Common use of Stay Clause in Contracts

Stay. at-home orders and other pandemic responses may have also reduced the ability of individuals affected by domestic violence to access 29 Xxxxx X. Xxxxx, et al., A Pandemic within a Pandemic—Intimate Partner Violence during Covid–19, N. Engl. J. Med. 383:2302–04 (Dec. 10, 2020), available at xxxxx://xxx.xxxx.xxx/doi/full/ 10.1056/NEJMp2024046. 30 Xxxxxx X. Xxxxxxx et al., Effects of the COVID–19 Pandemic on Routine Pediatric Vaccine Ordering and Administration—United States, Morb. Mortal. Wkly. Rep. 69(19):591–93 (May 8, 2020), xxxxx://xxx.xxx.xxx/mmwr/volumes/69/wr/ mm6919e2.htm; Xxxxxx Xxxxxxx-Xxxxx et al., Notes from the Field: Rebound in Routine Childhood Vaccine Administration Following Decline During the COVID–19 Pandemic—New York City, March 1–June 27, 2020, Morb. Mortal. Wkly. Rep. 69(30):999–1001 (Jul. 31 2020), https:// xxx.xxx.xxx/xxxx/xxxxxxx/00/xx/ mm6930a3.htm. 31 Office of the White House, National Strategy for the COVID–19 Response and Pandemic Preparedness (Jan. 21, 2021), https:// xxx.xxxxxxxxxx.xxx/xx-xxxxxxx/xxxxxxx/0000/00/ National-Strategy-for-the-COVID-19-Response-and- Pandemic-Preparedness.pdf. 32 In a study of 13 states from October to December 2020, the CDC found that Hispanic or Latino and Native American or Alaska Native individuals were 1.7 times more likely to visit an emergency room for COVID–19 than White This has included implementing individuals, and Black individuals were 1.4 times infection prevention measures or making ventilation improvements in congregate settings, health care settings, or other key locations. Other response and adaptation costs include capital investments in public facilities to meet pandemic operational 23 Centers for Disease Control and Prevention, COVID Data Tracker: Trends in Number of COVID–19 Cases and Deaths in the US Reported to CDC, by State/Territory, xxxxx://xxxxx.xxx.xxx/ covid-data-tracker/#trends_dailytrendscases (last visited May 8, 2021). 24 Id. 25 Centers for Disease Control and Prevention, COVID Data Tracker: COVID–19 Vaccinations in the United States, xxxxx://xxxxx.xxx.xxx/covid-data- tracker/#vaccinations (last visited May 8, 2021). 26 Xxxxxxx, supra note 4; Xxxx X´ . Xxxxxxxx et al., Mental Health, Substance Abuse, and Suicidal Ideation During COVID–19 Pandemic– United States, June 24–30 2020, Morb. Mortal. Wkly. Rep. 69(32):1049–57 (Aug. 14, 2020), https:// 27 Leeb, supra note 4. 28 Centers for Disease Prevention and Control, National Center for Health Statistics, Provisional Drug Overdose Death Counts, xxxxx://xxx.xxx.xxx/ nchs/nvss/vsrr/drug-overdose-data.htm (last visited May 8, 2021). more likely to do so than White individuals. See Xxxxxx, supra note 10. 33 Centers for Disease Control and Prevention, COVID Data Tracker: Trends in COVID–19 Cases and Deaths in the United States, by County-level Population Factors, xxxxx://xxxxx.xxx.xxx/covid- data-tracker/#pop-factors_totaldeaths (last visited May 8, 2021). 34 The CDC’s Social Vulnerability Index includes fifteen variables measuring social vulnerability, including unemployment, poverty, education levels, single-parent households, disability status, non-English speaking households, crowded housing, and transportation access. Centers for Disease Control and Prevention, COVID Data Tracker: Trends in COVID–19 Cases Over the last year, Native Americans have experienced more than one and a half times the rate of COVID–19 infections, more than triple the rate of hospitalizations, and more than double the death rate compared to White Americans.35 Low-income and minority communities also exhibit higher rates of pre-existing conditions that may contribute to an increased risk of COVID–19 mortality.36 In addition, individuals living in low- income communities may have had more limited ability to socially distance or to self-isolate when ill, resulting in faster spread of the virus, and were over-represented among essential workers, who faced greater risk of exposure.37 Social distancing measures in response to the pandemic may have also exacerbated pre-existing public health challenges. For example, for children living in homes with lead paint, spending substantially more time at home raises the risk of developing elevated blood lead levels, while screenings for elevated blood lead levels declined during the pandemic.38 The combination of these underlying social and health vulnerabilities may have contributed to more severe public health outcomes of the pandemic within these communities, resulting in an exacerbation of pre-existing disparities in health outcomes.39 and Deaths in the United States, by Social Vulnerability Index, xxxxx://xxxxx.xxx.xxx/covid- data-tracker/#pop-factors_totaldeaths (last visited May 8, 2021). 35 Centers for Disease Control and Prevention, Risk for COVID–19 Infection, Hospitalization, and Death By Race/Ethnicity, xxxxx://xxx.xxx.xxx/ coronavirus/2019-ncov/covid-data/investigations- discovery/hospitalization-death-by-race- ethnicity.html (last visited Apr. 26, 2021). 36 See, e.g., Centers for Disease Control and Prevention, Risk of Severe Illness or Death from COVID–19 (Dec. 10, 2020), xxxxx://xxx.xxx.xxx/ coronavirus/2019-ncov/community/health-equity/ racial-ethnic-disparities/disparities-illness.html (last visited Apr. 26, 2021). 37 Xxxxxx Xxxxxxx et al., Racial Disparities in Frontline Workers and Housing Crowding During COVID–19: Evidence from Geolocation Data (Sept. 22, 2020), NYU Xxxxx School of Business (forthcoming), available at xxxxx://xxxxxx.xxxx.xxx/ sol3/xxxxxx.xxx?abstract_id=3695249; Xxxxx XxXxxxxxx et al., Economic Vulnerability of Households with Essential Workers, JAMA 324(4):388–90 (2020), available at https:// xxxxxxxxxxx.xxx/xxxxxxxx/xxxx/xxxxxxxxxxx/ 2767630. 38 See, x.x., Xxxxxx X. Courtney et al., Decreases in Young Children Who Received Blood Lead Level Testing During COVID–19—34 Jurisdictions, a non-exclusive list of eligible uses of funding to respond to the COVID–19 public health emergency. Eligible uses listed under this section build and expand upon permissible expenditures under the CRF, while recognizing the differences between the ARPA and CARES Act, and recognizing that the response to the COVID–19 public health emergency has changed and will continue to change over time. To assess whether additional uses would be eligible under this category, recipients should identify an effect of COVID–19 on public health, including either or both of immediate effects or effects that may manifest over months or years, and assess how the use would respond to or address the identified need. The interim final rule identifies a non-exclusive list of uses that address the effects of the COVID–19 public health emergency, including:

Stay. at-home orders and other pandemic responses may have also reduced the ability of individuals affected by domestic violence to access 29 Xxxxx X. Xxxxx, et al., A Pandemic within a Pandemic—Intimate Partner Violence during Covid–19, N. Engl. J. Med. 383:2302–04 (Dec. 10, 2020), available at xxxxx://xxx.xxxx.xxx/doi/full/ 10.1056/NEJMp2024046. 30 Xxxxxx X. Xxxxxxx et al., Effects of the COVID–19 Pandemic on Routine Pediatric Vaccine Ordering and Administration—United States, Morb. Mortal. Wkly. Rep. 69(19):591–93 (May 8, 2020), xxxxx://xxx.xxx.xxx/mmwr/volumes/69/wr/ mm6919e2.htm; Xxxxxx Xxxxxxx-Xxxxx et al., Notes from the Field: Rebound in Routine Childhood Vaccine Administration Following Decline During the COVID–19 Pandemic—New York City, March 1–June 27, 2020, Morb. Mortal. Wkly. Rep. 69(30):999–1001 (Jul. 31 2020), https:// xxx.xxx.xxx/xxxx/xxxxxxx/00/xx/ mm6930a3.htm. 31 Office of the White House, National Strategy for the COVID–19 Response and Pandemic Preparedness (Jan. 21, 2021), https:// xxx.xxxxxxxxxx.xxx/xx-xxxxxxx/xxxxxxx/0000/00/ National-Strategy-for-the-COVID-19-Response-and- Pandemic-Preparedness.pdf. 32 In a study of 13 states from October to December 2020, the CDC found that Hispanic or Latino and Native American or Alaska Native individuals were 1.7 times more likely to visit an emergency room for COVID–19 than White This has included implementing individuals, and Black individuals were 1.4 times infection prevention measures or making ventilation improvements in congregate settings, health care settings, or other key locations. Other response and adaptation costs include capital investments in public facilities to meet pandemic operational 23 Centers for Disease Control and Prevention, COVID Data Tracker: Trends in Number of COVID–19 Cases and Deaths in the US Reported to CDC, by State/Territory, xxxxx://xxxxx.xxx.xxx/ covid-data-tracker/#trends_dailytrendscases (last visited May 8, 2021). 24 Id. 25 Centers for Disease Control and Prevention, COVID Data Tracker: COVID–19 Vaccinations in the United States, xxxxx://xxxxx.xxx.xxx/covid-data- tracker/#vaccinations (last visited May 8, 2021). 26 Xxxxxxx, supra note 4; Xxxx X´ . Xxxxxxxx et al., Mental Health, Substance Abuse, and Suicidal Ideation During COVID–19 Pandemic– United States, June 24–30 2020, Morb. Mortal. Wkly. Rep. 69(32):1049–57 (Aug. 14, 2020), https:// 27 Leeb, supra note 4. 28 Centers for Disease Prevention and Control, National Center for Health Statistics, Provisional Drug Overdose Death Counts, xxxxx://xxx.xxx.xxx/ nchs/nvss/vsrr/drug-overdose-data.htm (last visited May 8, 2021). more likely to do so than White individuals. See Xxxxxx, supra note 10. 33 Centers for Disease Control and Prevention, COVID Data Tracker: Trends in COVID–19 Cases and Deaths in the United States, by County-level Population Factors, xxxxx://xxxxx.xxx.xxx/covid- data-tracker/#pop-factors_totaldeaths (last visited May 8, 2021). 34 The CDC’s Social Vulnerability Index includes fifteen variables measuring social vulnerability, including unemployment, poverty, education levels, single-parent households, disability status, non-English speaking households, crowded housing, and transportation access. Centers for Disease Control and Prevention, COVID Data Tracker: Trends in COVID–19 Cases 26790 Federal Register / Vol. 86, No. 93 / Monday, May 17, 2021 / Rules and Regulations Over the last year, Native Americans have experienced more than one and a half times the rate of COVID–19 infections, more than triple the rate of hospitalizations, and more than double the death rate compared to White Americans.35 Low-income and minority communities also exhibit higher rates of pre-existing conditions that may contribute to an increased risk of COVID–19 mortality.36 In addition, individuals living in low- income communities may have had more limited ability to socially distance or to self-isolate when ill, resulting in faster spread of the virus, and were over-represented among essential workers, who faced greater risk of exposure.37 Social distancing measures in response to the pandemic may have also exacerbated pre-existing public health challenges. For example, for children living in homes with lead paint, spending substantially more time at home raises the risk of developing elevated blood lead levels, while screenings for elevated blood lead levels declined during the pandemic.38 The combination of these underlying social and health vulnerabilities may have contributed to more severe public health outcomes of the pandemic within these communities, resulting in an exacerbation of pre-existing disparities in health outcomes.39 and Deaths in the United States, by Social Vulnerability Index, xxxxx://xxxxx.xxx.xxx/covid- data-tracker/#pop-factors_totaldeaths (last visited May 8, 2021). 35 Centers for Disease Control and Prevention, Risk for COVID–19 Infection, Hospitalization, and Death By Race/Ethnicity, xxxxx://xxx.xxx.xxx/ coronavirus/2019-ncov/covid-data/investigations- discovery/hospitalization-death-by-race- ethnicity.html (last visited Apr. 26, 2021). 36 See, e.g., Centers for Disease Control and Prevention, Risk of Severe Illness or Death from COVID–19 (Dec. 10, 2020), xxxxx://xxx.xxx.xxx/ coronavirus/2019-ncov/community/health-equity/ racial-ethnic-disparities/disparities-illness.html (last visited Apr. 26, 2021). 37 Xxxxxx Xxxxxxx et al., Racial Disparities in Frontline Workers and Housing Crowding During COVID–19: Evidence from Geolocation Data (Sept. 22, 2020), NYU Xxxxx School of Business (forthcoming), available at xxxxx://xxxxxx.xxxx.xxx/ sol3/xxxxxx.xxx?abstract_id=3695249; Xxxxx XxXxxxxxx et al., Economic Vulnerability of Households with Essential Workers, JAMA 324(4):388–90 (2020), available at https:// xxxxxxxxxxx.xxx/xxxxxxxx/xxxx/xxxxxxxxxxx/ 2767630. 38 See, x.x.e.g., Xxxxxx X. Courtney Xxxxxxxx et al., Decreases in Young Children Who Received Blood Lead Level Testing During COVID–19—34 Jurisdictions, a non-exclusive list of eligible uses of funding to respond to the COVID–19 public health emergency. Eligible uses listed under this section build and expand upon permissible expenditures under the CRF, while recognizing the differences between the ARPA and CARES Act, and recognizing that the response to the COVID–19 public health emergency has changed and will continue to change over time. To assess whether additional uses would be eligible under this category, recipients should identify an effect of COVID–19 on public health, including either or both of immediate effects or effects that may manifest over months or years, and assess how the use would respond to or address the identified need. The interim final rule identifies a non-exclusive list of uses that address the effects of the COVID–19 public health emergency, including:

Stay. at-home orders and other pandemic responses may have also reduced the ability of individuals affected by domestic violence to access 29 Xxxxx X. Xxxxx, et al., A Pandemic within a Pandemic—Intimate Partner Violence during Covid–19, N. Engl. J. Med. 383:2302–04 (Dec. 10, 2020), available at xxxxx://xxx.xxxx.xxx/doi/full/ 10.1056/NEJMp2024046. 30 Xxxxxx X. Xxxxxxx et al., Effects of the COVID–19 Pandemic on Routine Pediatric Vaccine Ordering and Administration—United States, Morb. Mortal. Wkly. Rep. 69(19):591–93 (May 8, 2020), xxxxx://xxx.xxx.xxx/mmwr/volumes/69/wr/ mm6919e2.htm; Xxxxxx Xxxxxxx-Xxxxx et al., Notes from the Field: Rebound in Routine Childhood Vaccine Administration Following Decline During the COVID–19 Pandemic—New York City, March 1–June 27, 2020, Morb. Mortal. Wkly. Rep. 69(30):999–1001 (Jul. 31 2020), https:// xxx.xxx.xxx/xxxx/xxxxxxx/00/xx/ mm6930a3.htm. 31 Office of the White House, National Strategy for the COVID–19 Response and Pandemic Preparedness (Jan. 21, 2021), https:// xxx.xxxxxxxxxx.xxx/xx-xxxxxxx/xxxxxxx/0000/00/ National-Strategy-for-the-COVID-19-Response-and- Pandemic-Preparedness.pdf. 32 In a study of 13 states from October to December 2020, the CDC found that Hispanic or Latino and Native American or Alaska Native individuals were 1.7 times more likely to visit an emergency room for COVID–19 than White This has included implementing individuals, and Black individuals were 1.4 times infection prevention measures or making ventilation improvements in congregate settings, health care settings, or other key locations. Other response and adaptation costs include capital investments in public facilities to meet pandemic operational 23 Centers for Disease Control and Prevention, COVID Data Tracker: Trends in Number of COVID–19 Cases and Deaths in the US Reported to CDC, by State/Territory, xxxxx://xxxxx.xxx.xxx/ covid-data-tracker/#trends_dailytrendscases (last visited May 8, 2021). 24 Id. 25 Centers for Disease Control and Prevention, COVID Data Tracker: COVID–19 Vaccinations in the United States, xxxxx://xxxxx.xxx.xxx/covid-data- tracker/#vaccinations (last visited May 8, 2021). 26 Xxxxxxx, supra note 4; Xxxx X´ . Xxxxxxxx et al., Mental Health, Substance Abuse, and Suicidal Ideation During COVID–19 Pandemic– United States, June 24–30 2020, Morb. Mortal. Wkly. Rep. 69(32):1049–57 (Aug. 14, 2020), https:// 27 Leeb, supra note 4. 28 Centers for Disease Prevention and Control, National Center for Health Statistics, Provisional Drug Overdose Death Counts, xxxxx://xxx.xxx.xxx/ nchs/nvss/vsrr/drug-overdose-data.htm (last visited May 8, 2021). more likely to do so than White individuals. See Xxxxxx, supra note 10. 33 Centers for Disease Control and Prevention, COVID Data Tracker: Trends in COVID–19 Cases and Deaths in the United States, by County-level Population Factors, xxxxx://xxxxx.xxx.xxx/covid- data-tracker/#pop-factors_totaldeaths (last visited May 8, 2021). 34 The CDC’s Social Vulnerability Index includes fifteen variables measuring social vulnerability, including unemployment, poverty, education levels, single-parent households, disability status, non-English speaking households, crowded housing, and transportation access. Centers for Disease Control and Prevention, COVID Data Tracker: Trends in COVID–19 Cases 26790 Federal Register / Vol. 86, No. 93 / Monday, May 17, 2021 / Rules and Regulations Over the last year, Native Americans have experienced more than one and a half times the rate of COVID–19 infections, more than triple the rate of hospitalizations, and more than double the death rate compared to White Americans.35 Low-income and minority communities also exhibit higher rates of pre-existing conditions that may contribute to an increased risk of COVID–19 mortality.36 In addition, individuals living in low- income communities may have had more limited ability to socially distance or to self-isolate when ill, resulting in faster spread of the virus, and were over-represented among essential workers, who faced greater risk of exposure.37 Social distancing measures in response to the pandemic may have also exacerbated pre-existing public health challenges. For example, for children living in homes with lead paint, spending substantially more time at home raises the risk of developing elevated blood lead levels, while screenings for elevated blood lead levels declined during the pandemic.38 The combination of these underlying social and health vulnerabilities may have contributed to more severe public health outcomes of the pandemic within these communities, resulting in an exacerbation of pre-existing disparities in health outcomes.39 and Deaths in the United States, by Social Vulnerability Index, xxxxx://xxxxx.xxx.xxx/covid- data-tracker/#pop-factors_totaldeaths (last visited May 8, 2021). 35 Centers for Disease Control and Prevention, Risk for COVID–19 Infection, Hospitalization, and Death By Race/Ethnicity, xxxxx://xxx.xxx.xxx/ coronavirus/2019-ncov/covid-data/investigations- discovery/hospitalization-death-by-race- ethnicity.html (last visited Apr. 26, 2021). 36 See, e.g., Centers for Disease Control and Prevention, Risk of Severe Illness or Death from COVID–19 (Dec. 10, 2020), xxxxx://xxx.xxx.xxx/ coronavirus/2019-ncov/community/health-equity/ racial-ethnic-disparities/disparities-illness.html (last visited Apr. 26, 2021). 37 Xxxxxx Xxxxxxx et al., Racial Disparities in Frontline Workers and Housing Crowding During COVID–19: Evidence from Geolocation Data (Sept. 22, 2020), NYU Xxxxx School of Business (forthcoming), available at xxxxx://xxxxxx.xxxx.xxx/ sol3/xxxxxx.xxx?abstract_id=3695249; Xxxxx XxXxxxxxx et al., Economic Vulnerability of Households with Essential Workers, JAMA 324(4):388–90 (2020), available at https:// xxxxxxxxxxx.xxx/xxxxxxxx/xxxx/xxxxxxxxxxx/ 2767630. 38 See, x.x., Xxxxxx X. Courtney et al., Decreases in Young Children Who Received Blood Lead Level Testing During COVID–19—34 Jurisdictions, a non-exclusive list of eligible uses of funding to respond to the COVID–19 public health emergency. Eligible uses listed under this section build and expand upon permissible expenditures under the CRF, while recognizing the differences between the ARPA and CARES Act, and recognizing that the response to the COVID–19 public health emergency has changed and will continue to change over time. To assess whether additional uses would be eligible under this category, recipients should identify an effect of COVID–19 on public health, including either or both of immediate effects or effects that may manifest over months or years, and assess how the use would respond to or address the identified need. The interim final rule identifies a non-exclusive list of uses that address the effects of the COVID–19 public health emergency, including:

Stay. at-home orders and other pandemic responses may have also reduced the ability of individuals affected by domestic violence to access 29 Xxxxx X. Xxxxx, et al., A Pandemic within a Pandemic—Intimate Partner Violence during Covid–19, N. Engl. J. Med. 383:2302–04 (Dec. 10, 2020), available at xxxxx://xxx.xxxx.xxx/doi/full/ 10.1056/NEJMp2024046. 30 Xxxxxx X. Xxxxxxx et al., Effects of the COVID–19 Pandemic on Routine Pediatric Vaccine Ordering and Administration—United States, Morb. Mortal. Wkly. Rep. 69(19):591–93 (May 8, 2020), xxxxx://xxx.xxx.xxx/mmwr/volumes/69/wr/ mm6919e2.htm; Xxxxxx Xxxxxxx-Xxxxx et al., Notes from the Field: Rebound in Routine Childhood Vaccine Administration Following Decline During the COVID–19 Pandemic—New York City, March 1–June 27, 2020, Morb. Mortal. Wkly. Rep. 69(30):999–1001 (Jul. 31 2020), https:// xxx.xxx.xxx/xxxx/xxxxxxx/00/xx/ mm6930a3.htm. 31 Office of the White House, National Strategy for the COVID–19 Response and Pandemic Preparedness (Jan. 21, 2021), https:// xxx.xxxxxxxxxx.xxx/xx-xxxxxxx/xxxxxxx/0000/00/ National-Strategy-for-the-COVID-19-Response-and- Pandemic-Preparedness.pdf. 32 In a study of 13 states from October to December 2020, the CDC found that Hispanic or Latino and Native American or Alaska Native individuals were 1.7 times more likely to visit an emergency room for COVID–19 than White This has included implementing individuals, and Black individuals were 1.4 times infection prevention measures or making ventilation improvements in congregate settings, health care settings, or other key locations. Other response and adaptation costs include capital investments in public facilities to meet pandemic operational 23 Centers for Disease Control and Prevention, COVID Data Tracker: Trends in Number of COVID–19 Cases and Deaths in the US Reported to CDC, by State/Territory, xxxxx://xxxxx.xxx.xxx/ covid-data-tracker/#trends_dailytrendscases (last visited May 8, 2021). 24 Id. 25 Centers for Disease Control and Prevention, COVID Data Tracker: COVID–19 Vaccinations in the United States, xxxxx://xxxxx.xxx.xxx/covid-data- tracker/#vaccinations (last visited May 8, 2021). 26 Xxxxxxx, supra note 4; Xxxx X´ . Xxxxxxxx et al., Mental Health, Substance Abuse, and Suicidal Ideation During COVID–19 Pandemic– United States, June 24–30 2020, Morb. Mortal. Wkly. Rep. 69(32):1049–57 (Aug. 14, 2020), https:// 27 Leeb, supra note 4. 28 Centers for Disease Prevention and Control, National Center for Health Statistics, Provisional Drug Overdose Death Counts, xxxxx://xxx.xxx.xxx/ nchs/nvss/vsrr/drug-overdose-data.htm (last visited May 8, 2021). more likely to do so than White individuals. See Xxxxxx, supra note 10. 33 Centers for Disease Control and Prevention, COVID Data Tracker: Trends in COVID–19 Cases and Deaths in the United States, by County-level Population Factors, xxxxx://xxxxx.xxx.xxx/covid- data-tracker/#pop-factors_totaldeaths (last visited May 8, 2021). 34 The CDC’s Social Vulnerability Index includes fifteen variables measuring social vulnerability, including unemployment, poverty, education levels, single-parent households, disability status, non-English speaking households, crowded housing, and transportation access. Centers for Disease Control and Prevention, COVID Data Tracker: Trends in COVID–19 Cases Over the last year, Native Americans have experienced more than one and a half times the rate of COVID–19 infections, more than triple the rate of hospitalizations, and more than double the death rate compared to White Americans.35 Low-income and minority communities also exhibit higher rates of pre-existing conditions that may contribute to an increased risk of COVID–19 mortality.36 In addition, individuals living in low- income communities may have had more limited ability to socially distance or to self-isolate when ill, resulting in faster spread of the virus, and were over-represented among essential workers, who faced greater risk of exposure.37 Social distancing measures in response to the pandemic may have also exacerbated pre-existing public health challenges. For example, for children living in homes with lead paint, spending substantially more time at home raises the risk of developing elevated blood lead levels, while screenings for elevated blood lead levels declined during the pandemic.38 The combination of these underlying social and health vulnerabilities may have contributed to more severe public health outcomes of the pandemic within these communities, resulting in an exacerbation of pre-existing disparities in health outcomes.39 and Deaths in the United States, by Social Vulnerability Index, xxxxx://xxxxx.xxx.xxx/covid- data-tracker/#pop-factors_totaldeaths (last visited May 8, 2021). 35 Centers for Disease Control and Prevention, Risk for COVID–19 Infection, Hospitalization, and Death By Race/Ethnicity, xxxxx://xxx.xxx.xxx/ coronavirus/2019-ncov/covid-data/investigations- discovery/hospitalization-death-by-race- ethnicity.html (last visited Apr. 26, 2021). 36 See, e.g., Centers for Disease Control and Prevention, Risk of Severe Illness or Death from COVID–19 (Dec. 10, 2020), xxxxx://xxx.xxx.xxx/ coronavirus/2019-ncov/community/health-equity/ racial-ethnic-disparities/disparities-illness.html (last visited Apr. 26, 2021). 37 Xxxxxx Xxxxxxx et al., Racial Disparities in Frontline Workers and Housing Crowding During COVID–19: Evidence from Geolocation Data (Sept. 22, 2020), NYU Xxxxx School of Business (forthcoming), available at xxxxx://xxxxxx.xxxx.xxx/ sol3/xxxxxx.xxx?abstract_id=3695249; Xxxxx XxXxxxxxx et al., Economic Vulnerability of Households with Essential Workers, JAMA 324(4):388–90 (2020), available at https:// xxxxxxxxxxx.xxx/xxxxxxxx/xxxx/xxxxxxxxxxx/ 2767630. 38 See, x.x.e.g., Xxxxxx X. Courtney Xxxxxxxx et al., Decreases in Young Children Who Received Blood Lead Level Testing During COVID–19—34 Jurisdictions, a non-exclusive list of eligible uses of funding to respond to the COVID–19 public health emergency. Eligible uses listed under this section build and expand upon permissible expenditures under the CRF, while recognizing the differences between the ARPA and CARES Act, and recognizing that the response to the COVID–19 public health emergency has changed and will continue to change over time. To assess whether additional uses would be eligible under this category, recipients should identify an effect of COVID–19 on public health, including either or both of immediate effects or effects that may manifest over months or years, and assess how the use would respond to or address the identified need. The interim final rule identifies a non-exclusive list of uses that address the effects of the COVID–19 public health emergency, including:

Stay. at-home orders and other pandemic responses may have also reduced the ability of individuals affected by domestic violence to access 29 Xxxxx X. Xxxxx, et al., A Pandemic within a Pandemic—Intimate Partner Violence during Covid–19, N. Engl. J. Med. 383:2302–04 (Dec. 10, 2020), available at xxxxx://xxx.xxxx.xxx/doi/full/ 10.1056/NEJMp2024046. 30 Xxxxxx X. Xxxxxxx et al., Effects of the COVID–19 Pandemic on Routine Pediatric Vaccine Ordering and Administration—United States, Morb. Mortal. Wkly. Rep. 69(19):591–93 (May 8, 2020), xxxxx://xxx.xxx.xxx/mmwr/volumes/69/wr/ mm6919e2.htm; Xxxxxx Xxxxxxx-Xxxxx et al., Notes from the Field: Rebound in Routine Childhood Vaccine Administration Following Decline During the COVID–19 Pandemic—New York City, March 1–June 27, 2020, Morb. Mortal. Wkly. Rep. 69(30):999–1001 (Jul. 31 2020), https:// xxx.xxx.xxx/xxxx/xxxxxxx/00/xx/ mm6930a3.htm. 31 Office of the White House, National Strategy for the COVID–19 Response and Pandemic Preparedness (Jan. 21, 2021), https:// xxx.xxxxxxxxxx.xxx/xx-xxxxxxx/xxxxxxx/0000/00/ National-Strategy-for-the-COVID-19-Response-and- Pandemic-Preparedness.pdf. 32 In a study of 13 states from October to December 2020, the CDC found that Hispanic or Latino and Native American or Alaska Native individuals were 1.7 times more likely to visit an emergency room for COVID–19 than White This has included implementing individuals, and Black individuals were 1.4 times infection prevention measures or making ventilation improvements in congregate settings, health care settings, or other key locations. Other response and adaptation costs include capital investments in public facilities to meet pandemic operational 23 Centers for Disease Control and Prevention, COVID Data Tracker: Trends in Number of COVID–19 Cases and Deaths in the US Reported to CDC, by State/Territory, xxxxx://xxxxx.xxx.xxx/ covid-data-tracker/#trends_dailytrendscases (last visited May 8, 2021). 24 Id. 25 Centers for Disease Control and Prevention, COVID Data Tracker: COVID–19 Vaccinations in the United States, xxxxx://xxxxx.xxx.xxx/covid-data- tracker/#vaccinations (last visited May 8, 2021). 26 Xxxxxxx, supra note 4; Xxxx X´ . Xxxxxxxx et al., Mental Health, Substance Abuse, and Suicidal Ideation During COVID–19 Pandemic– United States, June 24–30 2020, Morb. Mortal. Wkly. Rep. 69(32):1049–57 (Aug. 14, 2020), https:// 27 Leeb, supra note 4. 28 Centers for Disease Prevention and Control, National Center for Health Statistics, Provisional Drug Overdose Death Counts, xxxxx://xxx.xxx.xxx/ nchs/nvss/vsrr/drug-overdose-data.htm (last visited May 8, 2021). more likely to do so than White individuals. See Xxxxxx, supra note 10. 33 Centers for Disease Control and Prevention, COVID Data Tracker: Trends in COVID–19 Cases and Deaths in the United States, by County-level Population Factors, xxxxx://xxxxx.xxx.xxx/covid- data-tracker/#pop-factors_totaldeaths (last visited May 8, 2021). 34 The CDC’s Social Vulnerability Index includes fifteen variables measuring social vulnerability, including unemployment, poverty, education levels, single-parent households, disability status, non-English speaking households, crowded housing, and transportation access. Centers for Disease Control and Prevention, COVID Data Tracker: Trends in COVID–19 Cases 26790 Federal Register / Xxx. 00, Xx. 00 / Monday, May 17, 2021 / Rules and Regulations Over the last year, Native Americans have experienced more than one and a half times the rate of COVID–19 infections, more than triple the rate of hospitalizations, and more than double the death rate compared to White Americans.35 Low-income and minority communities also exhibit higher rates of pre-existing conditions that may contribute to an increased risk of COVID–19 mortality.36 In addition, individuals living in low- income communities may have had more limited ability to socially distance or to self-isolate when ill, resulting in faster spread of the virus, and were over-represented among essential workers, who faced greater risk of exposure.37 Social distancing measures in response to the pandemic may have also exacerbated pre-existing public health challenges. For example, for children living in homes with lead paint, spending substantially more time at home raises the risk of developing elevated blood lead levels, while screenings for elevated blood lead levels declined during the pandemic.38 The combination of these underlying social and health vulnerabilities may have contributed to more severe public health outcomes of the pandemic within these communities, resulting in an exacerbation of pre-existing disparities in health outcomes.39 and Deaths in the United States, by Social Vulnerability Index, xxxxx://xxxxx.xxx.xxx/covid- data-tracker/#pop-factors_totaldeaths (last visited May 8, 2021). 35 Centers for Disease Control and Prevention, Risk for COVID–19 Infection, Hospitalization, and Death By Race/Ethnicity, xxxxx://xxx.xxx.xxx/ coronavirus/2019-ncov/covid-data/investigations- discovery/hospitalization-death-by-race- ethnicity.html (last visited Apr. 26, 2021). 36 See, e.g., Centers for Disease Control and Prevention, Risk of Severe Illness or Death from COVID–19 (Dec. 10, 2020), xxxxx://xxx.xxx.xxx/ coronavirus/2019-ncov/community/health-equity/ racial-ethnic-disparities/disparities-illness.html (last visited Apr. 26, 2021). 37 Xxxxxx Xxxxxxx et al., Racial Disparities in Frontline Workers and Housing Crowding During COVID–19: Evidence from Geolocation Data (Sept. 22, 2020), NYU Xxxxx School of Business (forthcoming), available at xxxxx://xxxxxx.xxxx.xxx/ sol3/xxxxxx.xxx?abstract_id=3695249; Xxxxx XxXxxxxxx et al., Economic Vulnerability of Households with Essential Workers, JAMA 324(4):388–90 (2020), available at https:// xxxxxxxxxxx.xxx/xxxxxxxx/xxxx/xxxxxxxxxxx/ 2767630. 38 See, x.x.e.g., Xxxxxx X. Courtney Xxxxxxxx et al., Decreases in Young Children Who Received Blood Lead Level Testing During COVID–19—34 Jurisdictions, a non-exclusive list of eligible uses of funding to respond to the COVID–19 public health emergency. Eligible uses listed under this section build and expand upon permissible expenditures under the CRF, while recognizing the differences between the ARPA and CARES Act, and recognizing that the response to the COVID–19 public health emergency has changed and will continue to change over time. To assess whether additional uses would be eligible under this category, recipients should identify an effect of COVID–19 on public health, including either or both of immediate effects or effects that may manifest over months or years, and assess how the use would respond to or address the identified need. The interim final rule identifies a non-exclusive list of uses that address the effects of the COVID–19 public health emergency, including:

Stay. at-home orders and other pandemic responses may have also reduced the ability of individuals affected by domestic violence to access 29 Xxxxx X. Xxxxx, et al., A Pandemic within a Pandemic—Intimate Partner Violence during Covid–19, N. Engl. J. Med. 383:2302–04 (Dec. 10, 2020), available at xxxxx://xxx.xxxx.xxx/doi/full/ 10.1056/NEJMp2024046. 30 Xxxxxx X. Xxxxxxx et al., Effects of the COVID–19 Pandemic on Routine Pediatric Vaccine Ordering and Administration—United States, Morb. Mortal. Wkly. Rep. 69(19):591–93 (May 8, 2020), xxxxx://xxx.xxx.xxx/mmwr/volumes/69/wr/ mm6919e2.htm; Xxxxxx Xxxxxxx-Xxxxx et al., Notes from the Field: Rebound in Routine Childhood Vaccine Administration Following Decline During the COVID–19 Pandemic—New York City, March 1–June 27, 2020, Morb. Mortal. Wkly. Rep. 69(30):999–1001 (Jul. 31 2020), https:// xxx.xxx.xxx/xxxx/xxxxxxx/00/xx/ mm6930a3.htm. 31 Office of the White House, National Strategy for the COVID–19 Response and Pandemic Preparedness (Jan. 21, 2021), https:// xxx.xxxxxxxxxx.xxx/xx-xxxxxxx/xxxxxxx/0000/00/ National-Strategy-for-the-COVID-19-Response-and- Pandemic-Preparedness.pdf. 32 In a study of 13 states from October to December 2020, the CDC found that Hispanic or Latino and Native American or Alaska Native individuals were 1.7 times more likely to visit an emergency room for COVID–19 than White This has included implementing individuals, and Black individuals were 1.4 times infection prevention measures or making ventilation improvements in congregate settings, health care settings, or other key locations. Other response and adaptation costs include capital investments in public facilities to meet pandemic operational 23 Centers for Disease Control and Prevention, COVID Data Tracker: Trends in Number of COVID–19 Cases and Deaths in the US Reported to CDC, by State/Territory, xxxxx://xxxxx.xxx.xxx/ covid-data-tracker/#trends_dailytrendscases (last visited May 8, 2021). 24 Id. 25 Centers for Disease Control and Prevention, COVID Data Tracker: COVID–19 Vaccinations in the United States, xxxxx://xxxxx.xxx.xxx/covid-data- tracker/#vaccinations (last visited May 8, 2021). 26 Xxxxxxx, supra note 4; Xxxx XE´ . Xxxxxxxx Czeisler et al., Mental Health, Substance Abuse, and Suicidal Ideation During COVID–19 Pandemic– United States, June 24–30 2020, Morb. Mortal. Wkly. Rep. 69(32):1049–57 (Aug. 14, 2020), https:// 27 Leeb, supra note 4. 28 Centers for Disease Prevention and Control, National Center for Health Statistics, Provisional Drug Overdose Death Counts, xxxxx://xxx.xxx.xxx/ nchs/nvss/vsrr/drug-overdose-data.htm (last visited May 8, 2021). more likely to do so than White individuals. See Xxxxxx, supra note 10. 33 Centers for Disease Control and Prevention, COVID Data Tracker: Trends in COVID–19 Cases and Deaths in the United States, by County-level Population Factors, xxxxx://xxxxx.xxx.xxx/covid- data-tracker/#pop-factors_totaldeaths (last visited May 8, 2021). 34 The CDC’s Social Vulnerability Index includes fifteen variables measuring social vulnerability, including unemployment, poverty, education levels, single-parent households, disability status, non-English speaking households, crowded housing, and transportation access. Centers for Disease Control and Prevention, COVID Data Tracker: Trends in COVID–19 Cases Over the last year, Native Americans have experienced more than one and a half times the rate of COVID–19 infections, more than triple the rate of hospitalizations, and more than double the death rate compared to White Americans.35 Low-income and minority communities also exhibit higher rates of pre-existing conditions that may contribute to an increased risk of COVID–19 mortality.36 In addition, individuals living in low- income communities may have had more limited ability to socially distance or to self-isolate when ill, resulting in faster spread of the virus, and were over-represented among essential workers, who faced greater risk of exposure.37 Social distancing measures in response to the pandemic may have also exacerbated pre-existing public health challenges. For example, for children living in homes with lead paint, spending substantially more time at home raises the risk of developing elevated blood lead levels, while screenings for elevated blood lead levels declined during the pandemic.38 The combination of these underlying social and health vulnerabilities may have contributed to more severe public health outcomes of the pandemic within these communities, resulting in an exacerbation of pre-existing disparities in health outcomes.39 and Deaths in the United States, by Social Vulnerability Index, xxxxx://xxxxx.xxx.xxx/covid- data-tracker/#pop-factors_totaldeaths (last visited May 8, 2021). 35 Centers for Disease Control and Prevention, Risk for COVID–19 Infection, Hospitalization, and Death By Race/Ethnicity, xxxxx://xxx.xxx.xxx/ coronavirus/2019-ncov/covid-data/investigations- discovery/hospitalization-death-by-race- ethnicity.html (last visited Apr. 26, 2021). 36 See, e.g., Centers for Disease Control and Prevention, Risk of Severe Illness or Death from COVID–19 (Dec. 10, 2020), xxxxx://xxx.xxx.xxx/ coronavirus/2019-ncov/community/health-equity/ racial-ethnic-disparities/disparities-illness.html (last visited Apr. 26, 2021). 37 Xxxxxx Xxxxxxx et al., Racial Disparities in Frontline Workers and Housing Crowding During COVID–19: Evidence from Geolocation Data (Sept. 22, 2020), NYU Xxxxx School of Business (forthcoming), available at xxxxx://xxxxxx.xxxx.xxx/ sol3/xxxxxx.xxx?abstract_id=3695249; Xxxxx XxXxxxxxx et al., Economic Vulnerability of Households with Essential Workers, JAMA 324(4):388–90 (2020), available at https:// xxxxxxxxxxx.xxx/xxxxxxxx/xxxx/xxxxxxxxxxx/ 2767630. 38 See, x.x.e.g., Xxxxxx X. Courtney Xxxxxxxx et al., Decreases in Young Children Who Received Blood Lead Level Testing During COVID–19—34 Jurisdictions, a non-exclusive list of eligible uses of funding to respond to the COVID–19 public health emergency. Eligible uses listed under this section build and expand upon permissible expenditures under the CRF, while recognizing the differences between the ARPA and CARES Act, and recognizing that the response to the COVID–19 public health emergency has changed and will continue to change over time. To assess whether additional uses would be eligible under this category, recipients should identify an effect of COVID–19 on public health, including either or both of immediate effects or effects that may manifest over months or years, and assess how the use would respond to or address the identified need. The interim final rule identifies a non-exclusive list of uses that address the effects of the COVID–19 public health emergency, including:

Stay. at-home orders and other pandemic responses may have also reduced the ability of individuals affected by domestic violence to access 29 Xxxxx X. Xxxxx, et al., A Pandemic within a Pandemic—Intimate Partner Violence during Covid–19, N. Engl. J. Med. 383:2302–04 (Dec. 10, 2020), available at xxxxx://xxx.xxxx.xxx/doi/full/ 10.1056/NEJMp2024046. 30 Xxxxxx X. Xxxxxxx et al., Effects of the COVID–19 Pandemic on Routine Pediatric Vaccine Ordering and Administration—United States, Morb. Mortal. Wkly. Rep. 69(19):591–93 (May 8, 2020), xxxxx://xxx.xxx.xxx/mmwr/volumes/69/wr/ mm6919e2.htm; Xxxxxx Xxxxxxx-Xxxxx et al., Notes from the Field: Rebound in Routine Childhood Vaccine Administration Following Decline During the COVID–19 Pandemic—New York City, March 1–June 27, 2020, Morb. Mortal. Wkly. Rep. 69(30):999–1001 (Jul. 31 2020), https:// xxx.xxx.xxx/xxxx/xxxxxxx/00/xx/ mm6930a3.htm. 31 Office of the White House, National Strategy for the COVID–19 Response and Pandemic Preparedness (Jan. 21, 2021), https:// xxx.xxxxxxxxxx.xxx/xx-xxxxxxx/xxxxxxx/0000/00/ National-Strategy-for-the-COVID-19-Response-and- Pandemic-Preparedness.pdf. 32 In a study of 13 states from October to December 2020, the CDC found that Hispanic or Latino and Native American or Alaska Native individuals were 1.7 times more likely to visit an emergency room for COVID–19 than White This has included implementing individuals, and Black individuals were 1.4 times infection prevention measures or making ventilation improvements in congregate settings, health care settings, or other key locations. Other response and adaptation costs include capital investments in public facilities to meet pandemic operational 23 Centers for Disease Control and Prevention, COVID Data Tracker: Trends in Number of COVID–19 Cases and Deaths in the US Reported to CDC, by State/Territory, xxxxx://xxxxx.xxx.xxx/ covid-data-tracker/#trends_dailytrendscases (last visited May 8, 2021). 24 Id. 25 Centers for Disease Control and Prevention, COVID Data Tracker: COVID–19 Vaccinations in the United States, xxxxx://xxxxx.xxx.xxx/covid-data- tracker/#vaccinations (last visited May 8, 2021). 26 Xxxxxxx, supra note 4; Xxxx XE´ . Xxxxxxxx Czeisler et al., Mental Health, Substance Abuse, and Suicidal Ideation During COVID–19 Pandemic– United States, June 24–30 2020, Morb. Mortal. Wkly. Rep. 69(32):1049–57 (Aug. 14, 2020), https:// 27 Leeb, supra note 4. 28 Centers for Disease Prevention and Control, National Center for Health Statistics, Provisional Drug Overdose Death Counts, xxxxx://xxx.xxx.xxx/ nchs/nvss/vsrr/drug-overdose-data.htm (last visited May 8, 2021). more likely to do so than White individuals. See Xxxxxx, supra note 10. 33 Centers for Disease Control and Prevention, COVID Data Tracker: Trends in COVID–19 Cases and Deaths in the United States, by County-level Population Factors, xxxxx://xxxxx.xxx.xxx/covid- data-tracker/#pop-factors_totaldeaths (last visited May 8, 2021). 34 The CDC’s Social Vulnerability Index includes fifteen variables measuring social vulnerability, including unemployment, poverty, education levels, single-parent households, disability status, non-English speaking households, crowded housing, and transportation access. Centers for Disease Control and Prevention, COVID Data Tracker: Trends in COVID–19 Cases 26790 Federal Register / Xxx. 00, Xx. 00 / Monday, May 17, 2021 / Rules and Regulations Over the last year, Native Americans have experienced more than one and a half times the rate of COVID–19 infections, more than triple the rate of hospitalizations, and more than double the death rate compared to White Americans.35 Low-income and minority communities also exhibit higher rates of pre-existing conditions that may contribute to an increased risk of COVID–19 mortality.36 In addition, individuals living in low- income communities may have had more limited ability to socially distance or to self-isolate when ill, resulting in faster spread of the virus, and were over-represented among essential workers, who faced greater risk of exposure.37 Social distancing measures in response to the pandemic may have also exacerbated pre-existing public health challenges. For example, for children living in homes with lead paint, spending substantially more time at home raises the risk of developing elevated blood lead levels, while screenings for elevated blood lead levels declined during the pandemic.38 The combination of these underlying social and health vulnerabilities may have contributed to more severe public health outcomes of the pandemic within these communities, resulting in an exacerbation of pre-existing disparities in health outcomes.39 and Deaths in the United States, by Social Vulnerability Index, xxxxx://xxxxx.xxx.xxx/covid- data-tracker/#pop-factors_totaldeaths (last visited May 8, 2021). 35 Centers for Disease Control and Prevention, Risk for COVID–19 Infection, Hospitalization, and Death By Race/Ethnicity, xxxxx://xxx.xxx.xxx/ coronavirus/2019-ncov/covid-data/investigations- discovery/hospitalization-death-by-race- ethnicity.html (last visited Apr. 26, 2021). 36 See, e.g., Centers for Disease Control and Prevention, Risk of Severe Illness or Death from COVID–19 (Dec. 10, 2020), xxxxx://xxx.xxx.xxx/ coronavirus/2019-ncov/community/health-equity/ racial-ethnic-disparities/disparities-illness.html (last visited Apr. 26, 2021). 37 Xxxxxx Xxxxxxx et al., Racial Disparities in Frontline Workers and Housing Crowding During COVID–19: Evidence from Geolocation Data (Sept. 22, 2020), NYU Xxxxx School of Business (forthcoming), available at xxxxx://xxxxxx.xxxx.xxx/ sol3/xxxxxx.xxx?abstract_id=3695249papers.cfm?abstract_id=3695249; Xxxxx XxXxxxxxx et al., Economic Vulnerability of Households with Essential Workers, JAMA 324(4):388–90 (2020), available at https:// xxxxxxxxxxx.xxx/xxxxxxxx/xxxx/xxxxxxxxxxx/ 2767630. 38 See, x.x.e.g., Xxxxxx X. Courtney Xxxxxxxx et al., Decreases in Young Children Who Received Blood Lead Level Testing During COVID–19—34 Jurisdictions, a non-exclusive list of eligible uses of funding to respond to the COVID–19 public health emergency. Eligible uses listed under this section build and expand upon permissible expenditures under the CRF, while recognizing the differences between the ARPA and CARES Act, and recognizing that the response to the COVID–19 public health emergency has changed and will continue to change over time. To assess whether additional uses would be eligible under this category, recipients should identify an effect of COVID–19 on public health, including either or both of immediate effects or effects that may manifest over months or years, and assess how the use would respond to or address the identified need. The interim final rule identifies a non-exclusive list of uses that address the effects of the COVID–19 public health emergency, including:

Stay. at-home orders and other pandemic responses may have also reduced the ability of individuals affected by domestic violence to access 29 Xxxxx X. Xxxxx, et al., A Pandemic within a Pandemic—Intimate Partner Violence during Covid–19, N. Engl. J. Med. 383:2302–04 (Dec. 10, 2020), available at xxxxx://xxx.xxxx.xxx/doi/full/ 10.1056/NEJMp2024046. 30 Xxxxxx X. Xxxxxxx et al., Effects of the COVID–19 Pandemic on Routine Pediatric Vaccine Ordering and Administration—United States, Morb. Mortal. Wkly. Rep. 69(19):591–93 (May 8, 2020), xxxxx://xxx.xxx.xxx/mmwr/volumes/69/wr/ mm6919e2.htm; Xxxxxx Xxxxxxx-Xxxxx et al., Notes from the Field: Rebound in Routine Childhood Vaccine Administration Following Decline During the COVID–19 Pandemic—New York City, March 1–June 27, 2020, Morb. Mortal. Wkly. Rep. 69(30):999–1001 (Jul. 31 2020), https:// xxx.xxx.xxx/xxxx/xxxxxxx/00/xx/ mm6930a3.htm. 31 Office of the White House, National Strategy for the COVID–19 Response and Pandemic Preparedness (Jan. 21, 2021), https:// xxx.xxxxxxxxxx.xxx/xx-xxxxxxx/xxxxxxx/0000/00/ National-Strategy-for-the-COVID-19-Response-and- Pandemic-Preparedness.pdf. 32 In a study of 13 states from October to December 2020, the CDC found that Hispanic or Latino and Native American or Alaska Native individuals were 1.7 times more likely to visit an emergency room for COVID–19 than White This has included implementing individuals, and Black individuals were 1.4 times infection prevention measures or making ventilation improvements in congregate settings, health care settings, or other key locations. Other response and adaptation costs include capital investments in public facilities to meet pandemic operational 23 Centers for Disease Control and Prevention, COVID Data Tracker: Trends in Number of COVID–19 Cases and Deaths in the US Reported to CDC, by State/Territory, xxxxx://xxxxx.xxx.xxx/ covid-data-tracker/#trends_dailytrendscases (last visited May 8, 2021). 24 Id. 25 Centers for Disease Control and Prevention, COVID Data Tracker: COVID–19 Vaccinations in the United States, xxxxx://xxxxx.xxx.xxx/covid-data- tracker/#vaccinations (last visited May 8, 2021). 26 Xxxxxxx, supra note 4; Xxxx X´ . Xxxxxxxx et al., Mental Health, Substance Abuse, and Suicidal Ideation During COVID–19 Pandemic– United States, June 24–30 2020, Morb. Mortal. Wkly. Rep. 69(32):1049–57 (Aug. 14, 2020), https:// 27 Leeb, supra note 4. 28 Centers for Disease Prevention and Control, National Center for Health Statistics, Provisional Drug Overdose Death Counts, xxxxx://xxx.xxx.xxx/ nchs/nvss/vsrr/drug-overdose-data.htm (last visited May 8, 2021). more likely to do so than White individuals. See Xxxxxx, supra note 10. 33 Centers for Disease Control and Prevention, COVID Data Tracker: Trends in COVID–19 Cases and Deaths in the United States, by County-level Population Factors, xxxxx://xxxxx.xxx.xxx/covid- data-tracker/#pop-factors_totaldeaths (last visited May 8, 2021). 34 The CDC’s Social Vulnerability Index includes fifteen variables measuring social vulnerability, including unemployment, poverty, education levels, single-parent households, disability status, non-English speaking households, crowded housing, and transportation access. Centers for Disease Control and Prevention, COVID Data Tracker: Trends in COVID–19 Cases Continued Over the last year, Native Americans have experienced more than one and a half times the rate of COVID–19 infections, more than triple the rate of hospitalizations, and more than double the death rate compared to White Americans.35 Low-income and minority communities also exhibit higher rates of pre-existing conditions that may contribute to an increased risk of COVID–19 mortality.36 In addition, individuals living in low- income communities may have had more limited ability to socially distance or to self-isolate when ill, resulting in faster spread of the virus, and were over-represented among essential workers, who faced greater risk of exposure.37 Social distancing measures in response to the pandemic may have also exacerbated pre-existing public health challenges. For example, for children living in homes with lead paint, spending substantially more time at home raises the risk of developing elevated blood lead levels, while screenings for elevated blood lead levels declined during the pandemic.38 The combination of these underlying social and health vulnerabilities may have contributed to more severe public health outcomes of the pandemic within these communities, resulting in an exacerbation of pre-existing disparities in health outcomes.39 and Deaths in the United States, by Social Vulnerability Index, xxxxx://xxxxx.xxx.xxx/covid- data-tracker/#pop-factors_totaldeaths (last visited May 8, 2021). 35 Centers for Disease Control and Prevention, Risk for COVID–19 Infection, Hospitalization, and Death By Race/Ethnicity, xxxxx://xxx.xxx.xxx/ coronavirus/2019-ncov/covid-data/investigations- discovery/hospitalization-death-by-race- ethnicity.html (last visited Apr. 26, 2021). 36 See, e.g., Centers for Disease Control and Prevention, Risk of Severe Illness or Death from COVID–19 (Dec. 10, 2020), xxxxx://xxx.xxx.xxx/ coronavirus/2019-ncov/community/health-equity/ racial-ethnic-disparities/disparities-illness.html (last visited Apr. 26, 2021). 37 Xxxxxx Xxxxxxx et al., Racial Disparities in Frontline Workers and Housing Crowding During COVID–19: Evidence from Geolocation Data (Sept. 22, 2020), NYU Xxxxx School of Business (forthcoming), available at xxxxx://xxxxxx.xxxx.xxx/ sol3/xxxxxx.xxx?abstract_id=3695249; Xxxxx XxXxxxxxx et al., Economic Vulnerability of Households with Essential Workers, JAMA 324(4):388–90 (2020), available at https:// xxxxxxxxxxx.xxx/xxxxxxxx/xxxx/xxxxxxxxxxx/ 2767630. 38 See, x.x.e.g., Xxxxxx X. Courtney Xxxxxxxx et al., Decreases in Young Children Who Received Blood Lead Level Testing During COVID–19—34 Jurisdictions, a non-exclusive list of eligible uses of funding to respond to the COVID–19 public health emergency. Eligible uses listed under this section build and expand upon permissible expenditures under the CRF, while recognizing the differences between the ARPA and CARES Act, and recognizing that the response to the COVID–19 public health emergency has changed and will continue to change over time. To assess whether additional uses would be eligible under this category, recipients should identify an effect of COVID–19 on public health, including either or both of immediate effects or effects that may manifest over months or years, and assess how the use would respond to or address the identified need. The interim final rule identifies a non-exclusive list of uses that address the effects of the COVID–19 public health emergency, including:

Stay. at-home orders and other pandemic responses may have also reduced the ability of individuals affected by domestic violence to access 29 Xxxxx X. Xxxxx, et al., A Pandemic within a Pandemic—Intimate Partner Violence during Covid–19, N. Engl. J. Med. 383:2302–04 (Dec. 10, 2020), available at xxxxx://xxx.xxxx.xxx/doi/full/ 10.1056/NEJMp2024046. 30 Xxxxxx X. Xxxxxxx et al., Effects of the COVID–19 Pandemic on Routine Pediatric Vaccine Ordering and Administration—United States, Morb. Mortal. Wkly. Rep. 69(19):591–93 (May 8, 2020), xxxxx://xxx.xxx.xxx/mmwr/volumes/69/wr/ mm6919e2.htm; Xxxxxx Xxxxxxx-Xxxxx et al., Notes from the Field: Rebound in Routine Childhood Vaccine Administration Following Decline During the COVID–19 Pandemic—New York City, March 1–June 27, 2020, Morb. Mortal. Wkly. Rep. 69(30):999–1001 (Jul. 31 2020), https:// xxx.xxx.xxx/xxxx/xxxxxxx/00/xx/ mm6930a3.htm. 31 Office of the White House, National Strategy for the COVID–19 Response and Pandemic Preparedness (Jan. 21, 2021), https:// xxx.xxxxxxxxxx.xxx/xx-xxxxxxx/xxxxxxx/0000/00/ National-Strategy-for-the-COVID-19-Response-and- Pandemic-Preparedness.pdf. 32 In a study of 13 states from October to December 2020, the CDC found that Hispanic or Latino and Native American or Alaska Native individuals were 1.7 times more likely to visit an emergency room for COVID–19 than White This has included implementing individuals, and Black individuals were 1.4 times infection prevention measures or making ventilation improvements in congregate settings, health care settings, or other key locations. Other response and adaptation costs include capital investments in public facilities to meet pandemic operational 23 Centers for Disease Control and Prevention, COVID Data Tracker: Trends in Number of COVID–19 Cases and Deaths in the US Reported to CDC, by State/Territory, xxxxx://xxxxx.xxx.xxx/ covid-data-tracker/#trends_dailytrendscases (last visited May 8, 2021). 24 Id. 25 Centers for Disease Control and Prevention, COVID Data Tracker: COVID–19 Vaccinations in the United States, xxxxx://xxxxx.xxx.xxx/covid-data- tracker/#vaccinations (last visited May 8, 2021). 26 Xxxxxxx, supra note 4; Xxxx X´ . Xxxxxxxx et al., Mental Health, Substance Abuse, and Suicidal Ideation During COVID–19 Pandemic– United States, June 24–30 2020, Morb. Mortal. Wkly. Rep. 69(32):1049–57 (Aug. 14, 2020), https:// 27 Leeb, supra note 4. 28 Centers for Disease Prevention and Control, National Center for Health Statistics, Provisional Drug Overdose Death Counts, xxxxx://xxx.xxx.xxx/ nchs/nvss/vsrr/drug-overdose-data.htm (last visited May 8, 2021). more likely to do so than White individuals. See Xxxxxx, supra note 10. 33 Centers for Disease Control and Prevention, COVID Data Tracker: Trends in COVID–19 Cases and Deaths in the United States, by County-level Population Factors, xxxxx://xxxxx.xxx.xxx/covid- data-tracker/#pop-factors_totaldeaths (last visited May 8, 2021). 34 The CDC’s Social Vulnerability Index includes fifteen variables measuring social vulnerability, including unemployment, poverty, education levels, single-parent households, disability status, non-English speaking households, crowded housing, and transportation access. Centers for Disease Control and Prevention, COVID Data Tracker: Trends in COVID–19 Cases 26790 Federal Register / Vol. 86, No. 93 / Monday, May 17, 2021 / Rules and Regulations Over the last year, Native Americans have experienced more than one and a half times the rate of COVID–19 infections, more than triple the rate of hospitalizations, and more than double the death rate compared to White Americans.35 Low-income and minority communities also exhibit higher rates of pre-existing conditions that may contribute to an increased risk of COVID–19 mortality.36 In addition, individuals living in low- income communities may have had more limited ability to socially distance or to self-isolate when ill, resulting in faster spread of the virus, and were over-represented among essential workers, who faced greater risk of exposure.37 Social distancing measures in response to the pandemic may have also exacerbated pre-existing public health challenges. For example, for children living in homes with lead paint, spending substantially more time at home raises the risk of developing elevated blood lead levels, while screenings for elevated blood lead levels declined during the pandemic.38 The combination of these underlying social and health vulnerabilities may have contributed to more severe public health outcomes of the pandemic within these communities, resulting in an exacerbation of pre-existing disparities in health outcomes.39 and Deaths in the United States, by Social Vulnerability Index, xxxxx://xxxxx.xxx.xxx/covid- data-tracker/#pop-factors_totaldeaths (last visited May 8, 2021). 35 Centers for Disease Control and Prevention, Risk for COVID–19 Infection, Hospitalization, and Death By Race/Ethnicity, xxxxx://xxx.xxx.xxx/ coronavirus/2019-ncov/covid-data/investigations- discovery/hospitalization-death-by-race- ethnicity.html (last visited Apr. 26, 2021). 36 See, e.g., Centers for Disease Control and Prevention, Risk of Severe Illness or Death from COVID–19 (Dec. 10, 2020), xxxxx://xxx.xxx.xxx/ coronavirus/2019-ncov/community/health-equity/ racial-ethnic-disparities/disparities-illness.html (last visited Apr. 26, 2021). 37 Xxxxxx Xxxxxxx et al., Racial Disparities in Frontline Workers and Housing Crowding During COVID–19: Evidence from Geolocation Data (Sept. 22, 2020), NYU Xxxxx School of Business (forthcoming), available at xxxxx://xxxxxx.xxxx.xxx/ sol3/xxxxxx.xxx?abstract_id=3695249; Xxxxx XxXxxxxxx et al., Economic Vulnerability of Households with Essential Workers, JAMA 324(4):388–90 (2020), available at https:// xxxxxxxxxxx.xxx/xxxxxxxx/xxxx/xxxxxxxxxxx/ 2767630. 38 See, x.x.e.g., Xxxxxx X. Courtney Xxxxxxxx et al., Decreases in Young Children Who Received Blood Lead Level Testing During COVID–19—34 Jurisdictions, a non-exclusive list of eligible uses of funding to respond to the COVID–19 public health emergency. Eligible uses listed under this section build and expand upon permissible expenditures under the CRF, while recognizing the differences between the ARPA and CARES Act, and recognizing that the response to the COVID–19 public health emergency has changed and will continue to change over time. To assess whether additional uses would be eligible under this category, recipients should identify an effect of COVID–19 on public health, including either or both of immediate effects or effects that may manifest over months or years, and assess how the use would respond to or address the identified need. The interim final rule identifies a non-exclusive list of uses that address the effects of the COVID–19 public health emergency, including:,

Stay. at-home orders and other pandemic responses may have also reduced the ability of individuals affected by domestic violence to access 29 Xxxxx X. Xxxxx, et al., A Pandemic within a Pandemic—Intimate Partner Violence during Covid–19, N. Engl. J. Med. 383:2302–04 (Dec. 10, 2020), available at xxxxx://xxx.xxxx.xxx/doi/full/ 10.1056/NEJMp2024046. 30 Xxxxxx X. Xxxxxxx et al., Effects of the COVID–19 Pandemic on Routine Pediatric Vaccine Ordering and Administration—United States, Morb. Mortal. Wkly. Rep. 69(19):591–93 (May 8, 2020), xxxxx://xxx.xxx.xxx/mmwr/volumes/69/wr/ mm6919e2.htm; Xxxxxx Xxxxxxx-Xxxxx et al., Notes from the Field: Rebound in Routine Childhood Vaccine Administration Following Decline During the COVID–19 Pandemic—New York City, March 1–June 27, 2020, Morb. Mortal. Wkly. Rep. 69(30):999–1001 (Jul. 31 2020), https:// xxx.xxx.xxx/xxxx/xxxxxxx/00/xx/ mm6930a3.htm. 31 Office of the White House, National Strategy for the COVID–19 Response and Pandemic Preparedness (Jan. 21, 2021), https:// xxx.xxxxxxxxxx.xxx/xx-xxxxxxx/xxxxxxx/0000/00/ National-Strategy-for-the-COVID-19-Response-and- Pandemic-Preparedness.pdf. 32 In a study of 13 states from October to December 2020, the CDC found that Hispanic or Latino and Native American or Alaska Native individuals were 1.7 times more likely to visit an emergency room for COVID–19 than White This has included implementing individuals, and Black individuals were 1.4 times infection prevention measures or making ventilation improvements in congregate settings, health care settings, or other key locations. Other response and adaptation costs include capital investments in public facilities to meet pandemic operational 23 Centers for Disease Control and Prevention, COVID Data Tracker: Trends in Number of COVID–19 Cases and Deaths in the US Reported to CDC, by State/Territory, xxxxx://xxxxx.xxx.xxx/ covid-data-tracker/#trends_dailytrendscases (last visited May 8, 2021). 24 Id. 25 Centers for Disease Control and Prevention, COVID Data Tracker: COVID–19 Vaccinations in the United States, xxxxx://xxxxx.xxx.xxx/covid-data- tracker/#vaccinations (last visited May 8, 2021). 26 Xxxxxxx, supra note 4; Xxxx X´ . Xxxxxxxx et al., Mental Health, Substance Abuse, and Suicidal Ideation During COVID–19 Pandemic– United States, June 24–30 2020, Morb. Mortal. Wkly. Rep. 69(32):1049–57 (Aug. 14, 2020), https:// 27 Leeb, supra note 4. 28 Centers for Disease Prevention and Control, National Center for Health Statistics, Provisional Drug Overdose Death Counts, xxxxx://xxx.xxx.xxx/ nchs/nvss/vsrr/drug-overdose-data.htm (last visited May 8, 2021). more likely to do so than White individuals. See Xxxxxx, supra note 10. 33 Centers for Disease Control and Prevention, COVID Data Tracker: Trends in COVID–19 Cases and Deaths in the United States, by County-level Population Factors, xxxxx://xxxxx.xxx.xxx/covid- data-tracker/#pop-factors_totaldeaths (last visited May 8, 2021). 34 The CDC’s Social Vulnerability Index includes fifteen variables measuring social vulnerability, including unemployment, poverty, education levels, single-parent households, disability status, non-English speaking households, crowded housing, and transportation access. Centers for Disease Control and Prevention, COVID Data Tracker: Trends in COVID–19 Cases Continued 26790 Federal Register / Vol. 86, No. 93 / Monday, May 17, 2021 / Rules and Regulations Over the last year, Native Americans have experienced more than one and a half times the rate of COVID–19 infections, more than triple the rate of hospitalizations, and more than double the death rate compared to White Americans.35 Low-income and minority communities also exhibit higher rates of pre-existing conditions that may contribute to an increased risk of COVID–19 mortality.36 In addition, individuals living in low- income communities may have had more limited ability to socially distance or to self-isolate when ill, resulting in faster spread of the virus, and were over-represented among essential workers, who faced greater risk of exposure.37 Social distancing measures in response to the pandemic may have also exacerbated pre-existing public health challenges. For example, for children living in homes with lead paint, spending substantially more time at home raises the risk of developing elevated blood lead levels, while screenings for elevated blood lead levels declined during the pandemic.38 The combination of these underlying social and health vulnerabilities may have contributed to more severe public health outcomes of the pandemic within these communities, resulting in an exacerbation of pre-existing disparities in health outcomes.39 and Deaths in the United States, by Social Vulnerability Index, xxxxx://xxxxx.xxx.xxx/covid- data-tracker/#pop-factors_totaldeaths (last visited May 8, 2021). 35 Centers for Disease Control and Prevention, Risk for COVID–19 Infection, Hospitalization, and Death By Race/Ethnicity, xxxxx://xxx.xxx.xxx/ coronavirus/2019-ncov/covid-data/investigations- discovery/hospitalization-death-by-race- ethnicity.html (last visited Apr. 26, 2021). 36 See, e.g., Centers for Disease Control and Prevention, Risk of Severe Illness or Death from COVID–19 (Dec. 10, 2020), xxxxx://xxx.xxx.xxx/ coronavirus/2019-ncov/community/health-equity/ racial-ethnic-disparities/disparities-illness.html (last visited Apr. 26, 2021). 37 Xxxxxx Xxxxxxx et al., Racial Disparities in Frontline Workers and Housing Crowding During COVID–19: Evidence from Geolocation Data (Sept. 22, 2020), NYU Xxxxx School of Business (forthcoming), available at xxxxx://xxxxxx.xxxx.xxx/ sol3/xxxxxx.xxx?abstract_id=3695249; Xxxxx XxXxxxxxx et al., Economic Vulnerability of Households with Essential Workers, JAMA 324(4):388–90 (2020), available at https:// xxxxxxxxxxx.xxx/xxxxxxxx/xxxx/xxxxxxxxxxx/ 2767630. 38 See, x.x.e.g., Xxxxxx X. Courtney Xxxxxxxx et al., Decreases in Young Children Who Received Blood Lead Level Testing During COVID–19—34 Jurisdictions, a non-exclusive list of eligible uses of funding to respond to the COVID–19 public health emergency. Eligible uses listed under this section build and expand upon permissible expenditures under the CRF, while recognizing the differences between the ARPA and CARES Act, and recognizing that the response to the COVID–19 public health emergency has changed and will continue to change over time. To assess whether additional uses would be eligible under this category, recipients should identify an effect of COVID–19 on public health, including either or both of immediate effects or effects that may manifest over months or years, and assess how the use would respond to or address the identified need. The interim final rule identifies a non-exclusive list of uses that address the effects of the COVID–19 public health emergency, including: