Servants, representatives karen bass of california. Representative Joaquin Castro from san antonio, who is the of the caucus, and has been very involved in immigration. Osby, from the university of San Francisco, he head ofident obamas the program in president obamas first term. , that2, he was my partner began, ironically, and china, was we talked about what becoming an epidemic unaddressed, as well as the traditional all of those years ago. Think are in a real strong position to answer ratio of about the economic disparities in this other countries across the globe. With dr. Ike to begin gosby. The obviousk question why do we have Racial Disparity both in the infection rate and the death rate of the coronavirus in the United States . Dr. Gosby well, thank you, mr. President. It is a real pleasure and honor to have an opportunity to speak to this issue. Correct in are convening this discussion. I think that what we, unfortunately, continue to see is an uncovering of the disparities in both a vulnerability of medical care and services and the ability to patience and care over the accurately time to diagnose and initiate treatments that correct chronic progressive diseases in the africanamerican community, and i think the covid so many has happened times in the past with other outbreaks, such as hiv, shows a disproportionate impact on those individuals who are not part of the medical Delivery System and caring with them and inability to Access Medical information , particularly in a manner that allows for work and activities to continue. Diabetes, coronary arteries, and respiratory infections, asthma, etc. This is a disparity that has been practiced as long as i have Practice Medicine and long before. I think it stems from a complex lack of social Economic Equity that is institutionalized and manifests itself in everything from our ability to identify individuals in care, and that inability to do that, over time, impacts differently on unfortunately,d covid has showed us once again that africanamerican communities are the target. Karen . Nton rep. Bass i certainly agree with everything that the doctor has said, but i will also include in there the unconscious bias of health professionals, because you can look at some disorders, and you can see the disparity that exists across social economic status and the africanamerican population, and one that we are dealing with increase in a real Maternal Mortality, which is something that is difficult to reconcile in 2020 in the United States, that Maternal Mortality would be a problem and that it would be disproportionate and it is disproportionate across social economic status. Well, we just had a painful example of that in america in the last week, and i am not saying racial motivations were behind it, but there was an africanamerican man who was also aerweight but was responsible worker and a father, was in the hospital, not tested, because we did not have enough testing equipment, and they thought he just had a bad hold, he isee days later dead, leaving young children. So we are seeing that here. Joaquin . Eah, thank you, mr. President. Thank you for committing this discussion, an absolutely important one during the pandemic in the wealthiest nation on earth. Longstanding inequities and challenges in our american society, and we see both the africanamerican populations very hard hit and latinos in different parts of the country also devastated. Example,rk, for latinos account for 34 of the deaths caused by a covid19. In my hometown of san antonio, the africanamerican population is 7 or 8 , but African Americans account for 30 and prince 36 of the deaths. Rep. Bass wow so the numbers, we have asked the cdc to produce comprehensive data so we can see exactly what is going on. But obviously, it speaks to many of the failings in our healthcare care systems in other parts of our society that we absolutely need to address. Mr. Clinton i want to ask you one thing, because i have composition death rate against the death rate in several american cities, and it between the population and the death rate, it is smaller in california than many other states. Islouisiana, the population 70 . Same and a lot of midwestern cities. What do you think the difference is in the disparity . Why do you think there is so much difference in some areas than others . Eric . Dr. Goosby yeah, let me take a shot of that, mr. President. I think, again, it is a multifactorial reason. Africanamerican and hispanic communities in San Francisco and in the east bay were seeing a this proportionate number of hispanics falling to both cases deaths, so we are seeing a similar picture that you are seeing in texas. I think communities that have jobs that are facing, interact with the public, the lower paid jobs that start often as clerical, where you are interfacing the public in transportation settings as well, disproportionately occupied by africanamerican, hispanic fact puts ourat community is front of a threat those that are not forced to do that are not put in front of. And i think the inability to, again, access and be retained in care plays out for all chronic progressive diseases, and in acute outbreaks, because of a similar need to identify similar people quickly. Mr. Clinton anybody else want to comment on that . Thinkastro yeah, i also that you have clusters of both africanamericans and latinos in states that have not set up best infrastructure of opportunity, for access to health care, for example. Texas, my home state, has the highest percentage of people that have no Health Care Coverage at all, and the state is about 12 , 13 African American and about 40 latino, so you have a lot of folks who are in places. Florida is another example that has not expanded medicaid. Texas has not expanded medicaid. Other Southern States as well. You mentioned the difference between a new york and the south. I think that has got to account for at least part of that equation. Rep. Bass and if you look at california, where the rates are still disproportionate. I mean, in los angeles, African Americans are 9 in the city and the county but 19 of the death california,still, the resources are much better. The commitment here. The commitment here to provide resources to the entire population, including the undocumented population, i , but thes been helpful disparity is still there. Mr. Clinton the insured rate in california is well over 95 , isnt it . Rep. Bass i do not know if it is quite that high, but it is high. It is absolutely very high, because of the commitment. We are very fortunate. I tell that to my californians all the time. [laughs] mr. Clinton when you get this in hand, i think that you can use that to really put the heat on these other states to expand medicaid, because there is no question that the absence of an Underlying Health network has contributed to the death working people, disproportionately compensated, africanamericans and hispanics. Rep. Bass but, mr. President , some of those same Southern States are the ones that reject the Public Health guidelines. [laughs] conversations] mr. Clinton i feel bad, because louisiana finally has a governor who would protect the workers, but he has not had enough time to put it in place. A lot of what happened in new orleans is because of mardi gras. We have got to recognize that the Health System itself has got to be built up. I want to ask you one other thing. I know that in california, there is an effort to do Contact Tracing. Yes, mr. President. Go ahead. Go ahead. On the board of health initiatives, and an attempt to do Contact Tracing for the whole state. But he cannot do it, because we have not built out the Public Health care network to nearly the level that we need. If they had all the people they need, they do not necessarily have a look the protective gear that they need for these people to go out and to interface, but it is a good beginning. We have got to be able to test millions more people, we have got to have workers that can be protected while they are doing this work. So i just wanted to say that, youre states, always request more money, but if we do not have a public Health Network that will expand out, when i think people are beginning to go back to work, we are going to have all of these problems flare up again. Reallysby i would strongly agree with everything you said, mr. President. I think that that is the bottom line, and i think it behooves all of us to understand those relationships and to ask of our Political Leadership that they focus on responding to this longterm, unmet need. I just wanted to mention one of whyother founders as to there is a disproportionate impact in both hispanic and africanamerican populations with the covid19 is because of have a morety to rapid course from exposure to infection, and to move from infection to serious illness more rapidly. More, as you mentioned, who have comorbidity. People with congestive heart failure, with coronary artery disease, with asthma, and with diabetes have a disproportionate sensitivity to this coronaviru ability to attach and interpolate to the cytoplasm of your cells. It attaches more efficiently. As a result, for the same exposure, more people exposed in the same way with those underlying diseases are more likely to incur an infection, and i believe that that is a black andr to favor hispanic communities, and we are, indeed, seeing this everywhere. Mr. Clinton so what can we do, through the congress and elsewhere, Going Forward . Rep. Bass let me just mention, that on behalf of the black caucus, there are very specific things we are proposing, and we are proposing right now concentrated, focused testing, where we have large concentrations of African Americans and a disproportionate death rate. What i am concerned about now is there is a lot of attention on the comorbidity and also on the individual behavior of africanamericans, which to me just amounts to blaming the victim, but i think we need to do focused testing, we need to do the Contact Tracing, we need to make sure the testing, the results are back rapidly. To doctors where it takes seven to 10 days. Need that antibody test, and we need organization so that people can be involved in the education work that needs to take place. I am concerned that, with the focus on the Underlying Health issues, that it then becomes an excuse to basically say, well, there is nothing we can do about it, because you guys have all of these health issues, and the situation is ignored. Mr. Clinton joaquin . Rep. Castro yeah, we also support an aggressive testing model. And Contact Tracing, they moved to a mitigation model after different localities felt like there were a number of cases that involved immunity spread. A lot of them stopped the tracing. We have got to do that aggressively. We have got to act aggressively. In the latino community, for example, you have an overwhelming number of latinos in the United States or citizens, but you also have folks who are undocumented and our legal permanent residents, and some of them are fearful of getting tested, either because they did not know whether that is going to affect their status or their ability to remain in the country, or, i have heard stories now of people who are simply afraid of the cost. They are afraid. It is almost like, you know, see no evil, hear no evil, where they did not want to avail themselves of the medical procedures, because they are fearful of the multiple thousands of dollars of bills that will come of that. I am also concerned that governors across the country are not aggressively testing at this point, because they did not want to be the face of this pandemic. They do not want to be on the news every night the way that new york is, and so they are hoping that they can ride this thing out, and it is clear that the communities that are paying the highest price for that are often low income communities and black and latino communities in the country. Rep. Bass can i mention a couple of other things . Mr. Clinton sure. I am concerned of the people that are incarcerated, and i also think of the detention centers. We are calling for the Early Release of people, but i did not want to see people just released into the community, they are tested, and, you know, we are aware of that. So i think we have to think about that as well, as well as protective gear for folks who are the essential workers. And then the data. We need to have the data, because right now, that death rate is basically anecdotal. The cdc is either and the doctor might know about this is either not taking the not compiling the data, or they are not disseminating it, but we definitely need to have it, to have the data. And not just the death rate, the infection rate, the hospital rate, etc. , the whole picture. Dr. Goosby you are absolutely right, congresswoman, and i really did not want to imply with equal morbidities that that was some explanation for why africanamerican and hispanic communities were disproportionately impacted. It nevertheless though is a reality that the health care Delivery System and our countrys leadership need to understand that disparity, that realitydeeply rooted that precludes covid19, and that underlying lack of Health Care Delivery interface with the population has got to be movessed for us, as we back into changing our mitigation strategies, the case findings and Contact Tracing becomes the only tool we have to transmission threats what we put together people more frequently and in larger numbers, so i strongly agree that the testing is critical that will enable us to be rational about who we put back in group connection, who we allowed to go back and be a doctor or a nurse in a hospital setting, or go back to work, knowing that they indeed have had the infection and they have moved through it and developed antibodies. I also want to say that it is more complicated than that, because we do not know yet if these antibodies provide any protection from second exposure, so we are assuming that that is indeed how it will work. It is hopeful and likely, but i have practiced long enough to know that some do not do that out all. Hiv is an example of a lot of antibodies that do not do anything, and you can get reinfected and reinfected with the same virus. So the science needs to move rapidly. We need to acknowledge, embrace, and accept the fact that the disparities that we have in communities, reaction to this pandemic are largely dependent on the health cares responsibility to mount a response. Do not, you will accelerate toward the decline. Is managed best buy communitybased that are already well interfaced with the communities, in this case, hispanic and African Americans, have the credibility as trusted, and we need, as the Public Health system, to take advantage of that interface, already established, and expand the capacity of communitybased organizations that can take on testing, referral, triage, etc. During this emergent need. Mr. Clinton lets talk about two things. First of all, the need to go back and do Contact Tracing in the communities, and second, the with the issues about incarcerated population. There are approximately 400 people at Rikers Island in new york alone that are there because they cannot post bail. And we know from the people who have been released so far that 86 of them show up for their first bail hearing if you give 93 of them do. They theyif cant make bail. Dont we need a system which would enable, first of all, prisons to have as much reasonable separation as letting people go, but as you pointed out, they have to be tested, and then they have to have someplace to go. Rep. Bass exactly. A virus. On with so is there a special program that funds those efforts in any of these bills, and if not, should there be . And can we create a National Movement that will make other governors and administrators feel more comfortable with this . Sweepingd a real for people who cannot afford to post bail. We have got to figure out how to do this nationwide. More peoplethat have not died in prisons already. Rep. Bass well, we will see, because i think the numbers are going to be quite explosive. One of the things that Congressional Black Caucus pushed for, but we did not succeed this last time but we will continue trying is at the same time we are calling for Early Release in a number of categories, for example, pregnant women should not be in jail. You mentioned bail. There are also people in jail and prison because of technical violations. They did not show up for a hearing or something. So how can you talk about social distancing and hygiene when that is not what you see in a prison . To have them and reentry programs, so that the communitybased organizations that work with them, we need to give them supplemental funding to make sure that as we are releasing people, number one, as you said, that they have someplace to go, that they are safe, and it is an opportunity i mean, i hate to put it this way, but it is an opportunity to see what happens when we do leave people out for bail, like you just said. 98 of them come back after a reminder . It is an opportunity to experiment, if you will come up with some of the criminal justice reforms we were already looking at. Mr. Clinton joaquin, what do you think about that . Rep. Castro i agree. We have known for years that in terms of our bell system, there are people in jail recently cannot afford to pay, and this pandemic has shown the danger, continuing with a system like that. Also mentioned earlier detention centers, for example, or the childrens shelters that dhhs runs, all are in these cramped roosevelt and the americans and others that were on the cruise ships. People that are in those close quarters like that, you have to be able to get them out of there and allow them to be in a socially distant place where the virus is not going spread right away. We have seen the spread in other places outside of prisons. In south dakota, for example, there is a meat packing plant where hundreds of people have come down with the coronavirus. So you know, we have to be more attentive to places in our society that we tend to put people in a corner and then ignore them. We have to toned those folks now, especially. Pres. Clinton what do you know one s Congress Know week, two weeks . The reason im asking, it seems to me if i were a governor it seems to to be glowing michigan or i would want to now how quickly i could assure tracer and Safety Equipment and they could be tested every day. Could be going places first of all, you have to have the equipment so you can tell the doctors, the nurses, the they deserve to stay live. Live. Then is there any system to rioritize Contact Tracing . A astro i have been case signing capability that we keyed up because we knew it was going to be critical and necessary for any return to normal. And we also knew that our was on to do the case our ability to do rapid testing. As rapidly as possible. Preferably within hours. Nd that began a conversation speaking just for San Francisco, that required that we talk to the Public Sector but also in at much of the population is insured in Third Party Payment relationship. We for the first time have to begin the discussion with large kaiser rty payers permanente, etc. , in San Francisco. Talk about a system that had a closed payment for testing, blood drawing, laboratory, human resources, etc. Reserved for the people that had their insurances and packages matched against an expanding need that covered the entire population of the city. Who had jurisdictions. Were we going to make everybody have their own separate lab . Were we going to be economical about it . I cant tell you how difficult that discussion was. Were talking to profit driven systems for a healthcare emergency need where the public charge, the unit responsible for the public wellbeing was not part of their selfperception but it became part of their selfperception as the discussion preceded. Hey all realized proceeded. We all took that step. Resources needed to move between. I think we were unique in that we were able to achieve that. It is a microcosm of what happened at the state and federal level with a lack of a federal focusing on what were doing, when were doing it, how were doing it to draw a consensus around human needs and commodity needs that really still hasnt occurred to this day. I kind of meandered around there ut i think that is it. Pres. Clinton what can for people that are listening, what can they help you Lobby Congress to do . Rep. Bass i think they could help us Lobby Congress to do the testing. I mean, it is just inexcusable. I think what has happened is that everything has been put out to the market. So to add to it something that confounds the whole situation is the promotion of hydroxychloroquine. I know they just distributed millions of tablets. So i think refocusing us back on testing, back on public education, back on the Contact Tracing. Staying focused. The other thing that is terrifying to me right now is you are seeing the beginning of a protest movement. I dont know if you saw what happened where michigan where you have people that were protesting the Public Health protocols that i noticed as they gathered in those crowds, none of them had their faces covered and they stopped traffic so there were healthcare workers that couldnt get to the hospital so i think pushing congress to continue along the road that we are, to provide the resources and to make sure that we get the testing and the treatment and all of that is the best thing that they could help us do right now and we need the utside help. I think there is something they can help with in the moment and after this pandemic has passed us, the moment has passed us, in terms of the now, what i would add is there has to be intense pressure on congress and our other institutions both public and private for honest transparency about what is going on. We have already seen dangerous examples of deception. For example, i was repeatedly asked how many of its workers and detainees have been infected with the coronavirus and they repeatedly did not include the numbers their Third Party Contractors who run the detention centers. So they lowballed that number until they were caught. Another example is in my hometown of san antonio, there were about 67 residents of a nursing home who became infected with the coronavirus. 7 of them ended up dying but five of those deathses were not initially disclosed by the nursing home. In other words they were going to cover up at least five of those deaths and not report them to the government and so both our public and our private institutions need a lot of pressure now to make sure they are being completely honest and transparent. And to add one more piece to that, when we as i mentioned earlier, this has exposed a lot of inequities in society. I hope that we are closer to believing that healthcare is a human right. Housing is a human right. Everybody should be able to get a good quality education to pursue their American Dream and that we can move forward as americans toward that agenda. Rep. Bass since the Underlying Health conditions have been exposed, we do need to get past this crisis and then after that, lets focus on this. Despair treasuries not new. Doctor, i dont know what youre finding but one of the things im worried about too is we dont know longterm consequences of this, the lung damage, the kidney damage. I dont assume because somebody has recovered that that means they are back to normal. Gov. Scott no, congresswoman, i think youre right to raise that. I know your Nurse Practitioner background is coming forward. An awareness, you see an acute sthreapt sets a course for that individual that travels years with them. I think youre prescient to say that we need to anticipate what we know of the patho physiology of this organism and as we learn more over the next three or four months, we will understand the multiple organs, during that initial phase, it lands and does damage. Some of it is permanent. We need to understand that overtime. I think also it was tragedy toik thiseople focused on as thrown broke, to be own a line of therapy with the droxychloroquine issues, the question initially, an antiretro viral for h. I. V. It is always the way these outbreaks happen. People think of therapeutic interventions. Those therapies really would be used first for those who were in extreme. That would be people who are in i. C. U. Level care. Most of whom would be intubated and to see if in the most ill youre able to change the course of that individual and then it comes back out into less ill uses. But it was a diverge ens i think in part that pulled us off of the focus that was needed for he testing to be implemented aggressively and rapidly. It put peoples attention and resources even followed it, because people are that scared and it is completely understandable but it was a divergeance. Pres. Clinton i just wanted to emphasize to everybody listening to you, how profoundly important it is that you get the support you need to get testing. Most people still have no idea how many millions of people are tested. Secondly, how much p. P. E. , protective equipment we need for the people we need to do the tests. If you want to do Contact Tracing, you have to protect the eople you want to do it. One of my personal obsessions is public supplies which i think is a disgrace. We should have done it differently. Lots of other things. E shouldnt be doing this. At least you should be supported , making sure these healthcare workers are in doing their jobs. The volume we need of masks and protective gear. All of these other people who people e able to working in grocery stores. If we are going to do Contact Tracing, we are going to need so much more protective gear. The members of Congress Need to support the people is. People. Not to allow a worsening of these economic and racial disparities. Im very grateful to all of you. We have six minutes left. Rep. Bass i would like to i had mentioned earlier that my concern about this merging what i hope is not emerging but this protest movement of people saying we need to open up our economy and we need to go out. People who are listening to this need to counter that as well. It needs to be driven by science. And not by politics. And if we push and people are going to openly object to the Public Health guidelines there needs to be a very loud voice countering that. Otherwise i dont know how the curve is going to be flattened. Were just going to have a whole other spike if this is the direction that a lot of people are going to take. Pres. Clinton i dont think it happened by accident. Rep. Bass absolutely. Pres. Clinton somebody put them up to it. T needs to be uncovered. Rep. Castro this protest movement, a lot of that anxiety, i believe a lot of it is by one particular group. A lot of it also is based on the fact that people are now out of work and they are wondering how they are going to pay their bills. So i know the question has been mostly about the health part but making sure that were healthy, to make sure that were healthy, we also have to make sure that the government is delivering economically to people so they feel they are in a better position so they dont have to go take chances out in the world when there is a pandemic going on and i can speak to my home state of texas where the delivery method for getting Unemployment Benefits for example has been quite poor unfortunately. A woman told me the other day that she called the Texas Workforce commission 103 time before she was able to finally get through. So i think some of that anxiety is people feeling as though im going o drown in debt or face the prospect of eviction or otherwise need to go out into the world and make money. So the government has to do a better job than what it has done so far in offering people Economic Relief as well. Pres. Clinton i agree with that. First of all, if you look at the we cant have people being thrown out of their homes because of this. We should take care of them efore the fallout. I think that is really important. I appreciate you saying that. I also believe that look at the the price we paid for ignoring the we paid a terrible price for the delay in dealing with all of this. That makes it more costly. Half the people have a difficulty with something costing 4 soon in it is not anticipated. We have to face the what they are facing. We can go back to work more quickly if we do it under conditions when they are knowing im grad you said that. For people who dont have any cushion feel. We will help them. Not put them into harms way. Anything else to say before we to . Gov. Scott thank you, mr. President and thank you to beth of you for your i think really insightful comments. I believe that we are at a crisis for the africanamerican and hispanic communities that is wrapped in this pandemic and it is up to individuals like yourselves who can connect the dots, but i hope this puts a surge of commitment interest and urgency the country to deal with these issues of disparity around healthcare, understand the connection to the economy and our countrys ability to rise up as a nation. We cannot have inequities in access and performance that we continue to allow. I believe the government needs to be much more aggressive in defining, understanding, quantitating and addressing these disparities across the board from health to education to housing, the homeless and prison populations. We can talk about disparities in all of those arenas. Thanks for this opportunity. I look forward to try to think of ways for this to take on momentum. Pres. Clinton i want to ask you to work closely with congress and try to give your support to there are things that we can do that will reduce the death rate by race and by income but the truth is we need universal access to healthcare. The Medicaid Expansion will get us to 97 or so if we can get it adopted. , thee need care for People Welfare workers. The africanamerican communities. This is something we have to eal with together. We have to recognize that this we dont act that have a public Health Network in very community in america. We have to replenish the stockpile of protective equipment. If we can do it, we can begin to go back to work and we can begin to get rid of the disparity in deaths. Thank you. Tonight on q a. Wall street trader turned photo journalist on his book digit about the plight of those living on the margins of society in america. It was a sunday morning i believe or a saturday that was empty. Informs the industrial part of hunts point. And immediately her intelligence just kind of came right through. And we spoke for about an hour. Half an hour or so. She told me her life which was just like a cliche of everything wrong that can happen to somebody. And eventually i asked her what i ask everybody that i photograph. How do you want me to describe you. Give me one sentence to describe you. She just shot back thats what i am. A prostitute, a mother of six and a child of god. Tonight at 8 00 eastern on cspans q a. Now more from the Clinton Global Initiative with former president clinton and Chelsea Clinton leading a discussion with students. This is over half an hour. Chelsea hello to you wherever you are in the world. Thanks to each and every one of you for joining us for our first ever cgiu event. My name is michelle. Im currently based here in brooklyn, new york. Im part of the