Category Archives: 2019-nCoV

Post-COVID Health Care

By tmess2 | Published December 26, 2022

We are now almost three years into dealing with COVID. Between changes to the virus and the development of vaccines, COVID has become one of those serious diseases that we just have to deal with rather than an all consuming emergency. But the response to COVID has created a political firestorm that will take years for our system to adjust.

Prior to COVID, those outside of county health departments (and their attorneys) rarely paid much attention to the laws in place to deal with contagious diseases. One of the major problems in our government (at all levels) is that (especially in those states with part time legislatures) is that nobody pays much attention to laws on the books until flaws in those laws create a serious problem. As a result, in many areas of the country, the laws still reflect a very traditional approach to pandemics and potential pandemics. For the most part, those laws allowed quarantine of sick patients and local restrictions designed to prevent the spread of disease. At the national level, quarantines of incoming travelers could also be imposed to assure that nobody was bringing in diseases.  (With all modes of travel being, compared to modern times, relatively slow, the potential for an extended quarantine was simply assumed in the planning for a business trip (and social travel of long distances was simply not common). 

These laws made sense in the nineteenth century. A significant part of the population lived in rural areas where it was easy for a family that had smallpox or similar life-threatening disease to isolate for a period of time.   And for people who lived in town, it was possible to get needed supplies to the quarantined homes by simply leaving them outside the home to be picked up after the delivery person left.  More significantly, travel was very limited and the number of jobs that were “essential” were relatively few.  While there were exceptions to the rule, goods that had to be transported from one part of the country to another tended to be more in the nature of luxury goods rather than necessities.  In short, it was possible to have a degree of success in stopping the spread of diseases by imposing strict quarantine rules without causing much of an impact on the economy.   And because of the limited contact between different parts of the country, the area subject to quarantine at any one time would be very limited as well.

In one of those coincidences, the science of fighting disease progressed somewhat faster than the science of transportation.  By the time that the car and the jet made it possible to have social travel between countries and for business people to hit six major cities in three countries within the same week, vaccines made most of the previously common deadly communicable diseases relatively rare.  In my personal experience, as an attorney to a county government, I can only remember quarantine coming up a handful of times, and some of those discussions were merely periodic reviews of policies and planning for worst case scenarios.  Because of the progression of medical science, the laws on quarantine became an “in case of emergency” backstop that were almost never used. 

Meanwhile, the changes to the global economy caused by the improvements in transportation have increased our dependency on products made by other people.  And urban/suburban vs. rural population has essentially flipped from urban areas representing around 20% of the national population prior to the Civil War to the rural population now fast approaching only 20% of the total population.  Continue Reading...

Also posted in COVID-19, Healthcare | Comments Off on Post-COVID Health Care

Notes from your Doctor: Let’s Talk Vaccines

By DocJess | Published September 21, 2020

There are currently 27 vaccines in Phase 1 trials, 15 in Phase 2, and 9 in Phase 3. Both China and Russia have approved vaccines, but, um, there are some problems as none were ready for prime time yet. In fact, one of the Chinese vaccines was approved for single dose, and now they’re going to give everyone who got a first dose a second one, because one dose alone didn’t confer protection.  You can see details on all of the vaccines here.

Source: New York Times, reprinted with permission.

The chart at the left presents information on the different trial phases. Sometimes Phases 1 and 2 are combined to speed up the process. And after Phase 3, there is an approval phase, although in some cases, there can be Emergency Use Limited Approvals.

These Phases are the same for the development of treatments, as well as vaccines, and sometimes for treatments, Emergency Use is a good idea. For example, let’s say that a drug for a Stage 4 cancer shows great promise. Because these patients are close to death, if a drug showed that it could buy patients an additional six months, when they only have weeks to live, Emergency/Compassionate Use may be warranted. There is limited concern about safety over efficacy if people are terminal.

With vaccines, you want to balance both safety and efficacy. You want to be sure that a vaccine offers protection and does not cause serious side effects. Can you do that in six months from molecule determination to the end of a Phase 3 study? Not hardly. Let’s be honest: we all want a vaccine. Or more accurately, all of us who see Covid-19 as a threat and not a hoax, can spell the word “science” correctly, and have ever read a newspaper, want a vaccine.

To understand what is being tested, and how those tests will be carried out, the drug companies write protocols. This is the one from Moderna. Pfizer has also published, and AstraZeneca says that they will be publishing soon. If you read it, you’ll see who they are testing their vaccine on, what they’re looking for, and what markers they will use to determine efficacy, safety and secondary considerations.

I receive a lot of questions about vaccines, so here goes….

Q: Will there be a vaccine prior to Election Day?
A: A real one? In the US? With data backing up safety and efficacy? NO.

Q: Will you, personally, take one of the vaccines?
A: Qualified yes. Before I take a vaccine, I will read all of the documentation on it that’s available. If it provides a minimum of 70% efficacy, and has shown no serious side effects for my cohort, then yes, I’ll probably take it.

Q: What does “70% efficacy” mean?
A: An efficacy rate relates to the proportionate reduction in disease among the vaccinated group. So, the measles vaccine (two doses) has an efficacy rate of 97%, meaning that almost everyone who gets the vaccine will avoid getting measles. The annual flu vaccine has an efficacy range of 50 – 70% meaning that at least half of the people who get it will either not get the disease, or, as is the case with the flu vaccine, get a much lessened set of signs and symptoms. The FDA is looking for an efficacy rate for the Covid vaccine in the 50% range, and the companies are shooting for 70%, although if you read the protocols, they are including mild illness in the 70%, which is troublesome. 

Q: If you personally take the vaccine, will you give up your mask, social distancing and limitations?
A: ABSOLUTELY NOT. I’m one of those people who believe that Covid will become endemic rather than pandemic over time. Meaning that it will become something that never goes away, like the common cold, seasonal flu or noravirus. I believe that the treatments being developed will eventually mean that Covid becomes much less deadly, and can be treated earlier in the course of the disease, but that it will stay with us. Further, until there are enough people who have taken the vaccine, and we have effective testing and tracing in place, it’s still something to avoid, which means masks, social distancing and limitations.

As an aside, I keep up with the masks and related PPE that are being developed. Many are now on Indiegogo and Kickstarter, and some will work and some won’t. In addition, established PPE companies are also developing lines. The run the gamut from “that might well work” to completely insane. BUT I believe that over the next year, these devices will be available: they will be reusable, washable, have filters that can be replaced, and some will have dedicated air supply systems. While expensive, they will be game-changers. Currently “your mask protects me, and my mask protects you” but this new generation will provide 99.7% protection to the wearer.

Q: Do you have a favorite amoung the vaccine candidates?
A: Not yet. There’s not enough information on the efficacy and safety differences between the mRNA, whole inactivated virus and DNA candidates. In addition, some candidates utilize adjuvants, which are additives making vaccines more potent, and those are still in Phase 1. Those may well be far more effective.

Q: When do you think vaccines will really be available?
A: At this time, I’m looking at next summer at the earliest for the current Phase 3 candidates. In addition to the safety and efficacy considerations, there are concerns about distribution. The Phase 3 candidates require being kept at -70oC for both transport and distribution. While certain vaccines (e.g. chicken pox) require being frozen, that’s at a higher freezing temperature (up to -15oC) and can be held in a fridge for up to 72 hours before distribution. In addition, the pharma companies producing the chicken pox vaccine provide freezers to the pediatricians and others who administer the vaccine.

I don’t know where the money for these specialized freezers will come from. Think about it: you have a freezer in your house. How cold can it go? The Administration has said that the shots will be free to all – they will need to figure out how to pay for the freezers, the transport, storage, ancillary vaccine accoutrements (e.g. alcohol swabs, band-aids, etc.) It would be unreasonable to expect already strapped local health departments, hospitals, and other distribution points to be able to cover those costs. I don’t see the funding coming out of the current Congress and approved by the Administration.

Next, the current vaccine candidates all require two shots per person. Will people be able to get those shots at the same location? If not, who will update the databases to know who got which shot when and where? Who will be in charge of the data: will it be at the Federal level or the State level? How will coordination with local distributors be undertaken?

There are close to 330 million Americans, meaning that 700 million doses of vaccine are necessary. How quickly can they be manufactured, stored and distributed? And when we talk manufacturing, they need to not only make the vaccine itself, but the vials, needles, etc. so there are supply chain considerations.

Thus, when I look at “vaccine” I think in terms of the logistics: not just of having an appropriate candidate but being able to get it to people, and I don’t see that happening anytime soon.

Q: You said there are two shots per person. Is that it?
A: Unlikely. There’s a better chance that this will be a vaccine, like a flu vaccine, that needs to be taken annually, or at least on some schedule. While safety and efficacy testing is going on, there is no possible way to know how long protection is afforded until years have passed.

Now, we would know if protection was afforded only for a few months, and we would know that quickly. Pretend that there is a vaccine that is safe and highly effective. But six months after the second dose was given to the Phase 3 volunteers many of them suddenly came down with Covid. We would then know that it only lasted more like five months. But will it last a year? Two years? Five? We can only know that over a period of years. Certainly blood tests will be available to show whether or not individuals have neutralizing antibodies and/or T-cell protection over time, and that’s informative, but not a guarantee of long-term protection. It’s only of the problems with rushing through a vaccine.

Q: If I take a vaccine, and a better one comes out later, can I take that one too?
A: Most likely yes. Zostavax was the original shingles vaccine. It provided about 50% efficacy for those aged 50 – 70, and less after age 70. But it was all there was, so many people took it. When Shingrex came out two years ago, everyone over age 50 was advised to get it, as it had efficacy of 97%. There was no downside to the people who had already taken Zostavax.

I expect that people will take multiple Covid vaccines over time, and it shouldn’t be a problem to segue to a different version with higher efficacy.

_______________________________________________

Please let me know if I missed a question you’d like answered.

 

Also posted in Coronavirus, COVID-19, Vaccines | Comments Off on Notes from your Doctor: Let’s Talk Vaccines

Holding a Convention in the Times of Social Distancing

By tmess2 | Published August 15, 2020

We are two days away from the start of the 2020 Democratic Convention.  We already know that some things will be different from the norm.  We will not have a full arena with delegates hearing presentations on committee reports during non-prime time hours.  To the extent that these matters have to be done, they are being done remotely.

But the real issue is how to handle the prime time speeches.  A speech delivered in front of a large arena will typically have natural applause lines and some “call and response” with the audience.  Signs are passed out in advance to the audience to create the perfect message during any crowd shots that the networks might choose to cut to.  None of that will happen this time.  But the natural temptation is to still have the same type of speeches.  Just presented live from a room with a small, socially-distanced audience.  But such speeches will not have the same power that they did when presented to a crowded, loud, vocal arena audience.

The change in format creates the real possibility to try something different.  Perhaps, rather than a stump speech format delivered at a podium, speakers could do a homey sit-down chat.  Or, you could do a pre-taped speech with cuts from the speaker to visuals that emphasize the speaker’s point (e.g., while discussing the ineptitude of the Trump Administration, showing photographs of Puerto Rico after Hurricane Maria).   Or you could have your “name speaker” introduce some testimonials from real people followed by a short summary from the “name speaker” of why electing Joe Biden will change these people’s lies for the better.  In short, the type of presentation that would never work in a crowded arena, could work when the convention is occurring virtually.

In modern politics, the national convention has changed from a business meeting in which everything has to be decided into a tool to present the party and the candidate in a positive light.  The traditional format of the convention, however, has placed limits on that effort.  This year, however, has upended the traditional format.  I am interested to see if either party takes advantage of the change in format to try something “out of the box” to better connect with voters.  Or will they try to pretend that nothing has changed.  It may not make a large difference in November, but realizing that the audience is not a monolith and different persuadable voters are persuaded by different techniques might make the small difference that turns a 100,000 vote loss into a 100,000 vote victory in a key state.

Also posted in 2020 Convention | Tagged , | Comments Off on Holding a Convention in the Times of Social Distancing

What Everyone is Getting Wrong about COVID

By DocJess | Published June 25, 2020

The frames for the discussion on how the US deals with COVID fall into two camps:

  • Save the economy vs lockdown the country
  • Wear a mask vs don’t wear a mask

So long as that’s what everyone concentrates on, the disease will not be “managed” until there is a set of vaccines (different vaccines will be necessary for different cohorts) and effective treatment protocols. And that’s not going to be near-term. Until that happens, cases will continue to rise, and will keep spreading, and it will happen stealthily, that is, we won’t know it’s a problem until after it is already a disaster. UNLESS we re-frame the discussion and adopt a program that will work to stem the spread. Honest, other countries have done it, and we need to do it here.

This is the United States, where politics trumps reality far too often. We have no national leadership, and we won’t until such time as the Orange Menace has been removed to the cell he so richly deserves and takes his minions with him. Therefore, solutions need to be at the state and local level, and there actually ARE ways to do this, get the case counts down, and simultaneously keep as much of the economy operational as possible.

What everyone forgets is the information on pandemic control “below the fold”. That means test as many people as possible, isolate the positives, and seriously contact trace. And yes, New York is the exact model that every state and locale should follow. Because it works. That means not only testing, tracing and isolating, but providing daily, transparent data at a micro level.

Tests are available, and tests are free. If you have insurance, they’ll take your card and bill your insurer, but the cost to you should be either zero or minimal. The more people who are tested, the better the chances of finding out where coronavirus is hiding. And it is hiding. Until we find it, it will keep spreading. The ONLY job the virus has is to infect every single person. That’s what it will do. If we can’t find it, we can’t get the R-Naught down below 0.8, which is where we need to be. For example, here in PA, the lowest transmission rate we’ve had was .82 in April, and our rate has been rising statewide since May 7th. It won’t be a disaster for another couple weeks, but it will keep rising because we are neither testing enough nor tracing nor isolating. You can see your state data here. And remember, there is a lag between date of infection, hospitalization, ICU and death. And that doesn’t even include the number of people who are permanently damaged or disabled from having a mild to moderate case of the disease. Not to mention the inflammatory syndrome in kids.

Testing doesn’t matter if there is no way to isolate people who are positive, whether they are symptomatic or asymptomatic. Municipalities and regions need hotels and other options for people who cannot isolate at home. If you are positive, and you go home to a place shared with other people, there is a high probability they too will become infected.

Testing is less effective if there is no contact tracing. If someone is positive, that person was infected by another person, and likely passed it on to one or more additional people. The chances of someone getting infected if he/she lives alone, and has 100% of everything delivered and has had no human contact since the original lockdown is zero. Contact tracing, testing contacts and then isolating the infected is what brought infection rates down in every single country that has successfully beaten back the scourge.

So what can you do? I hear you: “But I wear a mask, never touch my face, socially distance and wash my hands until the skin is coming off.” Should you be doing those things? ABSOLUTELY. But unless everyone does it, it’s not enough. Therefore, do this:

  1. Go get tested.
  2. Convince everyone you know to get tested.
  3. Call/write your local and state reps to allocate funding for contact tracing and isolation facilities. The system in most places (except NY) is not really viable. Here’s an example.
  4. Contact your city, county and state Health Department to get them to collect and disseminate data about daily new cases at the zip code level, percent positives, number of people tested, hospitalizations, ICU bed utilization, and deaths. That data needs to be tracked and disseminated daily. NOT total numbers to date, but accurate, daily numbers. The earlier trends can be spotted, the earlier they can be handled.

If you are unemployed, take a course (many are free) and get certified to be a contact tracer. Here’s one. Then apply for a job doing so. One of the reasons for a lack of contact tracing is a lack of people to do it. In addition, in many places, they are using unpaid volunteers – if you’ve got the time, find a local program to help in the effort.

In addition, if you can stay home. STAY HOME. Certainly, this isn’t an option for everyone, but if there is any possible way that you can minimize your interaction with other humans outside your household, do so.

The American economy is dependent on consumers buying goods and services: if you can, find a way to contribute to the economy, especially the local economy. But do it in a way that minimizes your interactions with other people. It’s a fallacy to believe that “opening” the economy while the virus is rampant will “save” the economy because if people don’t have confidence, they won’t spend money even if places are open. And as we’ve seen, often places re-open, and then close a day or two later because a worker or a customer tests positive, which brings us back to why testing is so critical.

To support businesses, consider curbside pickup in lieu of going inside – this provides the same amount of income to the vendor, and minimizes human contact. If you want to support your “touch” provider (e.g. hairdresser, manicurist, massage therapist, etc.) consider paying what you’d pay and then not getting the service. Certainly, not everyone can afford this, but if you can, this is the time to spread your money around. If you want to avail yourself of restaurant food and drink – stick to curbside instead of “dining in”.  It costs the restaurants less to serve you, they do less work, you’re still supporting them, and above all – please tip your server/delivery person well — they depend on tips.

As the numbers go up, most people are frightened, and should be. In the vacuum where leadership should be, it’s incumbent on each of us to do what we can to stay safe, and keep others safe. So get tested, and pester your officials to do all that’s possible on a local level. What EACH AND EVERY one of us does affects the case count. We can each be as diligent as the New Yorkers who faced the earliest assault were, or at the other end of the spectrum, we can be the covidiots who protested for the right to get their hair cut, refused to follow protocol, and are now part of the case count.

The choice belongs to each of us – be diligent, stay safe, and pressure all your elected officials to set up programs to test, trace and isolate.

Also posted in Coronavirus, Coronavirus Tips, COVID-19 | Comments Off on What Everyone is Getting Wrong about COVID

Notes from your Doctor: Surviving the Next Phase of Coronavirus

By DocJess | Published June 13, 2020

As you know, case counts are rising across the country, at last count, in 23 states, with 15 states showing their highest case counts since before they shut down. In some places, hospitals are days away from being overwhelmed. And yet, no one is planning on new lockdowns, most are planning further re-openings. To be fair, Oregon and Utah are pausing moving forward.

There is no national policy on what to do, nor how to handle things, so states are left on their own. In some states, governors say things like “we expected that there would be more cases” as hospitals implement emergency plans. That gem is courtesy of Doug Ducey of Arizona. In addition, if you are one of those who go out, you’ve indubitably seen fewer people wearing masks and observing social distancing.

WHAT IS A PERSON TO DO???

There are three major groups of people at this juncture. First, the people who believe that it’s all over, and it’s safe to go out, and if people end up sick or dead, so be it. If you’re one of those people, stop reading now, this article is not for you. At the other end of the spectrum, there are those who, due to physical condition and/or financial ability, are committed to staying in until there’s a vaccine. But most people either have to go out because they need to work, or are at the point where they need to find a way to negotiate living in a world where they just cannot stay cooped up in their houses for the next several years.

For those who are working outside your home, keep doing what you’re doing. Wear your mask AT ALL TIMES, observe the best amount of social distancing you can, wash those hands for a minimum of 20 seconds every chance you get, and use hand sanitizer if you can’t get to a sink. Your hands cannot be too clean. And THANK  YOU!

For those of you who are business owners desperate to get back to your shops, practices, offices, job sites, farms and plants, you have required rules and guidance from your individual states.

But what about those people who can work from home, or are retired, but want to get out a bit?

First, assess the risks. You know your personal risk: it’s either “average” or “high”. Then, know your community risk. You can access some amount of data about your area, and from that data, assess how prevalent coronavirus is in your immediate area.

There are a number of ways to do this, but the best way is to READ several legitimate sources. There is a lack of both transparency and consistency between sources, so it’s best to have a system that will give you the best possible information. If you live in New York, read the NY Forward dashboards at the bottom of the main screen. This is the best, most transparent site around. And it’s a shame that more states (Or Hey! The Whole Country) doesn’t adopt the same system.

If you don’t live in NY, you’ll need multiple sources. Below is my system, in the order that I check it every day.

  1. Worldometer – this site has higher numbers than everyone else. Their data sources are as local as they can get. Throughout the day, the chart of states will update as they collect the data from the individual states. Some states link to their data.
  2. CNN – while their data sources vary, scrolling down to look at the 7-day averages by state is a quick and easy way to view statewide trends.
  3. Effective Transmission Rate – This site will show you the transmission rate for a state. It’s a similar metric to the infection rate shown in the site below. It’s instructive because you can see quickly who’s red and green, and scroll down to see your state over time. However, it is only statewide, and as we know, local is everything, which brings us to….
  4. Covid Act Now – This site is well sourced, but dependent on state data, which varies by state. Some states are still conflating PCR and antibody test rates. But they provide several stats that are hard to find elsewhere, and you can see the data by county, which will help you assess your local risk.

The Covid Act Now site shows data by both state and county. While often the hospital rate is inaccurate since in some places hospitals are more regional than county, the infection rate and positive test rate are what you want to look at.

An infection rate UNDER 1 means that coronavirus is not spreading as each infected person is infecting LESS than one person. Above 1 means that each infected person is infecting MORE than one person. Once you hit 1.2, the rate of infection is increasing, and it’s BAD.

You also want to look at the positive test rate. The lower the number, the better. This tells you what percentage of people who are tested are positive. If the number is 50%, it means that half the people tested are positive, and likely they are only testing symptomatic people — when there was a dearth of tests, and the only people tested were, say, in hospitals, that number in some areas approached 80% positive. The goal is a positive test rate of 2% or under — at that rate ENOUGH people are being tested. Continue Reading...

Also posted in Coronavirus, Coronavirus Tips, COVID-19, Notes from Your Doctor | Comments Off on Notes from your Doctor: Surviving the Next Phase of Coronavirus

Notes from Your Doctor: Can I Touch Surfaces?

By DocJess | Published May 22, 2020

The news reported last night that it was safe to touch surfaces. Um, not exactly correct.

The CDC website says:

It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes. This is not thought to be the main way the virus spreads, but we are still learning more about this virus. (emphasis mine.)

Studies have shown coronavirus (and other viruses, bacteria and fungi) being active for hours on some surfaces, and up to a week on others. And Scott Gottlieb, MD former Commissioner of the FDA, is as unimpressed as I am.

The actual nuanced point that the CDC was trying to make (and understanding that they are being muzzled by the Administration) was that you are MORE likely to contract COVID-19 from another human than you are from a surface. And that’s true. What is NOT true is that you are completely safe touching various surfaces.

So what makes sense? Let’s look at two examples at opposite ends of the spectrum: a metal door handle at a public place, and the handle of a paper shopping bag. There is something called “viral load” which relates to how much virus is in how much blood, the higher the load, the more severe the condition. “Viral load” does not apply outside the body, but a corollary would be: how much of a risk is there predicated on how contaminated something might be?

If you are walking into a grocery store and need to pull the door handle, you’d consider how many people touched it since the last time it was disinfected. Of those people, how many might have asymptomatic coronavirus and touched their faces before touching the door? Touching that door is far less risky than being three feet away from an asymptomatic carrier who is not wearing a mask and who sneezes in your direction, but if you touch that door, you should still sanitize your hands asap, and definitely before touching your face, and you should wash your hands with soap and water as soon as you get home.

At the other end of the spectrum, let’s say that a friend brings you a present (or your medication, or a piece of fruit) in a paper shopping bag. He puts it down and moves back, and you pick it up. The chances of transference from that handle are far lower for the following reasons: first, it was touched by your friend, or ONE person, not many. Second, your friend would have to be an asymptomatic carrier, and have touched his face before putting the bag down and would have needed to touch just the spot that you did. Finally, paper (and cardboard) are far less likely to harbor pathogens than metal, and for a much shorter time.

So here is the guidance that is followed in my house, none of which has changed since the new CDC guidance:

  • Mail is placed in a pile. Letters are opened after 24 hours, shiny things (like magazines) are given 48 hours. Hands are washed after the mail is brought in.
  • Shipped Packages: Everything stays outside overnight and is opened the next day. Hands are washed afterwards.
  • Grocery Deliveries: Perishables are wiped and put away. Everything else sits for at least 24 hours, and we don’t wipe them.
  • Restaurant Food Deliveries: Every container is wiped, food transferred to bowls and dishes, and the packaging is immediately tossed.
  • Going Places: We generally don’t go anywhere, but occasionally we have to. I wear a small container of hand sanitizer on a lanyard around my neck, and loan it to my husband. Therefore, if we have to go through a door, we can immediately sanitize, and the lanyard and holder are disinfected when we get home. Another option is to have a paper towel in your pocket that you can use on the door, and then drop in the trash. (Please don’t litter.) We have not gone food shopping since this started, but if we did….my process would be to wear gloves in the store, touch as little as possible, stay as far as possible from anyone else, and on exiting the store, take my gloves off inside out and drop them in the trash, and immediately sanitize my hands. Once I got in the car, I’d sanitize again and properly remove my mask for the drive home by taking the elastic off one ear, and taking the mask off without touching the face covering part. The mask would then be dropped on the floor of the passenger side. A few days later, I’d put it in the washing machine. Once home, perishables would come in and be wiped and put away, and the food would stay in the car. (Once it gets hot, the non-perishables would be brought in and the bags left for 24 hours).

Is this extreme? Perhaps. But my approach is simple. These methods are easy, and don’t take a lot of time or effort. Are we LIKELY to get coronavirus from the mail, or a package or a grocery delivery? No. But is the chance zero? Also no. However, taking precautions on a regular basis has the added benefit of providing “muscle memory”. This is a theory from exercise that says you can train your muscles to do certain things. There is back and forth on the truth of that. However, if you embed something in your memory banks, it’s likely to stick with you. For example, if when you come into your house you always put your keys on a peg by the door, it becomes a learned process that you end up not thinking about, you just do it. (As an aside, I hope people end up feeling that way about voting, but I digress.)

So, if you get in the habit of being mindful about washing your hands, and sanitizing them when you’re out, and always wearing a mask and thinking before you touch something or get too close to someone, these are things that will stick with you as the world re-opens. We are all human, and all humans make mistakes. The more things you can put on “automatic pilot”, the more likely you are to avoid a mistake. And mistakes with coronavirus can be deadly.

Also posted in Coronavirus, Coronavirus Tips, COVID-19, Notes from Your Doctor | Comments Off on Notes from Your Doctor: Can I Touch Surfaces?

The COVID Shutdown and the Law

By tmess2 | Published April 23, 2020

For the past week or so, those who follow the news has been treated to the experience of misinformed Tea Party wannabes protesting that the COVID 19 restrictions adopted by state and local governments are violating their constitutional rights.  For those of us who have been following the courts, however, we have seen red state attorney generals winning cases against abortion providers who claim that those restrictions go too far in terms of limiting abortion.

For the most part, the restrictions at issue in these cases have been the limits placed by the various states on “elective” surgical procedures.  One example of the red states winning this case came earlier this week in the Eighth Circuit (which covers much of the farm belt in the central part of this country) looking at the restrictions imposed by Arkansas.  In the case, the Attorney General of Arkansas (supported by most of the red state Attorney Generals) asked for relief from the trial courts order enjoining the enforcement of this ban on non-emergency surgical abortions.  While the application of the law to the case is debatable under the specific facts of the case, the Eighth Circuit was clear on the law that applies to COVID-19 orders.

The basic principle — often repeated by the courts — is that constitutional rights are not absolute.  Instead, in some very narrow circumstances, the obligations of government to protect the public can overcome constitutional rights.  In cases decided in the late 1800s and early 1900s when local and national epidemics were somewhat common, the United States Supreme Court held that the “liberty secured by the Constitution . . . does not import an absolute right in each person to be, at all times and in all circumstances, wholly freed from restraint.”   In particular, “a community has the right to protect itself against an epidemic of disease which threatens the safety of its members.”   As such, “the rights of the individual in respect of his liberty may at times, under the pressure of great dangers, be subjected to such restraint, to be enforced by reasonable regulations, as the safety of the general public may demand.”

When faced with a regulation, the courts are supposed to employ a two-part test.  First, does the regulation have a real and substantial relation to the asserted health concerns?    Second, if it is not related to the asserted health concerns, is the regulation a plain and palpable invasion of constitutional rights?  By this standard, most of the basic rules being adopted by the states are clearly valid (and are similar to prior quarantine regulations), and the sole area for debate is whether some exceptions should be made in narrow circumstances to prevent the violation of constitutional rights.

We will only know in hindsight — if at all — whether all of the restrictions imposed during this crisis were necessary and whether they could have been relaxed sooner (or should have been kept in place longer).  But what should be clear — if One America, Fox, Attorney General Barr, and President Trump would do their jobs rather than trying to encourage division — is that throughout American history governments have had the power to impose very restrictive quarantine conditions when faced with an epidemic.  Keeping the astroturf protestors in the dark about the law and their history is counterproductive and actually poses a risk to health that could require prolonging the very measures that they allegedly are opposing.  Now not all Republican “leaders” are engaging in this dishonest demagoguery.  We do have some examples of true leadership in the Republican Party (for example, the governors of Ohio and Maryland), but too many are like Moscow Mitch and the Orange Menace with a focus on political advantage rather than serving the American people.

Also posted in COVID-19, Judicial | Tagged | Comments Off on The COVID Shutdown and the Law

Supreme Court October 2019 Term — COVID 19 Reset

By tmess2 | Published April 18, 2020

As with other institutions of government, COVID 19 has caused a degree of chaos in the court system.  The judicial system requires a degree of interaction between parties and judges, and social distancing requires finding new ways to handle these interactions.

The Supreme Court, like every other judicial institution, has had to find ways to cope.  Of course, the Supreme Court has been a notoriously slow institution to adapt to modern technology.  It was the last federal court to accept electronic filing.  As recently as a few years ago, everything but emergency petitions were filed by mailing (or having somebody personally deliver them) to the Supreme Court.

As this site has discussed over the years, the Supreme Court is what lawyers call a discretionary court.  That means that, with a limited number of exceptions, a party has to request that the Supreme Court take a case (the formal name for the request is a petition for writ of certiorari).  The Supreme Court then decides if it wants to hear the case.  So most of the decisions of the Supreme Court are decisions to not take a case.  There are also two small categories of cases in which the Supreme Court takes and immediately decides the case — both involving a reversal of the lower court.  One category is frequently referred to as “grant, vacate, and remand.”  Those cases typically involve an issue that the Supreme Court decided while the application for review is pending.  In these cases, the Supreme Court grants review, vacates the decision on that issue by the lower court, and remands (sends the case back) for the lower court to reconsider in light of the recently decided Supreme Court case on the issue.  The other is summary reversal.  These cases typically involve the unanimous conclusion that the lower court simply ignored the prior decisions of the Supreme Court.    But every year, the Supreme Court decides that it wants to fully hear approximately 70 cases per year (representing about 1% of the applications that the Supreme Court receives).

If the Supreme Court decides that they want to fully hear a case, the parties are given the opportunity to file more extensive written arguments (called briefs) followed by oral argument.  Each year, there are seven argument sessions (two-week periods in which the Supreme Court hears oral arguments in approximately twelve cases — rarely more but sometimes less especially when one of the argument days would be a holiday).  After each week’s argument, the Supreme Court holds a conference in which the justices meet to tentatively decide the cases argued that week and to decide which cases to accept for argument.  After the conference, each argued case is assigned to a justice to draft an opinion.

By the time that COVID-19 struck, the Supreme Court had already held five of its seven argument sessions.  But, it quickly became clear that future in-person arguments were not possible for either the March or April argument sessions.  For the first-time since the 1918 “Spanish” Flu, the Supreme Court has had to shut down and cancel its public sessions.   A century ago, the need to shut down for a month was a significant problem.  But, it is a manageable problem today.

First, from all indications, the Supreme Court is holding its weekly conference of the justices by teleconference.  And it’s possible for the justices to send draft opinions to each other (and back and forth with their clerks) over the Supreme Court’s computer network.  As such, the Supreme Court has continued to decide which cases to accept and have issued eight opinions in argued cases.

The bigger issue involves oral arguments.  There were 19 arguments scheduled for March and April.  As of now, the Supreme Court has scheduled nine cases for argument by telephone conference.  The Supreme Court — in a first for the Supreme Court — will livestream the audio from this argument to a media pool (which will almost certainly livestream the audio for the public).  It is unclear what the court intends to do with the remaining ten cases.  (The options include deciding these cases on the briefs, postponing the arguments until the fall, or scheduling a second round of teleconferenced arguments.)  It is also unclear what this rescheduling means for when opinions will be issued.  Typically, everything is wrapped up before July 4.  But that is normally over two months after the last oral argument.  Whether the Supreme Court can wrap up nine opinions is six weeks instead of ten weeks remains to be seen.

We are still waiting for several major decisions in cases that have already been argued.  Still pending from the October argument are the two cases on whether Title VII (barring discrimination in employees) covers discrimination based on sexual orientation or transgender status.  From the November argument session, you still have a case out of Hawaii on a key environmental issue and the DACA case.  From the December argument session, you still have the Second Amendment case out of New York City and the Affordable Care Act case on payments to insures.  From January, few of the cases have been decided, and the remaining cases include the Bridgegate case and the Montana case on whether stringent state establishment clauses violate the Free Exercise Clause of the U.S. Constitution.  As of this point, no opinions have yet been issued from the February arguments which include the Louisiana abortion case and the challenge to the structure of the Consumer Finance Protection Bureau.

The special teleconference argument session includes several key cases.  The cases include a Pennsylvania case involving the current regulations governing religious employers who object to providing contraceptive coverage under Affordable Care Act, a case on the “minister” exemption to Title VII for religious employers, a New York case on the ability of a state grand jury to issue a subpoena to a private entity for documents related to the president’s outside businesses, two joined cases on the ability of Congress to issue a subpoena to a private entity for documents related to the president’s outside businesses, and two cases on state laws punishing faithless electors.

Of course, every case is important to the parties to that case, to the industries impacted by the court’s interpretation of relevant laws, and the attorneys who practice in the relevant field of law.  But, to this point of the term, the Supreme Court — with the exception of its interference with the Wisconsin primary — has not yet decided any of the cases that are likely to be noticed by the general public and voters.  The decisions in these cases will undoubtedly play a key role in how voters perceive the Supreme Court and whether the Supreme Court will become an issue for progressive voters.  (In the past, the Supreme Court has been a key issue for conservatives which helped Trump eke out a win by preventing the defection of voters who had serious concerns about Trump as President but wanted to keep a conservative majority on the Supreme Court.)

Also posted in Civil Rights, Judicial, LGBT | Tagged , , , , , , | Comments Off on Supreme Court October 2019 Term — COVID 19 Reset

Random COVID 19 Thoughts

By tmess2 | Published April 11, 2020

Depending where you live, you are anywhere from days to weeks into the COVID 19 shutdown.  While we have previously looked at the impact of COVID 19 on presidential politics, this post will focus on some other impacts.

Let’s start with our state legislatures.  While the size varies from state-to-state, most of our legislative bodies are larger than should be gathered in one place at one time.  Thus, it makes sense for legislative bodies to minimize days when they are actually in session and to reduce the number of hearings that they are holding (which many have done).  On the other hand, many states have specific dates for their regular sessions.  So, at some point soon, these state legislatures will reach the point where they have to meet so that they can pass appropriations bills to continue operations into the next fiscal year.  How these state legislatures will handle these necessary votes — perhaps arranging for staggered voting so that one group of ten enters through separate doors, votes and then departs for the next group to enter — and what non-appropriations bills will also be deemed necessary remains to be seen.  (I know that, in my state, the Republican majority is very unhappy with redistricting reform that passed in 2018 and want to put another proposal — with just enough sweeteners on legislative ethics to appeal to voters who do not understand the new proposal — to undo most of the reform on the ballot,  Before COVID 19, it was likely that something would get on the ballot.  Now, it’s unclear if the desire to get this issue on the ballot is high enough to get very limited hearing time and floor time.)

On similar grounds, many states have an initiative and referendum process. This process requires a certain number of signatures (sometimes with geographic distribution requirements) by a certain date.  Particularly in a state in which — whether through intentional gerrymandering or population distribution — one party has control over the government, this process can often be the only way to get things like increases to the minimum wage or protection of worker’s rights passed into law.  With COVID 19 (even though the petition gathering may technically be exempt from the stay-at-home order in some localities), it is going to be very difficult to get enough signature for ballot initiatives this year.

Finally, we have fundraising — both for political organizations and for charities that fill the gaps left by the unwillingness of the right to spend money on social programs.  While there are other means to raise money — and if you use Amazon, I would encourage you to switch to their Amazon Smile site which refunds a small percent of your spending to the charity of your choice — many organizations rely on high attendance events to bring donors together and convince them to part way with a significant donation. For example, my county party uses an annual dinner/auction in late July to raise 90% of our funding.  While we have the revenue from 2019 to aid our candidates this year, it is unclear at the present time whether a 90-person dinner in July will be a viable option.

And candidates are going to have the same problem.  It may not be possible to do fundraisers before mid-May.  And the window before wave two strikes later this year may be small and prevent holding any fundraisers close to the election.  But the inability to raise moneys will not eliminate the need to do mailers and radio ads and phone banks (all though phone banks may need to be virtual).  The time period for door-to-door campaigning may be small, but that will only increase the need for mailers and ads which may make the 2020 election even more expensive for those running in small counties than past elections.

Likewise, charities are also going to be impacted in their ability to hold big fundraisers.  The local charity whose board I serve on had a video meeting this week to discuss our plans for the rest of the year.  We typically do three or four big fundraisers during the year — two of which are big gatherings and the others requiring us hitting the streets to sell chances to win prizes.  Those prizes are typically donated by local small businesses.  So, COVID-19 may limit our ability to hold big gatherings or sell chances.  And the impact of COVID-19 on the local small business is going to reduce our ability to ask for donations from many of our typical targets.

The bottom line is that COVID-19 is going to have a big impact on things that matter to us. When things relax in a month or two, if you live in a state that allows initiative, please take the time to consider signing an initiative petition if asked.  The time frame for getting signatures is going to be very compressed; so every signature will matter.  If you support a candidate or have a favorite local charity, please consider making a donation without waiting for a fundraiser because there might not be one.

Tagged , , | Comments Off on Random COVID 19 Thoughts

TODAY’S CORONAVIRUS TIP: INSIGHT

By DocJess | Published March 28, 2020

Holed up in your house gives you time you never had – those extra hours not spend commuting, nor running the kids around, nor out and about. How do you fill those hours? For me, it has led to introspection, and once those five minutes were up, puzzles.

More seriously.

Before the lockdown, I worked mostly from home, leaving for meetings with clients every few weeks, but mostly alone with my tech. You can see 2 of my 3 computers in the photo on the right. My days were filled with conference calls, working sessions, and enough time to crank out the documents and videos I’m paid to produce. My constant office mate is pictured to the left. Meet Fiona.

But still, I would be out of my house…the 5 am run to Starbucks most mornings. The shopping trips, the political events, the family gatherings….I even have friends, who I hug when I see them. Or used to. My husband is working from home now, too. And we still eat dinner at 6, and we take Fiona out afterwards.

Tim and I are lucky, we have separate office space in the house. If we didn’t, we’d never survive. One thing I’ve learned from the lockdown is that even though it can be lonely, private space and private time are necessary. And I’ve learned what I like to do with that time and space. Some are things I always want to do, and never have time for, like taking bubble baths, and some are things I never knew I’d like, but I find absorbing, like puzzles.

This weekend, I am going to try something I’ve never tried before. Well, not since I got my first computer in 1989, and when I got my first cell phone in 1995.

I’m turning off my screens for a couple days. Well, actually, I’m going to try and see how it goes. Maybe you will consider doing that, too. It’s my tip for the weekend, and I’ll be trying it with you. (Generally, I try things before I recommend them.) If it works, I’ll see you Monday morning with a new tip — if it doesn’t, I’ll see you Sunday morning.

But because I have the time now, I’d like to share some thoughts with you, and let you know what I’ll be doing with my weekend. I’ll also tell you what I would normally do with my weekend, because maybe, just maybe, I’ll make you laugh a little. And perhaps you’ll feel a little connected.

Normally on Saturdays, I run my errands. I often start out at the grocery store, while Tim goes to the produce market. This really works for us because I buy food, and Tim buys ingredients. Let me give you an example. I went to the Costco (in normal times) and bought one of those already cooked chickens, and some pre-made salad. A fancy salad. I put the chicken in a roasting dish, stuck it in the oven on “keep warm” and placed the salad in a serving dish. I tossed the evidence. When he arrived home about a half hour later (I had PLANNED!) and I announced that dinner was ready, he knew immediately that I hadn’t cooked the chicken. It was neither burnt nor falling apart, a dead giveaway.

My next stops are to do my banking. I keep my checking account in one place, and my savings account in another. I take cash from checking and deposit it in savings. Why? Because then it’s a pain to go GET money that I’m saving. I know all the tellers by name, and they know me. We chat. I tell them an Alexa joke. It’s not just money, it’s social. I miss banking.

Often on Saturdays I do something political. I will say to Tim “I’m going to have lunch with <insert name of man he’s never heard of>” and without missing a beat, he’ll say “Oh, what office is he running for?” (Everybody’s got a hobby.)

I spend one hour cleaning something on Saturdays. I hate cleaning, but I like a clean house. I suck at cleaning, but I put in the hour and clean something — in the interest of full disclosure, I own several vacuum cleaners. I love vacuum cleaners. Not so thrilled with actually vacuuming, but I like the machines.

Tim bakes bread on Saturdays. Tim is serious about bread. He has a true relationship with his sourdough starter, which involves some amount of interaction to keep it going. For about a year, he’s been working on a German sourdough rye. A crusty, delicious smelling rye. I’m always asking for him to make monkey bread, but alas, he doesn’t consider that a “serious” bread.

This weekend, Tim and I are going to give Fiona a bath. This is not something we do. EVER. Fiona goes to the groomer, an excellent dog whispering groomer. Somehow, this is not an essential service, and Fiona has a penchant for rolling in mud puddles. So, here’s how it’s going to go. She already knows that something is up, but we’ll be able to corral her and get her into the bathroom. We have these fancy suction cups on leash material that clip onto her collar and then hold her in the tub. We have a shower head with a hose. We have the special dog shampoo. We will be wearing bathing suits, surrounded by all our beach towels. Once she’s clean and we let her out, we’ll need all the towels. For us…sigh. We tried this once before.

At some point this weekend, I’m going to apply to the Church of the Flying Spaghetti Monster to become ordained. This is something I’ve wanted to do ever since my brother did it about 10 years ago. He’s got a wallet card. FINALLY I have time. And while I’m at that, I’m going to fill out the rebate form for Fiona’s flea and tick medication. I don’t understand how that stuff got so expensive, but it’s reached the point where you can get a $60 rebate if you can fill out the form correctly.

I’ll spend some time this weekend wondering about things that will never be. For example, the 25 cent wings at Applebee’s. We’ve seen a commercial for them, and I find this fascinating. I want a 25 cent wing. Tim has pointed out that we don’t go to Applebee’s, I’ve never eaten a chicken wing, I wouldn’t like a chicken wing, and I hate sauce. And yet, I’m sorry I missed the opportunity. I have always, ever since I was a teenager, wanted to go to a bar, drink a beer, eat pepperoni pizza, and watch a game of some sort. This to me is quintessential Americana, and I want to do it. There are a number of reasons I have never done this: first, I can’t stand the smell of beer and have never tasted one. Second, I was a vegetarian for most of my life, grew up in a kosher home, and I’ve never tasted pork. Finally, I don’t watch sports. Don’t understand them, can’t follow them….and all I can say about sports people is that I only know them once they run for office. Still, hope springs eternal.

I’m going to add things to my bucket list. Last November, after SEVEN YEARS of trying, I was able to cross off the number one item on my bucket list. My sister in law and I went to Harry Potter Land at Universal Studios in Orlando Florida. This was a spectacular undertaking. It had taken seven years because we had one window each year to arrange this trip, and something came up every year. But we went: no husbands, kids, grandkids, dogs….no computers…yeah okay, we had phones and tablets but no work computers….it was joyous and delightful. We stayed on property and took water taxis between venues. Someday lockdown will be over, and we are going to go again.  That picture, by the way, was taken looking up at the fire breathing dragon atop Gringott’s Bank, and was sitting under it, eating an ice cream cone. FOR BREAKFAST!  I think it pays to keep up with those bucket lists as a paean of hope that this nightmare will end. Perhaps you, too, will put some things on a bucket list and have hope!

I am going to read the salient points of this WaPo article to my husband. I tried to get him to read it, and he IS a reader, but he doesn’t like this sort of stuff. I think it’s important to find ways of being a healthy couple. Not just my insanity of disinfecting everything, but “healthy as a couple”. We are doing okay, so far, and we’ve been doing things we never did before. For example, I asked him out on a date last weekend. We went to the living room, and brought out Trivial Pursuits. Neither of us had played in probably 35 years. And you could tell…the pie pieces had faded so it was hard to differentiate between the orange and the pink, and the green and the blue. The board had faded too. Some of the answers were no longer valid. But we had fun, and it was good. Maybe you, too, will find something “old but new” to do with the one you love. It’s a good objective for a Saturday night.

As I do every day, I will call three people, and send three emails. These go to people I love, but also to people I haven’t seen in a while…I think that keeping connections up is critical at this time. The more connected we all are, the higher the probability that we will be able to emotionally survive the lockdown. Because it’s not just the being in your house, it’s the hugs, and the laughter, and all the other human interactions we have taken for granted all our lives. I hope you will take some time this weekend and reach out to someone, share a piece of yourself. As you can tell from my desire to be ordained by the Church of the Flying Spaghetti Monster, I’m not a religious person. But I truly believe in the universe – in the idea that we are connected in ways that matter. That there is more that unites us than divides us. We can look at all the other humans as potential infectious super spreaders, or we can say we are all humans, while still maintaining that critical 6′ social distance. We all want to go back to the world where we go to work, come home, kiss the ones we love, eat some dinner, and sleep where it’s safe. Even the annoying ones. I know I personally want to go back to being the person in the car on the highway cursing (from behind closed windows) at that idiot that dives from the left lane across the other lanes to get off at the exit.

So that’s what I’ve got for today (and potentially the weekend). I hope that you feel a little connected and will find a way to connect with others. And maybe stay off your screens, to the best extent possible. A break from the news, and social media. Give your eyes a rest. Be good to yourself, and the ones you love. We are all in this together.

Also posted in Coronavirus Tips | Comments Off on TODAY’S CORONAVIRUS TIP: INSIGHT