Plans for ending shelter in place are moving forward. Counties, cities, and states have announced new rules for public engagement with the goal of allowing people greater freedom of movement, small group gathering, and the resumption of services and retail business. The most restrictive plans are detailed by organization and require that people follow particular guidelines for reopening service and business. The variety of approaches are varied and sometimes difficult to follow but some news sources are trying to maintain updated status for all the 50 states.
Here in Colorado our governor has announced a second stage strategy for increasing movement while trying to keep the lid on Covid-19 infection. In his afternoon press conference today (April 27) he repeatedly said, “if we as a state slack off on social distancing measures and other ways to prevent the spread of the virus, additional restrictions could come back. It is up to us to keep moving towards fewer restrictions.” This warning is the governor’s attempt to motivate Coloradan’s even as experts are short on testing data; a shortage of information regarding infection of asymptomatic individuals (infected but not showing symptoms). Today the governor intends to address testing in particular. The worry is that we will move to Stage 3 of the plan before we have valid data.
The details of the new restrictions are not simply recommendations but directives for conducting business safely. Polis made it clear that the state has always maintained health guidelines for business and would continue to through this crisis.
If that’s what they are doing [ignoring state restrictions], then that is unsafe for the residents of Weld County, which has one of the highest per capita rates of COVID-19 in the state, and we will absolutely use every mechanism we have including they will forego their own eligibility for emergency funds. Those businesses could lose their license to operate under the state if they’re state-licensed businesses.
Jared Polis Newsconference – April 27, 2020
The threat of these consequences may not be as easy to apply as they sound. Weld County has already received their emergency funds so that cow has left the barn. But businesses should be careful not to risk their license as well as their reputation and concern for public safety. The consequences may be their end. I predict that businesses will do all they can to advertise and maintain the steps they take to protect customers if they are going to survive. Hilton Hotels have already begun.
While the variety of restrictions and recommendations that are streaming from various jurisdictions may seem confusing and contradictory, they can be boiled down to a few common sense reminders for most of us:
Under age 65. Stay at home unless you have something essential do. This includes food or home maintenance shopping, exercise, work, medical or other essential activity.
Over 65. Stay safe at home. Ask for help in getting essential supplies.
Carry a mask with you if you leave the house.
Maintain 6 foot distance whenever possible.
Put mask on when you cannot maitain 6 foot distance.
These 6 reminders will contribute to your health and the health of those around you. I expect they will become a part of our daily living and common courtesy into the next few years. Settle in, practice and these actions will become second nature.
The march to flatten the curve of Covid-19 infection continues with the inevitable twists and turns of human denial, bargaining, acceptance and adaptation. Sometimes it feels like progress, as though we are getting a handle on the disease and it’s many complications for living. At other times it feels hopeless, as though it will never end. We aren’t accustomed to being inconvenienced here in the US, even for an hour. We are like children in the car on family vacation, whining “Are we there yet!?”. The problem is, there are many stops along the way to a cure (18 months at the earliest). The stops; infection testing, antibody testing, symptom monitoring, social distancing and inoculation are coming slower and with more sacrifice than we would like. When we “get there”, the landscape, how we behave, how we structure public gatherings and how we plan our life will be very different.
Deny Science? at your own peril
The accommodations we make will be a negotiation between our desires/impulses/comfort/ideals and what promotes health for all. The balance is being negotiated in the courts and on the streets of America as I write. While healthy behavior is respected by 60-70% of the population, a minority feels that health and safety should not be the primary goal. In the courts, the right of people to assemble in church is being argued. Do people have the right to assemble for church if the assembly is contrary to public health? Some church leaders are arguing that if people can take a walk in the park, go to the grocery and hardware store, they should have the right to attend church services. They assert that states simply have no right to restrict their right to worship as they choose. They are ignoring the difference between the close assembly of a church and the open air, low density assembly in a park.
At state capitals people are protesting restrictions in movement. The motivation for the protests are diverse. Some decry the loss of jobs, business and income. Some simply don’t think the government has the right to make them isolate. Last week, stay-at-home protests took place in California, Michigan, Kentucky, Minnesota, Virginia, Utah, North Carolina and Ohio. On Sunday five other state including Colorado, Florida, Tennessee, Illinois, California, and Washington capitals saw protests. These protests are heavily represented by Trump supporters who have been emboldened by his calls to “liberate” their states from excessive stay-at-home orders. With news coverage as it is, this allows him to cover all the bases with his schizophrenic message. I digress…
There are no precedents for restricting people’s movement in the law. Does that mean that it shouldn’t be done – for the safety and long term security of our people and the economy.
A sustained, gradually modified, stay-at-home (SAH) effort. Modifying the SAH orders in accordance with infection data will increase the chances that new outbreaks will not occur. We need time to put other precautions (listed) in place. Republican and Democratic governors agree that their states still don’t have adequate supplies to respond comprehensively despite the presidents denials to the contrary. Our health cannot be driven by politics.
Continued social distancing when you leave home. The 6 foot distance does not lend itself to sporting events, concerts, rallys, traditional church services and other large gatherings. The risk is greater when people sing, shout, exchanging fluids in the process.
Tracking symptoms. While comprehensive testing of our population would be the ideal, tracking symptoms on a wide scale is necessary to understand the pattern of outbreaks.
Reliable testing. The fact that people can be infected and infectious without symptoms, means that testing is crucial. We need to double or triple the current level of testing.
Preparation for outbreaks. Our hospitals need to be outfitted with adequate supplies and space to respond quickly and safely to new outbreaks.
These precautions are accepted by public health experts, including the presidents advisors (and periodically by the president himself). And yet these precautions are white-washed by a very vocal albeit minority of opposition. Personally, I get lost trying to understand the motivation of people who deny these difficult but simple facts. I understand that the loss of income is devastating and motivates denial and rebellion. None of us want to stay home but we have to forgo our short term satisfaction for long term gain. What can be done?
Finding our way
The precautions (restrictions if you please) are non-negotiable. The sooner we face and enact them the faster we will recover our health and our economy. The question is not what but how can we negotiate our behavior within the boundaries of the restrictions. There are many examples of people doing just that. I submit that the energy of protests would be better spent figuring out how to work within these restrictions rather than railing against them. Here’s a short list:
Drive through – a truly American tradition. Since the advent of the automobile, people have found innovative ways to use their cars to eat, drink, watch movies, worship, marry, and procreate. In the throws of the pandemic we have added to the list of uses to get tested, check symptoms, “congregate” and pray,order take out food, and simply get out of the house. True, we have been asked to reign in the distance we travel, but this too will pass.
Shopping with distance and masks – While much is made about restricting our right to buy some products, shopping will slowly return as infection decreases. The face of shopping will (literally) change into the foreseeable future. I’m happy to see that all our stores in Colorado are enforcing masks with signs
Church assembly online and parking lots. It is difficult for me to feel sorry for people who complain that their right to worship is being denied. First of all, church is not a place or destination, but a state of heart and mind. The physical contact is important but must be weighed against the damage we may do to our community at large. Even if you disagree with my perspective on the meaning of church, suffice it to say that when we turn the corner on infection, this restriction will be modified. Until then, gather online, in cars, on the phone. Find support, communion, fellowship in any creative way you can. Many people are doing it across denominations, faiths and locals.
Have a PowerPoint party: Each participant makes a presentation about a topic they’re passionate about and then presents it.
Write a pen-and-paper letter. The postal system is still working, and there’s a certain charm to getting a letter in the mail.
Have a cocktail party over video — you won’t have to get a ride home afterward.
Start a book club over video or email.
Livestream on apps like Facebook to read books or tell stories to kids. Your friends who are parents will thank you!
Learn a new skill with friends. Crochet or paint watercolors together.
If you’re musically inclined, hold a virtual jam session.
Right to Liberty is a right to Health
The right to liberty is the foundation of our country as stated in the 14 Amendment:
No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any State deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws.
Acknowledging this, our (temporary and validated) restrictions on movement are at the foundation of life and liberty for without taking these measures, our states would be abdicating their responsibility for insuring both life and liberty. I realize that this is beside the point for people who are simply looking for a fight. That’s another story.
It is impossible to grasp all of the ways in which the pandemic is changing our way of life around the world. While most of the news coverage tracks the spread and death toll and the national/state government response to the virus, there is news on the efforts of local government, schools, business, and individuals to mobilize, survive and thrive in this new world.
Innovations in this time of disruption are inspired by our impulse to meet some basic human needs. We are searching for solutions; for our safety and security, our sense of belonging, agency (power), and expression (attention) to name a few. As with any innovation, some will be a flash in the pan, some will endure, evolve and be adapted into the fabric of our society. They are aimed at some basic need we have.
Safety and security
The need for safety and security is inescapable right now. The threat of infection and death, loss of loved ones, loss of our livelihood, and our entire way of life has us in it’s grip. While we stay at home, we search for new antidotes to our insecurity. This time of isolation has been a source of inspiration and reflection to some while it has led others to act out in protest, fearing the loss of livelihood more than death.
Following are a few examples of innovations inspired by our need for safety:
One development towards safety has been directed at an early warning system that is familiar to us all, the use of thermometers. By checking our temperature before we enter public locations and checking and sharing personal rises in temperature as they happen we may create a more effective safety net by identifying the pattern of infection.
Kinsa Health debuted it’s internet-connected thermometers eight years ago to track flu. The data the company is uploading for free to government and research scientists is helping pinpoint both where the next outbreak might occur and which communities are flattening the curve. They’re also proving that social distancing is working. – Here and Now – April 9, 2020
How many tests do we need to feel safe? Labs around the world and in the US are exploring new methods for testing people suspected of infection. Some of these methods will evolve into new standards while some will prove inaccurate or impractical. Hospitals have adapted new ways of administering tests in an effort to reduce exposure by creating drive through testing. At the same time scientists are trying to lower barriers to testing. While supplies and personnel continue to be in too short supply, lacking a national effort at distribution, we must increase testing in order to feel safe to interact.
An average of 145,000 tests a day were carried out over the past week nationwide, or about a million a week, according to the COVID Tracking Project. Experts disagree about how many tests would be required to get a handle on the outbreak, but even the most conservative recommendations from former officials like Scott Gottlieb — head of the Food and Drug Administration until last year — call for at least doubling the current level of testing now and tripling it by the fall.
While we continue to struggle with the necessary components of tests in the critical short run, researchers are moving forward with innovations that address the long term. Home tests are one of the approaches. While home tests run the risk of false positives due to contamination, there is an effort to improve them.
Saliva tests. A “Rutgers University scientist who oversaw the development of a saliva test to detect coronavirus said he believes this new way to collect patient samples could serve as a bridge to widespread national testing — modeled off the kits used by familiar commercial genealogical brands like Ancestry.com and 23 and Me.” – ABC News – April 16, 2020
Antibody testing. These tests determine if a person has had the virus and carries antibodies that protect them. A team in the UK is working on a home antibody test kit. A team in California has an antibody test that is administered in the lab. They hope to “expand manufacturing of its new coronavirus antibody test for use by the public within two months.” The same story describes other antibody tests under development…
Only one [antibody] test, produced by the Research Triangle Park, N.C., company Cellex, is already approved and being rolled out for use in select groups. Two others are awaiting FDA approval. One is from Aytu Biosciences/Orient Gene Biotech; the other is ScanWell Health/INNOVITA.
Six other tests have been approved in the U.S., but they are only for research or surveillance purposes. Other tests are still in development.
Five antibody tests have been approved for use in China. In addition, one is approved in Singapore and one in Korea.
The success of re-opening our economy will depend on our ongoing success at containment. One essential component will be the ability to track person-person contact when an infected person is identified. Tracing these associations and contacting and supporting people with information and resources will be essential to providing a safety net for movement.
Last night I searched for a job as a Tracer and found this information in the job description:
Contact Tracers will use a web-based client resource management (CRM) platform to reach out to contacts of patients diagnosed with COVID-19 with the goal of documenting a symptom check; referring contacts for testing according to established protocols; and providing them w/ quarantine guidelines
Human tracing can be augmented by technology that helps an infected person remember and report contacts they have had. Here are a couple different approaches.
Tim Brookins, a Microsoft engineer in Fargo, tweaked the Bison Tracker to build Care-19, an anonymous location tracker. It had more than 10,000 downloads in its first 36 hours.
The app can serve as a record for people to remind them where they’ve been if they test positive, and to alert them to possible contacts with infected people. They can choose to share information with state health workers.
Google and Apple have announced a joint effort to enable the use of Bluetooth technology to help governments and health agencies reduce the spread of the virus, with user privacy and security central to the design.
The system uses on-board radios on your device to transmit an anonymous ID over short ranges — using Bluetooth beaconing. Servers relay your last 14 days of rotating IDs to other devices, which search for a match. A match is determined based on a threshold of time spent and distance maintained between two devices.
If a match is found with another user that has told the system that they have tested positive, you are notified and can take steps to be tested and to self-quarantine.
As I continue to read about innovations, I intend to share them in the context of how they derive from and serve our most basic needs. While our instinct to meet these needs is active even in good times, the pandemic has us on high alert. We have to find new ways to meet familiar needs. Behavior is goal oriented. We act in order to fulfill our needs; sometimes for social good, sometimes for our selfish satisfaction. Sometimes pro-actively and sometimes reactively.
Next to safety and security, the need for belonging and affiliation is another need on high alert. In keeping with the directive of 6 foot social distance and safe at home, we are inclined to find ways to socialize and connect. In future posts I will describe some of the new ways that we have found to bridge this gap.
Last weekend health experts and politicians warned that the week of April 6th would be the deadliest week of the pandemic. The week did meet those expectations and put the US close to the lead for deaths by country. It is a surprise that, on the heels of that week, one of the main headlines is “how quickly can we open for business?” While it is a valid question (who isn’t concerned for their long term economic future) it is still seems premature. Such is the still intangible nature of the spread of Covid-19 and the political and economic angles that are complicating rational and regional interventions.
As we watch and hope for a reduction of infection and death, there are a few variables that seem key:
Supplies of PPE and ventilators in hard his areas.
Supplies of tests and the materials required to support tests.
Health of health care workers.
Health of “essential workers” still engaged in business and public service.
Access to tests by health care works and “essential workers”.
Good data: accurate accounts of infection by locale and group (race, age, living conditions,
Without progress on these variables, we can’t begin economic recovery in a sustainable way. We will be cycling in and out of economic insecurity.
Testing – How? Who?
As we embark on the journey to reopen the economy, there are a few basic ingredients that most agree need to be addressed. The most notable is testing, for without testing, the spread vs elimination of the viral infection is just speculation. Granted we have indicators (symptoms, hospitalizations, deaths) of the spread but these numbers don’t help us with a pro-active plan. They are but indications of our failure.
As we contemplate the re-opening of business and social gatherings, testing will be one of the most important and often discussed issues. The scientific community has moved at miraculous speed to develop tests for infection and anti-bodies. With tests in hand, one would think that administering it would be fairly straightforward, but history and the current political climate shows us otherwise.
The first hurdle in the quest for widespread testing is the supply and distribution. There is no indication that the federal government will play a significant role in coordinating the supply of tests or the components that are required to do testing. so states will be left to compete with each other and will set their own protocols for administration. On March 6th Trump said:
“Anybody that needs a test, gets a test. They have the tests. And the tests are beautiful.” He said the same day: “Anybody that wants a test can get a test.”
Clearly Trump’s declaration wasn’t true in March and isn’t true today. While there are indications that (as of April 12th) there is an uptick in the number of tests, the shortage has created a train wreck of problems in the management of the disease. First of all, doctors and nurses have to treat patients as if they have covid-19 until they determine their diagnosis. This leads to an overuse of precious PPE and an overuse of precious hospital space. Without tests, hospitals cannot safely discharge patients. Without adequate tests for doctors and nurses, they are excluded from work creating an even larger shortage of staff.
Testing for an open economy – When?
This week’s news cycle will be full of speculation regarding when our economy will reopen for business. We can expect tension between those assuring us that relief is right around the corner and people with more sober assessments. The decision should be linked to the rate of infection and the availability tests. Based on the precautions taken thus far, you can expect that the approach will vary from state to state, county to county and city to city. The Trump administration may continue to act a cheerleader rather than make a commitment. Or in the worst case, they will disparage the recommendations of local governments.
Fortunately there true models of testing procedure, social engagement and business management in other countries who are further down this path. New Zealand, Iceland and South Korea are 3 examples. Despite the tendency for the president to discount the success of others, our state and municipal leaders will find these models useful as they chart their own path.
Jared Polis of Colorado has extended sheltering recommendations to April 26th. This date has been tagged as a point of reassessment more than a solid deadline. Pragmatically, he has placed the onus our success on the behavior of Coloradans.
“If there is any way to safely end it sooner, then we will,” Polis said. “And likewise if Coloradans aren’t staying at home and the numbers of the dead and dying continue to increase, then it could go longer.”
Who will be tested? Will tests be administered strategically? Will guidelines be provided so that we make best use of a limited resource? These questions underline where the rubber (test) meets the road (people).
On the question of who will be tested there are some obvious gaps already. To date, essential workers and black americans are not being tested. These workers are exposed and exposing themselves to large numbers of people and they are dis proportionally minorities. Even if there is no overt bias against testing blacks and hispanics, the placement of testing sites mirrors the disparity in access to medical care, with a lack of availability in poor (typically black) neighborhoods. There are many reports of this disparity emerging:
In the days since I started writing this post, my prediction has been confirmed (though it doesn’t require omniscience to anticipate the broad strokes of Donald Trump)…
As states begin to cooperate and take the lead on strategies to reopen commerce and travel, the Trump administration has done an about face on the question of who is leading this response. The states’ initiative is assuring given the commitment to use data rather than “gut feelings” to bring the idling economy back into gear. The work has only begun of course but the reins are in the right hands with the governors. Even as the governors begin the work, Trump waves his hands and while reading names of his new “Opening the Country Council”. The list of almost 200 includes many who have been criticized by the president in the past. He will be “calling them” in the days to come.
When is the last time that Americans were asked to stay home and limit their activity? Unless you have recently had surgery or some other physical problem, the answer is probably never. When is the last time an American or a modern citizen of any country chose to slow down and limit activity? Seldom if ever.
This prolonged stay at home is challenging many skills. One of the most needed skills is patience.
Patience might be associated with passive resignation but in fact patience requires determination and endurance. Patience requires us to take the long view, to keep our eyes on long term value over short term satisfaction. What better way to describe our current state of living.
The long way home
It’s well and good to say that we need patience. It begs the question, “For what purpose?”. Patience without purpose would be an ignorant waste of time and effort. The purpose for our patience is clear; in order to eventually get close to people, to enjoy the social world we once knew, we need to stay apart. We need to do the opposite of what we want and listen to the reason of science; wash our hands , wear face protection in public and keep distance from one another. We need to stay home to return to the home we knew.
The desire to return to normal (home) has been enough to inspire patience in most people. It has inspired us to take coordinated action like we have never known. Not just in one town, state or country but worldwide. We are (mostly) acting in concert with one another, with the common goal of return.
The path we have chosen or agreed to walk has unintended benefits and challenges. Each day brings these to light, both on a national and a personal scale. Even in isolation we have found ways to be together with hope through Passover and Easter celebrations. We have continued to connect teachers with students and family with the sick and dying. We are learning to cook again. Parents have become teachers and are getting to know their children in ways they never dreamed.
As weeks are turning into months, the novelty of our isolation is becoming a long march home. As this continues, our patience is being tested. Can we endure for the long term? Will we build a new economy with liberty and justice for all?
Managing hope, fear and distraction.
Distraction is one of our favorite pastimes, in good times and bad. Distraction is used by mothers and fathers to manage infants and toddlers around the world. What better way to cajole a fussy baby or remove a prized possession from a two year old than sleight of hand. “Would you like to play with this?”
Modern adults are both victims and masters of distraction. And when the going gets tough, distraction provides the salve. Remember the last time you flew in an airplane? The fear of flying (is anyone immune?), the long wait, the cramped space in close proximity to strangers; all inspire us to get creative with distraction. With the discomfort we label as boredom, we come prepared or improvise various forms of distraction to fit the length of the en capsuled ordeal.
Distraction is the balm that soothes whatever ails us. It holds the promise of taking us away from where we are to the land of promise. Though the promise is seldom met, we feel we have made a skillful and satisfying move away from our discomfort and dis-ease.
Is there an alternative to distraction? What would it feel like if we reject distraction and just feel the feeling whether it is discomfort, fear or hope. What are the advantages to meeting discomfort head on?
Discomfort – my friend
This morning I woke at 4:30am. As I assessed my level of wakefulness while my thoughts began to search about and consider my options. I heard my dog Beau at the bottom of the stairs (always ready for me to greet and feed him). I considered the upcoming day and potential tasks and then considered my options for the moment; go back to sleep, read a book, meditate, write. As I lay with my stream of thought, I finally took some time to simply feel the energy of my body in it’s calm repose. In this relaxed mood, I took time to listen to my breath, scan my muscles and simply BE in the quiet moment.
This moment is all we have and each moment holds a choice. I am familiar with 12 hour work days, and 7 day work weeks. I chose to drive fast through the day’s agenda and drive my staff through it with me (though I had to beg for the overtime). I understand what it’s like to ignore my feelings and my family, eyes scanning the horizon for the next item. I have been hospitalized for ailments that were probably related to the push of work. Despite it all, I was sure that I was doing good and getting somewhere. Fortunately, I took time to meditate every morning and acknowledged the power of silence and watching my thoughts. It saved my life and made me much easier to live with.
Yesterday, Joni and I committed ourselves to a day of silent retreat and meditation. Given our required isolation, it seemed like an opportune time to make it complete. In the past we have done group and solitary retreats to improve our meditation practice and spiritual well-being. Self imposed isolation and silence can be a bit challenging at first but we have found it satisfying and enriching in the long run. Through repeated experience, we have made friends with silence and solitude.
The point of retreat is to draw a boundary and limit activity to the contemplation of the mind and body. Retreat allows for an increase the amount of time in meditation and contemplation; reading, listen, and contemplating books that connect us with our heart and mind. Except for eating and drinking coffee, we restrict our activities and indulgences like alcohol, watching movies, talking, recreational reading, news and surfing the internet. Essentially we cut out our usual preoccupation with business and general busy-ness.
Retreat isn’t something people are accustomed to and it isn’t magical. Just like any other exercise, the benefits are subtle but evident over time. Solitary retreat leaves us without the filters of distraction, alone with only our thoughts and emotions – whatever arises.
“Hello feelings. We have to talk”
This heading is a favorite of my meditation teacher, Tsoknyi Rinpoche. He uses it to remind us to say hello to whatever is troubling us, whatever is buzzing in the background of our mind. In his teaching, he points out what becomes obvious with practice, that much of our behavior is driven by forces at the periphery of our awareness. He suggests that we bring these forces to light, make friends with them, shake hands with them. Give them a job.
This moment in history is unprecedented. With the pressure to “return to normal”, it may soon change shape. Obviously there are important reasons to get back to work and revive this economy. At the same time, some of the instincts to get busy are unnecessary and destructive to loving one another and building a healthy community. Who would have ever thought that being apart would bring people together in this way. Given this, it isn’t a stretch to think that coming together again could tear us apart. The difference will be in the details of the method.
While we are always at a turning point in life, this is a moment of greater clarity. As dark as it is, the pandemic has opened a door of possibilities and choice. Many of us will take lessons from this time, allowing us to enrich our daily life. We will either nurture the lessons or rush to the next moment, only to reminisce about the good old days. There is hope that we can be the next, “Greatest Generation”, improved by these days of sacrifice.
On the other hand, there are political and social forces at work that beg us to feed the beast of the big economy; to buy and borrow or way back to “normal”. These are the same corporate forces that leveraged their way to dominance and will be hedging (literally) for their survival on the backs of consumers and the Gross Domestic Product. The alternative is that we recognize this folly and value living within our means, just as we might recognize the turbulent nature of our thoughts. We can set aside our expensive distractions for the value of family and friends. It is time to acknowledge the moment, whether it is uncomfortable or not. There are dreams to strive for. Many of them are right here at home. We can take the lessons of our retreat (stay at home) to bring us back to our center.