This was going to be a great decade. January 2020 felt like buying a new high-end SUV. A lot of cool technology and performance. It would be pricy, but you planned to work one 24-hour overtime shift a month to cover the extra cost of all of those upgrades until that promotion comes through. Weeks later, someone rear-ends you. The repairs are done, but things are not right. The back-up camera is out-of-focus and there is a back-order for parts. Emergency services after the COVID-19 pandemic will be like this collision-repaired SUV.
Humans Are Getting Restless and Sicker as They “Stay at Home”
Living in a chronically stressful situation makes humans forgetful, reduces hand-to-eye coordination, and slows reaction time to situations. Humans are more likely to have mood disorders or act out during a long period of stress.
Chronic stress can lead to malignancy because of a suppressed immune system. The chronic “fight-or-flight” situation may keep the heart rate and blood pressure elevated. Depending on the underlying medical conditions, there is a possibility of cardiac arrhythmias that may lead to myocardial infarction. These factors affect first responders as well as citizens.
Humans may starve or gorge. Type 2 diabetes may develop due to a “stay-at-home” diet and lifestyle. The gastrointestinal (GI) tract is more irritable – that may lead to GI inflammatory diseases.
About 18% of Americans have some type of mental health issue that requires treatment, about 6.7 million receive counseling. The FaceTime or telephone counseling sessions during the “stay-at-home” era may not be as effective as the face-to-face sessions.
Social isolation may result in Substance Use Disorder (SUD) users getting high alone, resulting in overdoses that will not be witnessed by others and lead to death. Those in recovery will have difficulty getting peer-to-peer support and remaining sober.
All of these factors mean that we will encounter a higher number of 9-1-1 calls involving people dangerously acting-out, more patients presenting with serious pathophysiology and more people falling through the safety net of available services.
Local and State Governments Suffer Reduced Revenue
About half of the income that runs state government comes from sales taxes, personal and business income taxes, excise taxes. The rest comes from federal grants and charges.
Many state governments have not returned to the financial health it had in the late 1990s. The recession of 2001 and the “Great Recession” of 2007-2009 were different than earlier recessions. The decline in tax revenue was steep in both periods and the recovery has been slower than any earlier recession. For our colleagues in public health, there were 250,000 state and jurisdictional positions never restored after the “Great Recession.”
The Urban Institute pointed out that: “Even though 42 states had recovered their nominal 2008 tax revenue levels by 2013, only 24 experienced real revenue growth.” Alan Greenblatt, looking at the projected 2020 budget fallout, points out:
Cities from Santa Barbara, Calif., to Scranton, Pa., have furloughed workers. In Akron, Ohio, 600 city employees — a third of the total workforce — have been furloughed.
County-level governments rely on property taxes for 72% of their revenue. It is the most stable source of government revenue but when the tenants of commercial properties do not pay their lease or go bankrupt during the “Stay at Home” quarantine the amount of property tax revenue received plummets.
A decline in state revenue impacts local jurisdictions as 32% of local revenue comes through a transfer of state funds to local jurisdictions. In Las Vegas and Baltimore, the local government leaders are starting the reduction-in-force process.
Las Vegas Metropolitan Police Department laid off more than 100 part-time employees last week. The emergency created by the coronavirus has allowed local governments throughout the Las Vegas Valley to suspend more than 25 labor contracts.
Baltimore informed its labor unions it is considering pay cuts, furloughs, and layoffs to address an anticipated $103 million revenue shortfall for the next fiscal year that starts July 1. The city wants to make $11 million in personnel cuts.
Many jurisdictions are looking at significantly lowered revenues. For example, San Antonio, Texas, anticipates a 17% decrease in sales tax revenue.
I would anticipate local jurisdictions will impose a hiring freeze, provide no cost-of-living pay raises for Fiscal Year 2021 (generally from July 1, 2020, to June 30, 2021), and postpone or cancel major purchases – like replacement apparatus. That promotion we talked about in the opening paragraph … probably will not happen this year.
Building Company Level Resilience
Mike Taigman points out that resilience is the ability to advance despite adversity.
… people who are resilient tend to be more able to adapt to changes in the world, whether it’s having a baby or getting divorced… and they are less likely to be thrown off by little things, like getting cut off in traffic or dropping your phone in the toilet. They tend to be braver and more willing to take reasonable risks, therefore they accomplish more. And they’re much more effective at achieving goals they set for themselves.
Anthony Bourdain’s reflection on firefighters after visiting Detroit Squad 3 reflects our cultural approach to challenges:
Firefighters, in my experience, are a lot like the Marines I’ve met over the years. No matter how badly led, ridiculously underequipped, underappreciated, no matter how doomed their mission, they take a bizarre and quite beautiful pride in at least being screwed more than everybody else and doing it with style. They seem to do what they do for themselves. It’s not a job. It’s a calling
As pointed out last week, one of the best resiliency resources is a webinar hosted by Taigmen: “First Responders, Stress Management and Coronavirus.” Taigman provides a thoughtful presentation with a rich list of resources.
This 1 hour, 22-minute webinar covers the neuroscience of resilience.
Link to the webinar: https://info.lexipol.com/webinar-coronavirus-stress-management-ty
Link to the research page: https://info.lexipol.com/coronavirus-stress-management
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Yaribeygi, H., Panahi, Y., Sahraei, H., Johnston, T. P., & Sahebkar, A. (2017). The impact of stress on body function: A review. EXCLI journal, 16, 1057–1072. https://doi.org/10.17179/excli2017-480 Accessed April 11, 2020: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5579396/
(2020) Mental Health in America. Peoria, Ill: Bradley University. Accessed April 11, 2020: https://onlinedegrees.bradley.edu/blog/mental-health-in-america/
Volkow ND. Collision of the COVID-19 and Addiction Epidemics. Ann Intern Med. 2020; [Epub ahead of print 2 April 2020]. doi: https://doi.org/10.7326/M20-1212. Accessed April 12, 2020: https://annals.org/aim/fullarticle/2764313/collision-covid-19-addiction-epidemics
Wilson, R. T., Troisi, C. L. & Gary-Webb, T. L. (2020 April 5) A deficit of more than 250,000 public health workers is no way to fight Covid-19. STATnews.com Accessed April 12, 2020: https://www.statnews.com/2020/04/05/deficit-public-health-workers-no-way-to-fight-covid-19/
Francis, N. & Sammartino, F. (2015 September) Governing with Tight Budgets: Long Term Trends in State Finances. Washington, DC: The Urban Institute. Accessed April 11, 2020: https://www.urban.org/sites/default/files/publication/66046/2000376-long-term-trends-in-state-finances.pdf
Greenblatt, A. (2020 April 9) State Budget Fallout: ‘A Hurricane That Hits All Over the Country’ The revenue drop from COVID-19 is barely starting to show up in official figures, but already furloughs and major shortfalls are common in state and local governments around the country. The pain may be sudden, but it could last for years. Governing.com. Folsom, CA: e.Republic. Accessed April 11, 2020: https://www.governing.com/finance/State-Budget-Fallout-A-Hurricane-That-Hits-All-Over-the-Country.html
Greenblatt, A. (2020 March 19) States and Cities Face the Prospect of Severe Budget Shortfalls. No one knows how deep or long the pandemic-triggered recession will be. But nearly every type of government revenue, including income, sales and gas taxes, will take a hit. Well-funded rainy-day funds should help. Governing.com. Folsom, CA: e.Republic. Accessed April 11, 2020: https://www.governing.com/finance/States-and-Cities-Face-the-Prospect-of-Severe-Budget-Shortfalls.html
LaFerney, D. (2020 April 10) Las Vegas police announce layoffs in wake of coronavirus struggles. Las Vegas Review-Journal. Accessed April 11, 2020: https://www.reviewjournal.com/news/politics-and-government/las-vegas-police-announce-layoffs-in-wake-of-coronavirus-struggles-2004337/
Davisdon, M. S. (2020 April 10) Coronavirus emergency allows for rare union contract suspensions. Las Vegas Review-Journal. Accessed April 11, 2020: https://www.reviewjournal.com/post/2004073
Anderson, J. & Richman, T. (2020 April 10) Baltimore unions told there could be pay cuts, furloughs and layoffs because of coronavirus budget shortfall. The Baltimore Sun. https://www.baltimoresun.com/coronavirus/bs-md-ci-police-personnel-cuts-20200410-kabfx5ybkvhl3mkluasdg323re-story.html
Hellgren, M. (2020 April 11) ‘Slap In The Face’ | Firefighters Union Says City Shouldn’t Be Discussing Layoffs, Furloughs During COVID-19 Pandemic. WJZ Baltimore CBS 13. Accessed April 11, 2020: https://baltimore.cbslocal.com/2020/04/11/slap-in-the-face-firefighters-union-says-city-shouldnt-be-discussing-layoffs-furloughs-during-covid-19-pandemic/
Garnham, J. P. (2020 April 2) Local governments, already hard hit by the coronavirus, are facing a fresh budget threat: economic recession. KSAT.com Accessed April 12, 2020: https://www.ksat.com/news/texas/2020/04/02/local-governments-already-hard-hit-by-the-coronavirus-are-facing-a-fresh-budget-threat-economic-recession/
Staff (2019 October 14) How Improving Resilience Can Make You Healthier, Happier and More Effective. JEMS. Accessed April 12, 2020: https://www.jems.com/2019/10/14/improving-resilience-healthier-happier-effective/