Tag Archives: public health

V-Day – With the vaccine comes hope

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The UK administered the first fully tested and approved COVID-19 vaccine this week. The U.S. could be administering the vaccine as early as next week. There is hope!

Projections are that by summer 2021, most everyone in the U.S. who wants a vaccine will be able to get it. There is hope!

The Biden Administration’s health team has been announced. There will be a new reliance on clinicians, scientists, and public health experts. There is hope!

And yet, the challenges are many. To name just a few: overall supply vs demand, distribution logistics and storage, logistics of administering the vaccine, establishing guidelines for prioritized groups to receive it, ensuring both doses are administered at the right time interval, and of course public trust in the vaccine.

As I have read and listened the past week, I have learned how the free market impacts the availability of key components for the manufacturers, that each state can decide on their group priorities after the CDC publishes the guidelines, and that only about 60% of the population say they are willing to take the vaccine.

On a more encouraging note, I have heard how provider organizations have been developing their vaccine administration plan for months and how a leading pharmacy chain is planning to scale administration across their 10,000 locations and has an app ready to go for tracking patients, scheduling appointments, and sending reminders for the second dose.

I encourage you to check out these resources to understand the issues involved:

In the Bubble with Andy Slavitt podcast – Toolkit: Where and When Can I Get the Vaccine? He talks about the science with Dr. David Agus and the logistics with CVS Health’s Tom Moriarty. Together they answer questions from listeners.

Interview with Dr. Atul Gawande in the New Yorker by David Remnick – Atul Gawande on Coronavirus Vaccines and Prospects for Ending the Pandemic. It covers a lot of ground and Dr. Gawande is as insightful here as he is in his regular New Yorker pieces and many books. Continue reading →

Well past time to support our healthcare workers – Part 2

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I knew that Governor Gina Raimondo had announced a two week pause starting November 30th and that there were growing concerns about hospital capacity here in Rhode Island. But when I got this alert pushed to my phone Monday morning like everyone else in the state, it became very real again.

I knew there was discussion about opening a field hospital in Rhode Island. But when I saw that the lead story on one of the national morning news shows was an interview with the field hospital director on opening day December 1st, it became very real again.

I knew that our ED at the largest hospital in the state was at a breaking point as I have been following Dr. Megan Ranney closely on social media in recent weeks. But when I heard her describe what it is like in the ED on this week’s In the Bubble podcast with Andy Slavitt – “Following One Shift in the COVID-19 Unit”, it became very real again. Listening to her describe mentally getting ready for her shift, donning and doffing layers of PPE that is worn the entire shift, assessing and admitting very sick patients, calling families with updates, and heading out the door with her physically exhausted co-workers at the end of a long shift, I came to appreciate even more what our frontline healthcare workers are doing 24×7 in hospitals across the country.

I am not a denialist. Quite the opposite. I have taken this virus seriously since the start. I wear a mask whenever I’m out and can’t be socially distanced. I keep a journal of all our outings and contacts. I have the Crush Covid RI app that includes a location tracker diary for the past 20 days on my phone. I have watched many news stories, read many articles, and listened to many podcasts in the past 9 months. I feel very educated and informed. And at times, I feel very sad – so many stories have brought me to tears.

When I hear about new restrictions in my state, I typically tell my husband no change for us, we’re already living that way.

But it hit me different this week. Continue reading →

With gratitude – yes, even in 2020

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Difficult as 2020 has been, it is my hope that each of us can find something to be grateful for this Thanksgiving. If you have lost a loved one to COVID, I know that no words can take away your pain and grief. If you are a “long hauler”, I hope that you are finding support from others as you navigate your ongoing health issues. If you have lost your employment due to the economic downturn, I hope you are finding support from your network to find a new job.

Many times, during the past 9 months I have said to my family and friends – I can’t complain, I’m healthy and alive. I never really felt my age, but since March I have been reminded that I am an “elder”. I am overall healthy with no underlying conditions but I’m in that over 65 group. My husband is 4 years older than me and does have some medical conditions. We have been mask wearers since mid-March and do our best to minimize our risks.

I have much to be grateful for. Healthcare workers caring for COVID patients on the front lines and scientists working to develop a vaccine. All those who support them in ways we see and don’t see. And yes, that includes the IT and HTM teams in every health system who provide solutions and systems that the clinicians depend on.

I am also grateful for all the essential workers – at the grocery store, providing public transportation, delivering packages, and the police and firefighters who protect us.

My family are my big rocks. And that has never been truer than this year. I am eternally grateful for them. Continue reading →

Well past time to support our healthcare workers

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Any graph or heat map you look at, one thing is obvious – the coronavirus is out of control and spreading rapidly. New coronavirus cases have jumped by more than a third in the U.S. over the past seven days, according to data from Johns Hopkins University, the fastest pace since late March. Every day since Election Day, more than 100,000 people in the country have tested positive for the virus with a daily record of over 187,957 new cases last Friday per Worldometers.info. We went from 10 million new cases to 11 million in just one week. And we have lost over 250,000 lives.

We saw heartbreaking stories on the news from ICUs in the Northeast during March and April. Then stories from southern states. And now from hospitals in the Midwest. But when you look at the heat maps, the virus is everywhere now.

Listen to any healthcare worker and one more thing is obvious – they are exhausted and burning out. They tell story after story of how hard it is to work 12- and 18-hour shifts caring for COVID patients only to drive home past crowded bars.

We have seen exhausted physicians and nurses share their stories for months. I cannot tell their stories, but I can share them. And I can encourage you to do the same. But more importantly, I can encourage you to take the basic steps needed at this point – messages we have all heard for nearly 9 months now – wear a mask, socially distance, and wash your hands frequently.

This virus is not a hoax. It is not something you can ignore or deny. A story from a nurse in the Dakotas is the latest to go viral. She describes patients who yell at her and say she does not need to wear PPE because they don’t have COVID, right up until they are intubated.

Our healthcare workers truly are heroes, but they are at a breaking point. Our hospitals are at or nearing capacity. There are over 73,000 people hospitalized with COVID, another record since the pandemic started. Field hospitals are opening again in many states. Continue reading →

COVID-19: The good, the bad, the different

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When it comes to COVID-19, there is little good. But every report that reflects progress is good news. Whether it is progress in how best to treat hospitalized patients, progress towards a vaccine, or the number of new cases, hospitalizations and deaths trending downward. I saw one of those reports just a few days ago when Shereef Elnahal, President and CEO, University Hospital in Newark, New Jersey shared their good news on social media:

“We made it.

For the first time since the #covid19 pandemic started, University Hospital has ZERO patients with coronavirus in house.

After over 1,000 discharges, leading northern NJ’s regional response, and folks in the City of Newark wearing masks, socially distancing, and getting tested, we hit a milestone that we’ve been hoping for since a time when almost every patient in our hospital had coronavirus.

So proud!”

There are probably many more hospital leaders in the Northeast who can finally report this same good news. And they have reason to be very proud of what they and their teams have done for their communities.

But there is plenty of bad. A health crisis with nearly 200,000 deaths and a projection that there could be over 400,000 deaths by the end of the year. An economic crisis with millions unemployed.

Another evolving bad news story is what we are learning about the “long-haulers”. These are people who had COVID-19 and months later report a variety of long-term symptoms. Continue reading →

Staying fit and informed

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If you are working from home during this pandemic, getting enough exercise each day can be a challenge. I spoke to a CIO colleague recently who said he used to get 10,000 steps a day just at work given the size of his office complex.

I recently decided that I needed to up my exercise routine to ensure I get 10,000 steps a day. A long dog walk at the end of the workday plus the steps inside my house from my home office to the kitchen and back are just not enough. While I have never been an early morning exerciser, I am now two plus weeks into a new routine. Instead of rolling out of bed and starting on email and work right away, I now go for a brisk walk. I try to do a minimum of 30 minutes but depending on the time of my first scheduled call of the day, I do anywhere from 20-45 minutes. The end of day dog walk rounds it out to ensure I hit my 10,000 steps.

Besides the physical and mental health benefits of more exercise, I also have more time to stay informed via podcasts. A few weeks ago, I wrote about my latest podcast recommendations. With my new exercise routine, I am ready to recommend two more:

The Osterholm Update: COVID-19 – If you had not heard of Dr. Michael Osterholm pre-COVID, you probably recognize his name by now. Continue reading →

Physical distancing: finding our way

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We saw our grandkids again on Sunday. A small family get together for Father’s Day and our youngest grandchild’s 4th birthday. As we all find our way and do our best to minimize our risks of COVID-19, being able to hug my grandkids brings me great joy and is one of the things I have missed the most these past few months.

There is a reason many people want to refer to this new practice as physical distancing, not social distancing. We need each other. Social isolation is not healthy. Technology has helped but it is not the same. Just ask someone who said their final goodbye to a loved one on FaceTime or Zoom.

Living in Rhode Island, my husband and I have taken the shutdown very seriously. Governor Gina Raimondo got ahead of it early with the shutdown order and then a slow, phased reopening. From mid-March until a few weeks ago, we have mostly stayed home except for the weekly groceries, a few trips to the garden nursery and Home Depot, the occasional takeout order, and the daily dog walks.

We limited family visits to outside spaces at our homes at a distance and no hugs. We are gradually loosening up on the hugs. As we all learn more about how the virus is transmitted, spending time with close family who have also been strict during this period seems reasonable.

My 4-year-old grandson first told me back in April on a family Zoom session that he was going to have a birthday parade, no gifts, and a small cake only for his mom, dad, and sister. It was sad to hear him explain this at such a young age but I thought it was probably a reasonable plan. The idea of a parade was exciting to him. But two months later we decided it was ok to do the backyard immediate family only gathering, which was 12 adults and the 4 young cousins, aged 4 through 7. The grandkids gave us hugs and briefly sat on our laps. It was good to not feel like we were all radioactive.

The slow opening of our own circles is a challenge we all must deal with. I do not take this virus lightly. I read a lot and listen to many interviews and podcasts with experts. I try to be as informed as possible about the science. And I take cues from my sister who has a public health background and my daughter who is an NP and has cared for COVID-19 patients in Boston. Continue reading →

At the intersection of racism and healthcare

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It has been two weeks since George Floyd was murdered by police in Minneapolis. Since then, millions of people have joined protests in major cities and small rural towns around the world to make their voices heard. They have said enough is enough, racism must end and real change is needed.

When the protests end and our national focus begins to shift, we can not go back to business as usual. The statements of support and solidarity made by so many these past two weeks must turn into action.

At the local, state, and federal level we must hold our government leaders accountable for change and exercise our right to vote for those committed to change. With the focus on police brutality, we are beginning to hear some major cities announce planned changes in policing. New York Governor Andrew Cuomo has introduced his “Say Their Name” agenda to reform policing in New York state. House and Senate Democrats have introduced the Justice in Policing Act.

In recent days, we have seen many “white coat” rallies as well – White Coats for Black Lives. My social media feeds are filled with pictures and stories of hospital staff rallies – many of them organized by the residents. Brigham and Women’s Hospital in Boston, UMass Memorial in Worcester, Massachusetts, and Henry Ford Health System in Detroit were just a few of them. And these are hospitals who saw thousands of COVID-19 patients in recent months. Truly our healthcare heroes.

In 2014, after Michael Brown was shot by police in Ferguson, we saw similar support. Students at 70 medical schools around the country organized a national white coat die-in saying it was an “important time for medical institutions to respond to the violence and race-related trauma that affect our communities and the patients we serve”. They lay down for fifteen and a half minutes. Eleven minutes to represent the number of times that Eric Garner said “I can’t breathe” as he was in a choke hold by police in New York City and four and a half minutes to represent the four and a half hours that Michael Brown’s body lay in the street after being shot by a police officer. And yet here we are in 2020.

These hospital staff rallies along with the many statements of support from hospital and health system CEOs are an important show of support but we also need action and attention to health disparities. I want to share two heartfelt CEO statements that were the most impactful for me. They are from healthcare leaders I have worked with and greatly respect. Continue reading →

Hospitals too are part of a safe reopening

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This past weekend was the unofficial beginning of summer. After 2+ months of stay at home orders and a few weeks of phased reopening depending on the state you live in, the images of large crowds packed in close and without masks at a pool in Missouri, on the boardwalk in New Jersey and at a race track in North Carolina were concerning. As I hope many others chose to do, we stayed home and had a family visit on our patio at a social distance.

We are hearing stories of super spreaders from Mother’s Day two weeks ago resulting in upticks of COVID-19 cases in many states. We see stories of a hair salon in Missouri where two stylists who were ill exposed over 140 customers. We see stories of no available ICU beds in Montgomery, Alabama where cases have reportedly doubled since that state reopened two weeks ago.

On Friday, the President ordered churches to reopen and threatened to override governors who refused to do so. Fortunately, many faith leaders acted responsibly and outlined plans for continued online or outdoor services until they are certain that they can safely reopen their doors to congregants.

News reports say the virus is still spreading at epidemic levels in 24 states and is not contained. This pandemic is not over. And it may be a long time before it is. So how do we begin to recover and safely reopen? Continue reading →

Year of the Nurse: We must support our nurses

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The first time I cried during this pandemic was March 17 when I read that in Italy people over 60 years old were being left on gurneys in the hallway to choke on their own sputum. Patients with coronavirus had

Message from Brigham and Women’s Hospital OR nurses: #StayHome

exceeded the hospitals’ capacity. I had been watching the news and stories from Italy closely in anticipation of what was going to happen in our country assuming we were just a few weeks behind them in this crisis. I cried then not only for Italy but for myself. I wondered if I was going to be one of those over 60 left to die if our hospitals were also unable to handle the potential number of very sick COVID-19 patients.

The second time I really teared up was when I thought about my daughter who is the Chief Nurse Practitioner (NP) on the inpatient orthopedic/spine service at Brigham and Women’s Faulkner Hospital in the Boston area and reassigned to work shifts in the ICU with COVID-19 patients. I feared the worst for my family. That she would get exposed and transmit it to her husband and five-year-old daughter who both have very bad asthma and are allergic to almost everything. We knew this virus was not just killing elders. People of all ages and especially those with underlying conditions were and are still at high risk.

Most of the times I have had tears since then has been watching a nurse or physician tell their story on the news. Describing what it is like to care for intubated COVID-19 patients, helping their patients’ families understand there is nothing more they can do, and sharing the fears they have for their own families when they go home from their shift. I have also cried when I see the stories of family members dying within days of each other from this virus, many of them people of color who are essential workers who can’t stay home.

I have listened to my own daughter describe the days she was assigned to work an ICU shift with COVID-19 patients. While it was not the overall intensity of what we have seen on the news in New York City hospitals, every individual case she described was just as sad and heartbreaking. And the emotional and physical toll on the nurses, doctors and respiratory therapists was obvious.

On the brighter side of this crisis, I have smiled with joy as healthcare workers in NYC celebrate the 500th or 1000th COVID-19 patient discharged from their hospital. Continue reading →