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Life goes on, obladi, oblada

A reflection on what we have learned – and not learned – about the spread of the coronavirus, as it moves toward pandemic

Image courtesy of CDC website

Close-up image of the coronavirus.

By Richard Asinof
Posted 3/9/20
Some observations on the details behind the coronavirus story, including the testing conundrum, the credibility gap, and the economic consequences.
What are the financial resources that are being spent in communications by Rhode Island state government to share data and daily updates on the coronavirus? How much does the average person on the street – from the cashier at CVS to the teller at Bank of America – really care about coronavirus developments? What would happen if nurses, rather than doctors, were featured on the cable TV news shows, as experts on medical care?
One of the lasting impacts of the spread of the coronavirus may be a dramatic change in our habits: people may tend to shun large public gatherings, such as concerts, political rallies, and even large annual meetings for the foreseeable future. Telemedicine may gain greater acceptance as a medical practice in interaction with patients. Handshakes may disappear as the standard business greeting. Going to the gym, going to classes at school, attending sporting events, even shopping in large malls may be activities that experience dramatic drop-offs in customers.

Editor's Note: Here is an update, on Tuesday morning, March 10, based in part on the news conference held late Monday afternoon by Gov. Gina Raimondo.

Gov. Raimondo declared a state of emergency, not because a state of emergeny exists, but to be able to leverage more dollars in federal aid.

The Governor has yet to call out the National Guard, but the state is working in a collaborative framework with them.

There are currently two operating drive-thru testing sites for coronavirus, in undetermined locations, but the Governor was coy talking about them, not identifying how many or offering details about their possible expansion. To be tested at such a drive-thru site, the patient would have to call to make an appointment with the R.I. Department of Health to use them. Members of the National Guard appear to be involved in some way with the drive-thru testing sites, but details were scant.

The Governor waived the waiting period to collect Temporarily Disability Insurance for those in self-quarantine in Rhode Island, but had no answer when Bill Bartholomew asked about workers who were independent contractors. Like so much in health care these days, the dividing line is between those with health plans and benefits through their employers, and those who do not -- many of whom are members of the gig economy.

The Governor urged businesses to "do the right thing" [an image flashed in ConvergenceRI of her and Spike Lee sharing the podium]; she also urged President Trump to declare a federal emergency to be able to gain access to more federal money for unemployment.

There was no need to panic, she assured the news media assembled, the risk of community transmission in Rhode Island was low, but without testing, how does anyone know? The Governor praised the more than 250 Rhode Islanders in self-quarantine as the true heroes.

Jennifer Bogdan, the Governor's top communications aide, at first ran away from ConvergenceRI, then, after talking with another report, said she would have to get back to me about the pending request for a one-on-one interview that was made more than a year ago, to which no answer has ever been received. I'm not holding my breath, but in the Governor's own words, "Do the right thing!"

One last note: The Brown Venture Prize Pitch Night, scheduled for March 16, has been cancelled, in an effort "to prioritize the health and safety of the entire Brown Community, joining a string of cancellations, including the St. Patricks Day Parade in Boston.

PROVIDENCE – There is an obvious truth in an old saying that comes to mind these days: the more you know the worse things get, and the worse things get the more you know. Visualize it as a mathematical curve mapping an inverse relationship between ignorance and knowledge.

That, in a nutshell, captures the illogical world we live in today as we grapple with the spread of the novel coronavirus, renamed COVID 19, in Rhode Island, in the nation, and in the world. Yes, it appears to fit the “technical” definition of a pandemic. And, yes, it appears that new virus will be here to stay, circumnavigating the globe on a regular basis, as the virus morphs and changes, immune to political boundaries and rhetoric.

• The conundrum on testing. Despite claims by the Trump administration to the contrary, there are simply not enough tests available to determine the spread of the coronavirus in the U.S. at this time. And, even if more tests were to suddenly become available in the next few weeks, as promised, it is unclear how the strategies of “containment” and now “mitigation” would change the public health approach. As a result, testing will continue to be used on a rationed, triaged basis. Those left out in the cold, so to speak, will be the poor, the under-insured and the uninsured. Translated, call it “health care for some.”

Here in Rhode Island, the facts keep rapidly changing on the ground, in real time, despite the best Herculean efforts by public health officials to manage the information and share data. Imagine a jigsaw puzzle where the pieces constantly change shape and colors: what fits together on one day will not fit together the next.

Consider the bizarre story about how a professor at Brown, Onesimo T. Almeida, who sought to be tested for coronavirus after becoming ill following attendance at a conference in Portugal, where colleagues at the conference had tested positive for the virus, was initially refused a test by the R.I. Department of Health because he did not meet the Centers for Disease Control and Prevention protocols.

The next day, when the CDC changed its protocols for testing, the professor was tested – in a kind of fast-food drive-in window scenario, in a parking lot at Rhode Island Hospital, where he was swabbed while sitting in his car by health care providers in protective gear. [This is actually the approach now being taken in South Korea, which has set up mobile testing sites to administer coronavirus tests in similar drive-through sites. South Korea has now administered more than 140,000 tests to date, compared with just 1,895 people in the U.S., according to story published on Friday, March 6, by The Atlantic. That drive-through method of testing, call it an improvisation, now appears to be becoming the norm: it has been adopted by the University of Washington’s UW Medicine system, where the system’s medical center in northwest Seattle has turned a hospital garage lot into a drive-though clinic that can test a person every five minutes. The approach is in response to the reality that the coronavirus has already caused at least 17 deaths in the Seattle and infected at least 83 people, according to NPR reporter Jon Hamilton.]

The professor said he had also initially contacted Brown University, which directed him to a phone number for security, which had no idea what to do. [That dead end apparently changed after President Christina Paxson held an all-faculty meeting last week.]

In a phone conversation, Almeida told ConvergenceRI that initially he had a very difficult time getting the results from the R.I. Department of Health, which turned out to be negative. Only his continuing threat to go public to the national media and the world media seemed to prompt the R.I. Department of Health to finally release the results of the test to him, according to Almeida.

One other fascinating note to the Brown professor’s story: Almeida said that his personal primary care doctor was part of a concierge practice, a growing trend for those dissatisfied with the current health care delivery system.

As to the glitch in the initial test kits developed by the CDC, the problem was not just limited to the distribution strategy but to the apparent negligence regarding the primers distributed with the polymerase chain reaction [or PCR]-based assay test kits, which contained faulty sequences. As one scientist attempted to explain the problem to ConvergenceRI, “The mistake that was made in the distributed primer sequences [apparently a hairpin loop in one sequence] is a mistake that most people with any molecular biology experience would not have made.” Curious and curiouser.

• Protocols and protection. A week ago, when attending the hastily arranged news conference at the R.I. Department of Health on Sunday afternoon, March 1, ConvergenceRI asked a question, having to shout it out to be heard over the media scrum: “What are the protocols for nursing homes and skilled nursing facilities in the state and for health care workers on the front lines to protect patients and health care workers from contracting coronavirus?”

The answer given by Dr. Nicole Alexander-Scott, the director of the R.I. Department of Health, in a reassuring voice, was that existing protocols were in place and that they would be sufficient.

It turns out that her answer wasn’t necessarily so. On Friday, March 6, the R.I. Department of Health, working with leadership at all the state’s nursing homes and skilled nursing facilities, issued new protocols for the protection of patients at nursing homes, many of whom were at greater risk of contracting and dying from the virus, given the likelihood of pre-existing health conditions and more vulnerable immune systems and susceptibility to respiratory infections.

The experience of the Life Care Center in Kirkland, Wash., which to date has had the largest number of fatalities in the U.S. linked to the coronavirus, suggests that nursing homes and their workers are most at risk for the community spread of the disease.

It also raises questions about the nature of training and protection being given to low-wage workers in nursing homes as they care for patients at risk from coronavirus.

• Take good care of yourself. The mantra repeated again and again by public health professionals is to follow common sense practices: wash your hands frequently, using soap and hot water; cover your mouth and your nose with your elbow when you cough and sneeze; do not shake hands but instead use fist or elbow bumps; and if you are sick, stay at home and don’t go to work. [And avoid going to large public events, such as political rallies, and try to avoid traveling in crowded elevators.]

That advice may work in the imaginary early 1960s world of Rock Hudson and Doris Day movies, but it is far removed from today’s reality of single parents working two to three low-wage jobs, often in the food service industry, where the likelihood is that if you don’t go to work, you will lose your job, regardless of the “health benefits” of following the advice from political leaders. While Gov. Gina Raimondo has attempted to lobby businesses to keep workers who may have to self-quarantine as a result of possible coronavirus infection, but it is unclear how Rhode Island businesses will respond positively to her use of bully pulpit.

It also promises to put an additional strain on the public schools in Providence, where there is already a dire need for more substitute teachers. And, to put an added strain at hospitals and nursing homes, if large numbers of nurses and front-line workers are asked to go into self-quarantine. Translated, nurses hold up more than half the sky of the health care delivery system.

Speaking of hospitals, it is unclear if hospitals in the state would have enough beds equipped with ventilators to handle a full-blown pandemic in Rhode Island, given that the health systems have adopted a kind of just-in-time supply system for hospital beds as a way to limit inpatient costs. Is there an accurate “census” of how many such beds exist in Rhode Island? Good question.

• The economic consequences. Despite the assurances from Larry Kudlow, White House economic advisor to President Trump, that the spread of the coronavirus has been “somewhat contained,” the economic consequences of disruption of supply chains to major global corporations, the continued disruptions of reduced travel and tourism, the number of large companies cutting back on conferences, and the most recent decision by Italy to put one-quarter of its population under quarantine in the northern part of the country near Milan will test the resilience of financial markets in the days and weeks to come.

As we go to press, the map of the U.S. continues to show the rapid spread of coronavirus from community-based transmission, with more than 500 cases now detected in 33 states, resulting in 21 deaths  with every indication that those numbers will continue to spike.

The underlying –and uncovered – economic story in all of this is the primary importance of investments in public health in securing the future prosperity of Rhode Island and the U.S.

• The credibility gap. The growing distance between what scientists and researchers say and what officials from the Trump administration are saying, particularly the President himself, harkens back to an infamous line from the movie, “Cool Hand Luke”: What we have here is a failure to communicate.

The greatest threat to the Trump presidency and to his re-election campaign in 2020 may prove to be his attempt to spin the situation regarding the spread of the coronavirus and to blame the problem on Democrats, not admitting to his own administration’s failings.

What is the Tim Hardin lyric? "I look to find a reason to believe, knowing that you lied, straight-faced…”

The news media. Much like the way that the news coverage of the Iran hostage situation in 1979 and 1980 dominated the news cycles and political coverage, the news coverage of the spreading coronavirus across the U.S. and the globe promises to dominate headlines for the foreseeable future.

Meanwhile, life goes on, ob-la-di, ob-la-da.


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