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The Virus & The Vaccine

Getting the COVID19 vaccine out of the freezer and into people’s arms has been slow. And, even as people battle unsympathetic websites to find slots for a shot, there still are many unanswered questions.

Will people who have been vaccinated still be asymptomatic and carriers who could infect others?

Will non-vaccinated people still need to wear PPE when interacting with them?

Will the vaccine protect against two new contagious strains of the virus?

What will the Biden administration do differently in its COVID19 response?

These questions and more, were answered by experts at an Ethnic Media Services briefing on January 13.

One of the biggest concerns to the country is the slow pace of the vaccine roll out. Though the US has 20 million doses of the Pfizer & Moderna vaccine, we face innumerable challenges at both the federal and state level, in getting the vaccine out to people. Only 5 million vaccines have been distributed as of January  11th.

According to Dr. William Shaffner, Professor of Preventive Medicine and Health Policy, and Professor of Medicine in the Division of Infectious Diseases at Vanderbilt University, a number of bottle necks choked a smooth vaccine roll out. At the national level, the uncertainty in vaccine shipments put a strain on the local level. States were not sure when vaccines would arrive, sometimes delivery was delayed, or fewer doses were received than anticipated. Occasionally shipments were sent to the wrong state in error.

Dr. William Shaffer

The Pfizer Deep Freeze

A key challenge for local distribution outlets was storing the Pfizer vaccine which requires “a really deep freeze” to keep it stable and intact. So only large medical centers with appropriate freezer storage capacity and personnel trained to handle it, first received the vaccine.  Fortunately, the Moderna vaccine does not need similar storage requirements and was distributed more easily, so vulnerable populations and frontline healthcare workers in long term care facilities, nursing homes and smaller community hospitals were able to access the vaccine.

Not Just Another Flu Campaign

“Quite frankly,” said Dr. Schaffer, many facilities assumed it would be “just another flu campaign,” but they were wrong. Insufficient preparation to administer the COVID19 vaccine rather “gummed up the works.”

                      Dr. Robert Wachter

California did get the science right, added Dr. Robert M. Wachter, Professor and Chair of Medicine at UCSF, “but did not get the logistics right.” Based on the way California managed its PPE and testing protocols, he was not surprised that vaccine distribution fared poorly. It’s a complicated process which ‘would have benefitted from a thoughtful national plan’ to determine for example, how to get a vaccine from a manufacturing plant in Michigan into a Fedex box that arrives in a central Californian distribution center. Glitches occurred because states, left to devise their own distribution process, “handed off responsibility to local institutions” which improvised protocols in “the last mile” of the roll out.

The lack of national guidance allowed too much “wiggle room” for error, stated Dr. Wachter.

Health Equity Gridlock

Another problem was created by rules about which cohorts got the vaccine first in a well-meaning effort to ensure health equity and that certain groups  – frontline healthcare workers, the elderly and essential workers – were prioritized for the vaccine. But how does a “Walgreens decide if you are a pre-school teacher or a grocery store worker or someone with a pre-existing condition,” argued Dr. Wachter. Do you need a note from your doctor or employer? “I haven’t received a convincing answer from anybody.”

‘We’ll Figure It Out’ Won’t Work

The lesson to learn is that “we’ll figure it out is not going to work with COVID19,” declared Dr. Wachter. He called it ‘scandalous’ that only 30% of all vaccines distributed have been injected when “millions of people should have received the vaccine by now.”

Congress only passed a coronavirus relief bill in late December 2020, to provide supplies necessary for distributing and administering the COVID-19 vaccine.

What we have  is a “9/11 or a Pearl Harbor worth of people dying a day” when we should be treating the distribution of the vaccine as an emergency, added Dr. Wachter.

Vaccines Going to Waste

Stories about vaccines going to waste make great news stories, but that’s not the real problem, said Dr. Shaffer. The issue is that doses are sitting in refrigerators and freezers but not making it into the final phase of delivery.

At UCSF, medical, 84% of vaccines have been distributed -15 thousand of about 18 thousand doses have been injected. The worry is how doses will make their way into rural or underserved communities.

Interestingly, Dr Shaffer reported that at Vanderbilt, a survey of healthcare providers found that they were hesitant and skeptical about the vaccine before it arrived. Vanderbilt responded with a major effort to educate its staff and address concerns to reassure reluctant people and change their minds. For example, the program had to counter fears  that the vaccine is not safe for pregnant women.

Both physicians reiterated that the vaccines were safe and effective to use.

Single or Double Dose

Data from all clinical trials find that two doses are required. The first shot offers partial protection after ten days and up to 80% to 90% protected  up to the minute before getting the second dose. “The second dose boosts  you up to the ultimate number of 95% and creates more durable immunity,” confirmed Dr. Wachter.

While models show that giving more people a first shot of the vaccine will save more lives than withholding doses for the follow up shot, there are legitimate concerns about delaying the second dose – will immunity fall off, will it promote mutations by having more people partly vaccinated, or will people forget to come back for their second dose? A single dose only will not work in the long term, but deferring a second dose will get more people vaccinated sooner. So the Biden administration’s plan to get more first doses out is ‘a good strategy’ agreed Dr. Shaffer.

Will You Still Be Contagious?

Preliminary data from a Moderna study indicated that ‘a substantial proportion of people vaccinated would not be able to transmit the virus. However, until final data sounds the all clear, warned Dr. Shaffer, people should continue to observe precautions with masks and social distancing.

Biden Roll Out

The best first step for the new administration must be to lead its Covid19 response based on science and clearly communicate its national policy, emphasizing “public health and scientific principles,”  said Dr. Shaffer. They also need to address the bottlenecks in vaccine distribution and reinforce they will work together with state and local levels to troubleshoot and resolve problems. Instituting a federal policy to ensure consistency in the COVID19 response across the country will be invaluable, he added.

Challenges Ahead

There is a real risk of politically driven resistance to the vaccine especially in rural areas and persuading people that it is safe and necessary will be quite difficult, Dr. Shaffer pointed out. But as demand grows for the vaccine, websites will have to handle thousands of people going online to make appointments, and venues will have to manage large cohorts arriving for their shot. A fair system needs to be established to ensure health equity in who gets the vaccine.

Meera Kymal is the Contributing Editor at India Currents
Image by Wilfried Pohnke from Pixabay

Kids show off their art on Zoom as Team Anti-Coronavirus.

Kids Make Art to Fund PPE for an Indian Hospital

Ten children from the ages of 3 to 13 based in Connecticut, Massachusetts, and New Jersey took to Zoom to organize and create Team Anti-Coronavirus. Their goal? To raise funds for Personal Protective Equipment (PPE) for frontline medical professionals treating COVID-19 patients at the Christian Medical College and Hospital (CMC) in Vellore, South India. 

“I had a lot of fun making cards and artwork with my baby brother,” says Anoushka. “My dad is a doctor. I want to help other doctors like him and all healthcare workers who are taking care of COVID-19 patients.” 

Anoushka is collaborating with her teammates Advaith, Ilakkiya, Neil, Nikhil, Oviya, Pragnya, Prisha, Shreya, and Veera. The youngsters have raised $550 so far by making cards, wearable art, and shrinkable charms for family and friends in exchange for a donation to a Go Fund Me campaign launched by journalist Sujata Srinivasan, whose son is part of the group. Srinivasan was motivated to contribute following her personal experience at CMC when she lost her mother to a road accident in 2018. The initiative is a collaboration with the Vellore CMC Foundation in New York, which will route all donations, which are fully tax-deductible, to CMC Vellore.   

The award-winning, Indian nonprofit institution was in the U.S. news recently as a case study in the Harvard Business Review, and for work by one of its medical college alumni Dr. Ankit Bharat, chief of thoracic surgery in the Department of Surgery at Northwestern. Bharat and his team performed the first double-lung transplant on a COVID-19 patient in the U.S., after her lungs were damaged by the virus. 

As of Nov. 1, the Johns Hopkins COVID-19 tracker showed 8.1 million positive cases in India. The number of COVID-19 deaths that were reported totaled 122,111. CMC alone has a positivity rate of 16 percent, down from as high as 30 percent, according to Dr. Kishore Pichamuthu, professor and head, Medical ICU, Division of Critical Care at CMC. “We have 75 COVID ICU beds in six units. Around 1,000 critically ill patients with COVID have been treated in these beds since April 2020,” he says. 

From the data provided by CMC, of the total 9,072 COVID-19 patients admitted at the hospital, 91.6 percent were discharged (as of 28 Oct). A total of 3,135 patients received a subsidy for COVID treatment to date – the total charity amount was approximately $1.5 million.

Resources are strained as more patients continue to seek treatment.

“Patients are still coming in swarms to CMC, mostly because of the large number of COVID beds offered by the hospital,” says Dr. Pritish Korula, associate professor, Surgical ICU, Division of Critical Care. “Treatment for COVID is expensive. While our hospital does its best to help numerous socioeconomically-deprived patients, it has been a struggle to meet patient needs as the volumes are so large and the pandemic has been going on for so long.” 

To donate to CMC COVID-19 relief, please visit: Go Fund Me for PPE

Srishti Prabha is the Assistant Editor at India Currents and has worked in low income/affordable housing as an advocate for children, women, and people of color. She is passionate about diversifying spaces, preserving culture, and removing barriers to equity.

Falling Through the COVID19 Cracks

When COVID19 snared President Trump in early October, he promptly received a dose of Regeneron and an airlift to Walter Reed Army Hospital;  physicians dispensed a course of therapeutics – Remdesivir and the steroid dexamethasone, and  supplemental oxygen as needed. That extraordinary spell of cutting edge treatment soon put the president back on the campaign trail almost within the week.

The price tag for the president’s helicopter ride and specialized, experimental treatment cost roughly about $1 million say experts, and was free, and funded by taxpayer dollars.

“I would not be surprised if it were to exceed $1m,” said Dr Bruce Y Lee, a healthcare researcher at the City University of New York.

The five star treatment afforded to Trump, however, is beyond the reach of average Americans, even those with insurance. With private insurance to cushion the cost, an average American would have to pony up $520 a vial  or $3120 for a course of anti-viral treatment.

At the other end of the healthcare spectrum are the uninsured – people who cannot afford even a single dose of Remdesivir, let alone an entire course of treatment, said Dr. David Hayes-Bautista Director of the Center for the Study of Latino Health and Culture, UCLA Health, at an October 23 Ethnic Media Services briefing.

His study of how the coronavirus impacts populations of color found that low-paid and uninsured workers in underserved communities rarely have health insurance to pay for treatment.

Without any protection, said Bautista, COVID19 finds gaps in care in the social services umbrella and the healthcare maze that marginalized communities have to navigate, and “the coronavirus falls upon them like rain.”

For uninsured workers who forage for healthcare access or have none, treatment is simply out of the question.

Quoting a UC Davis study, Bautista explained that $3120 for farmworkers in California is the equivalent of two month’s salary. What that means for farmworkers – many of whom are at high risk of exposure to COVID19 within the industry that employs them –  paying for treatment if they get infected means having to forgo food, rent, and other necessities that two months of income covers.

Disadvantaged populations have far higher case rates and mortality rates than non-Hispanic whites, said Dr. Bautista

When the virus hit, California shut down. People ‘grabbed their laptops’ and went home to work, but essential workers could not. Doctors, nurses and healthcare workers had to make sure they had PPE and equipment to treat COVID19 patients.

Other essential workers said Bautista, included meat packers, truck drivers, shelf stockers, grocery store workers, “folks working to make sure the rest of us can eat”, and check-out clerks who were far more exposed to the virus because “about 300 people pass within an arms-length.”

Those that tend to work in these occupations are mostly people of color, explained Bautista and the industries that expose them to the pandemic offer less access to care, treatment and follow up. As a result, California has high rates of exposure and mortality. The state now has a total of 922,005 positive cases. and a total of 17,626 deaths reports the California Department of Public Health.

In California, farm workers have been especially hard hit by COVID19. During the pandemic, migrant farmworkers continue to work shoulder to shoulder in ‘cuadrillas,’ and packing houses, or ride in crowded buses, putting their lives on the line to put food on our tables.

Vulnerable farmworkers (largely Latino, almost 100% immigrant, and 60-80% undocumented), are left out of the Affordable Care Act (ACA) because of their temporary status and cannot afford private health insurance. And yet, the county gave them letters confirming their essential status to travel, so they could go to work when the pandemic broke out. Workers were urged to see a doctor if they had symptoms, but without health insurance, “how would they pay to see a doctor, asked Bautista. “Some do not even know any doctors!” Their situation was further complicated by a requirement in the first few months of the pandemic, for sick people to get a doctor’s recommendation just to get a test – one they could barely afford.

“You could wind up paying $100 to almost $2000 for one test!” said Bautista. “In a farm worker family that quickly adds up.”

Even if a vaccine becomes available, said Denise Octavia Smith, Exec Director, National Association of Community Health Workers (NACHWA), it may be refused. Among Black and indigenous communities who have endured hundreds of years of medical testing and research on enslaved populations against their will, there exists a longstanding fear of vaccines, “We won’t be used as a guinea pig for white people.’’

Smith, who is tracking the disproportionate impact of Covid19 on under-resourced health systems, suggests supporting more community health workers familiar with barriers to care and wellbeing that marginalized populations experience, as trusted messengers to build bridges within these communities. This way, people who believe in efficacy of vaccine can get it when it becomes available

That moment could come sooner that they think. In a move that could transform life in COVID19  times for marginalized communities, the CDC is considering recommendations by ACIP (Advisory Committee on Immunization Practices ) to “remove unjust and barriers to good health and well-being” in some racial/ethnic minority groups that bear the disproportionate burden of the COVID19 disease.

The recommendations ask the CDC to “commit to fair stewardship in the distribution of a scarce resource.” Under review are outreach strategies that will  overcome barriers to access, and reduce health disparities in each phase of vaccine distribution.

The interventions must ensure that all affected groups, populations, and communities are treated fairly and have equal opportunity to access the vaccine and treatment, not just the privileged few.

The coronavirus doesn’t discriminate. Even the President got infected. What’s different is he had access to treatment well beyond the reach of essential workers who work to put food on our table. They are the ones “we forgot about,” said Bautista, and who will fall between the cracks of our healthcare jigsaw puzzle without a safety net.

Meera Kymal is a contributing editor at India Currents

Image: WorldBank, migrant worker in strawberry farm

Teens Ask Us to Save Our Saviours

As the COVID-19 pandemic hit the world, a Bellarmine College Prep junior, Rishabh Saxena, like everyone else, became increasingly concerned. He wanted to do his part and started the Save your Saviors campaign in early March to equip healthcare workers with Personal Protective Equipment (PPE) to help them win this fight.

Around the same time, Shivina Chugh, a junior at MSJHS in Fremont, was becoming increasingly worried as well. Rishabh and Shivina joined forces to help raise awareness for this cause as both their moms have been at the front line fighting this war and wanted to do their part to save people’s lives at the front line. After researching how the risks faced by frontline workers could be mitigated, they found that, in addition to other PPE, reusable and washable bio-suits helped keep the infection rate low among the healthcare workers in South Korea. Their research indicated that these bio-suits were already used in a few emergency rooms in hospitals across the United States but were not readily available.

They ran the idea of sourcing the bio-suits by their moms, a few Intensive Care Unit directors, and infection control personnel in a few hospitals who saw this project’s great value. At this point, they started contacting a few more hospitals to explore an interest in bio-suit as a way to increase protection for their staff. Not only was this idea well-received by the hospitals they contacted, but they also started getting referrals.  

Health Professionals wearing Bio-Suits given by Save Your Saviours.

Seeing a high demand for bio suits and other PPE, they decided to set up a GoFundMe campaign to raise funds. Fremont Bridge Rotary Club also contributed to this cause by raising money for this project. Together they raised $4,050 and were able to work with a few vendors to get bio-suits and other PPE promptly and pilot it in a few hospitals.

These bio-suits were delivered to Medical staff in ICU’S of Kindred Hospital and St. Rose Hospital. In addition, handing over bio suits to Alameda Highland County hospital in Oakland, CA, was immensely satisfying to the team because these residents provide care for the indigent patient population and, with bio suits, could avoid the high risk of catching infections that can prove fatal.

Dr. Steven Sackrin, at Alameda Highland County Hospital, said, “I want to extend our sincere thanks to your organization, Save your Saviors. The contribution of personal protective equipment is deeply appreciated. The bio suits are a particularly great addition to our supplies. The bio suits offer a superior degree of protection. It is so nice that they can be cleaned and reused. Most of our patients already have immense challenges, medical and especially non-medical. And our environment is already a bit threadbare and not on many people’s radar. But a sense of mission generally infuses the facility. It was so great that your organization was willing to share its efforts and contributions with this institution. Thank you very, very much for your generosity, thoughtfulness, and the grit/work that it took to accomplish what you have done.”

Dr. Evelyn Nakagawa at Kindred hospital echoed similar sentiments “Save your Saviors has provided bio suits that offer an extra layer of safety and help healthcare workers focus on their work with peace.

Shivina and Rishabh give materials to Highland Hospital.

Save your Saviors campaign initially raised money and helped save lives of Health care workers to buy Bio suits and launch them in several Intensive care units of Bay Area Hospitals. After finishing their first phase of helping Bay Area Health care workers, they have furthered this campaign to help some other segments of society who are greatly impacted in this COVID crisis time. They have done several drives to raise money to provide food and personal items required for the homeless shelter and domestic violence survivors. They are immensely thankful to several families in the Bay area who generously contributed to such a noble cause. One of the drives with their contributions, approximately worth $2000, has been shared with the vulnerable survivors in dire need.

Whether they are health care workers or underprivileged people in society like domestic violence survivors or homeless shelters, the fight to save people’s lives continues forward by these students’ efforts. They continue with their efforts during this unprecedented time. You can help their efforts here. 

Shivina Chugh is a rising senior at Mission San Jose High School, Fremont, CA. She is very active in her school clubs, Relay for Life, DECA, Peer Support Group and is the co-founder of the Save Your Saviors, which has helped the medical community during times of COVID-19 and continues to do so. 
Rishabh Saxena is a senior at Bellarmine College Prep School in San Jose, CA. He grew up building lego puzzles, tennis, and skiing. He is passionate about helping people. He founded Save your Saviors to serve the community. 

Back To The Future At School

Can schools safely reopen though the pandemic shows little sign of waning and educators stumble towards the first day of school in the absence of a clear cut strategy?

The answer is uncertain.

In early July President Trump demanded that schools “open quickly, beautifully, in the fall” for normal, in-person instruction.

The CDC responded with guidelines instructing school districts to build supportive community infrastructures to counter the onslaught of COVID-19 as schools reopened. They urged school officials to implement hygiene and social distancing practices and develop ‘proactive’ plans with health departments, parents and caregivers to deal with potential outbreaks.

A snapshot of the ‘new normal’ for K-12 schools.

Keeping active kindergartners apart; keeping their masks on; fewer students on school buses; limited class sizes; keeping staff safe; sanitizing; PPE; social distancing; online SATs; remote learning; iPads or computers for all.

For many schools, adjusting to the new normal would be a complicated and expensive endeavor.

School systems which struggled with pandemic restrictions would face even greater logistical and financial burdens meeting the new CDC requirements, leaving them with no other option than to continue with virtual classes moving forward.

President Trump tweeted his displeasure at the “very tough and expensive guidelines for opening schools,” and, under pressure, the CDC retracted its message, effectively relinquishing the decision making to school administrators. At the behest of the White House, the CDC emphasized the “importance of reopening America’s schools this fall,” and warned that extended school closures would “be harmful to children.”

This mixed messaging starkly reflects the reality that the CDC’s mission to reopen schools is at odds with the Trump administration’s intent to open at all odds, said Dan Domenech, Executive Director of the School Superintendents Association (AASA).

The Cost of Reopening

What is certain however, is that a safe return to in-person school comes with a hefty price tag – a whopping 200 billion dollars or more, or about $490 per K-12 student. At a panel discussion on how to safely reopen schools hosted by Ethnic Media Services on July 31, Domenech explained that the costs would cover laptops for students and an array of preventive measures that include sanitizers, masks, PPE and safe busing, before schools could consider opening their doors to staff and students. The expense would place an unprecedented financial burden on overstretched school district budgets in the next academic year.

So, a safe reopening would need a huge injection of federal funds (that the Council of Chief State School Officers projected would cost between $158.1 billion and $244.6 billion,) but the government is threatening to cut funds for schools that don’t fully reopen.

Many school districts cannot afford the expense, so policymakers at state and local levels are choosing to wait before making a decision on whether to reopen schools, based on assessments of COVID-19 threats in their region.

Is it safe to go back to school?

In a press briefing, the White House pushed the idea that the greater risk right now is to children’s learning, rather than to their health and wellbeing, announcing that, “We don’t think our children should be locked up at home with devastating consequences when it’s perfectly safe for them to go to school.”

Till recently, the common belief was that young children were not affected by COVID-19 and were unlikely to spread the virus. In fact the CDC reiterated that children pose no risks, stating that, “The best available evidence from countries that have opened schools indicates that COVID-19 poses low risks to school-aged children, at least in areas with low community transmission, and suggests that children are unlikely to be major drivers of the spread of the virus.”

However, new research from a pediatric hospital in Chicago that published its findings in JAMA, indicates that children carry high levels of the virus in their upper respiratory tracks and may efficiently spread infection by sneezing, coughing or shouting.

“In several countries where schools that have opened prematurely, such as Israel, we have seen a rise in cases,” said Pedro Noguera, Dean, USC Rossier School of Education.

As findings like these make parents and educators uncertain about reopening schools in a pandemic, it may be prudent for school districts to first assess the threat of COVID-19 infections in their area before making plans to send children back to school, suggested by Dr. Anthony Fauci, the nation’s top infectious disease expert, in recent interviews with PBS and the Washington Post.

Inequities in K-12 Education

As schools juggle in-person classes versus online learning and hybrid models, some wealthy families are resolving their uncertainty by creating private learning pods or ‘micro-schools,’ with hired tutors to educate their children. It’s an arrangement that reflects the inequities experienced by less privileged students from special needs, disadvantaged and low income backgrounds. Without tutors or pods, and limited access to internet and laptops, these children are likely to fall further behind and “experience tremendous learning loss,” noted Noguera.

The current education crisis stems froma  lack of leadership, said Noguera, adding that “The real questions facing the US is when will leadership emerge that can provide the guidance that schools need on how to manage instruction…safely … and how to reopen appropriately, in a manner that does not place lives at risk.” He called on local and community leaders to step up in the interim. It will be up to local and community leaders to create innovative ways to deliver education and support children and families, in the short term, said Noguera.

Moving forward into the future will be challenging for schools because the scope of funding required to make changes is not forthcoming from the federal purse . Without adequate funding for health and safety measures in place, Noguera stated that school districts will have to contend with, for example, teacher unions who recently announced they will go on strike over unsafe conditions.

Eleven million children do not have the laptops they need for remote learning, said Domenech. So, even though technology offers valuable learning platforms, it can be a double edged sword, when teachers are ill prepared to use it effectively and students who have little or no access to technology lose out on their learning.

Schools will have to show teachers how to close the “digital divide,” advised Noguera, by training them “to use the technology to deliver meaningful instruction to kids.” But, whatever devices students use for learning, without access to reliable Internet and Wi-Fi, low income and disadvantaged students would face inequities of digital access, warned USC Professor Shaun R. Harper. In LA, school districts have invested in making screens and hotspots available within communities so children can access learning; but children in rural areas have even less connection and risk being left behind.

Noguera suggested that instead of trying to adapt curricula to cell phones, another option would be to go back to “old school approaches to education” using pencil and paper, adding that “they worked before technology, and could work again.”

“For now, whether our education looks like mini learning pods, pandemic pods, micro schools, or collaborative tutoring with college students….that’s still going to provide inequity in our educational system.” cautioned Eddie Valero, Supervisor for District 4, Tulare County Board of Supervisors. He was referring to economist Emily Oster’s prediction that clusters of home schooling families are going to happen everywhere regardless, and “that will create an economic divide.” 

Re-envisioning the future of schooling

Panelists offered several perspectives on when and how schools should reopen.

In working with school superintendents on reopening of schools based on CDC guidelines, said Domenech, the future could feature one of three options – the popular hybrid model, with students on weekly shifts between online learning and in-person classes seated 6 feet apart, total remote learning, or returning to school full-time as before.

However, the continuing rise in infections across the country means that most schools may open remotely. It may be possible for students to return to school only in areas where the rate of infection is below 5%, advised Noguera, suggesting that less risky, outdoor learning may be one way to address the problem. However, places experiencing a surge in cases such as the Imperial Valley in southern California, will have “to rely on community organizations like non-profits to support families and deliver education to children in concert with the school district,” he said.

Noguera’s view was echoed by Mary Helen Immordino-Yang, USC Associate Professor at the Brain and Creativity Institute and Rossier School of Education, who suggested tapping into the “huge cohort of college-ready high school graduates” and using their skills as a resource for tutoring younger students. Engaging young people as a ‘brigade  of community tutors” could help solve the shortage of people in teaching and learning, and give them a sense of purpose,” said Yang.

Professor Harper, who leads the USC Race and Equity Center warned that ‘raceless’ reopening policies from school districts  would “yield racially disparate outcomes”. He suggested that more consultation with communities of color was needed to “racialize input” into the K-12 reopening strategy. That would involve considerations like providing proper PPE, testing and contact tracing for essential workers in schools who are more likely to be employees of color and are disproportionately exposed to infection, as well as trauma and grief support  for staff and students of color, who are more likely to have experienced loss of a family or community member to the virus.

The panelists called on the private sector, specifically high tech companies and philanthropists, to step up and help avert the crisis.

Big tech firms like Amazon said Noguera, which have accumulated huge profits during the pandemic, have a responsibility to assist.

Harper described this timeframe as an opportunity for philanthropists and foundations who want to close racial equity gaps by helping finance “accessibility to learning pods for poorer students who cannot afford it.” There is also a role, he suggested, for nonprofits, youth organizations and college access providers to add to their agendas and recreate pod-like experiences for disadvantaged youth during the pandemic.

Schools are relying on Congress to pass funding that will get K-12 education back on track safely, and Domenech predicts that the majority of schools in America will start the school year with remote learning because, ‘in order to bring any children into school, dollars will be required.”

Valero closed out the discussion by inviting policymakers to re-envision what school should look like for the future by thinking “in creative ways that disrupt our everyday normalcy for something different,” but he urged, “honestly it begins with access, opportunity and fairness for all students.”

“We need to model our classrooms with our most struggling students in mind.”

Meera Kymal is a contributing editor at India Currents 

Image by Katherine Ab from Pixabay; Image by Bob Dmyt from Pixabay

Indian Girls Are Making Masks Global

COVID-19 isn’t a test of whether we can fend for ourselves. Rather, it’s the story of those who choose to fight for the rest of us. And that’s precisely what a hundred young girls from Uttarakhand, India are trying to do — but they need your support. 

Since the coronavirus was declared a Public Health Emergency in January, countless medical facilities have struggled to accommodate the growing need for surgical masks. Hoarding, misinformation, and price gouging have all contributed to the scarcity of masks in hospitals. And while masks should be a priority for all members of society, it’s absolutely critical for medical professionals and sanitation workers, who are directly exposed to infected patients on a daily basis for hours at end. A single mask could break a chain of infections and hospitalizations before it even begins. According to the Mayo Clinic, masks have proven to filter out COVID-19 particles, thus protecting you from those infected but also allowing victims of the coronavirus to avoid infecting others. These girls know what’s at stake. 

That’s why Uttarakhand’s students, with the support of the non-profit organization Educate Girls Globally, have pledged to sew fabric masks and distribute them among communities in need. With nothing but their grit and their sewing machines, they have already brought a nascent change to their locale by providing a nearby hospital as well as the Uttarakhand Police Department with more than one thousand cloth masks. And that was all in a month’s work!

It was after a representative from Educate Girls Globally reached out to me that I realized the need more resources, attention, and support from the rest of the world. At a time when healthcare professionals are being forced to reuse existing masks, it’s crucial to encourage public movements that make more masks available. With the help of Educate Girls Globally, we started a GoFundMe account in hopes of scaling this endeavor to the international level. 

These funds will allow the girls to purchase additional materials, as well as transport these masks to healthcare facilities. More than twenty hospitals in the United States desperately need masks  — both  homemade and surgical — to protect caregivers, hospital visitors, and volunteers

These empowered young girls from Uttarakhand want to raise $25,000 to distribute more than 50,000 high-quality fabric masks to hospitals in the United States. They tell a story of perseverance amid immense adversity and fear. 

With your small financial contribution, we can give this story the ending it deserves.

To donate, click here.

Kanchan Naik is a junior at The Quarry Lane School in Dublin, CA. Aside from being the youth editor of India Currents, she is the editor-in-chief of her school’s news-zine The Roar. She is also the Teen Poet Laureate of Pleasanton and uses her role to spread a love of poetry in her community.

Heroes of War

Heroes of War 

Bracing themselves 

heavy armor

coat after coat

danger is principal.

 

They enter war

an invisible enemy 

the fiercest predator

with an unidentifiable weakness.

 

Their compassionate hearts

drive a noble sacrifice 

for the protection of lives 

they never knew.

 

Heroes they stand

knowing and holding 

the fear of 

surrendering themselves to defeat.

*****

Rashmika Manu is a freshman in high school. She enjoys writing poems, playing volleyball, and traveling. She visits India often and has a desire to help the poor and needy in the future.

Red Dawn Breaking Bad – A Warning Ignored!

A high-ranking federal official in late February warned that the United States needed to plan for not having enough personal protective equipment for medical workers as they began to battle the novel coronavirus, according to internal emails obtained by Kaiser Health News.

The messages provide a sharp contrast to President Donald Trump’s statements at the time that the threat the coronavirus posed to the American public remained “very low.” In fact, concerns were already mounting, the emails show, that medical workers and first responders would not have enough masks, gloves, face shields and other supplies, known as PPE, to protect themselves against infection when treating COVID-19 patients.

The emails, part of a lengthy chain titled “Red Dawn Breaking Bad,” includes senior officials across the Department of Veterans Affairs, the State Department, the Department of Homeland Security and the Department of Health and Human Services, as well as outside academics and some state health officials. KHN obtained the correspondence through a public records request in King County, Washington, where officials struggled as the virus set upon a nursing home in the Seattle area, eventually killing 37 people. It was the scene of the first major outbreak in the nation.

“We should plan assuming we won’t have enough PPE — so need to change the battlefield and how we envision or even define the front lines,” Dr. Carter Mecher, a physician and senior medical adviser at the Department of Veterans Affairs, wrote on Feb. 25. It would be weeks before front-line health workers would take to social media with the hashtag #GetMePPE and before health systems would appeal to the public to donate protective gear.

In the email, Mecher said confirmed-positive patients should be categorized under two groups with different care models for each: those with mild symptoms should be encouraged to stay home under self-isolation, while more serious patients should go to hospital emergency rooms.

“The demand is rising and there is no guarantee that we can continue with the supply since the supply-chain has been disrupted,” Eva Lee, director of the Center for Operations Research in Medicine and HealthCare at Georgia Tech and a former health scientist at the Atlanta VA Medical Center, wrote that same day citing shortages of personal protective equipment and medical supplies. “I do not know if we have enough resources to protect all frontline providers.”

Reached on Saturday, Lee said she isn’t sure who saw the message trail but “what I want is that we take action because at the end of the day we need to save patients and health care workers.”

Mecher, also reached Saturday, said the emails were an “an informal group of us who have known each other for years exchanging information.” He said concerns aired at the time on medical protective gear were top of mind for most people in health care. More than 35 people were on the email chain, many of them high-ranking government officials.

The same day Mecher and others raised the concern in the messages, Trump made remarks to a business roundtable group in New Delhi, India.

“We think we’re in very good shape in the United States,” he said, noting that the U.S. closed the borders to some areas. “Let’s just say we’re fortunate so far. And we think it’s going to remain that way.”

The White House declined to comment. In a statement, VA press secretary Christina Mandreucci said, “All VA facilities are equipped with essential items and supplies to handle additional coronavirus cases, and the department is continually monitoring the status of those items to ensure a robust supply chain.”

Doctors and other front-line medical workers in the weeks since have escalated concerns about shortages of medical gear, voicing alarm about the need to protect themselves, their families and patients against COVID-19, which as of Saturday evening had sickened more than 121,000 in the United States and killed at least 2,000.

As Mecher and others sent emails about growing PPE concerns, HHS Secretary Alex Azar testified to lawmakers that the U.S. had 30 million N95 respirator masks stockpiled but needed 300 million to combat the outbreak. Some senior U.S. government officials were also warning the public to not buy masks for themselves to conserve the supply for health care providers.

U.S. Surgeon General Jerome Adams tweeted on Feb. 29: “Seriously people – STOP BUYING MASKS! They are NOT effective in preventing general public from catching #Coronavirus, but if healthcare providers can’t get them to care for sick patients, it puts them and our communities at risk!”

Still, on Feb. 27, the FDA in a statement said that officials were not aware of widespread shortages of equipment.

“We are aware of reports from CDC and other U.S. partners of increased ordering of a range of human medical products through distributors as some healthcare facilities in the U.S. are preparing for potential needs if the outbreak becomes severe,” the agency said.

Simultaneously, Trump downplayed the risk of the novel coronavirus to the American public even though the Centers for Disease Control and Prevention was warning it was only a matter of time before it would spread across the country. On Feb. 29, the CDC also updated its strategies for health workers to optimize supplies of N95 masks.

An HHS spokesperson said Saturday the department has been in “an all-out effort to mobilize America’s capacity” for personal protective equipment and other supplies, including allowing the use of industrial N95 respirators in health care settings and awarding contracts to several private manufacturers to buy roughly 600 million masks over the next 18 months.

“Health care supply chains are private-sector-driven,” the spokesperson said. “The federal role is to support that work, coordinate information across the industry and with state or local agencies if needed during emergencies, and drive manufacturing demand as best we can.”

The emails from King County officials and others in Washington state also show growing concern about the exposure of health care workers to the virus, as well as a view into local officials’ attempts to get help from the CDC.

In one instance, local medical leaders were alarmed that paramedics and other emergency personnel were possibly exposed after encountering confirmed-positive patients at the Life Care Center of Kirkland, the Seattle-area nursing home where roughly three dozen people have died because of the virus.

“We are having a very serious challenge related to hospital exposures and impact on the health care system,” Dr. Jeff Duchin, the public health officer for Seattle and King County, wrote in a different email to CDC officials March 1. Duchin pleaded for a field team to test exposed health care workers and additional support.

Duchin’s email came hours after a physician at UW Medicine wrote about being “very concerned” about exposed workers at multiple hospitals and their attempts to isolate infected workers.

“I suspect that we will not be able to follow current CDC [recommendations] for exposed HCWs [health care workers] either,” wrote Dr. John Lynch, medical director of employee health for Harborview Medical Center and associate professor of Medicine and Allergy and Infectious Diseases at the University of Washington. “As you migh [sic] imagine, I am very concerned about the hospitals at this point.”

Those concerns have been underscored with an unusual weekend statement from Dr. Patrice Harris, president of the American Medical Association, which represents doctors, calling on Saturday for more coordination of needed medical supplies.

“At this critical moment, a unified effort is urgently needed to identify gaps in the supply of and lack of access to PPE necessary to fight COVID-19,” the statement says. “Physicians stand ready to provide urgent medical care on the front lines in a pandemic crisis. But their need for protective gear is equally urgent and necessary.”

By Rachana Pradhan and Christina Jewett
This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

(KHN Illustration; Getty Images)

COVID19 Testing is Our Salvation

We are weeks into widespread social distancing in many parts of the world, though it feels like months. Cases of COVID19 continue to mount, as expected, and we watch Italy and Spain for signs of when our society might be cast into crisis and chaos. Health care workers, the heroes of our time (and of all times, really), gird themselves for a flood of respiratory distress cases, projected to peak sometime in April. Physicians and nurses of all specialties are being asked to update their ventilator training in anticipation of being called to the front lines for service. Yet many fear that they will not have sufficient weapons for this fight, such as masks and ventilators.

At this time, it’s important to remember that COVID19 has a global case-fatality rate of about 2 to 3%, lower in the USA, meaning that most people will survive this. In the words of Larry Brilliant, “this is not a zombie apocalypse. It’s not a mass extinction event.” What is it, then? This is, and always has been, a health systems crisis more than simply a health crisis.

In a health crisis, we await salvation from a lucky mutation, a change in seasons (that will likely have no effect on this virus), a vaccine, or a cure. But in a health systems crisis, we can manufacture our own salvation through proper preparation, investment, leadership, and resource management.

In the early phase of a pandemic, it is possible to identify infected individuals, trace their contacts and quarantine them. Once there is community spread, the focus shifts to isolating populations and hardening the hospitals against the onslaught. We are clearly in this second half now.

At present, America’s one million hospital beds are not completely saturated by the number of serious COVID cases, except in overwhelmed places like New York. But in anticipation, health systems managers in many states are struggling to procure PPE (personal protective equipment), ventilators, and even sufficient front-line staff. But there is another way, and both Singapore and South Korea have shown us the first steps on that path.

With an extreme national lockdown that only permits movement of emergency personnel and essential services, lasting a couple of months or more, the number of new cases can be kept to a slow simmer. This is because it would take longer for new infections to occur, while allowing time for existing infections to resolve. The more severe the isolation, the longer it would take for a new case to emerge. The epidemic then recedes to a small number of active cases and a non-newsworthy number of hospitalizations.

The more lax these restrictions, and the slower governments are to enact them, the higher the peak of cases and deaths, and the longer it takes to push the rate of new infections down to a manageable number. But once that is achieved, we can all breathe a little easier.

The Institute for Health Metrics and Evaluation (IHME) predicts that proper social distancing would see the end of the first wave of the epidemic by early June. The timing of the arrival of a second or even third wave depends on the public health interventions made when the first wave abates.

Cases in the US as of March 27, 2020. Image provided by Pharexia.

This post-lockdown, post-first wave scenario resembles the early phase of the pandemic, with a few cases and contacts. That, then, is the time to apply the force of a newly resourced awesome preventative public health system. The secret weapon is something that exists now, that we can manufacture or purchase: tests, and lots of them.

The deployment of rapid, frequent, public testing at a national scale would allow society to return to productive normalcy while keeping the disease to a simmering annoyance.

A Herculean investment in the flotilla of new testing options now becoming available, including rapid 15-minute in situ and at-home testing would give us the epidemiological data to control the outbreak. With sufficient human resources support, every case could be quickly identified and isolated, their contacts immediately traced and tested, as well.

This would require a commitment to a strong and well-maintained public health infrastructure. But such an investment would be a pittance compared to the costs of either the expansion of our hospitals to accommodate throngs of dying patients or the economic cost of many more months of isolation.

In particular, the serology or antibody test would be critical for managing our staged return to society. Such a test would detect the products of the body’s immunological response to the virus, and would therefore tell us if a person were currently or previously infected. If the latter, then they would presumably be immune, and would be granted a free pass to return fully to normal life.

While several serology tests are now on the global market, some jurisdictions do not yet licence them. The challenges are largely scientific. First, the test cannot distinguish between past and present infection, so it would have to be followed up with another test to detect the presence of the virus and therefore determine if the person was still infectious. Second, the potential for false positives is high as it might detect antibodies to other coronaviruses, such as the common cold. And third, it is not yet known how much antibody needs to be present to confer immunity.

On the other hand, the more common nasal swab test, employed on a wide scale in almost every city, relies upon a well equipped laboratory to render a result. But a global shortage of the crucial reagents has resulted in a backlog of pending tests in several places. In many cases, university research labs are being raided to help supply the public health laboratories.

Given that expanded testing, absent a cure or vaccine, is our best path out of the pandemic morass, a natural question is whether the shortages and backlogs could have been avoided. The answer, unfortunately and unsurprisingly, is yes. 

Years ago, the Obama administration put together a comprehensive pandemic response plan that included policy provisions for acquiring critical equipment. That plan was scrapped by the current administration, undoubtedly contributing to the apparent inconsistencies and lack of direction in the national response thus far, and to most states’ inability to acquire PPE and testing kits.

The politics of this failure are tied up in the ideological and personal conflicts between the present and former administration, as well as in the unending tension between private and public sector solutions, pertaining to the question of which sector is best equipped to order, manage, validate, apply and monitor the deployment of tests on a national scale.

Health care system crises like the COVID19 pandemic are not elemental disasters delivered by the gods, but rather are manageable aspects of 21st century globalized life. They can be overcome with good leadership, investment, and planning. Thus far, the leadership has been disappointing, the investment late, and the planning ignored. But there is time yet for these problems to be solved, not by the rare and precious front line clinicians risking their lives, but by the administrators and policymakers, of whom we have no short supply.

Raywat Deonandan, PhD, is an Epidemiologist, Associate Professor and Assistant Director of the Interdisciplinary School of Health Sciences at the University of Ottawa in Canada. www.deonandan.com

Featured image is CDC 2019-Novel Coronavirus (2019-nCoV) Real-Time Reverse Transcriptase (RT)-PCR Diagnostic Panel.

AAPI Fights the ‘Rakshas Virus’

Nearly 100,000 Physicians of Indian origin in the United States serve every seventh patient across the United States – This powerful statistic shared by  Dr. Anupama Gotimukula, Vice president of AAPIUSA at a recent teleconference, underscores the significant numbers of Indian American medical professionals involved in the fight against the novel coronavirus.

The teleconference on Friday, March 27, 2020  was jointly organized by AAPI, the Indian Embassy in Washington, DC, and the National Council of Asian Indian Americans (NCAIA).

“While COVID-19 continues to disrupt life around the globe, AAPI is committed to helping its tens of thousands of members across the US and others across the globe,” said Dr. Suresh Reddy, President of AAPI. “We do acknowledge that these are challenging times, more than ever for us, physicians, who are on the frontline to assess, diagnose and treat people who are affected by this deadly pandemic, COVID-19. Many of our colleagues have sacrificed their lives in order to save those impacted by this pandemic around the world.”

The numbers are grim. Coronavirus deaths in the US  are over 3000  (exceeding the initial death toll of September 11), while over 175,000  people have tested positive for the virus – more than double that announced by China.

In response to the pandemic, AAPI has embarked on several initiatives, the most effective being a twice weekly conference call attended by  over 2,000 physicians from across the United States,  to share expertise and best care practices with other professionals from the healthcare sector.

Nearly 200,000 Indian students in the US are impacted by the pandemic, said Anurag Kumar, Minister of Community Affairs, who outlined efforts to give them assistance.

“We are coordinating with the community and hotels owned by AAHOA members in arranging accommodation for students, “ he said. “Everyone is advised not to travel abroad and back to India, stay where you are until things get better.”

Speakers on the forum highlighted the need for the people to recognize that Covid-19 is an aggressive type of virus. “Everyone needs to take appropriate precautions. Even if symptoms are negative, one is likely they carry symptoms,” advised Dr. Bharat Barai.

Social distancing matters cautioned Dr. Prasad Garimella, a critical care medicine specialist . “Social distancing is not isolating. Keep in touch with loved ones. Stay busy and stay connected. Filter and assess the news, look for credible sources to rely upon. Everyone needs to act like a health care professional and need to have the best attitude in order to defeat this deadly virus.”

Emergency medicine specialist Dr. Arunachalam Einstein endorsed  self-quarantine and masks as a way to prevent spreading. “Go out only for essential things,” he advised. “ Everyone coming to ED symptomatic and non-symptomatic and the staff must wear mask, which will prevent droplets from affecting others.   Even when going out to grocery shopping use masks.”

Dr. Sudhakar Jonnalagadda, expressed concern about the adverse effect of inadequate testing for at risk seniors, as well as for physicians  and healthcare workers fighting infection on the frontlines, stating  “It’s essential to create a wholesale expansion of free COVID-19 testing available in order for identifying asymptomatic carries and then isolating them.”

A rising number of people across age groups are affected by the highly infectious virus, said Dr. Usha Rani Karumudii, an infectious disease specialist, reporting that “People of all ages are prone to the disease. Hand hygiene and social distancing will help prevent. Precautions while shopping, reduce trips. wash and decontaminate hands after going out.”

AAPI also has launched a DONATE A MASK PROGRAM – a major initiative to protect the medical fraternity as they combat the “rakshas” virus.  Members were requested to donate generously to fight “this ferocious virus which has put basic existence of entire human race at stake.”

A severe shortage of GS masks and other protective gear is impacting  “the foot soldiers and front line physicians,” some of whom have succumbed to the deadly virus. A donation box labelled “DONATE A MASK,” has been added to the AAPI website ands a task force established to identify hospitals and direct supplies of Masks/PPE.

Updates  on AAPI initiatives  can be found at  www.appiusa.org

 

 

 

Local Teen Fundraises to 3D Print Face Shields

Aditya Indla is a Sophomore at Bellarmine College Preparatory in San Jose, CA. After realizing that healthcare workers are facing a severe shortage of protective equipment as they deal with the COVID-19 pandemic, he decided something needed to be done.

In collaboration with a researcher at UC Berkeley and Maker Nexus, he is planning to print hospital approved face shields and deliver them to the hospitals in need. He has created a gofundme page to help with the costs of creating the face shields.

Face shields are used by healthcare professionals to protect them when working with patients. Hospital supplies are running low. While they prefer to use commercially manufactured ones, during this emergency, they are looking for alternative sources.

The face shields cost $10 each to manufacture and his goal is to raise $3,000 to purchase the supplies to make 300 masks.

Please help support the healthcare professionals at the forefront of the COVID-19 fight by donating to his gofundme page!