercy in giving me a second chance,” Brown said. “I will do everything I can to justify your faith in me.” Brown said she is grateful for the support, prayers, and encouragement she has received, including from Tennessee Department of Corrections officials.
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The actor Kevin Spacey has been charged with felony sexual assault for allegedly sexually assaulting a teenager in a bar in Massachusetts in 2016. A public show-cause hearing was held for the case Dec. 20 where Clerk Magistrate Ryan Kearney issued a criminal complaint for the charge against Kevin S. Fowler, also known as Kevin Spacey. Spacey is due in court on January 7 to face the felony charge that could bring him up to five years in prison. Spacey has denied the charges.
The alleged assault on a male victim took place at a Nantucket bar in July 2016. Last year, former Boston TV news anchor Heather Unruh held a press conference to share her son’s allegation of sexual assault against Spacey. She stated that her then 18-year-old son said was sexually assaulted by Spacey inside the Club Car Restaurant on Nantucket. Unruh says her son was not of legal drinking age but had told Spacey he was and that the actor bought him drink after drink after drink. “My son was a starstruck, straight 18-year-old young man who had no idea that the famous actor was an alleged sexual predator or that he was about to become his next victim,” she said at the time. “When my son was drunk, Spacey made his move and sexually assaulted him.”
The Nantucket Police Department began its criminal investigation in November 2017, said Massachusetts attorney Mitchell Garabedian, the attorney for the alleged victim. The department has since transferred the case to the district attorney’s office. Garabedian said in a statement, “The complainant has shown a tremendous amount of courage in coming forward. Let the facts be presented, the relevant law applied and a just and fair verdict rendered.” Multiple men have come forward with accusations of sexual assault and harassment against Spacey since October 2017, which prompted Netflix to abruptly cut ties with and drop the actor from its hit political drama House of Cards. Spacey is still under investigation in Los Angeles and in England for other alleged sexual assaults.
Soon after the charges were filed against Spacey, the actor posted a bizarre video to his Twitter account where he portrays his House of Cards character Frank Underwood. The actor addresses his House of Cards fate while also saying that he knows his fans want him back. “I know what you want,” Spacey begins in Frank’s accent. “Oh sure, they may have tried to separate us, but what we have is too strong, too powerful. After all, we shared everything, you and I. I told you my deepest, darkest secrets. I showed you exactly what people are capable of. I shocked you with my honestly, but mostly I challenged you and made you think. And you trusted me, even though you knew you shouldn’t. So we’re not done, no matter what anyone says. And besides, I know what you want. You want me back.”
“Of course, some believed everything and have been just waiting with bated breath to hear me confess it all. They’re just dying to have me declare that everything said is true and that I got what I deserved. Only you and I both know it’s never that simple, not in politics and not in life,” he says. “All this presumption made for such an unsatisfying ending, and to think it could have been such a memorable sendoff.” He goes on to say that in both life and in art, nothing should be off the table: “I can promise you this. If I didn’t pay the price for the things we both know I did do, I’m certainly not going to pay the price for the things I didn’t do.” Spacey ended the 3 minute video by directly calling out his death on House of Cards. The actor puts on Frank’s signature ring before walking off. “My confidence grows each day that soon enough, you will know the full truth,” he says. “Wait a minute, now that I think of it, you never actually saw me die, did you? Conclusions can be so deceiving.”
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After weeks of denials and shifting narratives on the whereabouts of missing journalist Jamal Khashoggi, the government of Saudi Arabia has finally admitted that Khashoggi is dead. Khashoggi entered the Saudi Consulate in Istanbul on October 2 and was never seen again. Saudi officials now say Khashoggi was killed in a “fistfight” inside the consulate and that 18 Saudis had been arrested in connection with the death.
Turkish officials still maintain that Khashoggi was tortured, murdered and dismembered by a squad of 15 Saudi hit men shortly after entering the Saudi Consulate in Istanbul. They claim that audio and video recordings show Saudi officials used a bone saw to dismember Khashoggi’s body. They maintain that it was a premeditated hit carried out by a squad of hit men and that one of the men was a forensic specialist specifically brought in to conceal the crime.
CNN aired CCTV footage obtained from the Turkish authorities, showing the Saudi agent Mustafa Mohammed Madani, a member of the 15-man team, leaving the consulate by the back door. Madani was dressed in Khashoggi’s clothes, aside for mismatched shoes. He had also put on a fake beard that resembled Khashoggi’s facial hair, his glasses and his Apple Watch. Madani, who was of similar age, height, and build to Khashoggi, left the consulate from its back door and was later seen at Istanbul’s Blue Mosque, where he went to a public bathroom and changed back to his own clothes and discarded Khashoggi’s clothes.
The body double footage bolstered Turkish claims that the Saudis always intended either to kill Khashoggi or move him back to Saudi Arabia. Anonymous Turkish officials believe that Madani was brought to Istanbul to act as a body double and that “You don’t need a body double for a rendition or an interrogation. Our assessment has not changed since October 6. This was a premeditated murder, and the body was moved out of the consulate.”
An anonymous Saudi official claims Khashoggi had been threatened with kidnapping by Maher Mutreb and when he resisted, he was restrained with a chokehold, which killed him. Madani then left the consulate through the back door dressed in Khashoggi’s clothes. Khashoggi’s body was rolled up in a carpet and given to a “local cooperator” for disposal. The official claims it was Mutreb who overstepped by threatening a kidnapping and accidental killing. The team then filed a false report indicating they let Khashoggi leave after he warned of Turkish police interference. The official provided Saudi documents indicating the operation was part of a wider initiative to bring expatriate dissidents home and the original plan was to keep Khashoggi in an Istanbul safe house for a period where he would be persuaded to return home or eventually released. Many have been skeptical of their claims and still believe the Crown Prince Mohammed bin Salman ordered the hit.
Saudi officials again changed their story after Saudi Arabia’s attorney general said that evidence shared by Turkish officials suggests that the killing was premeditated. They now admit that the killing was premeditated and carried out by a rogue team, still maintaining that Crown Prince Mohammed bin Salman had no prior knowledge of the killing. Turkish President Recep Tayyip Erdogan has directly accused Saudi Arabia of the premeditated murder, calling it a political killing orchestrated by Saudi officials. Erdogan urged Saudi Arabia to disclose who ordered the murder of Saudi journalist Jamal Khashoggi, as well as the identity of a “local cooperator” involved in the murder plot. He also called for the Saudi suspects to be tried in Turkey. Erdogan said Turkey has more information about the case than it has shared so far, suggesting he could release more details if the Saudis refuse to reveal vital information.
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On July 19th, seventeen people died after a Missouri duck boat capsized and sunk on Table Rock Lake in Branson, Missouri. The boat, with 31 people aboard, sank around 7pm Thursday evening after it left for a ride on the lake that was hit by a thunderstorm generating near-hurricane strength winds. Witnesses captured video of two of the Ride the Ducks vessels being tossed around by waves as they struggled to make it back to land, only one made it back safely. One video shows water from the waves entering the craft before it capsized (rolled over onto its side) and then sank below the waves. It is believed the boat sunk in 40 feet of water, rolling as it sank, before landing on its wheels in 80-feet-deep lake water.
Duck boats are amphibious vehicles equipped with wheels and propellers that can be driven on roadways or on water. With a push of a lever, the vehicle can switch from being wheel-driven to relying instead on the rear-mounted propeller. Originally built to transport troops during WWII, they are now popular in many tourist areas with large bodies of water. The 17 victims in the tragedy ranged in age from 1 to 76 years with nine victims from the same family. None of the victims were wearing life jackets when found. There were life jackets on the boat but passengers weren’t required to wear them.
The National Transportation Safety Board recorded wind readings of 73 mph which were estimated to cause waves that rose to around 4 feet, with a possibility of 6-foot crests. An investigation into the cause of the tragedy and why the Ride the Ducks boat entered the lake despite severe thunderstorm warnings for the area. Branson is about 200 miles from Kansas City, and is considered a major family vacation destination. The town was under a severe thunderstorm warning issued about half an hour before the boat capsized.
Tia Coleman and 10 of her relatives were on a family vacation from Indiana. Her husband, her three children and five other members of her family died in the accident. Their names were: Angela, 45; Arya, 1; Belinda, 69; Ervin, 76; Evan, 7; Glenn, 40; Horace, 70; Maxwell, 2; and Reece, 9. Only Tia and her 13 year old nephew Donovan survived when the boat sank. The other victims included the driver of the duck boat, Robert Williams, 73; Steve Smith, a retired teacher from Osceola, Arkansas, and his teenage son, Lance; William and Janice Bright, a married couple from Higginsville, Missouri; William Asher and his partner, Rosemarie Hamann from Missouri; and Leslie Dennison from Illinois.
Tia Coleman, one of the 14 survivors, said passengers were told there was a storm coming before the trip and that they would alter their route to tour the lake before the storm hit. During an emotional interview from her hospital bed she said that the captain mentioned the life jackets before they went on the lake but said, “you won’t need them so we didn’t grab them, nobody did.”
She described the amphibious vessel being hit by waves and taking on some water. She said that immediately after a large wave went over the vessel, they were plunged under water where she couldn’t see or hear anything but felt her head hitting the top of the craft. Passengers were unable to make an immediate escape as the craft sank because the sides of the craft are windows with a canopy top. Once the canopy top gave way, some were able to swim to the surface as the craft continued to sink in the murky later water.
Vacationers and employees of a nearby dining showboat immediately began throwing life preservers, and life rafts into the water. Others jumped in and pulled people out of the water. Several people nearby with medical training tried unsuccessfully to revive unresponsive victims. Rescuers searched late into the night for survivors before calling it off due to poor visibility. The searching resumed the next morning until the remaining victims were found.
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JAMA Forum: How Will President Trump’s Policies Affect Domestic and Global Health and Development?
By Lawrence Gostin, JD on January 11, 2011
Donald Trump’s election to the US presidency marks a time of global transition, with singular importance to health. The world is witnessing the rise of populist movements characterized by concerns about trade, immigration, globalization, and international organizations. These seismic events could have profound effects on health and development in the United States and globally.
There is still a great deal we don’t know about the policies of a Trump administration, and how those policies will unfold in a constitutional system of checks and balances. Trump has not laid out specific details on major domestic policies, such as reforms related to the Affordable Care Act (ACA) or reproductive rights. Even less well understood are his views on global health issues, such as health assistance, the Paris Climate Change Agreement, and the World Health Organization (WHO).
Based on Trump’s earlier statements, what can we expect for 2017 and beyond?
The Affordable Care Act
A recent JAMA Viewpoint identified 4 major ACA reforms discussed by the House leadership and President-elect Trump: health savings accounts, selling health insurance across state lines, Medicaid block grants, and malpractice reform. Congress has already taken the first steps to repeal the ACA, with implementation possibly delayed before a replacement is enacted. His nominee for Secretary of the Department of Health and Human Services (HHS), Rep Tom Price, MD, (R, Georgia), earlier introduced legislation to dismantle the ACA. There is little empirical evidence that current Republican proposals would retain health coverage gains or significantly lower health care costs.
President-elect Trump has said he plans to keep 2 popular ACA features, retaining coverage of preexisting conditions and of dependent children up to age 26 years. The ACA was able to offer these benefits by widening the pool of insured individuals, particularly younger and healthier enrollees, through individual and employer mandates, which Trump opposes. Republican proposals also would not maintain subsidies in health insurance exchanges or retain the Medicaid expansion. This leaves 2 major unanswered questions: how to widen risk pools to stabilize insurance markets and how to maintain the gains in coverage.
Reproductive Health and Rights
Trump has vacillated on his views about reproductive health, although Vice President–elect Pence and Rep Price favor restricting contraception coverage and abortions and eliminating federal funding for Planned Parenthood. Although Trump might not fight for new federal abortion restrictions, he would likely turn a blind eye to state restrictions. The Supreme Court recently struck down 2 onerous state abortion restrictions, but the majority of states still have restrictive legislation in place.
As part of the law’s commitment to covering preventive services, the ACA guarantees access to reproductive and family planning services, such as contraception. Because family planning and other preventive services are defined in an administrative regulation, the HHS Secretary could change the rule without congressional approval. Eliminating this benefit would cause real financial hardship for many of the 62% of all women of reproductive age who use contraception.
Trump promised to nominate a strong “pro-life” Supreme Court justice, putting the Court in the same closely divided position before Justice Antonin Scalia’s death. If there were additional vacancies during Trump’s presidency, the Court’s pro-life block would probably prevail. Reproductive rights are facing strong headwinds as states pass laws that make it harder for poor women to access safe, legal abortions.
Climate Change
Climate change holds short-term and long-term peril for domestic and global health. Experts say it will exacerbate severe weather events, fuel heat waves, increase pollution, alter the geographical reaches of disease vectors, and produce crop failures, thereby increasing injuries, malnutrition, infectious diseases, asthma, and cardiovascular disease.
Trump (who, along with his nominee for the Environmental Protection Agency, Scott Pruitt) is distrustful of climate science. He pledged to undo the Obama Administration’s 2016 greenhouse gas targets and revoke financial commitments to United Nations (UN) climate change programs—although he said he had an “open mind.” His commitment to fossil fuel development (coal and oil) could reduce incentives for clean alternatives. At the same time, if he rejects the Paris accord, other world leaders might similarly renege on their environmental promises.
International Health
Broad bipartisan support exists for former President George W. Bush’s President’s Emergency Plan for AIDS Relief (PEPFAR), and successive presidents have supported the Global Fund to Fight AIDS, Tuberculosis and Malaria. Trump has not signaled diminished support for these programs, but international health assistance probably will be flat-lined, possibly reduced. This will maintain the US support for antiretroviral treatment in Africa and elsewhere, but would do little to expand coverage.
President Obama’s signature global health achievement is not likely to fair as well. His $1 billion Global Health Security Agenda (GHSA) is strengthening health systems in lower-income countries. President Obama also advocated for US leadership and funding during the Ebola and Zika outbreaks during his term. Trump would be less likely to push Congress to renew GHSA funding or allocate major resources to fight the next global health emergency.
The WHO has introduced major reforms, including a new health emergencies program and joint external evaluation of national health systems. Yet its new program is significantly underfunded. Absent GHSA funding to the Centers for Disease Control and Prevention and WHO, we are unlikely to see significant improvements in epidemic preparedness. That would leave the world highly vulnerable to novel circulating viruses and influenza strains.
Refugee Health
The millions of refugees fleeing conflicts in the Middle East and North Africa often lack basic health needs such as potable water, nutritious food, and housing. Overcrowded conditions fuel infectious disease outbreaks, while vulnerable women face sexual assaults. Turning the tide on these health threats requires humanitarian assistance and a willingness to shoulder a fair share of the burden in welcoming refugees. A new US administration is unlikely to increase (and may reduce) humanitarian assistance, while turning away vulnerable immigrants. Two hallmarks of Trump’s campaign were an antiimmigrant sentiment and an insistence on increased border security, both of which would harm refugees and other vulnerable immigrants.
Health, Development, and the Environment in the Balance
Fresh leadership at the UN and WHO, together with the Sustainable Development Goals, offers great promise. António Guterres, the former UN High Commissioner for Refugees, began serving as the ninth UN Secretary-General on January 1, and in May, the World Health Assembly will elect a new WHO Director-General. Both are charged with the task of working toward the ambitious UN Sustainable Development Goals, including bold health targets such as universal health coverage and fighting noncommunicable diseases.
The United States has historically exercised global health leadership, while sharply increasing health insurance coverage domestically under the Obama administration. As Trump takes office with the promise to “put America first,” what will that mean for our commitments to global health and progress toward universal health coverage? The future of health, development, and the environment hangs in the balance.
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About the author: Lawrence O. Gostin, JD, is University Professor and Faculty Director, O’Neill Institute for National and Global Health Law, Georgetown University Law Center, and Director of the World Health Organization Collaborating Center on Public Health Law and Human Rights. His most recent book is Global Health Law (Harvard University Press).
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