S1E6 / We All Count: Civil Rights & Coronavirus / Vanita Gupta & Michael Macagnone

I'm Dr. Celine Gounder.

And I'm Ron Klain.

And this is Epidemic. Today is Friday, March 27th. In this episode, we're going to speak with Michael Macchigoni, who's a policy reporter with Congressional Quarterly Roll Call.

And we're also going to be speaking with Vanita Gupta, one of the nation's leading civil rights lawyers. She'll talk about your rights during the time of coronavirus and also how this crisis is impacting one of the most important things we do as a country, the U.S. Census required by our Constitution every 10 years. This is not only a pandemic year, but it's a census year in the United States.

Today, we're joined by Michael Macchianone, a policy reporter at Congressional Quarterly Roll Call. Michael, you recently published a piece titled Coronavirus Crisis Complicates In-Person Census Outreach. I'm curious, what did you learn from your reporting?

Well, I've been reporting on the census for almost a year now, and the thing that stuck out the most from the very beginning has been how much the census process relies on person-to-person contact because people are distrustful of the government, of opening their doors to strangers, of responding to official mail, things like that. Outreach organizations from the national level to local neighborhood groups were counting on being able to talk to people face to face to convince them to respond to the census. And they really can't now. And they kind of have to fall back on social media, on traditional advertising, on hoping that somebody picks up a leaflet in a doctor's office because that's the only thing that's open these days. And they really don't know whether that's going to be enough right now. To get people to respond to the census.

Who are these people who are distrustful of the government? Because I don't think that's necessarily about one political party, right? So how might you skew the results if only people who really trust the government are responding here?

Well, it would be a worse version of what the results have been in past censuses. So in pretty much every census that they've had measurements for. There's been some sort of undercount, particularly of minorities, young children, people in rural areas. Worst undercount in the last census was actually Native Americans on reservations. And it's not just that they don't trust the census process, but also that they're harder to count. They may be a recent immigrant, so they don't understand the process and they need somebody to explain it to them. And there's also a corresponding overcount of people who own homes, Caucasian Americans. It might be a college student who's counted both at the college campus or at home, or somebody who's counted at both the home that they live most of the time and then maybe a second home like a summer home.

Is there any reason to believe that these hardest-to-count people might be the very people who are the most vulnerable for COVID-19?

A lot of the people who are hard to count also Because part of the reason they're hard to count is because they don't have access to the same sort of infrastructure that a lot of other people in the country do. So, for instance, they may not have a mailing address or a permanent residence, or they may live in an unconventional living arrangement or a complicated family that would make it more difficult for them to respond to the census and also maybe more difficult to get access to health resources or be able to kind of weather out the virus and work from home. They may have to risk exposure just to keep food on the table. But in general, across the board, response rates to surveys of all kinds, government and otherwise, have fallen in recent years, and it just seems like people don't want to participate, and that's really a problem for something as fundamental as the census.

Yeah, you know, Michael, I think it's important for people to understand that the census, it's not just a academic exercise to find some interesting data. So much of our lives are shaped by its outcome, right? Where funding goes for schools and social services, obviously how much power our neighborhoods get in Congress and the state legislature, and all kinds of aspects of our lives are touched by this count. But I think the point of your piece is that those groups that are always undercounted, people of color, immigrants, the very young, in some cases the very old, and certainly people in rural areas, those people who are always undercounted are going to be especially undercounted by this census proceeding the way it is at a time of coronavirus.

Yes, and also the aspect that has come up a lot in recent days because the process is supposed to start soon for this is what's called group quarters counting. So people who live on college campuses, in dorms, who live in prisons, who live in nursing homes and the like, that process has been delayed and disrupted by the pandemic. And this is going a little bit further ahead of the piece. So a little bit of preview of coming reporting that just about every aspect of the census so far, aside from the things that can proceed online or proceed over the airwaves, has been disrupted in some way by the pandemic, even to the point that the new hires for jobs that aren't gonna start until May can't actually get onboarded because they can't go to a fingerprinting center to get fingerprinted because it's closed right now.

Talk to me about the timeline here. If the census winds up really not getting its feet on the ground till August or September, what are the consequences of that?

Well, we haven't really had a census that missed its deadline. And right now the Census Bureau has said that it intends to still meet its December 31st deadline. But a lot of the other things before that are up in the air. And right now the Census Bureau is relying on online, phone, and mail self-response. But even in its planning documents, they estimated that they would get about 60% of the households in the country to respond on their own, and they were going to have to make up the 40% through knocking on doors, through combing through administrative records, through all of that. And the biggest portion of that was the door-knocking process where they hire 500,000 people to go door-to-door, and it's going to be really difficult to do that under these current conditions.

Yeah, so let's take a step back, and for people who are not census aficionados, I'm sure they may be listening and saying, hey, you know, they postponed the Olympics, you know, why do we have to do a census in 2020? Why not just do like the Olympics do and say we'll move it to 2021?

Well, uh, for, for one thing, it's the law that the census occurs this year, and that's a little bit of an easy answer. But this census was planned for more than a decade, and just changing the year, for one thing, would cost billions of dollars, and for another would maybe run into constitutional issues because the Constitution specifies a count every 10 years. But in order to delay the census, my understanding is that it would require a change in law, and Congress hasn't taken that step yet. The Census Bureau hasn't asked for that yet. So at least for right now, everybody is operating under the assumption that we're going to try and make the census work. This year, and it's going to be tough. And I have talked to a couple of people who have studied the history of the census, and there's not a really ready analogy for this. The flu pandemic— talking about 1918 flu pandemic— was in a very different public health sphere, and it was over and done before the 1920 census. And it is very hard to say that they faced a challenge like this before. Even the Census Bureau themselves said that this was something out of their nightmares. It's really hard to say, no, they're not going to be able to do it, but they do have a whole lot of challenges that they are struggling to deal with, and I don't think anybody could have really prepared for it.

All the way back to the very earliest days of our country in the 18th century, we've completed the census every 10 years through wars and disasters and all kinds of other challenges. So the question is, has the Constitution met its match in the coronavirus? We're gonna find out. So, Michael, thank you very much for joining us on the podcast. Thank you for your reporting, and thank you for your insights on this really important issue.

Thank you. Thank you for having me on.

We're pleased to be joined today on the Epidemic Podcast by Vanita Gupta, who's one of the nation's leading civil rights experts. She's on some lists to be a future Supreme Court appointee. Right now, she's the president and the CEO of the Leadership Conference on Civil Rights, and we're delighted to be joined by Vanita today. And let's start here. We're already seeing throughout the country instances of discrimination, of bullying, of other kinds of actions against Chinese Americans, Asian Americans, because the disease did begin in China. There's an association with that. What do you think about this? What are you seeing out there already?

Well, first of all, thank you so much for having me on this podcast. It's so incredibly important that it exists out in the world in a time of so much untruth and disinformation. But there's no question, Ron, that there are really serious civil rights implications for COVID-19 on this country and in the world right now. On the discrimination front, we have seen a whole host of ways in which the Asian American community around the country has been targeted, especially young kids. I think, for example, in San Fernando, California, a 16-year-old Asian American boy was physically attacked at school because he was accused of having the coronavirus. In New York, a woman was wearing a face mask and was believed to be Asian, and she was physically and verbally assaulted in a subway station. And then kind of more broadly, there's been an economic impact. Asian American businesses were seeing a significant decline in customers before there was active social distancing. And so these are some of the ways in which we have seen, you know, the impact, kind of the discriminatory impact as a result of this disease and this epidemic.

Well, you know, one thing we like to say on this podcast is, of course, the disease strikes humans, not any particular racial or ethnic group. There's no reason to discriminate against anyone. It's against the law, and it's also not based on science. If people see an incident like the ones you're describing, bullying or some other kind of incident, what should they do about it?

Well, these kinds of acts are against the law, and they're also just so kind of counter to what we stand for in the United States of America that if you are a witness or a bystander to this kind of incident, you should speak up. We need people to stand up in schools. For instance, if students and parents should be reporting it to their schools, schools have an obligation under federal law to ensure that all students are able to attend school free from harassment and discrimination. If there is an actual hate crime and physical attack, people should be calling the police or reporting it to the FBI. There should be no tolerance for to this kind of discrimination, and I think all of us have a responsibility to do what we can. We've got robust federal and state laws in place to protect vulnerable communities in this instance.

I've really been struck by some of the media coverage and even really places I really respect, like the New York Times had a piece maybe a week or two ago now, and they were reporting on the healthcare worker who was returning from Iran to New York City. And the picture that accompanied the story actually had nothing to do with that case. It was a picture of one of the best dim sum places in Chinatown, but it was really reinforcing that anti-Chinese xenophobia that we're already seeing. You know, what are you supposed to do if you're a business who is suffering from the way this is being covered in the media?

Well, I think the media has an enormous responsibility, and that kind of incident, it should not happen. There's all kinds of ways in which people get implicit and implicit messages that can reinforce stigmatization of particular communities. And I think the economic impact at this time right now is being felt across communities and frankly across, you know, national economies. Maybe the irony will be that in the social distancing phase of this, we will understand our common humanity and the common kind of vulnerabilities that we face not only as individuals and communities, but frankly across nations right now.

Vanita, what's been the history of this kind of scapegoating and xenophobia? You know, how has this behavior played out with prior infectious disease outbreaks?

We've seen the cycle of racism, ignorance, fear kind of causing scapegoating of particular communities during these kinds of outbreaks historically. You know, even just recently, we've been hearing from workers in retail, hospitality, and healthcare sectors that are hearing from customers and patients saying that they don't want to be treated by Asian American staff. We've heard that historically in these contexts. In the Ebola virus time, and Ron obviously knows this better than anyone, there was an effort by the federal government across agencies to message out the importance of fighting any discrimination against people from African nations. And the role of the federal government, of local and elected officials, faith leaders, in messaging out both during Spanish flu, during Ebola, and today is really important to kind of stand up against this kind of scapegoating. I think one of the things that is really difficult right now is many of us feel that the federal government and the administration are not doing what they should be in response to this virus. And then it is that much more incumbent on all of us to be out there pushing out the importance of fighting against discrimination and targeting of any community at this time.

So have we seen civil rights protections change over time in response to infectious disease outbreaks?

Well, I think over time there's been a much greater understanding of how civil rights protections actually include protections against discrimination for people who either have infectious diseases or may be prone to infectious diseases. But certainly protections include these category of problems that schools and hospitals and healthcare workers and restaurant owners are facing. But in the end, the laws on the books are only as powerful and meaningful as the kind of people are to enforce them and to norm them in their everyday lives. And that is a really important thing. So the work to kind of make sure that communities and individuals are protected against discrimination at this time requires kind of all of us being mindful and standing up and speaking out against discrimination when we see it and calling upon our leaders to kind of really double down and reinforce that message.

So Vanita, this is the one time every 20 years where we both conduct a presidential election and have a census. And so I'd like to ask you briefly about both of those events. Let's start with the census. How will the coronavirus affect the ability to complete the census in an accurate and complete way?

So this is having a major civil rights impact, but the good news with the census is that there right now is an opportunity since March 11th to fill out the census from the comfort of your home. And so right now you don't have to leave, you can practice social distancing, and you have 3 ways of actually completing the census. And I would urge all of your listeners to do it and then to spread the word. One is to go and to fill it out online. Another is to call 1-844-330-2020 and to fill it out by phone. And the third option is to fill out a paper form and mail it if you've received the paper form at home. It just takes a few minutes. If people fill that out, we won't need organizers to knock on your doors and to try to get them completed in the weeks and months after. The best thing we can do right now is for all of us to fill it out using one of those three mechanisms and to get everyone else that we know to do exactly the same. So that's my hope, given everything that's at stake with the census for the next 10 years for this country. I hope everyone will complete it.

So Vanita, as we're heading into this kind of shutdown economy phase where people are really being urged to stay home if they can and whatnot, What's your thought on workers' rights to decline to come to work and to try to hang on to their job if someone feels like they're particularly vulnerable, perhaps, uh, maybe over 60, uh, maybe have some kind of particular immunodeficiency disease? Do they have rights under federal anti-discrimination laws or the Americans with Disabilities Act to ask for some kind of an accommodation not to have to come to work?

You know, the nation is confronting this kind of social distancing and quarantine for the first time in the modern era, and it isn't clear to me that the laws in place are going to be sufficient. We haven't had enough protections. We don't have paid sick leave. A lot of companies are not giving time off to low-wage workers in a way that makes them feel secure and have economic and job security. Should they do what public health officials are saying they should do, which is to engage in social distancing. And so this is a problem because not all communities are equally protected right now, and this is something that we need to figure out in short order.

Eventually, businesses will start to reopen, and I imagine some employers will perhaps ask workers who they suspect had COVID-19 to go get tested or prove they're negative. Maybe even some will terminate workers who they believe had COVID-19. What rights do workers have in this situation to deal with those kinds of either terminations or just requests or demands from their employers?

You know, there are legal protections that have evolved as a result of our experiences and history through this. So right now, I think there's a lot of legal services and legal aid offices that are working to really think about how to create and provide guidance to lower-wage workers who won't have the access that you and I may have to understand the legal system and what our rights are right now. We need to make sure that we are pushing out the kind of know your rights for workers at all parts of the economy, but also ensuring that there is legal support for those who confront discrimination. We are certain to see it, and we have to be ready to deal with it.

Vanita, thank you so much for joining us on the Epidemic Podcast. We appreciate your wisdom and your views.

Thank you.

Thank you so much for having me.

Vanita mentioned that you can fill out your census form form online, and we certainly encourage everyone to do that. You can go to my2020census.gov— that's my2020census.gov— and complete the census safely and securely from your own home. So every week we also answer a couple of listener questions. You can send us your question by recording an audio file on your phone with that question and email it to us at hello@justhumanproductions.org. That's hello@justhumanproductions.org. So our first listener question today comes from Brianna, who works in a grocery store.

I'm an employee of a grocery store that helps over 1,000 people per day. It is impossible to keep a 6-foot distance at all times. Many of us are experiencing high levels of stress and anxiety. We fear it is not a matter of if but when we will be infected. Because the CDC doesn't recommend masks for anyone but healthcare providers, we aren't allowed to wear them. We feel expendable. I understand that surgical and N95 masks must go to healthcare workers who are saving lives, but our unprotected level of exposure is certainly fueling the spread of this virus. Given this high level of exposure, many of my coworkers are wondering if we should be allowed to wear homemade cloth masks. Online tutorials show double-layer cotton masks with home air filters cut as inserts and soft metal wire for accurate fitting. My question is, for retail workers, would a homemade cloth mask like this be better than nothing at all? Thank you.

That's a really difficult situation to be in because you are, in a sense, one of those essential personnel. You are a frontline worker in the midst of this pandemic, and you you are right to be concerned that you are at risk for infection working in a grocery store with lots of people coming in and out. I think the kind, the kind of cloth mask you're describing, making at home, would make a lot of sense. You could even just use a scarf or a bandana for the purpose of preventing transmission from yourself to other people. But if everybody does that, we will be protecting ourselves as a group. It's just important to remember that these masks are not going to protect you from infection against others. It's really about you protecting others against infection from you. I think the best we can be doing in that situation, given the tremendous shortage of masks both for healthcare workers as well as for really anybody else, is for all of us to be covering our nose and mouth when we're out in public. And if we all do that, we should be able to protect all of us as a group from transmitting infection.

Brianna, also I'd add that I have a piece that came out recently in the Washington Post where I talk about the fact that at a time of mass closures of businesses, we need to remember that a lot of people like you are at work and making it possible for other people to stay home. So first of all, thank you and all the unheralded heroes who are out there every day doing the work we need to do to keep society functioning, even as we try to get as many people to not be out there in society functioning. That wouldn't be possible without people like you. I also think it's really incumbent on policymakers to start to think about how we protect our workers who are working now and who will eventually go back to work before we have a complete solution to coronavirus. And what kinds of gear should they get What kinds of protections should we have for those workers? Of course, the medical gear first has to go to the healthcare workers. They need it most urgently on the front lines. But as we ramp up production of some of these things, as we start to really get more and more protections out there, we need to be thinking about this. There's a lot of conversation about putting the country back to work, but not enough conversation about how to keep workers safe. That should be the big public policy conversation we're having right now. So thank you. So our next question is from Jason Holder.

Hi, this is Jason from South Jersey. I have a question on how we're not testing anybody unless they're high risk now. I know that's what's happening here in New Jersey and what's happening in your state, New York. How does that mess with the data that we're collecting on the virus this year and what kind of effects will that have on the death rate for the virus and then how it's represented in the media, say maybe in the fall? Thank you.

So Jason, unfortunately we really do have a scarce supply of testing available for coronavirus right now, and so we're really having to target that resource to situations where it's going to change what we as healthcare providers do for our patients. And I'll give you an example of this. I saw a patient in the hospital who had a chronic lung infection, something that's been longstanding for which he takes 3 antibiotics, has been doing so for months. It's something that's distantly related to tuberculosis. And unfortunately, he's had issues with getting his insurance to cover one of those 3 antibiotics just over the last few months. And so he's been on and off that third antibiotic. He's gotten worse clinically. As a result of that, was actually in the hospital about a month ago for that. And then he comes into the hospital again, and then the question is, is he more short of breath now because he's been on and off that third antibiotic, or is he more short of breath because he now also has COVID-19? So that's a situation in which knowing if he tests positive or negative really does change what we're going to do for the patient. So that's the kind of situation in which we're trying to focus our testing right now. I do agree with you that it is going to impair our ability to collect and analyze data and, and draw scientific conclusions about that when we are not sure that all the people who are clinically diagnosed as having COVID-19 truly had it. So that may well create some biases and other problems with the data that we're collecting, but ultimately we have to focus on the clinical care and public health issues first and try to address some of these data collection issues as a high priority, but a little bit less urgent, relatively speaking?

And look, I think on the media issues, I think it's very important for us to hold the media accountable for how it represents the disease and its course. I think by and large, the reporting on coronavirus has been much more responsible and accurate than it was certainly at the peak of fears about Ebola back in 2014. But I think that we have to be mindful of false information in the media, and we have to be really insistent that they continue to focus on getting it right. That's certainly something we try very hard to do on this podcast. And if you ever feel like we've gotten it wrong, be sure to reach out to us and let us know that we haven't gotten it right.

Epidemic is brought to you by Just Human Productions. Today's episode was produced by Zach Dyer and me. Our music is by the Blue Dot Sessions. If you enjoy the show, please tell a friend about it today. And if you haven't already done so, leave us a review on Apple Podcasts. It helps more people find out about the show. You can learn more about this podcast, how to engage with us on social media, and how to support the podcast at epidemicpodcast.com. Epidemic.fm. That's epidemic.fm. Just Human Productions is a 501(c)(3) nonprofit organization, so your donations to support our podcasts are tax deductible. Go to epidemic.fm to make a donation. We release Epidemic twice a week on Tuesdays and Fridays, but producing a podcast costs money. We've got to pay Zack. So please Please make a donation to help us keep this going. Also check out our sister podcast, American Diagnosis. You can find it wherever you listen to podcasts or at americandiagnosis.fm. On American Diagnosis, we cover some of the biggest public health challenges affecting the nation today. In Season 1, we covered youth and mental health. In Season 2, the opioid overdose crisis. And in Season 3, gun violence. In America. I'm Dr. Celine Gounder.

And I'm Ron Klain.

Thanks for listening to Epidemic.