COVID-19

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Things Aren’t Always Black and White

Since January, when I decided to run for Pennsylvania House District 102, I’ve been spending a lot of time listening to people in the district about what is important to them. 

Politicians often frame things as being a stark black-and-white contrast: a binary choice between A or B, with no in-between. But my goal is to create a community where we can have in-depth discussions, despite our disagreements, and hopefully arrive at a solution that is agreeable to all – or at least most – of the constituents in the 102.

One example right now is the response to the COVID-19 pandemic. We’re presented with two options: stay in your homes and never leave, or resume normal life with no precautions. Asking people to stay home is unsustainable for any extended length of time. But opening up with no safeguards damages businesses as well. People are more reluctant to go out when they feel their health is at risk. 

But this pandemic isn’t an either/or situation. We can take commonsense personal actions (wearing a mask, washing our hands, and watching our distance) and combine those with community actions (testing, quarantining, contact tracing) to achieve the best of both worlds: protecting our community health while businesses resume their activities with some modifications.

Many Pennsylvanians are also concerned about school property taxes. Again, this issue gets framed as either (a) complete elimination or (b) taxes that continually spiral upwards. If elimination were an easy solution, it would have been done by now. But what if we could reduce the local school property tax burden, providing some relief to property owners, while still leaving some local control over our schools? 

To do this, we need to increase the state’s share of education costs. One solution: tax income from wages and interest at a rate of 2.8% (lower than the current rate of 3.07%) and all other income, such as capital gains, at a rate of 6.5%. This would generate at least $2 billion of additional revenue that could be used for education. Likewise, closing the Delaware loophole so that corporations operating in Pennsylvania pay their fair share could raise $600 million in new revenue. Many local school districts are currently paying 60% or more of their educational costs. More funding from the state could reduce the local taxes, while still providing high quality public education to our students.

These are just two examples from the conversations I’ve had with people in the 102. Some of you will agree with me, some will disagree. Others may want more details, or fewer. But if we can start to have discussions about innovative approaches to our common problems, we may actually accomplish something to help Lebanon County.

There is one choice that definitely is an either/or, though: who will represent you in the PA House for District 102. I hope you’ll consider me.

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Back to School

Teachers and students have embarked (or soon will) on this strangest of school years. I believe our schools are doing their best to balance the needs of the students, the school staff, and the community.

Still, given that in most communities we’re not even close to having the kind of systems and protocols in place that would lead to success, it’s no wonder that teachers, students, and parents feel some trepidation.

I know that teachers will step up, as they always do. I’ve said before, being a high school teacher was the hardest work I’ve ever done – but also the most rewarding. Currently I work with in-service teachers and know that these folks truly care about educating our young people. Our teachers are amazing, and I wish them all the best this year.

Our students will also be making sacrifices, both big and small. I hope they all stay safe and healthy and are able to experience some sense of normalcy.

But I’ve been troubled by reactions when teachers raise questions about the safety of returning to in-person instruction, particularly in schools where lack of resources makes it tough to follow guidelines for doing so safely. A common refrain is “kick the bums out and we’ll replace them with eager young teachers who want to be there.”

The only problem is, our teachers have been disrespected for so long that there is no glut of professionals waiting to replace them. In fact, there’s a teacher shortage, and if our current educators leave (or become incapacitated due to illness) that will become even worse. The coronavirus pandemic has only added to these issues.

So teachers, students, and fellow parents – I wish us all the best. We’ll need it. And in the meantime, let’s work as a community to make things safer, not just for schools but also for grocery store workers, healthcare providers, convenience store clerks, and everyone who’s working with the public to keep our lives as close to normal as they can. We’re all in this together.

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Masks Are Not Child Abuse

Representative Russ Diamond recently brought Lebanon County to national attention once again – but not in a good way. In a statement to the media, he said that masks do more harm than good. This statement caught the attention of Dr. Eric Feigl-Ding, an epidemiologist and health economist, who said such a statement was “dangerous nonsense.” Subsequently, Representative Diamond doubled down, tweeting an infographic that “a masked child is an abused child.”

The idea underlying the representative’s anti-science campaign, that we’re faced with an either/or option, is a false one. It’s not either wear a mask or open the economy. It’s not either follow safety guidelines or send kids back to school in the fall. We have to do both. In fact, these things depend on each other in order to happen.

We have many case studies to look at in regards to dealing with the coronavirus, given that it is a global pandemic. Sweden took a do-nothing approach, which originally appeared to lessen the economic consequences. However, data now show that not only did Sweden’s economy eventually suffer as much as its neighbors, but the country also had many more deaths than those countries that did implement shelter-at-home and other precautions.

Here in the US, we’re watching as states that reopened early and widely, without achieving the recommended metrics and with little in the way of safeguards in place, are now rolling back their openings and experiencing a surge in both positive cases and hospitalizations. Death, the ultimate negative effect, also may increase in the weeks to come – although some progress on treatments may (and hopefully will) help to alleviate that. Still, there are many instances where people with COVID-19 are faced with weeks/months/possibly a lifetime of negative health results.

And what about schools? As a supporter of public education, I recognize the value in having well-trained, professional teachers educating our children. There are also many social and emotional benefits to our children attending schools in person, especially for our most vulnerable.

At the same time, we cannot sacrifice these same children and teachers on the altar of convenience. We need to take seriously the recommendations of the experts. Our politicians — unless they are scientists with experience in medicine, virology, or epidemiology – should listen to those with expertise. Politicians can lead at a time like this by modeling appropriate behavior, providing clear and coherent messaging, and allocating resources to the areas that will help us resume some sense of normalcy.

I would urge everyone that, if we want our businesses to stay opened and our schools to resume in the fall, we focus on these things.

First, we must all – even children – follow the three W’s:

  1. Wear a mask correctly
  2. Wash your hands
  3. Watch your distance

Secondly, our public officials must work together with healthcare providers and private businesses to:

  • Ramp up testing, especially rapid results testing for our most vulnerable citizens and our public-facing workers
  • Isolate positive cases
  • Create teams of contact tracers, including use of technology, with effective protocols for identifying people who may have been infected by a positive case
  • Quarantine those who have been exposed until they’re verified not to have the coronavirus, including providing quarantine facilities if/when necessary

When it comes to reopening schools, if we rush into it with no concern for our students/teachers/administrators, as well as the communities they’re all a part of, we will only achieve failure. Here in Lebanon County we have the opportunity, with good leadership and strong community participation, to become an example of how to do things right. We should work together, at all levels, to make ourselves an example of what happens when we follow the best scientifically-based guidance available and focus on both public health and reopening. That’s the recognition I’d like to see Lebanon County receive.

Thanks for reading this! The biggest help you can give my campaign is to share this post widely within your social networks. I am dedicated to creating a grassroots movement to represent the constituents of the 102nd district, but to do so, I need your help in getting the message out.

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Lebanon County is Yellow Due to Failed Leadership

On Friday, June 19, the Department of Health announced the counties that would be moving to green in the next week, based on four criteria:

  • Stable, decreasing, or low confirmed case counts for the past 2 weeks as compared to previous 2 weeks
  • Contacts of cases are being monitored
  • PCR positivity rate < 10% in past 14 days
  • Hospital bed use is 90% or lower per district population

Lebanon County is the sole county that will be left in yellow next week, because we failed the first and third criteria. Our state representatives and senator, along with our DA, coroner, and two of our county commissioners, have failed us. In doing so, they have put Lebanon County residents’ lives and livelihoods at risk. This was entirely predictable.

Not only are we seeing an increase in the number of positive cases, with a positivity rate that indicates we’re still not doing enough testing, but our business owners who have been hoping  for green so they could reopen in accordance with the rules are disappointed once again.

What should our leaders have been doing?

  • Modeling safe, scientifically-based behavior like social distancing/wearing a mask*/washing their hands frequently
  • Messaging the necessity of such actions and the reasoning behind them, providing additional clarity when appropriate
  • Ensuring that medical professionals and first responders had enough PPE
  • Working with healthcare providers to get enough tests and testing sites to meet the positivity threshold of <10%
  • Securing funding for small businesses to help them stay afloat during this time
  • Providing protection for renters and homeowners who can’t afford their housing payments
  • Helping local businesses understand the guidelines for re-opening and providing resources for planning

*Wearing a mask whenever in public, not just when required to do so in order to secure a photo opportunity for providing meals to first responders.

Instead, they were:

  • Prematurely declaring that Lebanon County was in the yellow, despite not having met the metrics
  • Encouraging businesses to reopen in defiance of the state guidelines
  • Publicly denouncing science, scoffing at guidelines that were in our community’s best interests to follow, and holding press conferences to promote flouting the rules
  • Writing legislation to impeach the Governor
  •  Writing legislation to end the emergency declaration, possibly impacting the state’s ability to receive federal funds

What a wasted opportunity and complete failure of leadership. Pennsylvania stands as a model of how to safely and responsibly respond to COVID-19 and return to some sense of normal. Lebanon County, however, stands as a monument to arrogance, ignorance, and selfishness.

There are some in Lebanon County who disagree with me. They’re welcome to comment on my social media, message me, or send me an email. I’m always willing to listen to other perspectives and engage in discussion. If you look at Representative Diamond’s Facebook page, you’ll see overwhelming support for him. This is because he blocks constituents who disagree with him and deletes their comments. Doing so is possibly illegal and definitely runs against the spirit of the Constitution that he loves so much. Likewise, he’s often complained about Governor Wolf and Dr. Levine picking winners and losers. In the meantime, he put a huge amount of energy in promoting a restaurant that’s not even in his district, simply because its owners were willing to break the rules. Imagine how all the restaurant owners in the 102nd district, who are following the guidelines, feel. Where is their press conference? Why isn’t their representative devoting any time to promoting them?

As ignorant and arrogant as these actions are, I hope our county’s elected officials actually believe in the rhetoric they’re using. Because the alternative is that they know exactly the danger to our community’s physical and economic health and are proceeding anyway, simply to score some cheap political points.

Those are my thoughts on the subject. And here are some quotes from other Lebanon County residents about Friday’s news.

“If you go over to Berks County, almost everyone wears a mask and follows the social distance guidelines. I manage a home and community-based program so my staff are constantly out and around people with disabilities. They have been vigilant and stayed safe and healthy! They wear masks and wash their hands because they care about the vulnerable. But apparently Russ and it seems like half this county do not! It’s sad that a city as crowded as Reading could control the cases faster than Lebanon!” – Palmyra resident

“If Frank Ryan can spend six months in Iraq locked down on a military base for the Iraqi people, why can’t he do it for us to defeat COVID-19?” – Christopher Lancaster

“Our four intrepid representatives have made Lebanon County the laughing stock of Pennsylvania. I know they’re proud of themselves. I’m not. Their partisan grandstanding and feigned indignation have shown they only care about the constituents they can exploit for their own agenda. We’ll remember this come November.” – Lorraine S.

“If Lebanon County and you sir, were not too ignorant to wear masks we would be green. Great leadership. Thank you Governor Wolf and Dr. Levine for all you have done to protect PA residents. Vote for Matt Duvall!” – Marie A.

“When the LebCo Republican leaders pushed the county into the yellow phase, they said that it could be done safely. Since that time, they have done nothing to ensure safety. In fact, they elevated a restaurant that is not only operating in a manner outside of the yellow phase restrictions by offering indoor dining but is also not requiring masks. Their arrogance and ignorance does not serve the businesses that are struggling and following safety guidelines nor the businesses that are waiting to reopen. They only serve themselves not the people of Lebanon County by continuing to fight the Governor and not COVID-19.” – Tina P.

“I’m so sad and disappointed. This was a chance for people and parties to work together for the common good. The reality is that following the medically proven guidelines would have resulted in faster opening of the county and businesses. How short-sighted and arrogant of our county’s elected leaders to turn it into egotistical grandstanding.” – Denise S.

“Current elected officials have thumbed their noses at a very real threat to the population of this county. This is blatant selfishness on their part. Now with the increase of cases and deaths in this county we are paying for their greed and disregard of others.” – Karon I.

The biggest help you can give my campaign is to share this post widely within your social networks. I am dedicated to creating a grassroots movement to represent the constituents of the 102nd district, but to do so, I need your help in getting the message out.

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Medical Expert’s Advice on Wearing a Mask

A few days ago, our state representative in the 102 posted a 2015 article by Dr. C. Raina MacIntyre (et al). You can view the article at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4420971/. In the paper, Dr. MacIntyre and colleagues argue that medical masks are better for healthcare workers than cloth masks. Notably, the authors don’t argue for no masks. Indeed, based on my reading, I felt that the representative’s quote “My mask harms me, your mask harms you” was a misunderstanding of the article–hopefully not a deliberate one.

However, my saying so could be viewed as just more partisan politics. So I decided to ask an expert for her opinion. Below I’m including the personal correspondence I received from June 2 with Dr. MacIntyre, who our representative has already acknowledged as an expert on this topic. One thing I think is important to note: she highlights how the US–and I will add, specifically Pennsylvania–could use mask design and manufacturing to bolster our economy. Our legislators could have been working on programs to do just that, helping both our community’s health and our economy. The time is running out–if it’s not already past–for us to heed the advice of the scientists and experts in order to preserve our fragile return to a more normal lifestyle. Otherwise, we will end up with another surge of disease and be in a worse position than we have been.

And now, Dr. MacIntyre’s message.

See attached paper and my commentary in Lancet yesterday. [https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31183-1/fulltext]

We have had a huge number of inquiries about our 2015 RCT of cloth masks, with some desperate HCW in the US asking me “is it better I wear no mask when I work?”. This has horrified me to the extent that we have published a direct response to the original paper and another commentary (see below).

My position is, if a HCW cannot get proper PPE, they should not work.   I agree with Trisha Greenalgh’s commentary that countries should take responsibility and scale up production.

However, some HCW will choose to work (or be forced in some cases) in substandard PPE.  Especially as CDC is recommending bandanas. For them, I think it is important there are recommendations to help them navigate through the various home-made mask options.  There are some basic design principles which can improve the filtration and fit of a cloth mask, plus recommendations on daily washing.  Here is what we wrote in response to the barrage of communications about our 2015 trial:
https://blogs.bmj.com/bmj/2020/04/09/covid-19-should-cloth-masks-be-used-by-healthcare-workers-as-a-last-resort/

https://blogs.bmj.com/bmj/2020/04/09/covid-19-should-cloth-masks-be-used-by-healthcare-workers-as-a-last-resort/

I have cited some of the relevant work that can inform design of a good cloth mask.  This is a newer paper with some relevant data:  https://pubs.acs.org/doi/10.1021/acsnano.0c03252

And this one I think is very interesting because they show that a nylon stocking improves the performance of all kinds of masks including cloth and surgical – probably by creating a better fit and forcing air through the face piece, I would guess. https://www.medrxiv.org/content/10.1101/2020.04.17.20069567v2

Meanwhile we are analysing the washing data from our cloth mask study – it would seem there was an association between infection and self-washing compared to washing the masks in the hospital laundry.  We will submit this somewhere to further inform the field. It’s possible the people who reported self-washing actually didn’t wash as frequently as they reported.

On community use of masks, I do believe in universal face mask use for COVID 19, if we can provide good guidance on design. The folded Tshirt and ear-loop method demonstrated by your surgeon general is a poor design.  If the CDC is recommending bandanas, they need to be doing the research – but research to date suggests single layer masks are poor, as are untreated cotton (the Konda paper above suggests chiffon or polyester blends are best). The fabric needs high thread count, fine weave and water resistance. Most studies only test filtration and do not test water resistance.  Some of the good designs I have seen include multiple layers with cotton batting or other filter material between the layers.  I do believe, from the papers I have read that designing a good cloth mask is possible.  UFMU is important, along with distancing, because of the substantial capacity of pre and asymptomatic transmission, especially if society is being opened up again.

The US of all countries should be able to scale up production of surgical or cloth masks (and give people jobs while doing so) and it is a travesty that they have not, and that they are auctioning off the medical stockpile to private companies. 

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Protecting Our Most Vulnerable

The shelter-in-place restrictions for Pennsylvania were the best course of action to save lives. Even as we move into the yellow and green phases, we’ll need to be more cautious about how we interact with others – and home will still be the safest place to stay, until we have a vaccine.

It’s important to recognize, however, that this is not the case for everyone. For children who suffer from abuse or neglect, being at home may not be a safe haven or welcome reprieve from the world. The Moore Center at Johns Hopkins University published an article about this issue, including links to national resources. Here in Pennsylvania, Children and Youth Services is still running, even during the pandemic.

There are also resources available for those facing food insecurity. In my hometown of Annville, the school is providing food for families in need, and a number of local houses of worship are also offering food pantries. The Central Pennsylvania Food Bank is another resource that folks can use if they need food.

Finally, we shouldn’t forget about our elderly neighbors during this time. Check in via phone, or make a socially-distanced visit (for example, wear a mask, knock on the door and then wait on the sidewalk to talk to them while they stay on their porch).

We are still a community. While we want to follow the expert guidelines to keep each other healthy, we should also be doing what we can to protect the physical safety and mental health of those who need it.

Those are my thoughts, anyway. I’d love to hear yours! Comment on my Facebook page or Twitter.

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Moving Lebanon County to Yellow

Today, two of Lebanon County’s commissioners approved a resolution to defy Governor Wolf’s restrictions and move the county to the yellow phase of reopening, despite not meeting the requirements established by the Department of Health to do so. Commissioner Litz was the lone dissenting commissioner. This move was encouraged and cheered on by other local officials, including my state representative and senator.

This is an unprecedented and challenging time, and I can empathize with the pain and frustration some of my fellow citizens are facing. I can understand why a small business owner, facing the loss of their livelihood, would want to reopen. I can understand why a worker, faced with loss of income and a severely overwhelmed unemployment compensation system, would want to be able to return to work.

What I can’t understand is how elected officials, rather than working to address those issues (as well as increased testing, contact tracing measures, PPE for medical workers, and other items that would help us move into yellow and green), would instead turn this into a partisan shouting match that not only endangers lives, but puts these same businesses and workers at further risk due to the consequences of moving forward with this action.

Even more hypocritical, these same officials are now urging constituents to follow the guidance for yellow phase – despite their own actions, which indicate that rules and laws are only to be followed when you agree with them. Like Pandora, I fear that they may discover that the box they have opened has far more serious repercussions than they may have imagined.

All of that said, and even in these highly partisan times, I still believe that there is more to unite us than divide us. Like it or not, we all share our towns, our state, our country – and more importantly, our humanity. I like to focus on the businesses that have followed the guidelines, that are doing their best to protect their workers and customers, and that are urging patience and humanity. I respect the people who are risking their lives, from medical professionals to grocery store clerks, and many others in between. And I respect those who follow the rules, while still working to address the problems using the proper means and channels. And finally, I respect those who care enough about others to endure personal inconvenience for the greater good of our community.

While it would be nice to say “just stay home if you want to and let the rest of us go about our business,” the truth is we are all in this together. I believe there are enough likeminded people that we can still overcome this challenge, even as our leaders abandon their responsibilities and take the easy way out, encouraging actions that have serious repercussions for many of their constituents, but not for themselves personally. Nelson Mandela said, “To be free is not merely to cast off one’s chains, but to live in a way that respects and enhances the freedom of others.” Let’s all live in a way that promotes true freedom.

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We Must Have a Plan for Reopening

Last week, I posted that our county should prioritize safety and health as we begin the process of reopening – knowing that it will, indeed, be a process – and one that takes some time. A number of our local elected officials stated that Lebanon County had satisfied all requirements and was moving to yellow, despite Governor Wolf’s legal declaration otherwise. (And, it should be noted, despite the fact that Lebanon County had not actually met the requirements to do so.)

The governor, naturally, responded. He outlined the probable consequences of such an action. His response was completely predictable, and while the posturing of our local officials may have scored with some folks, available data suggest that most Pennsylvanians believe the governor is handling this correctly and that we shouldn’t be moving too quickly.

How did writing the letter actually help local businesses and workers? In my opinion, it did not. In fact, if anything it has made it more likely that a business which reopens too soon will be met with serious consequences, and won’t have any excuse for not understanding what would happen.

Here in Lebanon County, a week ago we had 774 confirmed cases, with at least 12 deaths. 2,933 people had tested negative. Today, May 13, Johns Hopkins reports that Lebanon County has 849 positive cases, at least 16 deaths, and 3,362 negative tests.

That’s an increase for Lebanon of 75 positive tests in a week. A look at the graph shows that our new cases are climbing again. This is not the direction we want to go, and further highlights that there is still work to be done to get our community to a safer place. Currently, about 20% of tests are coming back positive, which also indicates that we’re not doing enough testing (areas that have been most successful have 10% or less of their tests coming back positive).

Source: https://lebcogis.maps.arcgis.com/apps/opsdashboard/index.html?fbclid=IwAR08iyMfLkaB976JW0QC4GRdbOHQ3oe_9zoztM2JC-Uykojar8l-xHNl2Vo#/180580f672544d1382b6bb745ccba441

The letter last Friday, and subsequent posturing, was not a plan to reopen. A plan would address testing – both current and future. Does Lebanon County have the capacity to test widely/quickly/accurately? Can we ramp up testing if a “hot spot” emerges?

A plan would address personal protective equipment (PPE). Are local hospitals and medical professionals confident that they have the PPE necessary to support both our current level, as well as a possible outbreak? Are businesses aware of what PPE they should have for their employees? Their customers? Is there any support for businesses in regards to supplying PPE, especially to their workers?

A plan would make it clear how workers’ rights will be respected. Can workers take 14 days to self-quarantine if they are potentially exposed to COVID-19? Are they required to report to work, even if they are in an at-risk group? Will refusing to report for health reasons result in them losing the ability to claim unemployment insurance?

A plan would address customer safety. How should businesses respond to a customer who refuses to wear a mask or follow social distancing rules? Can businesses require customers to have a temperature screening or answer questions about their health before shopping? And what physical changes (screens, barriers, markings) should businesses make to keep their customers and employees safe?

Telling businesses they can reopen, but that they’re on their own in determining how to do so, is not a plan. Telling workers that they should ask their bosses about how they’ll be kept safe is not a plan. Telling customers “stay home if you don’t feel safe” is not a plan.

In the meantime, there are businesses that are open right now. Some of them are doing amazing things to prioritize employee and customer safety. Others, unfortunately, are not – and so the idea that “of course all businesses will be safe” is already proven false.

One argument has been that the guidance from the federal and state level has been unclear or missing. In some cases, that’s a valid complaint. In other cases, our local leaders have either failed to do their due diligence in reading and understanding the guidelines, or else have blatantly lied about the lack of information. These leaders could, in their various capacities, use their roles to provide a real plan for moving Lebanon forward, safely and responsibly. But they have not.

In a different situation, it might be interesting to see the results of this cavalier approach. But as it is, being wrong means the needless loss of lives, and a probable return to an even harsher lockdown. That’s a gamble some may be willing to take. I, for one, am not.