Coronavirus – R&R – Reachout and Rebuild

Frustrations Boil at Pace of Vaccinations at Long-Term Care Facilities

David Posnett — Sun, 17 Jan 2021 20:24:55 +0000

Our local ‘Retirement’ facility

The Trump administration raised hopes of a speedy process for nursing homes and assisted living facilities. Patience is wearing thin.

By Rebecca Robbins

In mid-December, a top Trump administration official floated an enticing possibility: All nursing home residents in the United States could be vaccinated against the coronavirus by Christmas. “It’s really a remarkable, remarkable prospect,” Alex M. Azar II, the secretary of health and human services, declared.

It turned out to be a fantasy.

A month later, vaccinations of some of the country’s most vulnerable citizens are going more slowly than many state officials, industry executives and families expected. Their hopes had been buoyed when government officials said long-term care facilities would be at the front of the line for vaccines.

CVS and Walgreens, which are largely responsible for vaccinating residents and workers in long-term care facilities, are on track to make at least initial vaccination visits to nearly all nursing homes they are working with by Jan. 25. The two pharmacy chains have already given out more than 1.7 million vaccine doses at long-term care facilities.

But the progress is uneven across the country and not nearly as comprehensive for different types of long-term care. For example, thousands of assisted living facilities — for older people who need less care than those in nursing homes — do not yet even have an appointment for their first visit from the pharmacy teams, in large part because states have given such facilities lower priority in their vaccine-distribution plans.

“I’ve had facilities call me, and I’ve had people cry, I’ve had people curse, because this was the first sign of hope that they’ve had in many, many months,” said Betsy Johnson, who leads a group that represents Kentucky’s nursing homes and assisted living facilities.

“It’s just human nature to think, ‘OK, but I was supposed to be first — and I don’t even know when my clinic is going to happen,’” Ms. Johnson said.

In Pennsylvania, teams from CVS or Walgreens are not scheduled to visit some nursing homes until February, and the vast majority of the state’s assisted living facilities have not yet been scheduled for a first visit, said Zach Shamberg, president of the Pennsylvania Health Care Association.

“There’s a great deal of frustration, there’s a great deal of apprehension, as to when or if this vaccine will come,” Mr. Shamberg said.

The pace of the vaccination program has taken on greater urgency as the rapidly spreading virus continues to decimate nursing homes and similar facilities. The virus’s surge since November has killed about 30,000 long-term care staff and residents, raising the total of virus-related deaths in these facilities to at least 136,000, according to a New York Times tracker. Since the pandemic began, long-term care facilities have accounted for just 5 percent of coronavirus cases but 36 percent of virus-related deaths.

Even as the vaccination campaign accelerates, the suffering is unlikely to wane. The coming months could be “the deadliest of the pandemic” for people living and working in long-term care, according to an analysis released on Thursday by the Kaiser Family Foundation.

The Trump administration announced in October that it had teamed up with CVS and Walgreens to lead a federal effort to vaccinate residents and workers at long-term care facilities, among the first eligible groups.

On Friday, CVS said it had given out just over one million doses in more than 12,000 initial visits to long-term care facilities. Nearly 8,000 visits are scheduled for the coming week. Walgreens said it had given out nearly 750,000 doses in nearly 9,000 visits to facilities, mostly nursing homes. The number of visits that Walgreens has scheduled with assisted living facilities “continues to accelerate,” a company spokeswoman, Rebekah Pajak, said.

The vaccinations by CVS and Walgreens were always expected to take several months because of the need to visit tens of thousands of facilities three times. The first two visits are for most residents and staff to get the two doses of the vaccine, with the third visit as a backup for people who missed the first clinic.

The idea that all nursing home residents could get their first doses by Christmas was not a realistic prospect even when Mr. Azar, the health secretary, floated it 12 days before the holiday. By that point, some states had told the Centers for Disease Control and Prevention that they would not activate the federal program to vaccinate their nursing homes until Dec. 28. The logistics would have been challenging even if states had put a priority on getting their first doses to nursing homes.

Michael Pratt, a spokesman for the Health and Human Services Department, said Mr. Azar had been speaking only aspirationally about what states were capable of doing, since they had enough vaccine doses to cover all nursing home residents by Christmas. But that would have required that states place less of a priority on vaccinating high-risk groups like heath care workers.

T.J. Crawford, a spokesman for CVS, said the chain was making first visits to all facilities within four weeks of each state’s activating its vaccination program for nursing homes or assisted living facilities.

“This isn’t a drive-through or stadium vaccination effort,” Mr. Crawford said. “We’re visiting more than 40,000 facilities with an average of less than 100 residents, in some cases going room to room.” He said CVS was “on track and delivering on goals established and communicated early in the process.”

But a growing number of governors and state health officials have voiced frustration with CVS’s and Walgreens’ speed.

In Mississippi, some long-term facilities won’t get their first visit until Feb. 11, the state health officer, Dr. Thomas Dobbs, said this month. “We’re clearly disappointed with the progress in the long-term care program,” he said.

Some states and cities are exploring ways to hasten the inoculations.

Seattle is using its Fire Department to vaccinate nearly 1,000 residents and staff at adult family homes, a type of long-term care, by the end of January. Florida hired an emergency services company, CDR Maguire, to give out doses at 1,900 assisted living facilities that had not been scheduled for visits by CVS and Walgreens teams before Jan. 24.

In Michigan, officials have asked the federal government to let them work with other pharmacies, such as the supermarket chains Meijer and Kroger, to speed up the vaccination effort in long-term care facilities, said Bobby Leddy, a spokesman for Gov. Gretchen Whitmer.

West Virginia is the only state that has not activated the federal program involving CVS and Walgreens, though Walgreens is separately working with West Virginia to vaccinate 32 of its long-term care facilities. Relying mostly on local independent pharmacies, the state said on Dec. 30 that it had wrapped up the first round at its 214 long-term care facilities.

Some of the initially feared problems that could slow down the vaccine rollout in nursing homes have not emerged as serious obstacles, at least so far, according to facility operators and industry researchers.

Despite widespread worries that the vaccines’ side effects — which can include fevers, chills and fatigue — would cause staff to miss work and residents to need more care, that has not happened to any significant degree. And while there was early confusion about how nursing homes should get consent from residents or their families, that process has largely gone smoothly.

But other things are slowing the campaign. A significant number of long-term care workers have balked at receiving the vaccine. The virus’s spread is also delaying the process. People should not be vaccinated while they still have Covid-19 symptoms or are isolating, according to the C.D.C.

Outbreaks and cases of Covid-19 in some long-term care communities have led Walgreens to delay scheduling initial visits or to reschedule them, said Rick Gates, an executive leading the company’s long-term care vaccinations.

CVS has encountered the same issue, though it has not been widespread. The company has left the decision about whether to proceed with visits in such cases to local clinic team leaders and officials at the facilities, Mr. Crawford said.

Another factor is that some states did not quickly activate their programs to vaccinate people at assisted living facilities and similar communities. In some cases, they waited until weeks after they began vaccinations at nursing homes.

But many long-term care facilities include both nursing homes and assisted living. In those cases, pharmacy teams have been able to vaccinate only a subset of residents.

In Prairie du Chien, Wis., for example, a team from Walgreens on Thursday made its first visit to the local nursing home, Prairie Maison, to inject nearly all of its roughly 50 residents with the Moderna vaccine.

But Prairie Maison is part of a larger senior community, which includes about 50 assisted living residents. Because Wisconsin did not activate its vaccination program for assisted living until Friday, those residents weren’t offered the vaccine — even though they are in the same building as the nursing home residents.

“Vaccinating one group and not the other doesn’t make a lot of sense,” said Dr. Mark Grunwald, the chairman of Prairie Maison’s board.

From Kristin Stephens

Assistant Vice President, Media Relations and Public Affairs, GREATER NEW YORK HOSPITAL ASSOCIATION

See prior blog posts relevant to Peconic Landing:

SARS-CoV-2 mink-associated variant strain

David Posnett — Sun, 08 Nov 2020 19:21:39 +0000

This story is of some concern…

(1) WHO, 6 November 2020

Since June 2020, 214 human cases of COVID-19 have been identified in Denmark with SARS-CoV-2 variants associated with farmed minks, including 12 cases with a unique variant, reported on 5 November. All 12 cases were identified in September 2020 in North Jutland, Denmark. The cases ranged in age from 7 to 79 years, and eight had a link to the mink farming industry. Four cases were from the local community.

Initial observations suggest that the clinical presentation, severity and transmission among those infected are similar to that of other circulating SARS-CoV-2 viruses. However, this variant, referred to as the “cluster 5” variant, had a combination of mutations, or changes that have not been previously observed. The implications of the identified changes in this variant are not yet well understood. Preliminary findings indicate that this particular mink-associated variant identified in both minks and the 12 human cases has moderately decreased sensitivity to neutralizing antibodies. Further scientific and laboratory-based studies are required to verify preliminary findings reported and to understand any potential implications of this finding in terms of diagnostics, therapeutics and vaccines in development. In the meantime, actions are being taken by Danish authorities to limit the further spread of this variant of the virus among mink and human populations.

SARS-CoV-2, the virus which causes COVID-19, was first identified in humans in December 2019. As of 6 November, it has affected more than 48 million people causing over 1.2 million deaths worldwide. Although the virus is believed to be ancestrally linked to bats, the virus origin and intermediate host(s) of SARS-CoV-2 have not yet been identified.

Available evidence suggests that the virus is predominantly transmitted between people through respiratory droplets and close contact, but there are also examples of transmission between humans and animals. Several animals that have been in contact with infected humans, such as minks, dogs, domestic cats, lions and tigers, have tested positive for SARS-CoV-2.

Minks were infected following exposure from infected humans. Minks can act as a reservoir of SARS-CoV-2, passing the virus between them, and pose a risk for virus spill-over from mink to humans. People can then transmit this virus within the human population. Additionally, spill-back (human to mink transmission) can occur. It remains a concern when any animal virus spills in to the human population, or when an animal population could contribute to amplifying and spreading a virus affecting humans. As viruses move between human and animal populations, genetic modifications in the virus can occur. These changes can be identified through whole genome sequencing, and when found, experiments can study the possible implications of these changes on the disease in humans.

To date, six countries, namely Denmark, the Netherlands, Spain, Sweden, Italy and the United States of America have reported SARS-CoV-2 in farmed minks to the World Organisation for Animal Health (OIE).

Public health response

Danish authorities have announced the following planned or ongoing public health actions:

Culling of all farmed mink (more than 17 million) in Denmark, including its breeding stock;
Enhancing surveillance of the local population to detect all COVID-19 cases, including through population-wide mass PCR testing for the region of North Jutland;
Expanding the percentage of sequencing of human and mink SARS-CoV-2 infections in Denmark;
Rapid sharing of the full genome sequences of the mink-variant SARS-CoV-2; and
Introducing new movement restrictions and other public health measures to affected areas in North Jutland to reduce further transmission, including movement restrictions between municipalities.

WHO risk assessment

All viruses, including SARS-CoV-2, change over time. SARS-CoV-2 strains infecting minks, which are subsequently transmitted to humans, may have acquired unique combinations of mutations. In order to fully understand the impact of specific mutations, advanced laboratory studies are required. These investigations take time and are done in close collaboration between different research groups.

The recent findings reported by the Danish Public Health Authority (Statens Serum Institut) in Denmark related to the novel variant of SARS-CoV-2 identified in humans need to be confirmed and further evaluated to better understand any potential implications in terms of transmission, clinical presentation, diagnostics, therapeutics and vaccine development.

Furthermore, detailed analyses and scientific studies are needed to better understand the reported mutations. The sharing of full genome sequences of human and animal strains will continue to facilitate detailed analyses by partners. Members of the WHO SARS-CoV-2 Virus Evolution Working Group are working with Danish scientists to better understand the available results and collaborate on further studies. Further scientific and laboratory-based studies will be undertaken to understand the implications of these viruses in terms of available SARS-CoV-2 diagnostics, therapeutics and vaccines in development.

Actions taken by the Danish authorities will limit continued spread of mink-associated variants of SARS-CoV-2 in Denmark, and in particular have been implemented to contain the unique variant reported to WHO. These actions include restricting movement of people, culling animals, widespread testing of people living in affected areas and increased genomic sequencing of SARS-CoV-2 viruses across the country.

WHO advice

This event highlights the important role that farmed mink populations can play in the ongoing transmission of SARS-CoV-2 and the critical role of strong surveillance, sampling and sequencing SARS-CoV-2, especially around areas where such animal reservoirs are identified.

The preliminary findings by Denmark are globally relevant and WHO recognises the importance of sharing epidemiological, virological and full genome sequence information with other countries and research teams, including through open-source platforms.

WHO advises further virological studies should be conducted to understand the specific mutations described by Denmark and to further investigate any epidemiological changes in function of the virus in terms of its transmissibility and the severity of disease it causes. WHO advises all countries to increase the sequencing of SARS-CoV-2 viruses where possible and sharing the sequence data internationally.

WHO advises all countries to enhance surveillance for COVID-19 at the animal-human interface where susceptible animal reservoirs are identified, including mink farms.

WHO also reminds countries to strengthen farming biosafety and biosecurity measures around known animal reservoirs in order to limit the risk of zoonotic events associated with SARS-CoV-2. This includes infection prevention and control measures for animal workers, farm visitors and those who may be involved in animal husbandry or culling.

The basic principles to reduce the general risk of transmission of acute respiratory infections are as follows:

Avoiding close contact with people suffering from acute respiratory infections;
Ensuring frequent hand-washing, especially after direct contact with ill people or their environment;
For people with symptoms of acute respiratory infection, practicing cough etiquette, such as maintain distance, cover coughs and sneezes with disposable tissues or clothing, and wash hands; use of masks where appropriate; and
Enhancing standard infection prevention and control practices in hospitals in health care facilities, especially in emergency departments.

WHO has issued guidance for Public health considerations while resuming international travel, recommending a thorough risk assessment, taking into account country context, the local epidemiology and transmission patterns, the national health and social measures to control the outbreak, and the capacities of health systems in both departure and destination countries, including at points of entry. In case of symptoms suggestive of acute respiratory illness either during or after travel, the travellers are encouraged to seek medical attention and share their travel history with their health care provider. Health authorities should work with travel, transport and tourism sectors to provide travellers with information to reduce the general risk of acute respiratory infections via travel health clinics, travel agencies, conveyance operators, and at points of entry.

(2) And what about in the US?

A report from Milwaukee, published Nov 6th, 2020

Laura Schulte Milwaukee Journal Sentinel: Two Taylor County mink farms under quarantine after more than 5,000 animals died from COVID-19.

Two mink farms in Taylor County are under quarantine after animals in the facilities tested positive for ARS-CoV-2, the virus that causes COVID-19 in humans.

Between the two farms, more than 5,400 mink have died, said Kevin Hoffman, the public information officer for the state Division of Animal Health.

The virus was confirmed at the first farm in early October when a dead mink tested positive for the disease. The farm was quarantined at that point, meaning no animals or animal parts could leave the premises. It’s believed the virus jumped from a human to the animals, Hoffman said, but an investigation into the transfer is still underway.

The outbreak at the second farm was found more recently, Hoffman said. It is not believed that the virus jumped from the first farm to the second.

Mink are members of the Mustelidae family that also includes weasels, badgers, otters, marten and wolverines. Wisconsin is one of the top producers of mink pelts in the U.S., Hoffman said. State officials are worried about the outbreaks and are regularly communicating with the state’s 19 mink farms.

“It’s certainly concerning that (mink) are so susceptible,” Hoffman said.

Valerie Zimbal, who owns Zimbal Mink Farm in Sheboygan Falls, said their mink population is being closely monitored for any signs of disease. They’ve also been implementing biosecurity measures since the pandemic started, like showering in and out, wearing masks, doing temperature checks and limiting visitors to the farm. If any employee feels sick, they are asked to stay at home.

Zimbal said the mink industry has been hit by the pandemic because mink coats and other fur clothing aren’t being bought as often since people are not out shopping as usual.

Wisconsin was the second state to have a confirmed case of COVID-19 in mink, after Utah, which confirmed its first case in August, according to the department.

Denmark to slaughter all farmed mink

The U.S. is not the only country facing outbreaks on mink farms. According to a Nov. 4 New York Times report, Denmark will kill all farmed mink due to concerns that mutation in the virus in mink could interfere with the effectiveness of a vaccine for humans.

Denmark ordered a lockdown in the northern portion of the country due to the mink outbreak, according to the Associated Press. So far, 12 people have been infected with the coronavirus mutation found in mink, which has shown a weak reaction to antibodies.

Animal welfare groups in the United States are hoping to avoid that outcome, and are calling for the government to shutter all farms to avoid the spread of the disease among the animals.

Animal Wellness Action, the Animal Wellness Foundation and the Center for a Humane Economy on Friday asked that governments in Oregon, Utah and Wisconsin to shut down their farms, and asked that the government establish a buy-out program for the farms.

So far, Hoffman said, no actions to close down mink farms in the U.S. have been recommended by the Centers for Disease Control and Prevention, but the agency is monitoring the situation closely.

Minks are more susceptible to the virus because of a protein in their lungs, which is similar to humans, Hoffman said. For that reason, there aren’t concerns over other types of animals, although two dogs in Wisconsin are known to have fallen ill due to the virus.

Hoffman encouraged pet owners with COVID-19 to take precautions, though, to keep their furry companions safe. He recommended wearing a mask while around your pet and keeping a six-foot distance between any ill housemates and pets.

“I know that can be really hard, but it’s the best thing you can do,” he said.

Grace Connatser of the Wisconsin State Farmer contributed.

Laura Schulte can be reached at leschulte@gannett.com and twitter.com/SchulteLaura.

How Masks Matter

David Posnett — Wed, 21 Oct 2020 14:50:42 +0000

OMG! Who did this?!?! Best 2 minutes of your day, week, month, maybe year. #WearAMask #SleepingBeauty #COVID19 #Masks #MasksSaveLives pic.twitter.com/ArgUIL77B3

— Eric Feigl-Ding (@DrEricDing) October 18, 2020

OK. Seriously, what is the latest on masks? Bottom line: if most people wear an effective mask we can significantly curb viral transmission

It is increasingly clear that there are differences in mask quality and protection. Here is one example of a recent report:

https://hartfordhealthcare.org/about-us/news-press/news-detail?articleid=27691&publicId=395

Fitted N95, no valve (14 in photo)
3-layer surgical mask (1)
Cotton-polypropylene-cotton mask (5)
2-layer polypropylene apron mask (4)
2-layer cotton, pleated style mask (13)
2-layer cotton, pleated style mask (7)
Valved N95 mask (2)
2-layer cotton, Olson style mask (8)
1-layer Maxima AT mask (6)
1-layer cotton, pleated style mask (10)
2-layer cotton, pleated style mask (9)
Knitted mask (3) NOT GOOD
Double-layer bandana (12) NOT GOOD
Gaiter-style neck fleece (11) USELESS

Read a more in depth study here: https://www.nature.com/articles/s41598-020-72798-7#Fig4

Another set of data looks at transmission among airline passengers on Emirates and specifically on their 8h flights Dubai – Hongkong. Emirates has a strictly enforced mask policy. Even on completely booked flights with, for example, 7 COVID+ passengers, there was no transmission to other passengers! https://www.npr.org/sections/goatsandsoda/2020/10/20/925892185/do-masks-really-cut-your-risk-of-catching-covid-19-on-long-plane-flights

Their conclusion is that strictly enforced mask usage works.

The bottom line: if most people wear masks we can significantly curb viral transmission. It is useful to have an effective mask too.

The following graph plots adherence to mask policy versus quality of the mask used. With poor quality masks it does not matter whether a high percent of people use a mask. And with poor adherence to mask wearing rules, even those that wear a high quality mask are not protected. One needs both a good mask and strict mask use enforcement.

https://www.theatlantic.com/health/archive/2020/04/dont-wear-mask-yourself/610336/

What are Trump’s chances?

David Posnett — Sat, 03 Oct 2020 13:48:27 +0000

What are the chances of hospitalization, ICU admission, and death in a COVID-19 patient like Donald Trump?

There is a ton of data relating to age of the patient, sex of the patient, obesity, pre-existing conditions, etc. There are important caveats, however: there may be different outcomes depending on the quality of the medical care, availability of new treatments, but also different outcomes depending on the timing of the infection within the course of the pandemic. Much of the data available on the web are analyses from Feb. through April 2020, early in the course of the pandemic. Current observations suggest that the case fatality rate (deaths per total diagnosed cases) is changing for the better. Much of the data is also different depending on the country or region selected for analysis. F. ex. in Southern and Western states of the US patients are younger than in the North Eastern states, according to recent trends!

For patients like D. Trump (74 yo; obese; male) the chances are:

hospitalization	about 30%
ICU admission	about 10-15%
death	about 5-10%

NB: obesity, with a BMI (Body Mass Index) of just over 30 in Pres. Trump’s case, increases the death rate by perhaps about 2-fold.

In one study from Georgia of 305 Covid-19 patients that were hospitalized, 39% were admitted to the ICU, but among those older than 65, 54% were admitted to the ICU. Of those in the ICU 37-48% died.

DT is already hospitalized. He now has perhaps a 1:2 chance of being admitted to the ICU and if he is admitted to the ICU, maybe a 1:3 or greater chance of death.

Here are some graphs to illustrate:

Death rates in the Spring of 2020 in various countries

Overall Case Fatality Rate (death rate) in the US over time

And here is a related article on the likely reasons for hospitalizing DT.

Letter from Dr. Norbert regarding COVID-19

David Posnett — Fri, 18 Sep 2020 19:10:52 +0000

COVID-19’s Human Toll, New Knowledge, Challenges Ahead

https://www.nbcboston.com/news/local/covering-coronavirus-straight-talk-on-covid-19s-death-toll/2120520/

Several of my patients have died of COVID; others hospitalized butt survived. Many more were COVID positive and for reasons that we are only beginning to understand survived with few aftereffects. Food insecurity is a new standard question whenever I speak to a patient. I’ve spoken in past COVID notes about one patient in his 30s who luckily survived weeks of intubation. While I’ve spoken to him almost on a weekly basis, I saw him for the first time only yesterday. Outwardly he looks the same. Yet he is permanently scarred – both physically and emotionally. He will likely never work again. He is undergoing rehabilitation and more procedures such as taking the filter in one of his major veins that was placed during his hospitalization for the blood clot in his leg that, in turn, was caused by COVID. Almost all my patients have an overarching sense of anxiety. I wash my hands incessantly with sanitizer; I wear a head screen over a mask whenever I am with a patient. When I come home, I undress and take a shower.

You’ve all heard about the fact that the executive branch politicized even our CDC guidelines. The vocal disagreement between the executive branch/ Republican members of Congress and scientists reached a crescendo this week with one senior HHS official taking medical leave after accusing scientists of sedition. Then executive branch leadership repeated many of the same accusations, without taking medical leave. Other challenges continue. Because we do not to date have a national COVID policy, we continue to have shortages of PPE equipment months and months after the outbreak. But the deficiencies are very solvable — “if the federal government gives the Strategic National Stockpile agency greater clout, provides it with access to better information and technology, and beefs up its expertise.” The cost of testing continues to be a challenge with individuals getting astronomical bills for COVID testing; more and more people living in the United States are going without health insurance. This in turn will have a serious impact on our health care system with the economically vulnerable among us suffering the most such as, for example, hospitals located in low income areas. This is particularly distressing as we learned this week that “Hispanic, non-Hispanic Black and non-Hispanic American Indian/Alaskan Native person accounted for 94 (78%) of the 121 deaths aged <21 years reported to the CDC.”

We are getting better at treatment of COVID 19 but have a long way to go. We are also getting better at our understanding of our bodily response. In a study with an accompanying editorial of the homogenous population of Iceland: “Whether antibodies that persist confer protection and retain neutralizing or other protective effector functions that are required to block reinfection remains unclear. Nevertheless, …the data point to the utility of antibody assays as highly cost-effective alternatives to PCR testing for population-level surveillance, which is critical to the safe reopening of cities and schools, and as biomarkers and possible effectors of immunity — useful tools…while we scan the horizon (and the pages of medical journals) for the wave of vaccines that will end the pandemic of Covid-19.”

Yet we of course realize that even with a vaccine, we will fall down yet again because we have no national policy. Though challenging, I am still using my minute leverage to encourage the National Academy of Medicine to be involved. In addition, Ask Nurses and Doctors is totally focused on the upcoming election. We are organizing health professionals in Fl, PA, and Michigan on behalf of Biden via the videos that will be circulated (Dr Abdul El-Sayed who did this video lives in Michigan and ran for governor of Michigan 2 years ago). If any of you are health professionals and would like to do a similar video – it will take no more than 10 minutes of your time. The organization AND is working for is identifying voters motivated by health care issues. Just contact me and/or spread the word. Among other activities, AND continues to work on several Congressional races from Iowa to Maine.

If you are celebrating the Jewish New Year (starts tonite!) – may it be as sweet as possible while understanding that whoever wins the White House and Congress will have many challenges. In the spirit of resolution, this is mine: which my friend Isa Aron passed on to me:

Question what is

Imagine what can be

And then do it

Lets do it together! I am lucky to know all of you.

Norbert

Notes from a Covid Doc

David Posnett — Mon, 03 Aug 2020 14:57:54 +0000

by Norbert Goldfield MD (August 3rd 2020)

Still Working with Patients with After Effects:

My COVID experiences this week in part revolve around helping one of my patients now permanently disabled from the after-effects of COVID; large numbers of patients refusing needed treatment due to extreme anxiety about COVID exposure, and patients who were COVID positive with continued symptoms almost certainly related to anxiety.

Local COVID Outbreak

A few days ago a local health facility, that I am affiliated with, identified several COVID-19 infected employees and patients on a clinical unit. The facility, being the transparent and thorough facility that it is, identified 23 COVID-positive employees and 12 COVID-positive patients. Contact tracing and testing is being conducted for any patients who test positive. It is likely that the outbreak resulted from several factors: employees who traveled to areas within the United States identified as “hot spots” and were found to be infected after return; staff convening in breakrooms and removing their masks without observing proper social distancing protocols; some staff members coming to work with symptoms; and inappropriate or inconsistent mask use in common- and public areas of the unit. Likely, a combination of these factors contributed to the transmission of the virus. As stated by the hospital, the best tools we currently possess to stave off any resurgence of this virus remain our proven public health interventions:

Hand Hygiene: long before COVID-19 appropriate hand hygiene was known to be highly effective in preventing the transmission of infectious diseases.
Not coming to work with symptoms
Face Masking: There is absolutely no down side; it is a high-value proposition.
Physical/Social Distancing: Last week, the first sentence of an article in the Proceedings of the National Academy of Sciences was: Social distancing is the core policy response to coronavirus disease 2019.
Do not participate in communal meals or share food sources (e.g. pizza parties, sandwich platters, cakes, etc.): although this infection is not food-borne, it is transmitted from person-to-person via respiratory secretions. These can contaminate inanimate objects, such as serving utensils, boxes, food, etc. and also contaminate your hands.
Avoid travel to high-risk areas: the reason for this is that such travel will increase the statistical risk of being exposed to COVID-19 and thus, could increase the risk of transmitting it to others upon your return. This is the rationale for the Travel Policy.

Sound familiar?

No National Plan

We still have no national policy that advocates firmly for these measures and provides the financial and organizational resources to implement them. In fact, we will never have a national policy from this administration. For example, because of federal incompetence, we cannot get testing efficiently done, thus missing most cases. I have submitted an op-ed with a colleague advocating that the Democratic-controlled House should step into the spotlight with a plan and use the bully pulpit to advocate for it.

Because many of my patients don’t want to access needed care, health insurers are doing just fine thank you but don’t expect lower premiums! I need to wrap my head around that, when my daughter is faced with stories like this. She is worried about the cost of a COVID test as her health insurance has a high deductible. Let’s keep in our hearts those health professionals who have lost their lives to the pandemic. My response to this overall tragedy is, I continue to work as a health professional on a number of congressional races and try to help steer electoral votes in FL, MI, and PA to Biden by emphasizing, using Jeff Lerner’s phrase, that health professionals advocate a truthful and scientific approach in the form of a ‘political vaccine‘. Feedback always welcome.

Norbert Goldfield, M.D.

Zoom Time

David Posnett — Sat, 11 Apr 2020 18:32:04 +0000

I am not sure why, but for the first time, each day this past week found me on multiple Zoom conference calls. Each of these was for a different group that I belong to, from my local Southampton Democratic Club to the national grassroots women’s group, SuperMajority. It is as if we all collectively woke up to the reality that this lockdown is going to be a long haul and this is the new normal not just for a few weeks but for a few months.

Like everyone, I am shaky with anxiety over this pandemic, worried that the people I know and love could become a statistic of this disease. I live in the suburbs outside of New York City where we have our own rising cases, though nothing like the five boroughs of the city. I lived on the Upper West Side of Manhattan for 25 years and my heart is breaking for what I will always consider “my city.” But my worst, chest-tightening moments of panic come when I think of my family members who are nurses on the front lines of this crisis. How can it be that in the United States, a healthcare provider is now taking his or her life in their hands just going to work? Every single one of these heroes deserves more than thanks from a grateful nation, they deserve wartime hazardous duty-pay. In lieu of that, the least this government can do is have their student debt wiped off the books for the job they are doing, risking their lives to save ours. We need to all start a movement to make this a reality. What would be a great hashtag for this mission, #thanksarenotenough?

Two weeks ago my anxiety reached a maximum level when my husband, son and I all came down with a cold. How surreal that the common cold induced frantic days obsessively taking my temperature and sleepless nights of pure dread, kept awake by coughing that I could not determine if it was wet or dry. It was hard to get through to the primary care physician’s office, the line was always busy, but once I did speak to a nurse my question was, “at what point should we worry?” Since there was no fever, chills or shortness of breath, she told me it was probably exactly what it appeared to be, a simple cold, but if any of those three symptoms appeared, to call right back. Call right back, I thought? It took me hours to get through this time when I didn’t have fever, chills and shortness of breath. But each day the cold lessened and by week’s end had passed as colds are wont to do. But this simple cold left a residue of fear in its wake that made me reluctant to even go outside for a socially-distant walk.

So, I have asked myself if in the midst of this once-in-a-century public health and economic crisis, should I take a break from politics, if only to help maintain my sanity? On our Democratic Club call the focus was on how can we reach out and help those in our township who are really suffering because they can no longer afford to buy food. It felt good to be helping out with something that was not political. I also gave up watching my MSNBC line-up at night. I listen to music while riding my exercise bike rather than watching Rachel Maddow. Some nights we watch movies, particularly movies that make us laugh. I still read the newspaper each morning but I skim through a lot and I have tried not reading headlines on my phone all day. It has helped quiet some of the panic.

But even digesting a much lighter diet of news, I cannot escape one undeniable fact, that this crisis, all of it, from the number of infected and dead, to the dire shortage of personal protective equipment for our healthcare providers, to the shuttering of businesses and skyrocketing unemployment, to the food shortages for low-income families, every bit of this trauma the country is now enduring, has been made much worse by the incompetence, selfishness and corruption of the Trump administration. And this inescapable fact sits in the pit of my stomach and emits a rage so white-hot that I can’t ignore it. And because of that, I can’t stop worrying about politics and in particular, the election this fall.

The Washington Post put together a complete accounting of just how much of a mess the Trump administration has made of our preparedness for this crisis. The April 4^th article is entitled “The U.S. was beset by denial and dysfunction as the coronavirus raged: From the Oval Office to the CDC, political and institutional failures cascaded through the system and opportunities to mitigate the pandemic were lost.” It is a big, investigative deep-dive into the dysfunction. It is gut-wrenching and infuriating but maybe the most important article every single American needs to read.

https://www.washingtonpost.com/national-security/2020/04/04/coronavirus-government-dysfunction/?arc404=true

On March 30^th the Editorial Board of The Boston Globe, put the blame for this failure of leadership squarely where it belongs. The title of the editorial says it all: “A President Unfit for a Pandemic. Much of the Suffering and Death Coming was Preventable. The President Has Blood on His Hands.”

https://www.bostonglobe.com/2020/03/30/opinion/president-unfit-pandemic/

To quote the editorial: “As the American public braces itself for the worst of this crisis, it’s worth remembering that the reach of the virus here is not attributable to an act of God or a foreign invasion, but a colossal failure of leadership.”

Much like The Washington Post article, the editorial goes through the entire timeline of failure on the part of the Trump administration and ends with the statement, “But come November, there must be a reckoning for the lives lost, and for the vast, avoidable suffering about to ensue under the president’s watch.”

It is this need for a reckoning that mandates we stay focused on politics and keep our eyes on the November election, despite the pandemic that rages around us. When Trump was elected, our outrage sparked the Women’s March and created the anti-Trump Resistance. That movement powered the blue wave in 2018. Despite the fears that now haunt our days and plague our nights, we must not lose sight of what has always been our prime directive, to make sure Trump is a one-term president. Our work in the Resistance was how we channeled our rage then and it must be how we channel our rage now.

But unlike the last three years, we cannot organize and attend rallies, we cannot knock on doors and speak directly to voters, we cannot even be together in a planning meeting or a Happy Hour social event. All last week, on every Zoom call with every organization, we struggled to answer the same question, “How are we going to get the public engaged when we are stuck in our homes?”

In an article on, April 5^th, The New York Times addressed this dilemma from a campaign’s point of view. “With Campaigns in Remote Mode, Pandemic Upends Battle for Congress: As retail campaigning has become all but impossible amid the public health crisis, candidates tread carefully in an uncertain political environment.”

This article did not address the dilemma from the non-candidate point of view, meaning how are we in the grassroots going to function this year if we cannot go outside? The next day, April 6^th, The New York Times corrected that oversight with an article looking at the impact on progressive campaigns and on the grassroots movement from the pandemic. “Progressives Built an Organizing Juggernaut for 2020. Then the Virus Hit: After a disappointing turn in the presidential race, grass-roots progressive groups focused on congressional races and down-ballot campaigns. In weeks, the coronavirus has destroyed their plans.”

To quote from that article: “The grim picture may have a profound political impact for the general election and beyond. Democrats were poised to have an organizing juggernaut ready for the 2020 election, with the goal of both reaching new voters and helping reverse the state and local losses they experienced during President Barack Obama’s years in power. Even more, liberal groups hoped this election cycle would formalize their political infrastructure, so the activism that erupted in response to Mr. Trump’s election could be harnessed going forward. That may still happen, but it will require creative financial and digital solutions, according to interviews with several leaders of progressive political organizations and left-wing candidates running for office in states like New York and Ohio. Optimists have called it a time for political innovation, while others worry the structural barriers could stymie the progressive movement at a critical crossroads.”

The article zeroed in on the bind we are all in. We spent 2017 learning how to get out of our houses and speak in person to voters. Then in 2018 we utilized that knowledge and those skills to propel the largest voter turnout for a midterm election in 40 years. Now we have to learn how we are going to be effective without person-to-person contact.

Below are a few initiatives that are trying to address that need. The first is an app called Outvote that is mentioned in this article. Here is the description on their website: “Outvote is an app that makes it easy to support the causes and campaigns you care about. The goal of the app is to promote voter participation within progressive campaigns. Our larger mission is to build a community of organizers that remain active between election cycles. By partnering with the biggest campaigns, advocacy organizations, and nonprofits, the Outvote community will be able to mobilize around current events, elections, and critical moments in policy formation for social equality and justice.” https://www.outvote.io/

But Outvote seems to be primarily for organizers, a valuable resource but not really a direct conduit to voters. Indivisible has an ongoing project with a direct line to voters that activists can participate in from their homes. It is called VoteFWD and involves writing letters to voters in swing states. Here is the description from the Indivisible website: ‘Want to get out the vote in key states from the comfort of your own home?Indivisible is excited to be partnering this election cycle with VoteFWD. VoteFWD provides activists with names, addresses and a data-driven proven template to write letters to voters in important states. Letter writers will save their letters and send them right before the election so that voters receive them at the perfect, most-strategic moment.”https://indivisible.org/resource/write-letters-voters-votefwd

On my Zoom call with SuperMajority, which joined with Pantsuit Nation, I heard about two projects. The first is called Turnout Tuesday where they are asking their members to call their state Secretaries of State and press them on how they are going to use the federal funds to make sure the vote in November is secure, particularly if they are going to invest in mail-in ballots. The second is text messaging to voters and they have been conducting training seminars to teach members how to do “rapid response textbanking” to alert voters about important issues. https://supermajority.com/

At my local Indivisible group, East End Action Network (EEAN), we were already planning postcard-writing parties, creating and mailing personal postcards to voters in our district, as we did in 2018. This will be a joint project with Indivisible North Fork. These events will begin in July, after the New York primary on June 23^rd when we have a Democratic congressional nominee. While it is certainly more fun to party together (you can read the descriptions of these events in my book, The Resistance and Me, available on Amazon), we can convert this initiative to home-based postcard writing rather than in groups if we are still not able to gather together by the summer. The end goal of getting the postcards out there can still be achieved.

These are all good ideas. But they don’t go far enough. The voter suppression outrage by the GOP in Wisconsin underscores the extreme lengths the Republicans will go to keep people from voting. We are going to need bigger and bolder ideas to take the place of speaking to voters in person if we are going to be able to counter those GOP schemes. Possibly because they are aware of this challenge, Indivisible will be hosting a series of training webinars in April for Indivisible leadership on how to better use the virtual space during this lockdown period. If you are a member of an Indivisible group, someone in your leadership has probably already received an email about signing up. If not, reach out to your Indivisible contact. I tried to find a link for these webinars on their general website and could not find one. I look forward to whatever ideas come out of these webinars and will include them in later blog posts.

I am particularly worried what happens to voter registration. Normally the spring and early summer are key periods to focus on voter registration but how can that be done digitally and from our homes? I have been wondering if it is at all possible to conduct a virtual voter-registration drive and I would love to hear back if anyone has any ideas about this. How can we reach residents in the district who are not registered to vote? Is that even possible? They wouldn’t be in MiniVAN but would there be a way to cross reference residents with voter registration rolls to determine constituents who aren’t registered? We could mail them personal letters including the voter registration form if they cannot register online through the state motor vehicle department. Is there any way at all we could create such a list?

Along with my fear that we are not going to be able to register new voters, is a concern that our digital efforts are not going to reach the Independents and Unaffiliated voters we need to win in November. Maybe we should think about sending postcards right now to these voters with the facts about how the Trump administration has mishandled the pandemic, facts that would break through the fog of misinformation that Trump and his propaganda machine at Fox News are spewing out. These postcards could also have contact information for services that many constituents need during this crisis, such as food banks and how to file for unemployment benefits. And these voters are in MiniVAN. We would have to figure out how to pay for printing the postcards and the postage since these would not be funded by the campaigns.

We know from the midterm election how much time, effort and boots on the ground it took to power the blue wave. It is a process that starts months before with voter registration, educating the public, supporting primary candidates and then getting-out-the-vote. We do not have the luxury of waiting for the crisis to pass, waiting until we are able to knock on voters’ doors, not while Trump and the right-wing media saturate the airwaves with lies about this pandemic while at the same time erecting barriers to voting. If we are going to hold Trump and the GOP accountable in November, we need to act now and to do that we need bigger and bolder ideas of how we are going to reach voters, counter the lies and protect the ability for every American to vote.

By Barbara Weber-Floyd

Author, The Resistance and Me: An Insider’s Account of the Two-Year Mission to Stop the Trump Agenda and Take Back the House

(Available on Amazon and at Canio’s Books, Sag Harbor)

Blog post also on:

https://sites.google.com/view/theresistanceandme

https://www.dailykos.com/stories/2020/4/10/1936191/-Zoom-Time

Why is COVID-19 Testing Important?

David Posnett — Sun, 29 Mar 2020 04:24:17 +0000

Earlier today, March 28, 2020 and According to News 12

Suffolk County Executive Steve Bellone says 4,138 people in the county have tested positive for coronavirus.

Bellone also says 409 people are hospitalized due to coronavirus, with 139 in the ICU. “There are 2,644 hospital beds, with 570 available. There are also 309 ICU beds, with 78 available.” Clearly, we will soon run out of necessary beds and of course ventilators.

Bellone says there are 30 deaths in the county due to coronavirus.

7 deaths have occurred in the retirement home Peconic Landing

At Peconic Landing, the Greenport retirement home, there was another death today, the seventh. There are about 40 people known to have tested positive. Peconic Landing has perhaps 377 staff, and well over 300 residents (301 independent “members” and 86 nursing home patients). Peconic Landing is the hotbed of COVID-19 in Suffolk county. Think of it as a “Cruiseship”. And it is full of frail elderly clients. Find the updated information regarding Peconic Landing and COVID here.

The leadership of Peconic Landing claims there are no available tests for their home. I understand that there may be a rush on tests, but isn’t the situation at Peconic Landing a quasi emergency? Their residents are mostly over 80 years old. If they get sick with COVID-19 one would expect a mortality rate of 10-20% at least. For the rest of us, the mortality (risk of dying if we get the virus) is more like 1-2% .

Some say “well aren’t they going to die anyway?” How would you feel if your parent or grandparent were there?

Why is it important to test everyone at Peconic Landing?

There are currently 2 types of testing:

RT-PCR test – it detects viral RNA and therefore a component of the virus itself. This involves a nasal swab that is sent to a lab and the turnaround is about 1-2 days currently.
Antibody test: A new test for IgM and IgG antibodies (Ab), which are part of the immune system’s response to the virus. This test takes 15 minutes and involves a pinprick of a finger, like the glucose test performed by diabetics.

Both tests should be done because the combined information might be useful:

Here are the 4 possible outcomes and what they mean.

PCR+ Ab –

you have COVID-19, symptomatic or asymptomatic. You should take precautions (self-isolation) to avoid transmission of virus to your loved ones. You absolutely may not have any contact with residents at a home, like Peconic Landing.

PCR+ Ab+

you are likely recovering from COVID-10 (1-3 weeks out); you may have been symptomatic or not. Because you are still PCR+ you need to take precautions (isolation). Isolation should be for 10 days after symptom onset or for the duration of symptoms plus 3 days after resolution of symptoms. You absolutely may not have any contact with residents at a home, like Peconic Landing.

PCR- Ab-

you never had COVID-19. You are susceptible, and if you live or work in a high risk situation, such as Peconic Landing, you shouldn’t be there. But if that is impossible, you should take very stringent precautions.

PCR- Ab+

you are fully recovered from COVID-19. Generally, this group could be considered “immune” and possibly

- go back to work
- might be well suited for caretaker and health provider roles
- might donate plasma at a blood bank to be administered to critically ill COVID-19 patients in the ICU: this is called passive immunotherapy, used successfully for the Spanish Flu and for Ebola.

On the Diamond Princess Cruise ship, all elderly passengers and those with underlying medical conditions, and all crew were tested. Passengers who had negative [SARS-CoV-2] RT-PCR test results, no respiratory symptoms, and no close contact with a person with a confirmed case of COVID-19 completed a 14-day ship-based quarantine before disembarking. In other words, testing helped make informed decisions to save as many lives as possible.

We should do the same for our senior friends at Peconic Landing.

Where Were You Lee Zeldin?

David Posnett — Fri, 27 Mar 2020 19:20:54 +0000

In the March 19 issue of the Western Edition of The Southampton Press, the A section is devoted to articles about the coronavirus pandemic and the impact on Suffolk County and Southampton Town. There are quotes and statements from Governor Andrew Cuomo, Suffolk County Executive Steve Bellone, Southampton Town Supervisor Jay Schneiderman, mayors, school superintendents and hospital administrators. Conspicuously missing is any statement from Congressman Lee Zeldin.

On the congressman’s Facebook page and in his appearances on Fox News, from January through early March of this year, his comments included supporting President Trump against impeachment, criticizing New York for bail reform, insinuating that Democrats want to enable voting by undocumented residents, and the highlighting the danger of MS-13. But not one word about the growing epidemic.

Now that the pandemic has been declared a national emergency, his website has information for the public about the virus and his office has issued a series of press releases. But we know that Congress was informed by our intelligence services in January that the novel coronavirus that began in China at the end of 2019 had the potential to be a global pandemic. China released the genetic code for the virus at the beginning of January to help scientists in other countries prepare test kits and institute procedures to contain the virus. We did neither.

Instead, President Trump called it a Democratic hoax, Fox News repeated this misinformation campaign, and Zeldin focused on spreading lies about bail reform. Countries like Australia and South Korea that immediately implemented policies to test and contain the virus are in far better shape today.

No resident of the district should be surprised. Zeldin has not stood with protecting the public health of his constituents at any time in his tenure in Congress. He voted repeatedly to repeal the Affordable Care Act, voted for the GOP deficient replacement bill in 2017, and lied about that vote in the 2018 midterm election, pretending he supported protections for pre-existing conditions.

The constituents of the 1st District are now facing a grave danger to both the public health and economic health of our district. Our hospitals in Suffolk County are facing overwhelming numbers of emergencies. And our shuttered businesses and their employees are facing ruin.

We, the taxpayers of this district have the right to know why we are on a COVID-19 case accrual curve closer to Italy than to South Korea. Where was Congressman Zeldin when this threat was building? Why was he busy spouting right-wing talking points and propping up a president who was calling this a hoax rather than raising the alarm about the threat to our district and getting us the necessary resources?

We need answers.

By Barbara Weber-Floyd

Westhampton Beach

How to Handle Food and Groceries Coming in to Your Home

David Posnett — Thu, 26 Mar 2020 20:42:55 +0000

Watch a doctor demonstrate how to safely bring groceries home during the coronavirus crisis. This is very useful! Specially the latter half starting at 5:00 min.