Intended for healthcare professionals


Covid-19: South Africa variant found in the US as Biden expands health coverage

BMJ 2021; 372 doi: (Published 29 January 2021) Cite this as: BMJ 2021;372:n282

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  1. Janice Hopkins Tanne
  1. New York, USA

The US Centers for Disease Control and Prevention (CDC) said on 28 January that two unrelated infections with the South Africa variant of covid-19 had been found in South Carolina.1 The cases were detected by polymerase chain reaction testing early in January, according to the state’s acting public health director. No other cases have been linked to the two cases so far, CNN reported.2 The CDC said, “At this time, we have no evidence that infections by this variant cause more severe disease. Like the UK and Brazilian variants, which have also been detected in the US, preliminary data suggests this variant may spread more easily and quickly than other variants.”

On the same day, President Joe Biden made two executive orders—one to expand health insurance coverage and one to end restrictions imposed by the Trump administration on abortion and reproductive rights in the US and internationally. He said these actions would “undo the damage Trump has done.”

The order expanding health coverage will restore the Affordable Care Act (ACA), also known as Obamacare, and Medicaid (health insurance for those on low incomes) to the way they were before Trump became president, Biden said.3 As the pandemic continues, with thousands dying every week, Biden noted that more than 30 million people remain uninsured. “Black, Latino, and Native American people are more likely to be uninsured, and communities of colour have been especially hard hit by both the covid-19 pandemic and the economic downturn,” Biden noted in his executive order. He directed the secretary of health and human services to open a special enrolment period for uninsured and underinsured Americans from 15 February to 15 May 2021 to allow them to seek coverage through the federal marketplace.4 The same order directs relevant departments and agencies to review policies and practices and to waive, rescind, revise, or revoke those that “undermine Medicaid and the ACA.”

A memorandum on protecting women’s health at home and abroad ends restrictions on federal funds that “have made it harder for women to obtain necessary healthcare.”5

In the US, the memorandum removes the Trump administration’s restrictions on the federal Title X funds that support family planning and have led to the “defunding” of Planned Parenthood and other providers of women’s healthcare in several states. “Six states no longer have any Title X providers,” said Alexis McGill Johnson, president of Planned Parenthood, in a statement.6 Title X funds especially support healthcare for poor and racially disadvantaged women. The restrictions prohibited recipients of Title X funds from referring patients to abortion providers and made it more difficult for many women to receive complete medical information.

Internationally, the memorandum ends the “global gag rule,” also known as the Mexico City Policy. Johnson said that the rule prohibited foreign non-governmental organisations from receiving US funds if they provided information, referrals, or abortion services, or advocated for legalisation of abortion, “even if these activities were supported solely by non-US funds.” The Biden memorandum also restores funding to the United Nations Population Fund.

In an opinion piece in the Washington Post, Herminia Palacio, head of the Guttmacher Institute, and Daniel Grossman, director of Advancing New Standards in Reproductive Health at the University of California, San Francisco, called for a suspension of the requirement that mifepristone (the “abortion pill”) be dispensed in person during the pandemic “so that people do not have to risk their health to access needed care.” They noted that it can be dispensed by mail in several countries, including the UK. The in-person requirement had been suspended during the pandemic but was reinstated by the Supreme Court this month.7

They also called for an end to the Hyde Amendment, which prohibits the use of federal funds for abortion (except for cases of rape, incest, or risk to life) and thus limits abortion coverage for many women on low incomes. They also suggested eliminating the Helms Amendment, which since 1973 has blocked the use of US foreign aid to support abortion services.


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