Situation report from New Jersey Paramedic Steve Velásquez: “And to think the scores of ambulances, hundreds of out of state providers, thousands of emergencies, hundreds of out of hospital cardiac arrests and pronouncements we performed, the 15 of our own we buried, the scores of our own that are/were sick or recovering or will sustain long term physical or psychological damage from this… was all done in the name of an elaborate hoax by those who would control us. At least that’s what Karen of Facebook is telling me.”
As communities transition from lock-down to a phased opening, fire and ems commanders are facing unique and challenging situations as we continue to be on the front line of public safety, public health and medicine.
Revisiting the Hammer and the Dance
Tomas Pueyo created a great visualization, “The Hammer and the Dance,” to look at lockdown and reopening. “The dance” is the period we’re entering now. The period where we need to think about our movements like the ebb and flow of a complicated dance.
Pueyo says that “It’s called ‘the dance’ because it is a much more fluid phase. You might have outbreaks, so you need to react to that. It’s much more technical, too.” More testing, more contact tracing, masks and social distancing are elements of the dance.
“What I will say is life will never go back to what people have in mind as normal,” Pueyo said. “Once you change your habits as a society for months, it is likely that many of these habits will remain afterwards, so the world we knew until February 2020 is gone.”
KGO-TV (2020)
How Long Will We Dance?
Michael Osterholm, Ph.D., MPH, is the Director of the Center for Infectious Disease Research and Policy at the University of Minnesota. He advises both Republican and Democratic presidents and was the interim Director of the Centers for Disease Control (CDC). His 2017 book Deadliest Enemy, foretold a global pandemic.
Blue Zones founder Dan Buetner interviewed Osterholm and calls him “… one of the most dependable, non-political sources for straight answers for COVID-19.” Here are some of the bullet points, you should read the entire interview. (click here)
- If you’re under age 55, obesity is the #1 risk factor.
- Wearing a cloth mask does not protect you much if you’re in close contact with someone who is COVID-19 contagious. It may give you 20 minutes, instead of 10, to avoid contracting the disease.
- We can expect COVID-19 to infect 60% – 70% of Americans. That’s around 200 million Americans.
- We can expect between 800,000 and 1.6 million Americans to die in the next 18 months if we don’t have a successful vaccine.
- There is no guarantee of an effective vaccination and even if we find one, it may only give short term protection.
We have to learn not only how to die with this virus, which tragically we’ve had to do, but we also have to learn how to live with it. If we’re not going to lock up and we’re not going to open up willy-nilly, then what is the approach? What are the things that we can do to change society that will help us maintain society to the best we know but at the same time also reduce transmission? That’s a key activity right now that public health needs to be playing a very important role in. (Osterholm)
The 1918 Influenza had a second wave in the fall that was made more severe by a mutated virus spread by wartime troop movements. (Roos 2020) There were three waves of infections in the two years that the 1918 Influenza was active.
In Chapter 19 “Pandemic: From Unspeakable to Inevitable” Osterholm describes a tabletop pandemic scenario that starts in April, gets hammered down by late July, second wave begins in late September and continues through June.
I speculate that the current spike of new cases in western and southern states are from the first wave perking up after lockdown ended. The second wave comes with the fall flu season and COVID-19 will continue well into 2021.
COVID Clusters
With each subsequent week of patient data we get a clearer pattern of who is getting sick. (Lu) This includes work places where there is no ability to socially isolate and conditions that facilitate the transmission of the coronavirus through aerosol transmission.
Nursing homes and assisted living facilities are COVID clusters, representing 42% of U. S. deaths. (Roy)
New data from CDC shows that the death rates among Black and Hispanic/Latino people are much higher than for white people, in all age categories. (Brookings)
Not long after the virus started spreading, counties with relatively larger black populations faced higher case counts, higher COVID-19-related mortality, and a faster pace of progression compared to counties with a lower share of black people. The 681 high-concentration black counties account for only about a third of the U.S. population but 53 percent of the cases and 63 percent of the deaths nationally. (Zephyrin)
More than 28% of people diagnosed with COVID-19 are Hispanic. (Zarefsky)
In New York City communities with large Hasidic populations experienced some of the highest infection rates in the city. (Stack) This situation also infected most of the firefighters working Brooklyn Park’s FDNY Engine 282/Ladder 148 that were responding to crowded “places of worship, schools and mikvahs,” or ritual baths, in the ultra-Orthodox enclave, an FDNY employee said. (Balsamini)
The reasons for these racial differences are driven by essential workers in high-risk medical and service jobs, inadequate infectious disease resources, poverty, and community practices.
Emergency Service Exposures From Community Infection
The first COVID-19 San Jose firefighter was infected off the job and asymptomatic. He infected 15 of his colleagues, 10% of the fire department, by March 6.
He covered a shift for a buddy at another firehouse, exposing colleagues there. He attended a career development course at the department’s training center — and the disease spread further. … From March 6 to March 12 the number of infected San Jose firefighters increased to over 50.
Kelliher 2020
The first FDNY EMT diagnosed with the coronavirus was infected off-the job from a person who recently travelled overseas (Maisel 2020).
Both of those examples occurred at the beginning, when the Hammer was coming down. With communities opening up again, we are looking at the Dance and the continuing challenge of off-the-job infections.
Last week provides a great example of our current situation, with 8 Greensboro, North Carolina, firefighters getting infected after a four-fire station golf outing. (Fox 8 WGHP)
Battalion Chief Tom Bouthillet, Hilton Head Island Fire Rescue, points out “This is the new challenge. Previously, we were worried about exposure on medical calls. Post-shutdown, off-duty exposures are more likely. Kids are getting exposed in daycare, spouses are getting exposed in their jobs, and then there’s daily life, whether a golf outing, wedding, or some other thing. Test, trace, isolate.“
Face Masks As A Political Issue
Prior to some governors requiring face masks as part of the phased opening up of states, less than half of the population were voluntarily wearing masks.
“Attitudes about masks have become politicized,” said Robert Kahn, a University of St. Thomas Law School professor who has been following the mask debate. “I don’t think they were always that way, like in, say, March, early on in this.” (Vetterkind 2020)
Surveys in May showed that 75% of Democrats and 53% of the Republicans are wearing facemarks (Pepinsky 2020)
The conflict and confusion of mask usage comes from the mixed messages, as pointed out in this June 2 Washington Post 4-minute video, showing Dr. Anthony Fauci saying on March 8 that citizens should not be wearing masks – in part to keep the too-small inventory of masks available for medical staff – and then saying that citizens should be wearing cloth face masks on April 2:
A long article in the June 19th Washington Post looks at the face mask battle:
Mask-wearing for some people is an identifier of broader beliefs and political leanings. Like so many issues rooted in science and medicine, the pandemic is now fully entangled with ideological tribalism. This has played out before: helmets for motorcyclists, seat belts in cars, smoking bans in restaurants.
To many people, masks represent adherence to civic duty and a willingness to make individual sacrifices for the greater good of public health. To others, masks symbolize government overreach and a violation of personal liberty.
Within the work environment, company commanders have the employer directives for use of personal protective equipment. Delivering clinical care best practices provides infection control directives. Caregivers may encounter patients that fight them when deploying a facemask.
COVID Conspiracies and the Infodemic
Along with the pandemic there has been an infodemic – an overabundance of information – including false or misleading stories. Nature provides an example of a false story:
On 19 March, the website Biohackinfo.com falsely claimed that Gates planned to use a coronavirus vaccine as a ploy to monitor people through an injected microchip or quantum-dot spy software. Two days later, traffic started flowing to a YouTube video on the idea. It’s been viewed nearly two million times.
The idea reached Roger Stone … who in April discussed the theory on a radio show … The interview was covered by the New York Post, which didn’t debunk the notion. Then that article was liked, shared or commented on by nearly one million people on Facebook. “That’s better performance than most mainstream media news stories,” says Joan Donovan, a sociologist at Harvard University in Cambridge, Massachusetts.
Nearly 8 in 10 surveyed by Gallop/Knight between April 14-20 say misinformation about the virus is a major problem. Asked to identify the common sources of mis-information, 68% said social media and 54% say the Trump administration. (Jones 2020)
In addition, 36% of the respondents saying that they feel overwhelmed by all of the COVID-19 information.
23,000 Non-Peer Reviewed Articles
Kim Tingley, writing for The New York Times Magazine, describes two actions taken by peer-reviewed publishers to make potentially life-or-death research available as quickly as possible:
- Dropping the paywalls of Science, The Lancet, Journal of the American Medical Association (JAMA) and The New England Journal of Medicine to make coronavirus content free online.
- Encouraging researchers to post their submissions on pre-print servers, where anyone can access them before they undergo a peer-review process.
This means that an article submitted to Science was available in days instead of months. Posting initial research findings on pre-print servers allows researchers to quickly share preliminary work and may help the scientific community to collaborate more effectively and efficiently.
The Atlantic science writer Ed Yong describes how peer-review and scientific knowledge works:
It’s less the parade of decisive blockbuster discoveries that the press often portrays, and more a slow, erratic stumble toward ever less uncertainty. “Our understanding oscillates at first, but converges on an answer,” says Natalie Dean, a statistician at the University of Florida. “That’s the normal scientific process, but it looks jarring to people who aren’t used to it.”
With over 23,000 non-peer reviewed scientific papers about the disease and the novel coronavirus that causes it flooding the scientific community (Brainard), factoids and tidbits are grasped as “the solution” without follow-up studies. This creates contradictory comments and erodes the public’s confidence in scientific information,
The Dunning-Kruger effect
There is a phenomena known as the Dunning-Kruger Effect. Coined in 1999 by then-Cornell psychologists David Dunning and Justin Kruger, the Dunning-Kruger Effect is a cognitive bias whereby people are unable to recognize their own incompetence. And not only do they fail to recognize their incompetence, they’re also likely to feel confident that they actually are competent. (Murphy)
ZDoggMD – Doctor Zubin Damania – provides a 7 minute video explaining this: “From antivaxxers to moon landing deniers to poorly-trained medical folks, our idiocracy is often fueled by the so-called Dunning-Kruger effect.”
A person can counteract this effect by questioning what you know and pay attention to those who have different viewpoints. Seek feedback from people you trust who are knowledgeable in your area of interest. Be open to constructive criticism. Keep learning.
Some people will cherry-picking factoids from non-peer reviewed research to justify an ideological tribalism that supports a conspiracy theory. It is not the company commander’s role to dissuade a person’s belief. We are there to provide a service.
Unfortunately, as the pandemic continues to disrupt normal life, it builds frustration, anger and rage in some people. Fire and ems providers may find themselves in harm’s way.
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Pueyo, T. (2020 March 19) Coronavirus: The Hammer and the Dance. What the Next 18 Months Can Look Like, if Leaders Buy Us Time. Medium.com Accessed June 18, 2020 https://medium.com/@tomaspueyo/coronavirus-the-hammer-and-the-dance-be9337092b56
Kreutz, L. (2020 May 20) SF author’s viral ‘Hammer and the dance’ gives new perspective amid COVID-19 pandemic. ABC 7News KGO-TV. San Francisco. Accessed June 18, 2020 https://abc7news.com/hammer-and-the-dance-update-tomas-pueyo-coronavirus-article/6199923/
Buettner, D. (2020 June 6) COVID-19: Straight Answers from Top Epidemiologist Who Predicted the Pandemic. Bluezones.com. Minneapolis, Minnesota Blue Zones LLC. Accessed June 18 https://www.bluezones.com/2020/06/covid-19-straight-answers-from-top-epidemiologist-who-predicted-the-pandemic/
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Roy, A (2020 May 26) The Most Important Coronavirus Statistic: 42% Of U.S. Deaths Are From 0.6% Of The Population. Forbes.com. Accessed June 20, 2020 https://www.forbes.com/sites/theapothecary/2020/05/26/nursing-homes-assisted-living-facilities-0-6-of-the-u-s-population-43-of-u-s-covid-19-deaths/#16bfbb3b74cd
(2020 June 7) COVID-19 Nursing Home Data. data.CMS.gov. Baltimore, MD. Centers for Medicare & Medicaid Services. Accessed June 20, 2020 https://data.cms.gov/stories/s/COVID-19-Nursing-Home-Data/bkwz-xpvg/
Ford, T., Reber, S. & Reeves, RV. (2020 June 16) Race gaps in COVIS-19 deaths are even bigger than they appear. Brookings.edu. Washington, DC: The Brookings Institute. Accessed June 20, 2020 https://www.brookings.edu/blog/up-front/2020/06/16/race-gaps-in-covid-19-deaths-are-even-bigger-than-they-appear/
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Zarefsky, M. (2020 May 21) Physicians detail COVID-19’s impact on Latinx communities. AMA. Chicago, IL: American Medical Association. Accessed April 20, 2020 https://www.ama-assn.org/delivering-care/population-care/physicians-detail-covid-19-s-impact-latinx-communities
Stack, Liam (2020 April 21) “Plague on a Biblical Scale “: Hasidic Families Hit Hard by Virus. In the New York area, the epidemic has killed influential religious leaders and torn through large, tight-knit families. The New York Times. Accessed June 20, 2020 https://www.nytimes.com/2020/04/21/nyregion/coronavirus-jews-hasidic-ny.html
Balsamini, D., & Edelmann, S.(2020 April 11) NYC firehouse crippled by coronavirus as 11 firefighters test positive. New York Post. Accessed June 20, 2020 https://nypost.com/2020/04/11/brooklyn-firehouse-crippled-by-covid-19-as-11-test-positive/
Kelliher, F. & Debolt, D. (2020 April 6) ‘The threat from within’ : How the coronavirus spread through San Jose’s fire department. As the pandemic reached the Bay Area, first responders quickly realized that they were facing a threat on multiple fronts. The Mercury News. Accessed June 17, 2020 https://www.mercurynews.com/2020/04/05/first-coronavirus-cluster-san-jose-fire-department/
Maisel, T. (2020 March 9) FDNY confirms that first EMT has been diagnosed with coronavirus. AMNY. Accessed June 17, 2020 https://www.amny.com/coronavirus/fdny-confirms-that-first-emt-has-been-diagnosed-with-coronavirus/
Digital Desk (2020 June 17) 8 Greensboro firefighters test positive for coronavirus after 4-station golf outing, Fox8 WGHP. High Point, NC. Accessed June 17, 2020 https://myfox8.com/news/8-greensboro-firefighters-test-positive-for-coronavirus/
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Yong, Ed (2020 April 29) Why the Coronavirus Is So Confusing: A guide to making sense of a problem that is now too big for any one person to fully comprehend. The Atlantic. Accessed April 29, 2020: https://www.theatlantic.com/health/archive/2020/04/pandemic-confusing-uncertainty/610819/
Brainard, J. (2020 May 13) Scientists are drowning in COVID-19 papers. Can new tools keep them afloat? Science. doi:10.1126/science.abc7839 Accessed June 21, 2020 https://www.sciencemag.org/news/2020/05/scientists-are-drowning-covid-19-papers-can-new-tools-keep-them-afloat
Murphy, Mark (2017 Jan 24) The Dunning-Kruger Effect Shows Why Some People Think They’re Great Even When Their Work Is Terrible. Forbes.com Accessed June 20, 2020 https://www.forbes.com/sites/markmurphy/2017/01/24/the-dunning-kruger-effect-shows-why-some-people-think-theyre-great-even-when-their-work-is-terrible/#5ae2c84a5d7c
Dunning, D. (2011) Chapter five – The Dunning-Kruger Effect: On Being Ignorant of One’s Own Ignorance. Advances in Experimental Social Psychology. 44, 247-296 https://doi.org/10.1016/B978-0-12-385522-0.00005-6
Feature Image: New Jersey Turnpike: Exit 15. Photo credit: Rob L. via Henry Cortacans et al #NJEMSTASKFORCE1