COVID workers need support but anti-vaxxers not so much

Maine Writer- Gratitude echoed during this daunting pandemic and any other time, when the goal of our community is to support one another during particularly challenging times. (Be sure to scroll and read the comment posted on this Central Maine Editorial Board opinion. I pasted it at the end of the article.) 

Gratitude and grace needed during the holidays (and any other time too!): The advice of the Maine CDC director strikes the right chord in a bewildering, frustrating time.

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Dr. Nirav Shah, director of the Maine Center for Disease Control (CDC) and Prevention, took a few moments at the start of his Wednesday briefing to make some observations about celebrating the holidays during a pandemic.

Before sharing what he knew about the fast-spreading omicron variant of the Sars-CoV-2 virus, the status of the state’s hospital capacity and efforts to vaccinate more people, Shah spoke about how our attitudes toward this disease could fit with the spirit of the season – a time of gratitude and grace.

Central Maine Editorial Board: We couldn’t agree more. Both qualities are in short supply this year, and the need is great.

Our gratitude, Shah said, is deserved by so many people, starting with health care workers, who have been fighting on the front lines of a crisis that keeps changing.

Nirav Shah Director of the Maine Center for Disease Control and Prevention

“They do this in a variety of settings,” Shah said. “Health care workers at hospitals, nursing homes, EMS stations, home care workers, hospice workers, every sector of the health care system has played a role in our response to COVID-19.”

Shah continued: “The work they do matters, perhaps more than ever before. And they do it over this holiday season because the disease doesn’t take a break.”

These workers deserve our thanks. “And if you know one – and you must – give them a high-five and thank them for what they have done throughout the pandemic.”

To the list of the deserving, Shah added public health workers – from community outreach workers to lab technicians – as well as volunteers who staff vaccination clinics and other community efforts, and members of the Maine National Guard who have been serving a role since the beginning of the pandemic, which has only expanded.

At the same time that he called attention to the people around us who should be thanked, he reminded us about those who need our generosity – the people in our lives, our friends, families, coworkers and neighbors who may be evaluating the risk of the pandemic in ways we don’t understand.

“These days it seems, when it comes to COVID, each of us feels like we are on an island,” Shah said. “Everyone who is taking COVID more seriously than you is an over-reactionary worrywart. And everyone who is taking COVID less seriously than you, it’s easy to cast them as someone who doesn’t get it, someone who is denying science.”

But, neither of those extremes is right.

“What is true is that everyone approaches COVID differently through their own lens, a lens that reflects and refracts their own health status, their family’s health, whether they’ve been vaccinated as well as a host of other factors,” Shah said. “No two people, right now, will think of COVID and their own risk in the same way. And that means that no two people will take the exact same set of steps, especially as we go into the holiday season.”

This can be frustrating and confusing and has already caused conflict within families, workplaces and communities. 

Yet, Dr. Shah’s prescription is to meet these differences with generosity instead of anger.

“Recognize that they are coming at this world, a messy, bewildering world, with a different set of thoughts and values than you may be,” he said. “It can be frustrating, but it’s also a time where grace will get us much further than will irritation.”

This is not exactly the kind of advice we expect to get from a doctor, but it struck the right tone at a time when so much of the news we have been hearing is bad.

After nearly two years of uncertainty and disappointment, we have learned not to see this pandemic as a transitory phenomenon that will be over sometime soon.

But, rather than settle into despair, we can offer our grace to the people in our lives who need it, and our thanks to those who have been giving so much to protect us from a disease that consistently and stubbornly surprises.

Among those to whom we offer our thanks are the people at the Maine CDC, whose work has never been more demanding or important, and their director, Dr. Nirav Shah.

Comment published on the editorial page:  

From Maine Stoic:  I admire Dr. Nirav Shah very much, make no mistake. I have followed his guidance since the beginning of the pandemic. Nevertheless, I have reached the point where I have to disagree with the notion of being gracious and accepting of those who refuse to be vaccinated. What if twenty percent of the Maine population decided from time to time to put on a blindfold and walk down a busy street firing a deadly weapon in random directions, leaving a trail of injury and death behind them? What would Dr.Shah, or most other rational people think of that scenario? 

How would Dr.Shah have the greater majority of us respond to these people? The unvaccinated are doing very much the same thing. The time is long past where we, individually and collectively, must respond to the vaccine refusers in some stronger and more effective manner.

From P. Turlo: “These days it seems, when it comes to COVID, each of us feels like we are on an island.” The island analogy is misleading. There are certainly shades of gray. Yes, we should take into account the fact that many "may be evaluating the risk of the pandemic in ways we don’t understand." But there's another group who will simply deny science and who will put others at risk for 'political' reasons. Those 'reasons' involve a deep, unfounded distrust of 'science.' Dr. Shah has been extremely helpful and comforting for months on end. His attempt to promote 'grace' is commendable, but in some cases it will fall on deaf ears. When it comes to the deniers, "grace," in many cases, won't get us further. I agree with the thanks we should give to all the healthcare workers and the long list of support staff who tend to those with COVID. 

They have many, many long days ahead. God keep them safe.

Epidemiology Research classic - A small town in Maine was the source of a super spreader COVID

A noteworthy report!  As a University of Southern Maine Nursing alumna, this report is consistent with the high research standards taught to us in the excellent curricula.

Cases are being investigated to Calvary Baptist Church, in Sanford, Maine, where Pastor Todd Bell continued to hold in-person services after officiating the wedding

CDC- Centers for Disease Control and Prevention

Faculty and staff from the University of Southern Maine (USM) contributed to a new analysis and narrative being used by the U.S. Centers of Disease Control, to better understand the spread of COVID-19.

Their report examines an August wedding held in rural Maine, in Millinocket, and COVID-19’s tragic reach across hundreds of miles, eventually infecting at least 177 (!) people.

Of those infected, seven people were hospitalized and seven died. The report was published in the U.S. CDC’s Morbidity and Mortality Weekly Report, the agency’s primary vehicle for scientific publication of timely, authoritative and objective public health information and recommendations.

The University of Southern Maine's contribution included outbreak investigations by Sarah Bly, Megan Kelley and Craig Rothfuss — all School of Nursing epidemiology staff embedded with the Maine CDC — and Sara Huston, an associate research professor at the Cutler Institute. 

Other contributors include corresponding author Parag Mahale of the U.S. and Maine CDC and Sara Robinson and Siiri Bennett (Maine's State Epidemiologist) of the Maine CDC.

The report includes detailed numbers and dates on the spread of the disease, charting its spread from the intimate wedding to infections at a nursing home and a county jail.

The virus’s spread across the distances from a small event in a remote location should serve as a warning, said Huston, who helped craft the narrative.

“It travelled hundreds of miles and made so many people ill,” Huston said. “We were able to tie all the pieces together.”

In several key moments, the analysis found that people were not performing some commonly recommended tasks: wear a mask, maintain social distancing, wash your hands frequently, avoid gatherings and stay home when feeling ill.

Several Maine media outlets — including the Portland Press Herald and the Bangor Daily News — have written about the report.

Maine's CDC director Dr. Nirav Shah praised the report’s contributors during his Nov. 13th, briefing, according to the Portland Press Herald.

“It was published in the U.S. CDC’s flagship journal … and we did that for a couple of reasons, the first was we wanted to make sure that the other epidemiologists around the globe who are contending with COVID-19 have the benefit of understanding what we had uncovered with that outbreak,” said Shah in the Press Herald. “The second was we wanted to draw attention to just how far and wide and quickly and silently the virus can spread.”

Senator Susan Collins is wrong to defend Donald Trump's botched coronavirus response

Moving past a botched beginning- echo opinion published in the Bangor Daily News

Dear Senator Collins, "Trump spent weeks downplaying the coronavirus and failing to prepare..."

The coronavirus is continuing to spread in Maine, and Gov. Janet Mills and Dr. Nirav Shah of the Maine Center for Disease Control are pleading for more help from the federal government. Dr. Shah has repeatedly called for more personal protection equipment (PPE), even saying that current supplies amount to an umbrella in the midst of a hurricane.

As a physician, I am horrified that our medical teams, and their families, have not been fully protected. Now that the national supply of PPE has run out, we are in a bidding war with other states that the federal government should be organizing with a consistent strategy.

Sen. Susan Collins defended Donald Trump in an interview with the Bangor Daily News saying he “did a lot that was right in the beginning.” How can that be true? Trump spent weeks downplaying the coronavirus and failing to prepare.

The first moments of a medical emergency are the most important to respond to quickly. If not, the outcomes worsen and the rest is catch-up.

Trump continues to contradict public health experts and berate reporters who ask him reasonable questions about the response. He has undeniably made this crisis worse with his confusing responses using denial and premature medical proclamations as strategies.

The beginning of this pandemic was botched. Let us acknowledge that, even if Collins does not, and move forward with our state responses as best as we can. Most fortunately, we have teams we can trust to be smart, flexible and collaborative in these difficult times. We are all in this together, so let’s figure it out.

Rep. Patricia Hymanson

How COVID-19 community spread is impacting Miane- a message from Dr. Dora Mills

MAINE- Not-So-Brief COVID-19 Update. March 17, 7 AM. Novel coronavirus has spread fairly rapidly here in Maine the last two days. While the actual numbers may not seem impressive - the official count yesterday morning being 17 (in one day this number increased to 32 on March 18) – there are concerning but also not completely unexpected trends.

Clean-Wash your hands often with soap and water for at least 20 seconds. Avoid touching your eyes, nose, and mouth.

Clean and disinfect frequently touched surfaces and objects. Cover- Cough or sneeze with a tissue, then throw the tissue in the trash. If no tissue is available, cough or sneeze into your upper sleeve, not your hands. Contain- Stay home when you are sick, except to get medical care. Avoid close contact with people who are sick.

First, there is increasing evidence of community spread in the Portland area, as more cases accumulate who do not have a known exposure history (e.g. travel to an area with an identified outbreak or exposure to someone with diagnosed COVID-19). That usually means the laboratory-confirmed case counts are the tip of the iceberg, and the actual number of people with infection is several times higher.

Second, the numbers of people testing positive have expanded into some other counties up the coast - Knox and Lincoln counties.

Third, several health care workers have tested positive. As a result, two outpatient facilities have closed for two weeks because so many of the staff were exposed. One is a public health clinic that serves those who are homeless or have underlying conditions such as TB, AIDS, or drug addiction, and the other is an oncology practice.

Besides being concerned about how to care for these clinics' patients and the possibility of exposure to COVID-19 of these vulnerable patient populations, these two examples show the deep impact and strain on the healthcare system that even two infections among health care workers can have. This is why it is critical we focus on two healthcare goals – to care for patients and to ensure the safety of healthcare workers (including first responders) - as well as to focus on the broader public health goal of preventing the spread of the epidemic.

Fourth, one person who tested positive lives in a senior living facility. We know from Washington State and some other locations that such facilities are at risk for major outbreaks.

So, while the numbers in Maine may not seem too impressive, the stories behind them should cause all of us to pause.

With that said, the overall numbers are also a concern. Early epidemiology studies of COVID-19 in China indicate we can expect to see case numbers doubling every six days. More recently, the doubling times seen in Europe and the U.S. have been between two and four days. With 17 known to be infected in Maine, a doubling time of six days could mean that in 24 days 272 Mainers could have COVID-19. With a doubling time of three days (closer to what is actually occurring in the U.S.), that means 4,352 Mainers - without interventions - could have COVID-19 in 24 days. These numbers could be much higher, since we don’t really know how many in Maine currently have COVID-19, given that some early cases indicate community spread in Greater Portland and given that the Maine CDC and NorDx labs were just able to start testing last week. BUT, and this is a critical point - the numbers could be much lower, depending on our individual and collective actions we take now.

Clearly we are on the steep uphill slope of the epidemic curve, which, if unchecked, rises exponentially until most of the population gains immunity. This is the epidemic curve that everyone wants to flatten. It is the one that we absolutely must flatten. We had warnings from China, then South Korea, and now Italy and most of Europe.

The good news is that with at least one case identified on Sunday indicating community transmission, rapid action has taken place the last two days. After taking action last week with the identification of the first person testing positive (e.g. recommending all indoor gatherings of 250 or more be postponed and other actions), Dr. Nirav Shah, Maine CDC (Cebter for Disease Control and Prevention) director, and Governor Mills (full disclosure, she’s my sister) held a rare Sunday evening press conference to announce increasingly aggressive actions, including declaring a civil state of emergency and recommending that all schools close, healthcare postpone elective surgeries and visits, long term care facilities restrict visitors, all events with 50 or more people be postponed, and that all gatherings of more than 10 people that include individuals who are at higher risk for severe illness, such as seniors, be postponed until further notice.

The City of Portland on Monday announced an emergency curfew, including that all establishments where groups gather must close all day Tuesday as well as after 8 pm for the rest of the week. Since St. Patrick’s Day is usually a major holiday here in this community with a strong Irish heritage and known for its restaurants and breweries, this curfew was a somber but wise step to help stem the tide of COVID-19.

Additionally, President Trump declared that over the next 15 days Americans should not gather in groups of more than 10 people, schooling should be at home, and discretionary travel and social visits should be avoided. He also stated that if anyone in a household tests positive for the virus, everyone who lives there should stay home.

All of these actions are taken in order to increase the doubling time, i.e. slow the spread or “flatten the curve”, and to preserve the healthcare system so they can care for patients. Social distancing strategies were not implemented during this most critical phase of early exponential growth of the epidemic in Italy, Iran, and Hubei Province in China, and that is one reason why the epidemic has been so catastrophic there. But this early phase, in which these strategies can work, is a narrow window because of the exponential growth and a short doubling time, especially when there is already community transmission, as is the case in Portland.

Other social distancing strategies include sheltering-in-place, which is now in effect in San Francisco and means that everyone is asked to stay at home, as we do in a blizzard. And to clarify two other terms one commonly hears these days: quarantine is when someone who has been exposed to an infected person but is not yet symptomatic is kept separated from others, most often in their own home. Isolation involves separating someone who is infected or symptomatic from others. Sometimes quarantine is also considered a form of isolation.

Although I wrote the other day on the pros and cons of school closure, with community spread and a short doubling time currently seen in the U.S. (2.4 days), it seems like a prudent move. We will only know afterward whether the benefits outweigh the risks. However, we do need to address some very time sensitive and critical issues, such as: how to feed children who are dependent on schools for food; and how to provide child care for health care workers, first responders, and other employees essential for public health and safety. Addressing the food needs of children and the child care needs of essential workers often means bringing groups of children and adults together, but as long as other social distancing and vigilant respiratory hygiene strategies are implemented, the benefits likely outweigh the risks.

I feel the most important point I can make today is that although our governments have taken swift and aggressive actions the last two days – the City of Portland, the State of Maine, and the U.S. federal government – those actions are only as effective as we the people take responsibility. This is the time. We are in a very narrow window that our individual and collective actions can make a big difference. And only a few infected people spreading the disease can cause havoc - i.e. cause the epidemic curve to spike. This is especially true as we increasingly understand there may be significant spread among those who are not yet symptomatic.

What should we do? Except for your household members who have not been exposed to COVID-19 or who are not sick, keep at least six feet from everyone else. At MaineHealth’s corporate headquarters, for a critical meeting yesterday, we sat in a room, each at a separate table, keeping us at least 6 feet apart. Other meetings are held by phone or using video technologies. And we need to remain very vigilant with respiratory hygiene.

If you are able to work from home, then do so. If you are in higher risk category (>50, but especially >70, or have a chronic serious medical condition), then you need to stay away from others as much as possible, and yes, including staying away from grandchildren.

If you run an organization or business, what should you do? There are many factors to consider, including: how critical are the services you provide; what is the risk profile of the people you serve as well as that of your workforce (e.g. do you have many older people who work for you or whom you serve); can you use distant technologies or other distancing strategies to provide your services (e.g. for restaurants, home delivery or take out)? Besides considering these factors, the situation may change, since if COVID-19 continues to spread exponentially, governments may have to take more drastic measures (such as closing businesses and ordering sheltering-in-place as has occurred in several European countries).

Even on Saturday, when we only had six who had tested positive in Maine, the impact on people’s lives was so evident. In my urgent pursuit to replace a broken phone, I encountered a young salesman at the store who shared that his fiancé just lost her job, as the restaurant where she works closed for the duration of the pandemic. He was expecting to be laid off soon, since they had received word his store would also be closing. He said the local Apple store had already closed. We are fortunate that so many businesses can now allow workers to telecommute. But retail stores, restaurants, movie theaters and many others cannot.

As we discuss the number of “cases” of COVID-19, as Dr. Nirav Shah so well pointed out at Sunday evening’s press conference, there are people and families behind each of these cases. I would add that there are many more “cases” than those who test positive: there are those who are infected who are not tested; students who are at home wondering where their next meal will be; workers who have lost their jobs; and families who are having to close their businesses. Although I feel heartened that all levels of government seem to be trying to address all of these “cases”, it is clear that it will take all of us working together to assure the safety and overall health of our communities.

On this St. Patrick’s Day, I’ll be donning some green and a shamrock brooch of my mother’s. My hope is that just as we normally come together for this holiday, that we instead come together in the spirit of the Irish - to support each other, to call friends, to email a message to loved ones, and to ensure that social distancing is not social isolation. Indeed, we may be separate, but it is together in spirit how we will get through this challenging time.

And a podcast of this post, read by my daughter, is here:
https://www.podbean.com/media/share/pb-ch5zi-d66fd3…