Thursday, July 30, 2020

COVID 19 and Race

 Nationwide, blacks make up 13% of the population and account for 23% of the deaths.  According to the COVID Tracking Project, through today 25,932 black lives have been lost to COVID-19.  The project says “black people are dying at a rate more than 1.5 times higher than their population share.”

The COVID Racial Data Tracker

In Connecticut blacks make up 10% of the population, but account 15% of the deaths.

State-by-State Dashboard

Why might that be?

Here are some reasons:

Blacks could more genetically susceptible to COVID-19.

Or, more likely it could be because black people in America are more likely to live in poverty, in more crowded living quarters, have higher risk of hypertension and diabetes, have poorer diets, less access to health care, and be less likely to have jobs that allow them to work from home and mitigate their risk of contact with carriers.

Certainly the reasons for the above have a lot to do with American history, politics, and long-standing discrimination and disadvantage.

We have lived too long as two Americas. 

As we battle COVID-19, both the disease and the economic consequences, we should strive to leave no one behind, and work to see that all Americans have equal access to health care, educational and economic opportunity, and to the hopes and aspirations of a better life.  One America.

Peace to all.

Monday, July 27, 2020

American Summer

 I originally posted this in August of 2006.

It’s been over ten years I’ve been working in the city. Driving around in the ambulance, you can see the changes. None of the book stores I used to stop at are still in business. The barbeque place in the north end where they sold cornbread muffins for twenty-five cents is gone. The Lion’s Den – the Jamaican vegetarian restaurant — where you could smell the marijuana smoke coming from the backroom when you went in to buy soy patties – burned to the ground and was demolished. One of the city hospitals closed. The nursing homes all have new names. People still shoot each other and do heroin and call the ambulance for dumb things. There are still a lot of drunks, but none of the old ones are left. We don’t respond in the south end anymore – another company does. The fire department is a first responder now instead of the police who rarely ever came in the first place. Instead of navy blue uniforms we wear light blue shirts. There are more medics on the road these days where before there were just a few of us. We never did transfers unless they were ALS; now transfers are a regular part of the day. I’m as apt to be doing a dialysis run as I am responding to a motor vehicle.

I‘m working with a guy who has been around as long as I have, and we are talking about how some girls who were pretty when we started are now on the heavy side, how some medics who were sparks are now burnt out, how some new stuff is good – like all the overtime — and some is bad – like how the out-of-town dispatchers don’t know the streets. We talk about how you can never rely on anything to stay the same. All you can do is try to do your job and treat your patients decently. The seasons come, the seasons go.

The afternoon is slow. We are posted in an area near the edge of town. Instead of posting on the specific street corner that represents the area we are covering, we are about a quarter of a mile away at the maintenance entrance of a park, right next to a small pond. It is a beautiful August day – blue sky, a slight cooling breeze. We shut the engine off. I open the door and stretch my legs out. My partner goes over and sits on a bench. We are the only ones there. Five minutes later we get a page. Effective immediately per the PD we are to move to the assigned area. We look around and don’t see anyone. I look at the maintenance building, at the windows to see if anyone on a phone is looking out at us. Someone obviously complained to the police about us being in the park.

We get in the ambulance and drive up the road to the posting location and park on the asphalt in the sun. The AC is running, but we are in an old car and the engine is really loud. I try to do the crossword puzzle in the morning paper, but it’s late in the week and as you get toward Friday, it gets much harder. I don’t make much progress.

We go on a couple calls. On a motor vehicle, as we arrive lights and sirens, the cops give us the cut sign. They say they canceled us – it just never made it through the dispatchers. Then we get the dispatch. We’re canceled.

Dispatch sends us over to Main Street for an ETOH. The man who called leans out from a third floor window under a flag of Puerto Rico and points across the street to the baseball field and says, “He’s over there under the tree. He drinks too much. You need to take him to detox.”

We get back in the ambulance and drive over to the field, get out walk along the tree-lined fence, until we come to the entrance, and then walk over to where we see a man in a Yankees tee-shirt sitting with three forty ounce beers. He’s a got a big grin on his face. He’s just cracked open the first one and has two full ones sticking out of a paper bag.

“What’s up?” I ask.

“Drinking beer in the park,” he says.

“You know why we’re here?”

“Cause I’m not supposed to drink in the park?”

“No, that’s not our business. We’re here to see if you’re okay, if you’d like to go to the hospital. Do you need detox?”

“No, I just want to drink my beer. Did my uncle call you?”

“Is he the guy in the third floor window?”

“Yeah. He kicked me out of his apartment. He drinks more beer than I do.”

“Well, just because he wants you to go to detox, we can’t take you against you will, but you realize, if you pass out, we can come and take you.”

“I understand.” He smiles. He sees we are no danger to him.

I’m looking around at the lush green field, the beautiful August day, the beer which is cold right from the store. I look at my partner and I know he’s thinking the same thing I am. “If we weren’t on the clock,” I say, “We’d love to join you. You have a good afternoon. Don’t outdo yourself, and if you ever aren’t feeling well and need to go to the hospital or want detox, just give us a call. And if you do pass out and your uncle calls, we’ll have to take you in. Understand?”

He smiles again, and extends his hand. “You guys are alright,” he says. “It’s a deal.”

We walk back to the ambulance, get in, and then drive back to the apartment building where we call up to the guy in the window. “We can’t take him,” I say. “It’s America. He’s alert and oriented. He’s got rights.”

The man, who we can see has a long-necked bottle of beer of his own in his hand, shrugs and thanks us for trying.

“He passes out, you call us back, and then we’ll come and get him.”

He waves, and sticks his head back inside.

I don’t know about my partner, but when I get home I have a few cold ones myself and sit out in my back yard and enjoy the summer evening.

Time passes. Sometimes you need to stop and enjoy the seasons.

Dragon Breath

 

“Rebound!  Get under the boards!  Use your butt! And rebound!”

I am next to the father of a girl on the team playing my daughter’s team.  He is wearing a mask, but it is under his chin and as he shouts at his poor daughter, I can see the spittle flying from his mouth.  The man next to him is also weaning a mask, but he pulls it down every time he yells at the ref.  “Travel!  That’s a travel!”

All the other members of the team’s fan contingent sitting in the stands nearby are wearing masks, but many of those masks are also on their chins or if they are over their mouths, they don’t cover their noses, and the parents pull them down to yell at their daughters or the refs.

I feel bad for the guy’s daughter.  She is the tallest and heaviest person on the court and she is doing her best, but only when she scores does she draw praise.

I am sure her father loves her, and loves watching her play, but I worry that he doesn’t recognize the seriousness of what is happening in the world.  Why wouldn’t he follow the rules and wear his mask properly rather than sending his dragon breath of possible COVID spittle into the air of this facility where sixty girls are playing basketball on three courts in a gym that is hot and not as well ventilated as the other gyms the girls have played in?

Maybe some people think the same of me, wondering why I allow my daughter to play at all in an indoor gym in this time of COVID.

The other gyms my daughter has played in have all followed strict protocols, but this one is crowded and hot and the mask wearing is half-assed and there are no temperature checks at the doors, and teams waiting to play next are allowed to congregate in the building instead of being held outside.

I am thrilled my daughter is getting to play again, and while COVID is very low in Connecticut now, there are hints of an uptick, and I have told her to enjoy each game as if it were her last because if COVID comes back or if anyone gets sick at any of these games, they are going to get shut down.  Or if the numbers come up and she is asked to play again in a gym like this, I will shut her down.  Still it will be a shame.

Sports adds immense value to life.  You need joy in life and sports bring my daughter great joy.  It all makes me wonder about the limits of risk.  I will continue to work as a paramedic and treat COVID patients and come home to my family.  I will let my daughter play sports as long as I believe it is safe and it brings her joy.  I won’t eat in a restaurant or get on an airplane or go to anyone’s house for a party.  I wear my mask when I am within six feet of anyone not in my immediate circle.  Other than going to the grocery store and taking my daughter to her practices and games, I stay in my own bubble as well as I can.

I don’t understand why everyone is not following the safety protocols.  I don’t understand why people don’t wear masks.  I don’t understand why a business that needs to stay open doesn’t take every precaution they can.  Ban the parents if you have to.  Let us watch online.  Better that than add risk.

I think in the end, there is an absence of education and understanding of the germ.  Many people don’t understand that masks save lives.  My daughter’s coach keeps them outside until the game starts.  He makes them wear masks unless they are in the game.  Everyone who comes off the court, has to sanitize their hands.  Game out over, out the door.

I hope her sports seasons continue.  I hope that no one gets sick.  But I am worried.

What if COVID stays with us forever like the common cold?

Will we close all sports down?  Will we play through it despite collateral damage?  Or will we find good safety protocols and stick to them?  

I am watching sports on TV now.  Breaking news.  The Florida Marlins baseball team, 14 of their players have tested positive for COVID and their game tonight has been cancelled.  The talking heads on TV are saying the major league baseball season is doomed.

Report: Marlins-Orioles game canceled due to possible COVID-19 outbreak

In another story, an NBA basketball player is let out of the bubble they have been keeping the players in to minimize risk to attend a funeral.  He is spotted that night in a strip club.

Lou Williams must quarantine for 10 days, will miss at least two games

People, wear your masks. Reduce risk wherever you can.  Be careful.  The dragon is still out there.

Much is in jeopardy.

Saturday, July 25, 2020

Hidden Bias

 I don’t like having too many choices.  A few years ago, I wanted to get a bigger TV.  I just wanted to go into the store and come out with something in the 50-60 inch size.  I went into the store fully intending to buy a TV, yet I walked out of there with nothing.  Why? Because there were too many choices.  I could have made an easy choice if it was size alone, but the choices weren’t about size.  They were about features and gizmos and catch phrases for technology that I mostly didn’t understand.  This one had this and that one had that, and it was all too much for me to decide.  I ended up just giving my daughters my credit card and a price limit  and telling them to bring home something nice.

I needed a new dermatologist.  My aunt died of melanoma many years ago, so I am supposed to get an annual mole check.  I was going to one doctor for many years, but then he unexpectedly closed his practice, and I never got a new one.  The other day I noticed a new mole on my arm that wasn’t there before.  While it looked pretty innocuous, it spurred me to get back to having my annual checks.  To do so, I needed a new dermatologist.  I went to the hospital web site and there were almost twenty dermatologists to choose from.  Here’s where the problem came in. 

I would have been happy to take any one of them, but I had to choose one.  And it wasn’t a list of names, there were pictures.

I felt like I was suddenly part of a research experiment/focus group.  Who was most likely to be chosen (or not) and for what reason?  Which of their hands would I place my life in?

The older white man (Marcus Welby)   Should I take him as the trusted old time doctor or should I avoid him because he might be out of touch with the latest science and maybe behind his smile and good nature, be hiding a touch of dementia?

The middle aged Asian woman.  Should I choose here she might be super smart or should I avoid her because she might be harder to understand if she has a strong accent?

The young black doctor.  Should I take him because he may have overcome much to become a doctor or, is there a worry that he may be there only as a token?  Of all the doctors he is shockingly the only one from his race.

The young white man.  Should I take him because he may be up on all the latest info?  Or do I worry he is a rich kid who has everything handed to him on a silver platter and he may only have gotten into med school because his Daddy donated to the college hospital or is best friends with the Dean?

As each picture provoked multi responses in me, I wondered if I should just go "eeny, meeny, miny, moe?"

I ended up getting a referral from a doctor friend.  I called for the appointment without checking the name against the pictures.  I was asked if I minded being seen by a resident instead, and that was fine with me.

When I went for my appointment I was seen by both a resident and an attending, and I found them both very professional, and I was grateful for their time.  The mole indeed turned out to be innocuous.

Still the episode of reacting to the pictures troubled me because as much as I want to view everyone the same, the exercise brought out hidden biases, maybe biases that I may not act on, but ones that flashed into the control room of my brain, raising troubling questions.

It all made me wonder what people’s impressions are of me when I come through their door.  I am a very tall scraggly looking, long haired, mustached sixty-year-old white man?

Do I project experience?  Do they think I might have dementia?  Do I look kind?  Do they trust me with their lives?  Or do I scare them?  What biases do they hold toward me?

Hopefully, once I introduce myself and start caring for them, they feel okay about me being their provider.

Home Test

 

I participated in a research project this week, testing a home COVID antibody test. I had to do it while being watched via a zoom link by a study monitor, as well as answering a series of questions about the test.

Here’s how it went. The package came in the mail. After opening it, I placed all the components out on a prepared sheet. I ran my hands under warm water to get the blood circulating, then wiped my nondominant ring finger with an alcohol swab, and pricked myself with a lancet just like the ones we use to test a diabetic’s blood sugar. I hadn’t pricked myself in a long time. When we tell the patient it is like a little bee sting, that is a good description. I still feel it. They give me a little tube to collect the blood. More is needed than what you get to do a blood sugar. I had to milk my finger repeatedly to get enough blood to fill the tube. Next I held the tube over the test kit and dropped the blood into the specified collection hole. Then I added two drops of a buffer solution and waited 12 minutes. Just like a pregnancy test or fentanyl test strips, a line appears indicating the result. I took a picture of the test and uploaded it on the phone app. A doctor is supposed to contact me later with the results, although it was pretty easy to figure out for myself.

No antibodies.

The test was simple and easy.

I would buy a kit if they were on the market and I wanted to know if I had COVID antibodies.