Public Health Experts Have Undermined Their Own Case for the COVID-19 Lockdowns – Reason.com

In theory, the mass protests following the alleged murder of George Floyd put public health officials who have ceaselessly inveighed against mass gatherings in a difficult position. They have called for a moratorium on most types of public activities, but particularly gathering in large crowds where increased aerosolization from loud talking and yelling could spread the COVID-19 virus to massive groups.

But when it comes to the protests against police brutality, many medical experts think there should be an exemption to the COVID-19 lockdown logic.

More than a thousand public health experts signed an open letter specifically stating that “we do not condemn these gatherings as risky for COVID-19 transmission. We support them as vital to the national public health and to the threatened health specifically of Black people in the United States.”

The letter conceded that mass protests carried the risk of spreading coronavirus, and offered some good—if naive—advice for people who are going out anyway: wear masks, stay home if sick, attempt to maintain six feet of distance from other protesters. Many protesters are wearing masks, but others are not. And while we can blame the police for forcefully corralling people into close quarters, it’s a bit rich for public health experts to endorse protesting under conditions that they know are impossible for protesters to meet.

Indeed, for the purposes of offering health care advice, the only thing that should matter to doctors is whether their harm-reduction recommendations are being followed: how big is the event, is it outdoors, are masks being worn, etc. However, the letter distinguishes police violence protesters from “white protesters resisting stay-home orders,” as if the virus could distinguish between the two types of events. While I am not a doctor, my understanding is that it cannot.

The letter led a Slate writer to claim that “Public Health Experts Say the Pandemic Is Exactly Why Protests Must Continue.” The argument here is that coronavirus is more deadly for black people because of systemic racism and that protesting systemic racism is a sort of medical intervention.

“White supremacy is a lethal public health issue that predates and contributes to COVID-19,” the letter continues.

There is much truth to this! Black people in America do have worse health outcomes, but so do low-income people of every race and ethnicity. Is it medically acceptable for a poor person to protest against lockdown-induced economic insecurity? For people who live paycheck to paycheck to protest looming evictions and foreclosures? What about people experiencing loneliness, depression, and bereavement? Again, my understanding is that the virus does not think and thus does not choose to infect us based on what we’re protesting.

Many people all over the country were prevented from properly mourning lost loved ones because policymakers and health officials limited public funerals to just 10 people. For months, public health officials urged people to stay inside and avoid gathering in large groups; at their behest, governments closed American businesses, discouraged non-essential travel, and demanded that we resist the basic human instinct to seek out companionship, all because COVID-19 could hurt us even if we were being careful, even if we were going to a funeral rather than a nightclub. All of us were asked to suffer a great deal of second-order misery for the greater good, and many of us complied with these orders because we were told that failing to slow the spread of COVID-19 would be far worse than whatever economic impact we would suffer as a result of bringing life to a complete standstill.

People who failed to follow social distancing orders have faced harsh criticism and even formal sanction for violating these public health guidelines. To take just one extreme example, New York City Mayor Bill de Blasio threatened to use law enforcement to break up a Jewish funeral.

After saying no to so many things, a significant number of public health experts have determined that massive protests of police brutality are an exception to the rules of COVID-19 mitigation. Yes, these protests are outdoors, and yes, these experts have encouraged protesters to wear masks and observe six feet of social distance. But if you watch actual footage of protests—even the ones where cops are behaving badly themselves—you will see crowds that are larger and more densely packed than the public beaches and parks that many mayors and governors have heavily restricted. Every signatory to the letter above may not have called for those restrictions, but they also didn’t take to a public forum to declare them relatively safe under certain conditions.

“For many public health experts who have spent weeks advising policymakers and the public on how to reduce their risk of getting or inadvertently spreading the coronavirus, the mass demonstrations have forced a shift in perspective,” The New York Times tells us.

But they could have easily kept the same perspective: Going out is dangerous, here’s how to best protect yourself. The added well, this cause is important, though, makes the previous guidance look rather suspect. It also makes it seem like the righteousness of the cause is somehow a mitigating factor for spreading the disease.

Examples of this new framing abound. The Times interviewed Tiffany Rodriguez, an epidemiologist “who has rarely left her home since mid-March,” but felt compelled to attend a protest in Boston because “police brutality is a public health epidemic.” NPR joined in with a headline warning readers not to consider the two crises—racism and coronavirus—separately. Another recent New York Times article began: “They are parallel plagues ravaging America: The coronavirus. And police killings of black men and women.”

Police violence, white supremacy, and systemic racism are very serious problems. They produce disparate harms for marginalized communities: politically, economically, and also from a medical standpoint. They exacerbate health inequities. But they are not epidemics in the same way that the coronavirus is an epidemic, and it’s an abuse of the English language to pretend otherwise. Police violence is a metaphorical plague. COVID-19 is a literal plague.

These differences matter. You cannot contract racism if someone coughs on you. You cannot unknowingly spread racism to a grandparent or roommate with an underlying health condition, threatening their very lives. Protesting is not a prescription for combatting police violence in the same way that penicillin is a prescription for a bacterial infection. Doctors know what sorts of treatments cure various sicknesses. They don’t know what sorts of protests, policy responses, or social phenomena will necessarily produce a less racist society, and they shouldn’t leverage their expertise in a manner that suggests they know the answers.

It’s clear that we’ve come to the point where people can no longer be expected to stay at home no matter what. Individuals should feel empowered to make choices about which activities are important enough to incur some exposure to COVID-19 and possibly spreading it to someone else, whether that activity is reopening a business, going back to work, socializing with friends, or joining a protest against police brutality. Health experts can help inform these choices. But they can’t declare there’s just one activity that’s worth the risk.

This content was originally published here.

Machine learning helps Invisalign patients find their perfect smile | CIO

Machine learning helps Invisalign patients find their perfect smile

Align Technology’s mobile app helps Invisalign wearers stay on schedule, while machine learning and other features help lure prospective consumers to try the orthodontic device.

The mobile computing trend requires enterprises to meet consumers’ expectations for accessing information and completing tasks from a smartphone. But there’s a converse to that arrangement: Mobile has also become the go-to digital platform companies use to market their goods and services.

Align Technology, which offers the Invisalign orthodontic device to straighten teeth, is embracing the trend with a mobile platform that both helps patients coordinate care with their doctors and entices new customers. The My Invisalign app includes detailed content on how the Invisalign system works, as well as machine learning (ML) technology to simulate what wearers’ smiles will look like after using the medical device.

“It’s a natural extension to help doctors and patients stay in touch,” says Align Technology Chief Digital Officer Sreelakshmi Kolli, who joined the company as a software engineer in 2003 and has spent the past few years digitizing the customer experience and business operations. The development of My Invisalign also served as a pivot point for Kolli to migrate the company to agile and DevSecOps practices.

The pitch for a perfect smile

My Invisalign is a digital on-ramp for a company that has relied on pitches from enthusiastic dentists and pleased patients to help Invisalign find a home in the mouths of more than 8 million customers. An alternative to clunky metal braces, Invisalign comprises sheer plastic aligners that straighten patients’ teeth gradually over several months. Invisalign patients swear by the device, but many consumers remain on the fence about a device with a $3,000 to $5,000 price range that is rarely covered completely by insurance.

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Outcomes Data Registry for Dentistry – TeethRemoval.com

Using large amounts of data from many different dentists or surgeons is a way to improve the quality of healthcare. From such clinical data registries in healthcare
many things can be gleaned regarding information about individual surgeries or medical devices. The American Association of Oral and Maxillofacial Surgeons (AAOMS) has recently launched OMS Quality Outcomes Registry or OMSQOR for short which is discussed on pages 7-12 of the March/April 2019 issue of AAOMS Today. The groundwork for OMSQOR actually began in 2014 and OMSQOR officially launched in January 2019. The way OMSQOR works is that treatment data from all members who participate will be collected in a national registry that will be used to help improve the quality of care and patient outcomes. Such quality data will allow for tracking surgical outcomes, complications, and possible gaps in treatment. OMSQOR will even allow an individual surgeon to compare their patients to all patients in the database to identify areas in their practice they may be lacking and improvement is needed. AAOMS is encouraging all of their members to sign up and participate.

The data registry will be used to help AAOMS be able to better advocate on behalf of oral and maxillofacial surgeons along with conduct additional research to improve outcomes. Practice patterns across the entire specialty can be tracked. This can allow for better reimbursement for services that is fair where insurance companies may be challenging them. This can also allow for better data showing how often an anesthesia death occurs by oral and maxillofacial surgeons. This is important to them because many have challenged their delivery model of having the surgeon both perform surgery and deliver anesthesia which is not how surgeries are conducted in other specialties. The data registry can allow for the frequency of particular complications after particular surgeries to be identified. Of particular interest is identifying the frequency of nerve injuries after wisdom teeth surgery. The data registry can also be used to explore medical prescription prescribing habits which is of particular interest with recent studies demonstrating possible over prescribing of opioids which are then diverted to non medical use. According to the AAOMS Today article:

“Often, anesthesia advocacy stalls because AAOMS does not know how many anesthetics OMSs safely and routinely use. With OMSQOR, relevant aggregate data can be collected and safety statistics shared with federal and state agencies as well as insurance companies.”

Currently the safety of oral and maxillofacial surgeons delivery anesthesia is measured by several morbidity and mortality studies that have been conducted over time see for exaxmple http://www.teethremoval.com/mortality_rates_in_dentistry.html along with anecdotal reports and hearing about patient death or serious injury from media reports. Included with OMSQOR, is a Dental Anesthesia Incident Reporting System (DAIRS) which is an anonymous self-reporting system used to gather and analyze
information about dental anesthesia incidents. For example if an equipment fails or a cardiac event occurs in a patient a surgeon could report this anonymously using DAIRS. All dental dental anesthesia providers are being encouraged to report to DAIRS in order to help improve patient outcomes.

Even with the advantages of OMSQOR it is true that some members may be hesitant to want to use the system. This is because it can potentially be a significant time burden involved with the initial set-up to import all the data and surgeons may frankly just not like everyone else knowing intimate details about their practice. In addition their may be concerns with patient privacy. Both patient information and surgeon information will however be de-identified in the data registry so these concerns should not be subdued. Even so it may be possible to re-identify de-identified data. For example if there is a rare complication or death that occurs and is then picked up by the news media it may be possible to piece together who the patient and doctor is. Even with the limitations it seems that if many oral and maxillofacial surgeons and dental anesthesia providers use both OMSQOR and DAIRS then patient outcomes for dental procedures including wisdom teeth surgery may improve in the future.

This content was originally published here.

Among U.S. Health Workers, COVID-19 Deaths Near 300, With 60,000 Sick : Shots – Health News : NPR

Registered nurses and other health care workers at UCLA Medical Center in Santa Monica, Calif., protest in April what they say was a lack of personal protective equipment for the pandemic’s front-line workers.

Mario Tama/Getty Images


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Registered nurses and other health care workers at UCLA Medical Center in Santa Monica, Calif., protest in April what they say was a lack of personal protective equipment for the pandemic’s front-line workers.

The coronavirus continues to batter the U.S. health care workforce.

More than 60,000 health care workers have been infected and close to 300 have died from COVID-19, according to new data from the Centers for Disease Control and Prevention.

The numbers mark a staggering increase from six weeks ago when the CDC first released data on coronavirus infections and deaths among nurses, doctors, pharmacists, EMTs, technicians and other medical employees. On April 15, the agency reported 27 deaths and more than 9,000 cases of infection in health care workers.

The latest tally doesn’t provide a full picture of illness in this essential workforce, because only 21% of the case reports sent to the CDC included information that could help identify the patient as a health care worker. Among known health care workers, there was also missing information about how many of those people actually died.

Still, the growing number of health care workers infected by the coronavirus provides sobering evidence that many are still working in high-risk settings without reliable or adequate protection against the virus.

“It is underreported,” says Zenei Cortez, president of National Nurses United (NNU), the largest union of nurses in the country.

The union has compiled its own count of more than 530 health care fatalities from COVID-19, using publicly available information like obituaries. A recent NNU survey of 23,000 nurses found that more than 80% had not yet been tested for the coronavirus.

Across the country, many nurses say they still don’t have enough personal protective equipment (PPE) such as masks and gowns and are required to reuse N95 masks and other supplies — practices that were considered substandard before the pandemic. Many hospitals and nursing homes continue to operate with inadequate supplies and are rationing them.

“Everything is under lock and key. If you are going to respond to an emergency, you sometimes have to wait for someone to unlock a cabinet,” Cortez says of some hospitals’ PPE supplies.

Cortez cites the death of a nurse from Southern California who rushed to the bedside of a COVID-19 patient who had stopped breathing. The nurse was wearing only a surgical mask, which offers less protection against airborne infection than the closer-fitting N95 respirator mask.

“Fourteen days after that incident, she died because she contracted the virus,” Cortez says. “If the PPE was readily available, she maybe could have put on the N95 mask and been prevented from getting the virus.”

Cortez worries that some of these unsafe practices around infection control have become normalized in U.S. health care settings and will persist in the coming months as the country reopens.

NPR recently reported that in the spring of 2017 the Trump administration halted the final implementation of new federal regulations that would have required the health care industry to prepare for an airborne infectious disease pandemic. Consequently, there are no federal workplace rules that specifically protect health care workers from deadly airborne pathogens such as influenza, tuberculosis or the coronavirus.

“The really sad thing is not having solid numbers from many states,” Pat Kane, executive director of the New York State Nurses Association, says regarding the number of COVID-19 cases and deaths among health care workers.

Early in the outbreak, Kane says, many nurses could not get tested. Her own statewide union has lost more than 30 nurses in the pandemic.

“Some of them actually died outside of the hospital, trying to recover at home,” she says.

More than half of the nurses in the New York state union still report not having enough personal protective equipment.

“In some places, we still see people operating under contingency and crisis guidelines,” she says.

In early May, New York Gov. Andrew Cuomo touted the results of an antibody testing survey that showed a 12% infection rate among health care workers in New York City, compared with the 20% infection rate among residents citywide.

But Kane says that lower number isn’t something to celebrate.

“Our members showed up and many of them made the ultimate sacrifice,” she says. “And many of them got sick. That was Round 1. We should be better informed by our experience.”

As more regions in the United States reopen, the safety of health care workers needs to be a key benchmark for decision-makers, Kane says, and must include enforceable precautionary standards — not just voluntary guidelines for employers, which shift according to the amount of PPE available.

At Northwestern University, Dr. James Adams says the number of health care workers with COVID-19 dropped significantly after his hospital started requiring everyone on-site to wear masks.

Adams says closely tracking the full extent of the COVID-19 burden among health workers will be crucial as access to testing improves.

“Up to this point, we have largely not known what is going on with the workforce and this infection rate,” says Adams, a professor of emergency medicine. “What we need is the confidence of health care workers, and we should track this in order to ensure their health.”

This content was originally published here.

Motivated by his son Beau, Joe Biden pledges help for veterans with burn pit health issues – CBS News

Throughout his presidential campaign, one of the most striking elements of Joe Biden‘s appeal has been his empathy. The personal tragedies he has suffered inform his interactions with voters who are also experiencing loss. And his sorrow could also guide policy decisions as commander-in-chief, offering assistance to veterans who may be suffering from service-related medical conditions — as he believes his son did. 

With a familiar quiver in his voice, Biden regularly on the campaign trail shares memories of his son Beau, who died in 2015 from glioblastoma brain cancer. A handful of times Biden detailed how he thinks his son’s cancer may have been related in part to the large, military base burn pits during his 2009 service in the Iraq War.

“He volunteered to join the National Guard at age 32 because he thought he had an obligation to go,” Biden told a Service Employees International Union convention in October. “And because of exposure to burn pits — in my view, I can’t prove it yet — he came back with Stage Four glioblastoma.”

Biden’s precise language — “in my view, I can’t prove it yet” — appears to be intentional as he lends his voice to the ongoing and somewhat controversial debate over whether the burn pits caused lasting health issues for American veterans.

“We don’t have 20 years”  

As the Iraq and Afghanistan military operations grew, so did the installations of bigger burn pits on military bases, rather than the smaller burn barrels that had previously been used. The pits were meant to dispose of everything from garbage to sensitive documents and even more hazardous materials. 

“They build as big as this auditorium,” Biden said to a CNN town hall audience in February, “It’s about 8-to-10-feet-deep and they put everything in it they want to dispose of and can’t leave behind, from flammable fuel to plastics to all range of things.”

But in the middle of a war zone, concern about the burn pits was sometimes considered secondary to other safety issues. 

“You’ve got dust storms, you have the enemy, you have all sorts of things going on that some smoke in the air doesn’t really seem like as important of an issue at the moment,” Jim Mowrer, who befriended Beau at Camp Victory in Iraq in 2009, told CBS News. Other times, Mowrer, 34, who now serves as co-chair for the Veterans for Biden committee, said he tried to filter the air by wearing a face covering.

“The concern factor became more of a concern after we came home,” Beau’s overseas boss, Command JAG Kathy Amalfitano, 59, told CBS News. Amalfitano said she remembers discussing the burn pits with Beau a few times, but added “I know our thought process was that this was part of the deployment.”

Biden is not alone in thinking burn pits impacted soldiers’ health.

Since 2014, more than 200,000 Afghanistan and Iraq War veterans have registered in the “Airborne Hazards and Open Burn Pit Registry” run by the Department of Veterans Affairs (VA), detailing exposure to service-related airborne hazards from burn pit smoke and other pollution.

And while these veteran health concerns seem widespread, the VA’s policy only recognizes “temporary” irritation from burn pit exposure. Citing a range of studies, the department states that “research does not show evidence of long-term health problems from exposure to burn pits.”

One ongoing study is by National Jewish Health and funded by the Defense Department, and is examining lung issues and has yielded “a spectrum of diseases that are related to deployment,” the study’s principal investigator Dr. Cecile Rose told CBS News last year. ” [The diseases] weren’t there before, and they are clearly there after people have returned from these arid and extreme environments.” However, Rose cautioned that findings are complicated by other possible culprits, like desert dust and diesel exhaust.

Advocates for veterans say not enough is being done to address veterans’ health claims regarding the burn pits.

From 2007 to 2018, the VA processed 11,581 disability compensation claims that had “at least one condition related to burn pit exposure,” a department spokesman told The New York Times last year. But the department only accepted 2,318 of these claims. The department said the rest did not show evidence connected to military service or the condition in the claim was not “officially diagnosed,” the Times noted. 

The VA did not respond to CBS News’ request this week for updated numbers.

“I always push back on…the VA administration folks who try to use the ‘perfect study’ as a criteria to show proof,” California Representative Raul Ruiz, a doctor and vocal burn pits critic, told CBS News. Ruiz criticized the VA’s reliance on long-term studies to validate clams. 

“We don’t have 20 years because then these veterans are going to be dying without the care they need,” Ruiz said.

A report five years ago by a Defense Department inspector general said it was “indefensible” that military personnel “were put at further risk from the potentially harmful emissions from the use of open-air burn pits.” But the Supreme Court last year rejected a victims’ lawsuit against contractors who oversaw some of the burn pits.

“If these [burn pits] had happened in the United States, the Environmental Protection Agency and Centers for Disease and Control would have this corrected immediately,” said Iraq War veteran Jeremy Daniels, adding he believes burn pits caused him to be wheelchair bound.

Modern-day “Agent Orange”?

Biden on the campaign trail invoked the healthcare struggles of Vietnam veterans exposed to the herbicide Agent Orange to explain the need to address burn pits.

“You were entitled to military compensation if you could prove that Agent Orange caused whatever the immune system damage was to you,” Biden said, accenting the word “prove” during a Veterans Day town hall in Oskaloosa, Iowa. “But you had to prove it and it’s very hard to prove.”

After reading a book on burn pits detailing Beau’s case, Biden has advocated easing this burden of proof for veterans who say the burn pits have harmed them in some way, as he first told PBS.

Biden has a plan that pushes for congressional approval to expand the list of “presumptive conditions”– meaning veterans’ health conditions would be presumed causal to the burn pits making them eligible for greater VA healthcare. He also aims to expand the claim eligibility period for toxic exposure conditions to five years after service instead of one year and increase federal research by $300 million in part to focus on toxic exposure from burn pits.

This push has intensified in recent years on Capitol Hill, and bills funding more research into burn pits have already been signed by President Trump. The recent National Defense Authorization Act also required the Department of Defense to implement a plan to phase out burn pits and disclose the locations of the still-operating pits. Enclosed incinerators are an alternative.

There were nine active military burn pits in the Middle East as of last year, according to the Defense Department’s April 2019 “Open Burn Pit Report to Congress” shared with CBS News, though some advocates think the actual number is higher. 

Some veterans expressed doubt that recent efforts will lead to more aid for veterans exposed to burn pits, given the slow-moving bureaucracy and concern over higher health care costs. And others question whether a Biden administration would act more decisively than the Obama administration, which primarily focused on long-term studies.

But Biden says that his motivation is far greater than his family’s own personal loss, and that the “only sacred” commitment the United States has is to American soldiers.

“It’s not because my son died…[he] went from very, very healthy but he lived in the bloom of those burn pits for a long time. He’s passed—it doesn’t affect him,” Biden said in Oskaloosa. “But the point is that every single veteran shouldn’t have to prove and wait until science demonstrates beyond a doubt…We just have to change the way we think a little bit.”

May 30 will mark the five-year anniversary of Beau Biden’s death.

This content was originally published here.

Ontario’s health minister shopped at Toronto LCBO while awaiting COVID-19 test results | CP24.com

Ontario’s health minister says she was following the advice of medical professionals when she decided to shop at a Toronto LCBO on Wednesday afternoon while awaiting her COVID-19 test results.

Health Minister Christine Elliott and Premier Doug Ford, who have since tested negative for the virus, underwent COVID-19 testing on Wednesday after learning that the province’s education minister, Stephen Lecce, had earlier come in contact with someone who tested positive for the virus.

Ford and Elliott, who had held a joint press conference with Lecce one day earlier, decided to skip their daily briefing at Queen’s Park on Wednesday afternoon out of an abundance of caution.

Elliott also cancelled an appearance at a Brampton mobile testing site that was scheduled for 3 p.m.

Lecce released a statement shortly before 2 p.m. on Wednesday confirming that his test results had come back negative and about an hour-and-a-half later, Elliott was seen shopping at an LCBO near Dupont Street and Spadina Avenue.

A photo sent to CP24 shows Elliott, who is wearing a surgical mask, standing beside a basket and looking at the store’s VQA wine selection.

“Minister Lecce’s results came back negative before I went for testing and so while there was no real need for me to go to be tested, I had made a public commitment to do so and so that’s where I went,” Elliott told reporters at Queen’s Park on Thursday.

“I went and while I was at the assessment centre having the test, I was advised that because I had not directly been in contact with anyone with COVID that I did not need to self-isolate…That was the medical advice I was given and that is what I did and my test results came back negative of course.”

Elliott and Ford returned to Queen’s Park for their daily COVID-19 update on Thursday afternoon.

“To be clear, both Premier Ford and Minister Elliott have had no known contact with anyone who has tested positive for COVID-19, and as a result, there is no need for either of them to self-isolate,” a statement from the premier’s office read.

“They will continue to follow public health guidelines.”

Lecce’s office confirmed Thursday that he will continue to self-isolate.

“Minister Lecce is feeling well and continues to work from home. He is following the advice of his doctor by continuing to monitor for any symptoms,” a statement from the education minister’s office read.

“Out of an abundance of caution, although the exposure risk was extremely low, he will be self-isolating for the remainder of the 14 days since the time of exposure, on June 6. The Minister again would like to offer his sincere thanks to the team at UHN and everyone yesterday who sent positive thoughts and messages.”

Public health experts have cautioned that negative test results are not always an indication that a person isn’t infected with the virus, especially when tests are conducted a short time after exposure.

Those who have tested negative for the virus are still advised to monitor for symptoms as the virus has an incubation period of 14 days.

“As we outlined our testing criteria at the assessment centres… if you have signs and symptoms and you’re suspected of being a COVID case, you will get your test and then you are supposed to stay in self-isolation until you get results,” Dr. David Williams, Ontario’s chief medical officer of health, said at a news conference on Thursday.

“Other criteria, you say, ‘Well, I was in contact with a known positive.’ That is another reason to get tested and you still have to self-isolate until you get that result back, including people who say, ‘Well I’m not sure but I was in a highly risky area, I don’t know.’’”

He noted that the rules are different for people who are not experiencing symptoms of the virus and have not been in contact with a known case.

“Testing asymptomatic people… say 5,000 workers, none of them have symptoms, none of them are cases, we are not going to say all 5,000 wait for five, six days to get results back. They just continue going to work because it is asymptomatic testing,” he added.

“They have no signs and symptoms, they have no contact with a case, no possible contact with a case, and there is no evidence of an outbreak. So it is a different situation altogether.”

This content was originally published here.

Arizona coronavirus: Banner Health reaches capacity on ECMO lung machines

Arizona’s largest health system reaches capacity on ECMO lung machines as COVID-19 cases in the state continue to climb

Stephanie Innes
Arizona Republic
Published 2:24 PM EDT Jun 6, 2020
Coronavirus 2019-nCoV vials
solarseven, Getty Images/iStockphoto

Hospitalizations in Arizona of patients with suspected and confirmed COVID-19 have hit a new record and the state’s largest health system has reached capacity for patients needing external lung machines.

Arizona’s total identified cases rose to 25,451 on Saturday according to the most recent state figures. That’s an increase of 4.4%, since Friday when the state reported 24,332 identified cases and 996 deaths. 

Some experts are saying that Arizona is experiencing a spike in community spread, pointing to indicators that as of Saturday continued to show increases — the number of positive cases, the percent of positive cases and hospitalizations.

Also, ventilator and ICU bed use by patients with suspected and confirmed COVID-19 in Arizona hit record highs on Friday, the latest numbers show.

Statewide hospitalizations as of Friday jumped to 1,278 inpatients in Arizona with suspected and confirmed COVID-19, which was a record high since the state began reporting the data on April 9. It was the fifth consecutive day that hospitalizations statewide have eclipsed 1,000.

On Saturday morning, officials with Banner Health notified the Arizona centralized COVID-19 surge line that  Banner hospitals are unable to take any new patients needing ECMO — extracorporeal membrane oxygenation.

ECMO is an an external lung machine that’s used if a patient’s lungs get so damaged that they don’t work, even with the assistance of a ventilator.

The Arizona surge line is a 24/7 statewide phone line for hospitals and other providers to call when they have a COVID-19 patient who needs a level of care they can’t provide. An electronic system locates available beds and appropriate care, evenly distributing the patients so that no one system or hospital is overwhelmed by patients.

Banner Health, which is the state’s largest health system, is also nearing its usual ICU bed capacity, officials said Friday and if current trends continue is at risk of exceeding capacity. Banner Health typically has about half of Arizona’s suspected and confirmed COVID-19 hospitalized patients.

The state’s death toll on Saturday was 1,042, with 30 new deaths reported. On Friday the tally for the first time reached four figures — 1,012 total deaths —  three weeks after Gov. Doug Ducey’s stay-at-home order expired.

What we know about the known deaths, based on the state data:

Ducey said at a Thursday news conference that “we mourn every death in the state of Arizona.”

“… I’m confident that we’ve made the best and most responsible decisions possible, guided by public health, the entire way,” Ducey said.  

Saturday marked Arizona’s fifth consecutive day of high numbers of new coronavirus cases reported, with 1,119 positives reported Saturday, a record 1,579 reported on Friday, 530 on Thursday, 973 on Wednesday and 1,127 new cases reported on Tuesday.

Dr. Cara Christ, director of the Arizona Department of Health Services, said at a Thursday news conference that the increase in cases was expected given increased testing and reopening. 

“As people come back together, we know that there is going to be transmission of COVID-19,” Christ said. “We are seeing an increase in cases, and so we will continue to monitor at this time. But we have to weigh the impacts of the virus versus the impacts of what a stay-at-home order can have on long-term health as well.”

Before this week, new cases reported daily have typically been in the several hundreds. The state has reported new cases each day, typically in the several hundreds. The daily increase in case numbers also reflects a lag in obtaining results from the time a test was conducted.

Additional deaths are reported each day as well and have varied between single- and double-digit increases. The number of deaths reported each day represents the additional known deaths reported by the Health Department that day, but could have occurred weeks prior and on different days.

The date with the most deaths in a single day so far is April 30 with 26 deaths, followed by May 7 with 25 deaths and April 23 and May 8 with 24 deaths each. Next comes April 20 with 23 deaths and April 19, May 3 and May 5 with 22 deaths on each of those days, according to Friday’s data, which is likely to change in the days ahead as more deaths are identified.

Maricopa County’s confirmed case total was at 12,761 on Saturday according to state numbers. 

“We are seeing some indicators that the number of cases in Maricopa County are starting to rise,” county spokesman Ron Coleman said this week in an email. “This is in addition to an increase from increased testing.”

The number of Arizona cases likely is higher than official numbers because of limits on supplies and available tests, especially in early weeks of the pandemic. 

The percentage of positive tests per week increased from 5% a month ago to 6% three weeks ago to 9% two weeks ago, and 11% last week. The ideal trend is a decrease in percent of positives tests out of all tests. 

In addition to an increase in hospitalizations, ventilator use in Arizona by suspected and positive COVID-19 patients statewide jumped to 292 on Friday, which was the highest number reported since the state data began on April 9.

Also, ICU bed use by patients with positive and suspected COVID-19 on Friday was 391 — a record high and the 11th consecutive day that the number has been higher than 370.

The latest Arizona data

As of Saturday morning, the state reported death totals from these counties: 489 in Maricopa, 205 in Pima, 85 in Coconino, 72 in Navajo, 57 in Mohave, 49 in Apache, 41 in Pinal, 24 in Yuma, six in Yavapai, 4 in Cochise, three in Santa Cruz and three in Gila.

La Paz County officials reported two deaths and Graham County reported one death, although the state site listed them as just having fewer than three deaths. Greenlee County reported no deaths.

Of the statewide identified cases overall, 47% are men and 53% are women. But men made up a higher percentage of deaths, with 54% of the deaths men and 46% women as of Saturday.

Overall, Arizona has 354 cases and 14.49 deaths per 100,000 residents, according to state data.

The scope of the outbreak differs by county, with the highest rates in Apache, Navajo, Santa Cruz, Yuma and Coconino counties.

Of all confirmed cases, 9% are younger than 20, 42% are aged 20 to 44, 16% are aged 45 to 54, 14% are aged 55 to 64 and 17% are over 65. This aligns with the proportions of testing done for each age range.

The state Health Department website said both state and private laboratories have completed a total of  271,646 diagnostic tests for COVID-19, and 109,266 serology, or antibody, tests.

Most COVID-19 diagnostic tests come back negative, the state’s dashboard shows, with 7.2% positive. For serology tests, 3% have come back positive.

Maricopa County’s Department of Public Health provided more detailed information on a total of 12,685 cases Friday (the state reported the county case total at 12,761):

Cases rise in other counties

According to Friday’s state update, Pima County reported 2,950 identified cases. Navajo County reported 2,152 cases, while Yuma County reported 1,850; Apache County 1,692; Coconino County 1,267; Pinal County 1,067; Santa Cruz County 530; Mohave County 485; and Yavapai County 326. 

La Paz County reported 158 cases, Cochise County 122, Gila County 43, Graham County 39 and Greenlee County nine, according to state numbers.

The Navajo Nation reported a total of 5,808 cases and at least 269 confirmed deaths as of Friday. The Navajo Nation includes parts of Arizona, New Mexico and Utah.

237 cases in Arizona prisons

The Arizona Department of Corrections’ online dashboard said 237 inmates had tested positive for COVID-19 as of Friday, up from 198 one day prior. 

The cases were at these eight facilities: 75 in Florence, 97 in Yuma, 28 in Tucson, 12 in Phoenix, nine in Marana, six in Eyman, six in Perryville, two in Kingman and two in Lewis.

Four inmate deaths have been confirmed — two in Florence and two in Tucson, and three deaths are under investigation, the dashboard says.

Ninety-nine staff members have self-reported positive for the virus, and 69 have been certified as recovered, the department said. 

Both legal and nonlegal visitations have been suspended through June 13, at which point the department will reassess. Temporary video visitation will be available to approved visitors and inmates who have visitation privileges, the department announced. Inmates are eligible for one 15-minute video visit per week. CenturyLink also is giving inmates two additional 15-minute calls for free during each week visitation is restricted.

Separately, the Maricopa County Jail system as of Friday was reporting 30 inmates who had tested positive for COVID-19, county officials said. That was up from six positive inmates one week prior.

Arizona Republic reporter Alison Steinbach contributed to this article

Reach the reporter at Stephanie.Innes@gannett.com or at 602-444-8369. Follow her on Twitter @stephanieinnes

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This content was originally published here.

44 Black Mental Health Support Resources for Anyone Who Needs Them | SELF

Black lives matter. Black bodies matter. Black mental health matters. This latest string of rampant and wanton brutality against Black people flies in the face of these indisputable truths. As a Black woman myself, I’ve spent years trying to process the violence and racism that are part and parcel of living in this country in this skin. But I’ve never had to do it during a pandemic that, of course, is decimating Black lives, health, and communities the most.

In my years as a mental health reporter and editor, I’ve been heartened to slowly see the collection of mental health resources for Black people start to grow. It’s still not where it needs to be, but there is solidarity and support out there if you need help processing what’s happening (and there’s nothing weak about needing it, either). Here’s a list of resources that may help if you’re looking for mental health support that validates and celebrates your Blackness.

It starts with people to follow on Instagram who regularly drop mental health gems, then goes into groups and organizations that do the same, followed by directories and networks for finding a Black mental health practitioner. Lastly, I’ve added a few tips to keep in mind when seeking out this kind of mental health support, especially right now.

People to follow

Alishia McCullough, L.P.C.: McCullough’s Instagram places an emphasis on Black mental wellness and self-love, along with social justice issues like fat liberation. She also posts about participating in live virtual panels on issues like living with an abuser while social distancing and having to live with toxic family during the new coronavirus crisis, so if you’re craving that kind of content, consider following along.

Bassey Ikpi: Ikpi is a mental health advocate who I first became familiar with when she appeared on The Read podcast, where she talked about her now best-selling debut essay collection, I’m Telling the Truth But I’m Lying, in which she writes about her experiences having bipolar II and anxiety. Ikpi is also the founder of the Siwe Project, a global non-profit that increases awareness around mental health in people of African descent.

Cleo Wade: The best-selling author of Heart Talk and Where to Begin: A Small Book About Your Power to Create Big Change in Our Crazy World, Wade’s poetic Instagram dispatches offer quiet meditations on life, love, spirituality, current events, relationships, and finding inner peace.

Donna Oriowo, Ph.D.: I first heard about Oriowo, a sex and relationship therapist, when a friend told me I had to listen to a recent Therapy for Black Girls podcast episode where Oriowo discussed whether Issa and Molly can repair their friendship on Insecure. Oriowo shared so much insight into Issa and Molly’s psyches that I was having lightbulb moment after lightbulb moment. And as a sex and relationship therapist, her Instagram feed destigmatizes Black sexuality and relationships specifically, which is essential.

Jennifer Mullan, Psy.D.: Mullan’s mission is, as her Instagram handle so succinctly sums up, decolonizing therapy. Check out her feed for ample conversation about how mental health (and access to related services) are impacted by trauma and systemic inequities, along with hope that healing is indeed possible.

Jessica Clemons, M.D.: Dr. Clemons is a board-certified psychiatrist who spotlights Black mental health. Her Instagram encompasses everything from mindfulness to motherhood, and her live Q + As and #askdrjess video posts really make it feel like you’re not only following her, but connecting with her, too.

Joy Haven Bradford, Ph.D.: Bradford is a psychologist who aims to make discussions about mental health more accessible for Black women, particularly by bringing pop culture into the mix. She’s also the founder of Therapy for Black Girls, a much-loved resource that includes a great Instagram feed and podcast.

Mariel Buquè, Ph.D.: Click the follow button if you could use periodic “soul check” posts asking how your soul is holding up, gentle ways to practice self-care, help sorting through your feelings, advice on building resilience, and so much more.

Morgan Harper Nichols: If you don’t already follow Nichols but like stirring art mixed with uplifting messages, you’re in for a treat. Her Instagram feed is a swirly, colorful dream of what she describes as “daily reminders through art”—reminders of how valid it is to still seek joy, and of your worth, and of the fact that “small progress is still progress.”

Nedra Glover Tawwab: In Tawwab’s Instagram bio, the licensed clinical social worker describes herself as a “boundaries expert.” That expertise is critical right now, given that safeguarding our mental health as much as possible pretty much always requires firm boundaries. Tawwab also holds weekly Q+A sessions on Instagram, so stay tuned to her feed if you have a question you’d like to submit.

Thema Bryant-Davis, Ph.D.: A licensed psychologist and ordained minister, some of Bryant-Davis’s clinical background focuses on healing trauma and working at the intersection of gender and race. If you happen to be avoiding Twitter as much as possible for the sake of your mental health, like I am, you might like that her feed is mainly a collection of her great mental health tweets that you would otherwise miss.

Brands, collectives, and organizations to follow

Balanced Black Girl: This gorgeous feed features photos and art of Black people along with summaries of their podcast episode topics, worthwhile tweets you can see without having to scroll through Twitter, and advice about trying to create a balanced life even in spite of everything we’re dealing with. Balanced Black Girl also has a great Google Doc full of more mental health and self-care resources.

Black Female Therapists: On this feed, you’ll find inspirational messages, self-care Sunday reminders, and posts highlighting various Black mental health practitioners across the country. They have also recently launched an initiative to match Black people in need with therapists who will do two to three free virtual sessions.

Black Girls Heal: This feed focuses on Black mental health surrounding self-love, relationships, and unresolved trauma, along with creating a sense of community. (Like by holding “Saturday Night Lives” on Instagram to discuss self-love.) Following along is also an easy way to keep track of the topics on the associated podcast, which shares the same name.

Black Girl in Om: This brand describes their vision as “a world where womxn of color are liberated, empowered & seen.” On their feed, you can find helpful resources like meditations, along with a lot of joyful photos of Black people, which I personally find incredibly restorative at this time.

Black Mental Wellness: Founded by a team of Black psychologists, this organization offers a ton of mental health insight through posts about everything from destigmatizing therapy, to talking about Black men’s mental health, to practicing gratitude, to coping with anxiety.

Brown Girl Self-Care: With a mission described as “Help Black women healing from trauma go from ‘every once in a while’ self-care to EVERY DAY self-care,” this feed features tons of affirmations and self-care reminders that might help you feel a little bit better. Plus, in June, they’re running a free virtual Self-Care x Sisterhood circle every Sunday.

Ethel’s Club: This social and wellness club for people of color, originally based in Brooklyn, has pivoted hard during the pandemic and now offers a digital membership club featuring virtual workouts, book clubs, wellness salons, creative workshops, artist Q+As, and more. Membership is $17 a month, or you can follow their feed for free tidbits if that’s a better option for you.

Heal Haus: This cafe and wellness space in Brooklyn has of course closed temporarily due to the pandemic. In the meantime, they’ve expanded their online offerings. Follow their Instagram to stay up to date with what they’re rolling out, like their free upcoming Circle of Care for Black Womxn on June 5.

The Hey Girl Podcast: This podcast features Alexandra Elle, who I mentioned above, in conversation with various people who inspire her. Its Instagram counterpart is a pretty and calming feed of great takeaways from various episodes, sometimes layered over candy-colored backgrounds, other times over photos of the people Elle has spoken to.

Inclusive Therapists: This community’s feed specializes in regular doses of mental health insight, a lot of which seems especially geared towards therapists. With that said, you don’t have to be a therapist to see the value in posts like this one that notes, “You are whole. The system is broken.”

The Loveland Foundation: Founded by writer, lecturer, and activist Rachel Elizabeth Cargle, The Loveland Foundation works to make mental health care more accessible for Black women and girls. They do this through multiple avenues, such as their Therapy Fund, which partners with various mental health resources to offer financial assistance to Black women and girls across the nation who are trying to access therapy. Their Instagram feed is a great mix of self-care tips and posts highlighting various Black mental health experts, along with information about panels and meditations.

The Nap Ministry: If you ever feel tempted to underestimate the pure power of just giving yourself a break, The Nap Ministry is a great reminder that, as they say, “rest is a form of resistance.” Rest also allows for grieving, which is an unfortunately necessary practice as a Black person in America, especially now. In addition to peaceful and much-needed photos of Black people at rest, there are great takedowns of how harmful grind/hustle culture can be to our health.

OmNoire: Self-described as “a social wellness club for women of color dedicated to living WELL,” this mental health resource actually just pulled off a whole virtual retreat. Follow along for affirmations, self-care tips, and images that are inspirational, grounding, or both. (Full disclosure: I went on a great OmNoire retreat a year ago.)

Saddie Baddies: Gorgeous feed, gorgeous mission. Along with posts exploring topics like respectability politics, obsessive-compulsive disorder, self-harm, and loneliness, this Instagram features beautiful photos of people of color with the goal of making “a virtual safe space for young WoC to destigmatize mental health and initiate collective healing.”

Sad Girls Club: This account is all about creating a mental health community for Gen Z and millennial women who have mental illness, along with reducing stigma and sharing information about mental health services. Scroll through the feed and you’ll see many people of color, including Black women, openly discussing mental health—a welcome sight.

Sista Afya: This Chicago-based organization focuses on supporting Black women’s mental health in a number of ways, like connecting Black women to affordable and accessible mental health practitioners and running mental health workshops. They also offer a Thrive in Therapy program for Illinois-based Black women making less than $1,500 a month. For $75 a month, members receive two therapy sessions, free admission to the monthly support groups, and more.

Transparent Black Girl: Transparent Black Girl aims to redefine the conversation around what wellness means for Black women. Their feed is a mix of relatable memes, hilarious pop culture commentary, beautiful images and art of Black people, and mental health resources for Black people. Transparent Black Guy, the brother resource to Transparent Black Girl, is also very much worth a follow, particularly given the stigma and misconceptions that often surround Black men being vulnerable about their mental health.

Directories and networks for finding a Black (or allied) therapist

Here are various directories and networks that have the goal of helping Black people find therapists who are Black, from other marginalized racial groups, or who describe themselves as inclusive. This list is not exhaustive, and some of these resources will be more expansive than others. They also do different levels of vetting the experts they include. If you find a therapist via one of these sites who seems promising, be sure to do some follow-up searches to learn more about them.

This content was originally published here.

How The ‘Lost Art’ Of Breathing Impacts Sleep And Stress : Shots – Health News : NPR

Breathing slowly and deeply through the nose is associated with a relaxation response, says James Nestor, author of Breath. As the diaphragm lowers, you’re allowing more air into your lungs and your body switches to a more relaxed state.

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Breathing slowly and deeply through the nose is associated with a relaxation response, says James Nestor, author of Breath. As the diaphragm lowers, you’re allowing more air into your lungs and your body switches to a more relaxed state.

Humans typically take about 25,000 breaths per day — often without a second thought. But the COVID-19 pandemic has put a new spotlight on respiratory illnesses and the breaths we so often take for granted.

Journalist James Nestor became interested in the respiratory system years ago after his doctor recommended he take a breathing class to help his recurring pneumonia and bronchitis.

While researching the science and culture of breathing for his new book, Breath: The New Science of a Lost Art, Nestor participated in a study in which his nose was completely plugged for 10 days, forcing him to breathe solely through his mouth. It was not a pleasant experience.

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Nestor says the researchers he’s talked to recommend taking time to “consciously listen to yourself and [to] feel how breath is affecting you.” He notes taking “slow and low” breaths through the nose can help relieve stress and reduce blood pressure.

“This is the way your body wants to take in air,” Nestor says. “It lowers the burden of the heart if we breathe properly and if we really engage the diaphragm.”

Interview Highlights

On why nose breathing is better than mouth breathing

The nose filters, heats and treats raw air. Most of us know that. But so many of us don’t realize — at least I didn’t realize — how [inhaling through the nose] can trigger different hormones to flood into our bodies, how it can lower our blood pressure … how it monitors heart rate … even helps store memories. So it’s this incredible organ that … orchestrates innumerable functions in our body to keep us balanced.

On how the nose has erectile tissue

The nose is more closely connected to our genitals than any other organ. It is covered in that same tissue. So when one area gets stimulated, the nose will become stimulated as well. Some people have too close of a connection where they get stimulated in the southerly regions, they will start uncontrollably sneezing. And this condition is common enough that it was given a name called honeymoon rhinitis.

James Nestor’s previous book, Deep, focused on the science behind free diving.

Julie Floersch/Riverhead Books


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James Nestor’s previous book, Deep, focused on the science behind free diving.

Another thing that is really fascinating is that erectile tissue will pulse on its own. So it will close one nostril and allow breath in through the other nostril, then that other nostril will close and allow breath in. Our bodies do this on their own. …

A lot of people who’ve studied this believe that this is the way that our bodies maintain balance, because when we breathe through our right nostril, circulation speeds up [and] the body gets hotter, cortisol levels increase, blood pressure increases. So breathing through the left will relax us more. So blood pressure will decrease, [it] lowers temperature, cools the body, reduces anxiety as well. So our bodies are naturally doing this. And when we breathe through our mouths, we’re denying our bodies the ability to do this.

On how breath affects anxiety

I talked to a neuropsychologist … and he explained to me that people with anxieties or other fear-based conditions typically will breathe way too much. So what happens when you breathe that much is you’re constantly putting yourself into a state of stress. So you’re stimulating that sympathetic side of the nervous system. And the way to change that is to breathe deeply. Because if you think about it, if you’re stressed out [and thinking] a tiger is going to come get you, [or] you’re going to get hit by a car, [you] breathe, breathe, breathe as much as you can. But by breathing slowly, that is associated with a relaxation response. So the diaphragm lowers, you’re allowing more air into your lungs and your body immediately switches to a relaxed state.

On why exhaling helps you relax

Because the exhale is a parasympathetic response. Right now, you can put your hand over your heart. If you take a very slow inhale in, you’re going to feel your heart speed up. As you exhale, you should be feeling your heart slow down. So exhaling relaxes the body. And something else happens when we take a very deep breath like this. The diaphragm lowers when we take a breath in, and that sucks a bunch of blood — a huge profusion of blood — into the thoracic cavity. As we exhale, that blood shoots back out through the body.

On the problem with taking shallow breaths

You can think about breathing as being in a boat, right? So you can take a bunch of very short, stilted strokes and you’re going to get to where you want to go. It’s going to take a while, but you’ll get there. Or you can take a few very fluid and long strokes and get there so much more efficiently. … You want to make it very easy for your body to get air, especially if this is an act that we’re doing 25,000 times a day. So, by just extending those inhales and exhales, by moving that diaphragm up and down a little more, you can have a profound effect on your blood pressure, on your mental state.

On how free divers expand their lung capacity to hold their breath for several minutes

The world record is 12 1/2 minutes. … Most divers will hold their breath for eight minutes, seven minutes, which is still incredible to me. When I first saw this, this was several years ago, I was sent out on a reporting assignment to write about a free-diving competition. You watch this person at the surface take a single breath there and completely disappear into the ocean, come back five or six minutes later. … We’ve been told that whatever we have, whatever we’re born with, is what we’re going to have for the rest of our lives, especially as far as the organs are concerned. But we can absolutely affect our lung capacity. So some of these divers have a lung capacity of 14 liters, which is about double the size for a [typical] adult male. They weren’t born this way. … They trained themselves to breathe in ways to profoundly affect their physical bodies.

Sam Briger and Joel Wolfram produced and edited this interview for broadcast. Bridget Bentz, Molly Seavy-Nesper and Deborah Franklin adapted it for the Web.

This content was originally published here.

Suddenly, Public Health Officials Say Social Justice Matters More Than Social Distance – POLITICO

“The injustice that’s evident to everyone right now needs to be addressed,” Abraar Karan, a Brigham and Women’s Hospital physician who’s exhorted coronavirus experts to use their platforms to encourage the protests, told me.

It’s a message echoed by media outlets and some of the most prominent public health experts in America, like former Centers for Disease Control and Prevention director Tom Frieden, who loudly warned against efforts to rush reopening but is now supportive of mass protests. Their claim: If we don’t address racial inequality, it’ll be that much harder to fight Covid-19. There’s also evidence that the virus doesn’t spread easily outdoors, especially if people wear masks.

The experts maintain that their messages are consistent—that they were always flexible on Americans going outside, that they want protesters to take precautions and that they’re prioritizing public health by demanding an urgent fix to systemic racism.

But their messages are also confounding to many who spent the spring strictly isolated on the advice of health officials, only to hear that the need might not be so absolute after all. It’s particularly nettlesome to conservative skeptics of the all-or-nothing approach to lockdown, who point out that many of those same public health experts—a group that tends to skew liberal—widely criticized activists who held largely outdoor protests against lockdowns in April and May, accusing demonstrators of posing a public health danger. Conservatives, who felt their own concerns about long-term economic damage or even mental health costs of lockdown were brushed aside just days or weeks ago, are increasingly asking whether these public health experts are letting their politics sway their health care recommendations.

“Their rules appear ideologically driven as people can only gather for purposes deemed important by the elite central planners,” Brian Blase, who worked on health policy for the Trump administration, told me, an echo of complaints raised by prominent conservative commentators like J.D. Vance and Tim Carney.

Conservatives also have seized on a Twitter thread by Drew Holden, a commentary writer and former GOP Hill staffer, comparing how politicians and pundits criticized earlier protests but have been silent on the new ones or even championed them.

“I think what’s lost on people is that there have been real sacrifices made during lockdown,” Holden told me. “People who couldn’t bury loved ones. Small businesses destroyed. How can a health expert look those people in the eye and say it was worth it now?”

Some members of the medical community acknowledged they’re grappling with the U-turn in public health advice, too. “It makes it clear that all along there were trade-offs between details of lockdowns and social distancing and other factors that the experts previously discounted and have now decided to reconsider and rebalance,” said Jeffrey Flier, the former dean of Harvard Medical School. Flier pointed out that the protesters were also engaging in behaviors, like loud singing in close proximity, which CDC has repeatedly suggested could be linked to spreading the virus.

“At least for me, the sudden change in views of the danger of mass gatherings has been disorienting, and I suspect it has been for many Americans,” he told me.

The shift in experts’ tone is setting up a confrontation amid the backdrop of a still-raging pandemic. Tens of thousands of new coronavirus cases continue to be diagnosed every day—and public health experts acknowledge that more will likely come from the mass gatherings, sparked by the protests over George Floyd’s death while in custody of the Minneapolis police last week.

“It is a challenge,” Howard Koh, who served as assistant secretary for health during the Obama administration, told me. Koh said he supports the protests but acknowledges that Covid-19 can be rapidly, silently spread. “We know that a low-risk area today can become a high-risk area tomorrow,” he said.

Yet many say the protests are worth the risk of a possible Covid-19 surge, including hundreds of public health workers who signed an open letter this week that sought to distinguish the new anti-racist protests “from the response to white protesters resisting stay-home orders.”

Those protests against stay-at-home orders “not only oppose public health interventions, but are also rooted in white nationalism and run contrary to respect for Black lives,” according to the letter’s nearly 1,300 signatories. “Protests against systemic racism, which fosters the disproportionate burden of COVID-19 on Black communities and also perpetuates police violence, must be supported.”

“Staying at home, social distancing, and public masking are effective at minimizing the spread of COVID-19,” the letter signers add. “However, as public health advocates, we do not condemn these gatherings as risky for COVID-19 transmission.”

Was it fair to decry conservatives’ protests about the economy while supporting these new protests? And if tens of thousands of people get sick from Covid-19 as a result of these mass gatherings against racism, is that an acceptable trade-off? Those are questions that a half-dozen coronavirus experts who said they support the protests declined to directly answer.

“I don’t know if it’s really for me to comment,” said Karan. He did add: “Addressing racism, it can’t wait. It should’ve happened before Covid. It’s happening now. Perhaps this is our time to change things.”

“Many public health experts have already severely undermined the power and influence of their prior message,” countered Flier. “We were exposed to continuous daily Covid death counts, and infections/deaths were presented as preeminent concerns compared to all other considerations—until nine days ago,” he added.

“Overnight, behaviors seen as dangerous and immoral seemingly became permissible due to a ‘greater need,’” Flier said.

The frustration from some conservatives is an outgrowth of how Covid-19 has affected the United States so far. In Blue America, the pandemic is a dire threat that’s killed tens of thousands in densely packed urban centers like New York City—and warnings from infectious-disease experts like Tony Fauci carry the weight of real-world implications. In many parts of Red America, rural states like Alaska and Wyoming still have fewer than 1,000 confirmed cases, and some residents are asking why they shuttered their economies for a virus that had little visible effect over the past three months.

Pollsters also have consistently found a partisan split on how Americans view the pandemic, with Democrats believing that the media is underplaying the risks of Covid-19 while Republicans say that the threat has been exaggerated. That attitude may change with virus numbers on the march in states like Alabama and Arkansas.

People on both sides are already trying to figure out whom to blame if coronavirus cases jump as widely expected after hundreds of thousands of Americans spilled into the streets this past week, sometimes in close proximity for hours at a time. When we discussed the possible risks of a large public gathering, protest supporters like Karan and Koh seized on police behaviors —like using pepper spray and locking up protesters in jail cells—which they noted created significant risks of their own to spread Covid-19.

“Trump will try to blame protestors for [the] spike in coronavirus cases he caused,” a spokesperson for Protect Our Care, a progressive-aligned health care group, wrote in a memo circulated to media members on Wednesday. While acknowledging the risks of mass protests, “the reality is that the spikes in cases have been happening well before the protests started—in large part because Trump allowed federal social distancing guidelines to expire, failed to adequately increase testing, and pushed governors to reopen against the advice of medical experts,” the spokesperson claimed.

Contra those claims, public health experts like Koh generally acknowledge that it’s going to be difficult to tease apart why Covid-19 cases could jump in the coming weeks, given the sheer number of Americans joining mass gatherings, states relaxing restrictions and other factors that could pose challenges for disease-tracing on a large scale.

Some experts also are cautious of condemning states for rolling back restrictions after inconclusive evidence from states that already moved to do so. For instance, a widely shared Atlantic article in April framed the decision by Georgia’s GOP governor to relax social-distancing restrictions as an “experiment in human sacrifice.” A month later, Georgia’s daily coronavirus cases have stayed relatively level and it’s not clear whether the rollback led to significant new outbreaks.

What is clear is that the only successful tactic to stop Covid-19 remains social distancing and, failing that, thoroughly wearing personal protective equipment. Yet there’s also considerable video and photo evidence of maskless protesters, sometimes closely huddled together with public officials—also sans mask—in efforts to defuse tensions, or recoiling from police attacks that forced them to remove protection.

That means a collision between the protests and coronavirus is coming, which will force decisions big and small. Will local leaders need to reimpose restrictions when cases go up? Will that advice be trusted? Or is it possible that their guidance was too draconian all along?

Some participants in the new protests—whether marching themselves or drawn in from the sidelines—say they recognize the threat they’re facing.

A Washington, D.C., man named Rahul Dubey attracted national attention for sheltering protesters from the police inside his home on Monday night. On Wednesday, he told me that he was on the way to get a coronavirus test and was planning to self-quarantine himself for two weeks—having spent hours in close proximity to dozens of maskless people.

It’s a reminder of a line often heard from medical experts: Public health should be above politics. Now some conservatives are invoking it too.

“The virus doesn’t care about the nature of a protest, no matter how deserving the cause is,” Holden said.

This content was originally published here.