Amid the coronavirus pandemic, state health officials across the country are at the front lines in treating patients and preventing additional COVID-19 infections and deaths.
In Pennsylvania, the health official leading the charge is Rachel Levine, who said Tuesday in an interview with the Washington Blade as Pennsylvania health secretary she has long feared this situation.
“I’ve always said that public health preparedness has to be a priority, and what keeps me up is worrying about the possibility of a global pandemic,” Levine said. “And here we are.”
But Levine stands out among top state health officials throughout the country because she’s transgender. As Pennsylvania health secretary, she’s the highest ranking openly transgender health official — in health or other areas — in the United States.
Appointed by Pennsylvania Gov. Tom Wolf as health secretary in 2017, Levine said her priorities have been the opioid crisis, maternal child health, environmental health, nursing home regulations — but now she’s charged with taking on a global pandemic.
Levine’s approach to mitigating and preventing the spread of coronavirus over the past two months has been three fold: Expand testing, prepare the health care system for the peak of cases and rescue COVID-19 patients.
“We have been working with the health care system in terms of personal protective equipment, in terms of their beds, their supplies, their staff, etc., to make sure they can deal with the quote-on-quote surge,” Levine said.
With testing a key component of her approach, Levine said she’s giving “particular attention toward testing vulnerable communities in minority and underserved communities,” which have shown to face the brunt of the epidemic.
Malcolm Lazin, executive director of the Philadelphia-based Equality Forum, compared Levine to another prominent health official in representing the LGBTQ community in the fight against the coronavirus.
“She certainly has been viewed as the Anthony Fauci of Pennsylvania,” Lazin said. “She does daily briefings and has helped to inform citizens in Pennsylvania around COVID-19.”
The efforts appear to have shown success. According to the Pennsylvania Department of Health, the state has pushed out more than 3 million N95 masks, more than 238,000 gowns, close to 1.38 million procedure masks, more than 1.34 million gloves, more than 73,000 face shields and more than 5,600 coveralls.
Many of these supplies have been provided through the national stockpile, but some have come from state storage and other state efforts in Pennsylvania, per the department.
In terms of testing, Pennsylvania is currently testing all people who are symptomatic at its public testing sites, including the Wilkes-Barre area, and is looking to expand testing further through partnerships with Rite Aid and CVS, according to the department.
Levine had an impressive resume and background that led to her role as Pennsylvania health secretary. Previously, she served under the Wolf administration as Pennsylvania physician secretary.
Before that time, as a physician at Penn State Hershey Medical Center, she created Penn State Hershey Medical Center’s adolescent medicine division and eating disorders clinic. A Harvard graduate, Levine studied medicine at Tulane University School of Medicine.
The next step for Pennsylvania is the process to reopen the economy safely after weeks of shutdown as the pandemic raged. Levine said she expects the state to roll out on Friday a color-coded system of green, yellow and red that will begin the process.
Under the first stage of the system, Levine said lower-risk areas, such as rural portions of Pennsylvania, will be designated as yellow and allowed to reopen under some restrictions and additional testing.
Meanwhile, Levine said higher-risk areas, such as Philadelphia, will be designated red and required to stay under lockdown, and green designations are further down the road.
“So the next step is the Stage 3 reopening of businesses, but continuing the social isolation measures, such as masks, hand washing and staying six feet apart and all of these other things that we have been pushing,” Levine said. “We will prepare for any potential surge…as we go from summer to fall.”
Levine says CDC testing rollout under Trump ‘not done efficiently’
While state officials are at the forefront in the fight against the coronavirus, the Trump administration has been under fire for its approach to the pandemic. Chief among the criticisms was the delay in developing and distributing tests for the coronavirus, which many say could have helped contain the disease as part of a contact tracing system.
Levine was among the critics of the Trump administration for its delay in testing, which she called the “biggest challenge” Pennsylvania has had with the federal government.
“The testing was at CDC and it was going to go to the states, and then there were problems,” Levine said. “The testing had to be held back, and we didn’t start testing for probably a month later, and I think that that was really challenging.”
The delay in testing capabilities from the Trump administration, Levine said, was particularly frustrating during the early days of the epidemic because “at that time, we were in more of a containment phase.”
“We were tracking one case, five cases,” Levine said. “If they had ramped up testing at that time, that would have been very beneficial, but here we are. So clearly, the rollout of testing to the states was not done efficiently.”
As health secretary, Levine said she’s engaged with the Centers for Disease Control and just about every day has had talks with officials in the Department of Health & Human Services and the Food & Drug Administration.
Although the Trump administration has built an anti-LGBTQ record — implementing policies such as a transgender military ban and regulations enabling anti-LGBTQ discrimination in the name of religious freedom — Levine said being transgender has “not at all” been an issue in her dealings as health secretary with the federal government.
Many health experts, according to media reports, have said the United States needs to double — or even triple — its testing to begin to reopen the country safely on a nationwide basis.
Levine said that level of testing in the United States is reasonable to expect, but predicted it won’t happen in the short term and more likely for the late summer or fall.
“If we have the ability to have a point-of-care rapid test, where a doctor can basically take a swab or smear from the tongue or the mouth, do a test the same way we do a flu test and know if someone’s positive or negative…in five or 10 minutes, that will be a game changer,” Levine said. “Then we could do widespread population-based testing, and I think that will be very helpful.”
Levine also expressed caution over antibody tests. As reported Wednesday by NBC News, Congress is raising the alarm over these tests giving users false positives that may indicate they are immune from COVID-19, when, in fact, they are not.
Even if the tests are accurately determining whether a user has the COVID-19 antibody, Levine said their clinical utility is still unclear.
“We don’t know how protective those antibodies are, and how long-lived they are,” Levine said. “So to use them clinically, and say, ‘John Smith, you had COVID-19, you have antibodies, you’re immune. That is not clear.”
One complaint from LGBTQ advocates during the coronavirus crisis is that states aren’t collecting data on whether coronavirus patients identify as LGBTQ — even though they’re collecting racial and sex demographic information. The data, advocates say, could back up the case the LGBTQ community is particularly vulnerable to COVID-19.
Among those states is Pennsylvania. Data on whether coronavirus patients identify as LGBTQ isn’t collected, Levine said, because “it’s not part of our system.” Levine said she doubted whether that would even be possible “given our computer system,” but added it was in the process of being updated.
“If it’s not part of our information system, we wouldn’t be able to do it on a statewide basis,” Levine said.
Another concern from LGBTQ advocates is the Trump administration moving forward with undoing an Obama-era rule that interpreted Section 1557 of Obamacare, which bars discrimination on the basis of sex in health care, to prohibit bias on the basis of transgender status or sex stereotyping.
LGBTQ advocates say that move from the Office of Civil Rights at the Department of Health & Human Services would green light the refusal of care for LGBTQ people in the health care system — a concern Levine echoed in her interview with the Blade.
“If they completely rescind the Obama administration’s interpretation, I think that that even heightens the concern that LGBTQ individuals will be discriminated against in health care settings in the midst of a global pandemic,” Levine said.
It should be noted in 2016, a federal judge issued an order blocking the U.S. government from enforcing the Obama-era rule and the Trump administration declined to appeal that decision, so altering the regulations in the back end won’t change in terms of function.
The underlying law is still also in place, so LGBTQ people who feel they’ve experienced discrimination in health care can still sue in court, but they can’t take it up with the Office of Civil Rights at HHS.
Further, the Supreme Court is poised imminently to issue a decision on whether anti-LGBTQ discrimination is a form of sex discrimination, thus illegal under Title VII of the Civil Rights Act of 1964. Such a decision would likely have bearing on the enforcement of all laws barring discrimination on the basis of sex, including Section 1557 of the Affordable Care Act.
Levine’s leadership role during the coronavirus pandemic has prompted some LGBTQ movement leaders to talk privately about the idea of her being appointed to a future Biden administration, potentially as secretary of health and human services.
If Levine were given the role, she’d be the first openly transgender Cabinet member in U.S. history.
Asked about prospects of serving in a Biden administration, Levine said the talk was “extremely flattering,” but she hasn’t given the appointment any thought amid the crisis facing her state.
“Right now, I have to tell you I am laser-focused on protecting the health of everyone in Pennsylvania,” Levine said.
The Biden campaign didn’t respond to the Blade’s request to comment on a potential Levine appointment. Former Vice President Joseph Biden has signaled his administration would reflect the diversity of the country and promised to name a woman as his running mate.
Hector Vargas, executive director of GLMA: Health Professionals Advancing LGBTQ Equality, also praised Levine, crediting her with “developing and implementing science-based public health strategies that will save lives and keep Pennsylvanians healthy and safe.”
“This is what her training and experience calls her to do, and it’s what makes her extremely successful in her work protecting the public health,” Vargas said. “She has been a tremendous asset to Pennsylvania and its residents and would be the same in any position whether at the state or national level.”