Corona Daily 223: Why Prioritise Nathan Dunlap?

Epidemiologists and bioethicists in many countries have recommended including prisoners in the top priority list for covid vaccinations. USA, the country with the highest per capita prisoners, (in total 2.3 million behind bars) had initially placed the incarcerated among the earlier vaccinees. In March 2020, the state of Colorado abolished the death sentence. Nathan Dunlap was one of three prisoners on death row whose sentence was commuted to life imprisonment as a result. In 1993, the 19-year-old Dunlap was fired by the restaurant where he worked. Frustrated, he had taken revenge by shooting and killing four employees.

An op-ed in a Denver newspaper criticized giving vaccines in shortage to prisoners before giving them to honest citizens. The author of the op-ed rebuked the plan to inoculate Nathan Dunlap ahead of his own law-abiding 78-year-old father. This was followed by an infuriated backlash on social media supporting this argument.

Colorado governor Jared Polis, a generally liberal man, an openly gay governor, announced at a press briefing there was “no way the limited supply of shots would go to prisoners before it goes to people who haven’t committed any crime”.

Prisoners have now disappeared from the priority lists of many American states. Countries in the EU, UK and India haven’t given much attention to prisoners. Prima facie, it seems a fair and sensible argument that free people must receive vaccines before incarcerated people.

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Inmates live in extremely crowded conditions, sharing bathrooms and eating facilities. Social distancing is out of the question. Their access to protective gear is unheard of. Prisoners have high rates of hypertension, heart conditions and other comorbidities. In the USA, they are disproportionately Black and Hispanics, the vulnerable groups.

14 out of Colorado’s 15 largest outbreaks occurred in prisons or jails. Nationally, in the USA, more than 40 out of 50 cluster outbreaks began in prisons. The viral spread doesn’t stay in the prison walls. Contrary to what people think, an average sentence in the USA is just seven months. Jails hold many suspects for very short periods of time, sometimes only for a few hours before sending them back. The prison staff, often from the minority communities, goes home. They can carry the virus to their families and neighbours. Visitors and those released can act as transmission agents.

It is important to note there are 500,000 people in American jails awaiting trial, who are presumed innocent until convicted. In Texas jail, 80% of those who died of covid-19 were never convicted of a crime. Another 44,000 are in juvenile facilities and 42,000 in immigration detention centers.  

Guarding them are the 400,000 correction officers. One plan is to vaccinate only the prison staff (because they are not criminals). That doesn’t solve the issue of jails and prisons becoming the Covid-19 hotspots. So far in the USA, the covid case rate is four times higher in prisons than in general population, and the death percentage double inside than outside.

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Prisoners are already punished by deprivation of freedom. One health-care director described prisons as essentially long-term care facilities with bars. Morally speaking, it is debatable whether the state has a right to impose on prisoners additional punishment by exposing them to the virus or denying them vaccine protection.

Even if moralistic arguments are kept aside, data shows that prisons are some of the worst super-spreading places in any country. Immunizing incarcerated people is a practical necessity. Vaccinating those inside can make the lives of those outside safer.

Ravi 

Corona Daily 224: Treating the Present as History

Most galleries, libraries, archives and museums (GLAMs); the institutions that preserve our cultural heritage, are shut since March. A third of the museums worldwide are at risk of permanent closure in the next twelve months. I could write a couple of articles about the sorry state of museums, but it makes for depressing reading. Recently, though, I came across an interesting article by Andrew Dickson in the New Yorker. He talks to Alexandra Lord, a curator at the National Museum of American History in Washington. In a normal year, this museum gets more than four million visitors.

As luck would have it, in February the museum was preparing an exhibition called “In Sickness and in Health” about the Philadelphia yellow-fever epidemic in 1793. Alexandra Lord was collecting materials for it, when the coronavirus struck. On 14 March, the museum abruptly shut.

Curators like Lord instantly recognize the hugeness of a story. They start thinking about how to tell the coronavirus story to the future visitors of the museum. The New Yorker says after 11 September, the rapid response teams from different museums had started collecting objects while the dust was, literally, still settling.

In the current pandemic, some museums collected diaries kept by children, essays by passengers infected on a Carnival cruise ship, masks, hand sanitisers, PPEs, ventilators and vaccines. The National Museum of American History alone has 1.8 million objects, most of them in storage. To bring in more objects requires serious justification.

Some ordinary artifacts can have great historic significance. Examples are a glass bottle melted by the bomb at Hiroshima. Or the desk clock recovered from the debris of the Twin Towers, with its hands frozen at 09.04. Finding such objects and preserving them for decades is a challenge for curators.

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While London’s Victoria and Albert Museum was shut, its rapid response curators created an online series called “Pandemic objects”. It features the history of handwashing, including a seventeenth century Iranian ewer used for the Muslim ritual of wudu, and a 1960 British sink. Some museum blog posts addressed pandemic beards, toilet paper, and mourning jewellery. In England, in pre-Victorian times, it was customary to set aside money in the will so your friends could buy a ring to remember you.

The Vienna museum has had more than 3000 pandemic items submitted to it. They include notices from the Vienna police department, hospital passes, homemade face masks, special contact-free door openers. There are funeral photos with only two attendees at a grave. Body bags are a heartbreaking artifact.

In Germany, a soccer ball from the first Bundesliga match with empty stadiums is considered to have historical value. Also, the holy water in packets distributed by churches to their members.

National Museum of American History has received objects and digital photos from the public. One of them is from the daughter of a pilot who flew the last commercial flight from the USA to China before travel was stopped in January. The digital photo shows a message her father received in the cockpit telling him to turn around and “deadhead” home, with no passengers.

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Alexandra Lord was surprised how few objects the museum had about Spanish flu, almost nothing. One reason, she says, was that back then museums weren’t interested in the lives of ordinary people, only royalty and aristocracy. Secondly, perhaps in the chaos of the second world war, it took people time to realise how serious the Spanish flu pandemic was. Lord also cites a more important reason: people wanted to forget the whole thing, rather than preserve any memories of it.

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Towards the end of the interview, Lord was asked about her feelings witnessing the great coronavirus story. She paused and said, “Back in May my mother died of Covid-19. We as curators, are part of a story we are collecting. It’s not just an unfolding event, many of us are experiencing it, too” she said.

Ravi 

Corona Daily 225: Out-of-the-Fridge Thinking

46-year-old Steven Brandenburg, wearing his hospital uniform, opened the fridge door. He once again looked behind him to make sure he was alone. His gloved hand took out a box of Moderna vaccine vials. Shutting the fridge, he scanned the room for a good place to hide them. A pile of scientific magazines lay in the corner. Brandenburg stuffed the box of vials behind them. In the semi-dark room, he checked the time on his smartphone. 18.39. That was good enough. He tiptoed out, closed the room, and headed home. Despite the rampage of the virus, nothing much should happen this week. It was Christmas eve.

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Next morning, he was back in the room. As a licensed pharmacist employed by the hospital, he had legitimate access to the room. But his heart was in his mouth. Fortunately, nothing had changed. The box of the vaccine vials was still in the corner behind the magazines. He checked the time. 09.38. Excellent. He gently picked up the box and kept it in the fridge, exactly from where he had dislodged it.

That same evening, he returned to the room and repeated yesterday’s procedure. He resisted the temptation to remove more boxes from the fridge. 500-600 was a good number to start with. This was working well. Post-Christmas, the hospital may get more crowded. He would make any necessary adjustments.

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Next morning, Steven Brandenburg was in for a shock. With gloves on, he was about to pick the box up from behind the magazines, but the box was gone. Bizarre. He opened the fridge to locate the cavity where the box had been. It had vanished. When he checked the phone for time, he saw a message asking him to meet the hospital director. It said the matter was urgent.

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On Monday, 28 December, the Aurora Medical center issued a press statement: “We learnt that about 50 vials of Moderna vaccine were inadvertently removed from a pharmacy refrigerator overnight. Our internal review determined that as a result of the unintended human error, the vials were not replaced after temporarily being removed to access other items. While some of the vaccine was administered within the approved 12-hour post-refrigeration window, most of it had to be discarded.”

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The pharmacist colleague who was bewildered to find the precious box in the corner continued to question Brandenburg. The review team kept probing him. Brandenburg had never played poker in his life. In two days, he broke down. He confessed in writing his act was intentional. FBI and FDA representatives were summoned. Brandenburg was sent to the Ozaukee County jail.

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Moderna vaccine, if kept outside the fridge for more than 12 hours, becomes useless. Once thawed, it can’t be refrozen. 57 people were unfortunately given shots that would probably be ineffective. Each of them was contacted, and the situation explained to them. Moderna scientists said the useless vaccines won’t have any adverse effect. The 57 people will need to be given the first shot once again. In total, more than 500 doses worth $11,000 had to be thrown away. In times where the state of Wisconsin was losing forty residents to Covid-19 every day, that was a significant loss.

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Brandenburg has been charged on three first degree counts: recklessly endangering safety, adulterating a prescription drug, and criminal damage to property. All three are serious felony charges that could put him behind bars for several years. As to why he planned the act of sabotage is not yet known.

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American hospitals are now thinking of keeping refrigerators in secured areas, installing CCTVs, limiting access.

In 2006, a group of British young men planned to carry liquid explosives disguised as soft drinks on several transatlantic flights. That plot was foiled. But till today, none of us is allowed to carry on flights a bottle of more than 100 ml in our handbags.

Small destructive acts of madmen can have long-term expensive ramifications.

Ravi 

Corona Daily 226: Use it or Lose it – Unused Leave in 2020

The issue of Paid Leave for employees has occupied the minds of the HR policy-makers for decades. A country’s labour laws and an individual employer’s policies decide the length of the paid holidays, whether unused leave can be rolled over to the next year, encashed, or simply allowed to lapse.

In Europe, with strong labour laws and better life-work-balance, paid leave is taken for granted. America and Japan, where work is life, are the worst countries in this regard. A 2018 research found that 55% of Americans and 48% of Japanese didn’t use their holiday allowance, however meagre.

The 2020 pandemic has made the issue of paid leave far more complicated. Until yesterday, Americans becoming sick with Covid-19 were entitled to two weeks of paid leave. While the US cases are reaching new daily records, from today, 1 January, that USA federal mandate has been withdrawn. Some 87 million workers are likely to be affected.

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Even before the pandemic, the USA was the world’s only wealthy nation to not have a federal paid sick leave mandate. While countries like Norway or Luxembourg allow up to 50 days of paid sick leave, the USA mandates ZERO. An American worker missing five days due to the flu or one undergoing a 50-day cancer treatment is not entitled to any paid sick leave.

Since March 2020, most workers-from-home have put in at least one extra hour daily. Presenteeism has been a problem. New terms like staycation or holistay (where you become a tourist in your city or during a strict lockdown, in your backyard) are familiar to employees everywhere. Pandemic Year One is over, and the employers must decide what to do with the unused leave of their employees.

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The standard policy across USA has been “use it or lose it”. 42% of the American companies said they are reviewing the policy to make it flexible. Goldman Sachs will allow rollover of 10 days and Bank of America 5 days. General Motors and Ford will give cash compensation for unused leave. Citigroup will offer 1 extra day of holiday if all vacation was used in 2020. Reuters doesn’t allow any rollover.

Cash compensation is a philosophical debate. Why does an employee need a vacation? To recover from the hard work and long hours. Refreshed after the holiday, employees can work with improved productivity. I personally welcome companies forcing employees to take at least a month off from work each year. (That is why I never considered working in the USA). Marathon runners must rest and recover after the run. Should they accept cash and continue running?

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UK normally allows 8 days to be carried forward. Now four weeks of unused leave can be carried over into 2021 or 2022, in effect five weeks can be rolled over. Denmark will allow rollover. Belgium will allow it till the end of March.

I have earlier talked of the software company GitLab which operates remotely, without any offices, since 2011. To recognize the significant rise in working hours, it now organizes “family-and-friends days”. On specified days, the company shuts down all its operations, with none of its more than thousand workers allowed to log in. 15 January is their next mass holiday. Google, Slack and Cloudera are thinking of introducing similar policies.

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With work becoming partly or fully remote, the pandemic offers an excellent opportunity to rethink the paid holiday policy. USA has the most lopsided work-life balance. Even without all the data, I have seen my relatives and friends in the USA relying on strong medicines to suppress illnesses rather than allow natural recovery. This total commitment to work is likely to become worse if the employee is working from home all the time.

Joe Biden would do well to study the European labour laws. The American workers must have sufficient leave, in order to discuss unused leave.  

Ravi 

Corona Daily 227: Parents Look Out

This week, the UK’s Royal College of Pediatrics and Child Health (RCPCH) warned eating disorders were on the rise among children and adolescents. This was based on a survey of forty pediatricians and child specialists in England. The number of their patients have tripled or quadrupled this year. Waiting lists are long and beds for patients in severe shortage. Children with eating disorders are appearing in advanced stages of illness. They have missed interaction with friends, teachers and doctors, any of whom may have noticed and pointed out the visible change earlier.

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The three key eating disorders are binge eating (eating too fast, too much, eating when not hungry), anorexia (fear of gaining weight, starving oneself to remain slim) and bulimia (binge eating followed by vomiting it out – some professional ballerinas are victims of bulimia).

Social media has aggravated the crisis by glorifying thinness and fitness. Forgetting that genetics also contribute to the size and shape of our bodies, many young girls fall victim to body comparison. Young boys, on the other hand, may get obsessed with a muscle-oriented body image or a six-pack abdomen. Modern teenagers know ratios like BMI (body mass index), and have weighing machines and apps to monitor them.

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Pandemic and lockdowns have made matters worse. Eating disorders are now considered a crisis in child mental health. Children are isolated with school closures, exams are postponed, sport activities cancelled, physical exercise is curtailed and replaced by increased screen time and social media. There was also an extensive media coverage further focusing on BMI and how overweight people are vulnerable to Covid-19.

UK pediatricians have identified two patient profiles in the pandemic time. One is the high achieving, ambitious, truly driven young girls. They had meticulously planned their future which is now in danger or shattered. The second type is those with personality disorders and problems with controlling their emotions.

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What symptoms should parents look out for?  (a) Child eating very fast (b) cutting food into small pieces (c) going to the bathroom or shower immediately after meals (d) hiding how much was eaten (e) significant weight loss or gain (f) avoiding meals with others (g) sudden change in diet (h) obsessive exercise (i) refusing to eat food previously enjoyed (j) use of negative comments about their bodies or other people’s bodies (k) wearing larger clothing (l) avoiding social situations (m) excessive fear of going out (n) skipping meals. (o) calorie counter apps on phones.

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Studies in the UK, USA and Netherlands suggest this crisis is widespread.  

In the USA, 9% of population (29 million) suffers from eating disorders. NEDA (National Eating Disorders Association) reported that in November, 72% more people were seeking help through online chats, as compared to previous years.

In Canada, some Olympic and Paralympic athletes became new victims of eating disorders. They had a set exercise and diet routine. With the Olympics postponed, and rigourous training halted, athletes are left confused, their diets disrupted.

Since September, there is a noticeable eating disorder spike among children in North America and Europe. To combat this crisis, school reopening should be a priority.

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This discussion is also relevant for adults. Our set routines, commute to the office and back, prime of the day spent in the office keep us away from food. Diet management is one of the lesser-known benefits of office-going.  Locked up at home, we need to be super-disciplined to manage diet, exercise and sleep. A bowl of chips can be quietly finished next to a business Zoom call. Fears about the virus and financial worries can cause retributive eating and drinking.

During new year parties, some people celebrate by binge-eating after midnight. What a way to start a New Year. If the curfew regulations can reduce indiscriminate eating while entering the new year, it will set a good tone for orderly eating in 2021.

Ravi 

Corona Daily 228: Fang Fang and Zhang Zhan

On 20 January, the 11-million strong city of Wuhan was gripped by fear. It was to face the first major lockdown of this year. A deadly, highly contagious virus had already taken fourteen lives and the state media was shifting its stance on the fatal virus with every new infection.  

Fang Fang’s first reaction was shock, followed by anger. On 25 January, the first day of the Lunar New Year, she logged on to her Sina Weibo account to write her first diary entry. It started with the words: Technology can sometimes be every bit as evil as a contagious virus. Fang Fang, 65, had had her account shut down before, not surprising in China. The first day’s post ends with the words: “Let’s see if this post is able to be uploaded.”

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In February, Zhang Zhan, a 37-year-old former lawyer, travelled 400 miles from Shanghai to Wuhan. She began going around Wuhan with her video camera and smartphone documenting what was happening on the streets. She tried to talk to people, but many refused to talk in front of the camera, requesting that it be directed at their feet instead. Police sometimes stopped Zhang asking her what she was filming and why. Zhang was not an accredited journalist. She was a street reporter, better known as a Citizen Journalist. She videorecorded the overflowing hospitals, empty shops, and the Wuhan Institute of Virology. Her filming of crematoria suggested people were cremated day and night, far more than officially reported.

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Fang Fang began posting an entry every day. This was a candid first hand account of a Wuhan resident. The simple straight-from-the-heart prose went viral. Tens of millions of Chinese readers would stay up late each night just waiting to read the Wuhan diary’s next installment. She continued to write for two months.

Michael Berry, a professional Chinese-English translator, was one such reader who decided to share the diary with the world by translating it into English.

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Zhang Zhan was uploading her video clips on WeChat, Twitter and YouTube. Twitter and YouTube are blocked in China. In February, Chen Qiushi, who had live-streamed videos from Wuhan during the city’s lockdown and posted reports on social media, disappeared. Two other independent journalists were detained. Zhang began questioning the authorities about the detentions and disappearances.

In March, China expelled thirteen journalists from the New York Times, Washington Post and Wall Street Journal. Their crime was to criticize China’s initial response to the coronavirus. Beijing said the journalists were dispatched because of US restrictions on how Chinese State media operates in the USA.

Zhang continued to do her bit, until May 2020, when she too was arrested.

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Fang Fang had planned sixty entries. On the last day, coincidentally, the government announced Wuhan would reopen on 8 April. On that day, websites in the US uploaded pre-sale information for the English edition of Wuhan Diary, written by Fang Fang, translated by Michael Berry.

In the introduction, Fang describes the whole thing to be a dream, as if the hand of God had been silently arranging everything behind the scenes.

*****

Zhang Zhan was in jail without being charged until November. After she announced a hunger strike, she was handcuffed and force-fed through a tube in her throat. On Monday, 28 December, she was brought to the court room in a wheelchair. She was charged for “picking quarrels and provoking troubles” (article 293 of China’s Penal Code). The court sentenced her to four years in prison. Her mother who was present, sobbed.

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I wonder why the Chinese state treated the two women so differently. Age? Or material presented - is textual matter less dangerous for the state than the visual?

In terms of quality, Zhang’s clips look ordinary. The Chinese clips are without subtitles, and in many, she simply talks facing the camera. Her viewership was small. That can’t be the reason to put her behind bars for four years.

Wuhan Diary is short, honest, readable, in a book format. That may have kept Fang Fang free, while Zhang Zhan languishes in prison.  

Ravi   

Corona Daily 229: The Year’s Biggest News Story

In April this year, the few times I ventured out on the roads, shopping bags in hand, a mask covering my face; the talk on the streets stunned me. Whether the conversation was between people I knew or strangers, there was only one topic: the coronavirus. Nobody talked any longer about cricket, Bollywood, politics, TV debates, border skirmishes, illegal immigrants – nothing, just the coronavirus.

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The Economist published a fascinating analysis in its last week’s issue. It tried to answer the question: has the covid pandemic been the biggest news story ever? The Economist was founded in 1843. The magazine has all issues available in digital form for the past 178 years. Its editors requested the New York Times to join in the research. The New York Times made its archives available from its starting year 1851.

The research analysts combed through every article published in those two newspapers by inserting keywords for each year. (Exhausting, but not impossible any more in the digital world).

Economist published its first article on the novel coronavirus on 16 January. At the end of January, covid-19 appeared on its cover. Between February and April, ten consecutive weekly issues had virus on its cover. By late March, 80% of the published stories in Economist included the word covid-19 or coronavirus.

In 2020, covid-19 related stories had a 47% share in Economist and 46% in the New York Times.

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The same analysis found that the Great Depression in the 1930s and the 2008 crash had news coverage of less than 20%. The Y2K problem was the big story of the year, but could reach only 30%. The words internet and online, although a rage in the twenty-first century, have never figured in more than 20% of the stories in any year. The fall of the Berlin wall (1989) was mentioned in less than 10% stories. Fall of the British Empire with India’s independence in 1947 was surprisingly little worthy of news. The Spanish flu’s (1918-20) coverage on both sides of the Atlantic was fairly limited.

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In the past 170 years, only two stories were bigger in The Economist.

The First World War was obviously not called that until the Second World War happened. The share of Economist stories referring to the Great War, as it was called then, reached 53% in 1915.  The Second World War was also in the news throughout, reaching 54% in 1941. Since America was an ocean away from the wars, the New York Times stories with the word “war” peaked at 39% (1918) and 37% (1942).

Covid-19 is the biggest story of the year ever for the New York Times, and with the exception of the two World Wars, for The Economist.

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Newspapers are often accused of focusing on bad news. I think that is simply a reflection of human nature. When we gossip, we rarely compliment the absent people we talk about. Similarly, public fear since the start of the pandemic is often reflected in the newspapers.  

In March, tabloids often used the phrase “killer virus”. One article in The Telegraph reproduced on-the-ground reports from Wuhan: “Mask-wearing patients fainting in the street. Hundreds of fearful citizens lining cheek by jowl, at risk of infecting each other, in narrow hospital corridors as they wait to be treated by doctors in forbidding white hazmat suits. A fraught medic screaming in anguish.”

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Here is wishing that covid-19 is no longer the biggest news story in the forthcoming year.

Ravi 

Corona Daily 230: Israel Wants Selective Shoulders

On Saturday, 19 December, Israel’s PM Benjamin Netanyahu received the first vaccine shot in Israel. Israel’s “Give a Shoulder” campaign has secured four million doses of the Pfizer vaccine. Israel will issue “green passports” to the vaccinated, to allow them greater freedom of movement. Netanyahu boasted he had managed to call Albert Bourla, Pfizer’s CEO, at 0200 am to clinch the vaccine deal for Israel. (Albert Bourla is a Greek Jew).

Since 1967, Israel has occupied the Palestinian land of East Jerusalem, the West Bank and the Gaza strip. Who is going to vaccinate this population? Israeli health minister Yuli Edelstein rejected it was Israel’s responsibility- moral or otherwise. He admitted it is in Israel’s self-interest to vaccinate the neighbour who sends thousands of workers into Israel every day but said nothing will be done for non-Israelis until all 9 million citizens of Israel are first inoculated. “We can’t deny an Israeli citizen a vaccination because we want to help someone else.” he said.

The Give a Shoulder campaign includes Jewish settlers inside the West Bank, but not its 2.5 million Palestinians.

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Israel and the Palestinian Authority have struggled to contain the outbreaks. Tens of thousands of Palestinian labourers employed in Israel have transmitted the virus there and back. Israel has reported more than 370,000 cases, and 3,000 deaths. The Palestinian Authority has reported more than 120,000 cases with 1,100 deaths.

More than 25,000 Palestinian children born during the pandemic have not had their birth registered by Israel.

The Gaza strip, variously described as a concentration camp, a crime against humanity, a collective punishment, is in grim condition. Its two million residents include those in the refugee camps. Almost 86,000 Palestinians, living on average 12 per apartment, are packed within a quarter-square-mile of density, ready-made for a coronavirus explosion.

Gaza gets about 8 hours of electricity every day. It suffers daily rolling blackouts and unsafe drinking water. Power cuts severely affect hospitals and infrastructure. Its 60 ICU beds, and an emergency 38-bed field hospital are full. Supply chains are broken. WHO usually sends humanitarian help from Dubai via Jordan. Supplies of vital equipment, including respirators, are hampered.

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Palestinian leaders say they can’t afford the Pfizer vaccine ($20 a dose) or Moderna ($30 a dose) even if they were to become available. Palestinians have only a single refrigeration unit, in the oasis town of Jericho, capable of storing the Pfizer vaccine.

Russia reportedly plans to offer 4 million doses of Sputnik-V in future. Palestinians have requested UAE to share with them the Chinese vaccines. Whatever arrangements are made, Israel will be the deciding authority. The Israeli regulators must review and approve the vaccine before it can enter the Palestinian territory. Unapproved vaccines can be stopped at checkpoints.

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The Israeli citizens, including those in the occupied West Bank, will get the recognized, approved vaccines. As a humanitarian measure, Israel may allow Russian or Chinese vaccines to be delivered to the Palestinian territories. The apartheid character of the Israeli regime is further highlighted by the vaccine double standards.

The coronavirus knows no geographical or racial boundaries. Israel’s economy needs thousands of Palestinian labourers shuttling to work in Israel every day. It is naïve on Israel’s part to think the selective vaccine policy will work.

Ravi 

Corona Daily 231: Travel Nurses

Laura Liffiton, a 32-year-old nurse, worked in an overrun ICU in a crowded New York city hospital in April. In July, she flew to Arizona, where she lost four patients on her first day. In October, she travelled to Green Bay, Wisconsin. She has been sleeping only four hours a night. In different cities, she has seen overwhelmed doctors and nurses, lines of intubated and dying patients, with no end in sight to the misery of the situation.  

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Laura is one of the fifty thousand or so travel nurses in the USA. They work on temporary contracts, and move from city to city. For some, travelling is the motivation, for others money. Early-career nurses want to work in different places to gain experience. Those nearing the end of their careers, with little family burdens, want to use their last few years of work to increase their retirement savings. In normal times ICU and medical surgical nurses are the highest in demand.

Specialised agencies bill the hospitals and provide the “travelers”, who stay in hotels, Airbnbs or rented apartments. They usually stay in one place for three months. The three months were historically granted as a maternity leave, during which a travel nurse would replace the one on maternity leave.

When natural disasters such as hurricanes or tornadoes strike, travel nurses serve a useful function. They reach the hot spot, work in the disaster zone, and then leave.

What is happening this year is unprecedented. In November, the demand for travel nurses went up by 44%. California, Texas, New York, Florida and Minnesota are the five states with the worst shortages.

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Now, more than 100,000 Covid patients are hospitalized every day in the USA. Ordinarily a nurse, particularly in ICU, serves a maximum of two patients. Now, nurses are looking after eight. The governor of North Dakota has allowed covid-positive doctors and nurses to continue working, as long as they are asymptomatic. The University of Utah hospital has been using 36-hour shifts for nurses and the state of Iowa has run out of staff beds.

In summer, travel nurses were mainly needed to help in operating rooms on postponed cases and backlogs from the spring wave. In normal times, hospitals scrutinized the resumes to carefully select the best candidates. Now they specify only the number. Like the rush to get the vaccines, there is a rush to get the travel nurses.

The dynamic between the staff nurses and travel nurses is complicated. In a Sacramento hospital, only staff nurses were given higher quality equipment such as air-purifying respirators. With travel nurses earning substantially more, staff nurses are bound to feel upset. Some of them have left their permanent staff positions to become travelers.

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The prices for travel nurses are skyrocketing. Before the pandemic, hospitals would pay $75 an hour, now it is three times more. A traveler can earn anywhere from $5000 to $10000 a week. On top of that, now hospitals are asking for travelers for vaccination. Joe Biden wants America to give 100 million shots every month. Rural hospitals are struggling to find money to pay the high rates for travelers.

The never-ending work is risky. One organization has identified 922 frontline health workers who died of covid after helping the patients.

High pay has drawn more supply, but because this profession requires training and qualifications, there is a limit to the supply. There just aren’t enough nurses. The agencies are shuffling nurses in what they call robbing Peter to pay Paul.

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In my view, the USA needs to take the extraordinary step of expanding the travel nurse concept to nurses from overseas. Countries like India and the Philippines, with relatively fewer cases now, would be able to provide a few thousand nurses on an emergency basis.

Ravi 

Corona Daily 232: The Strange Case of Ice Hockey

Against all odds, Canada is hosting the 2021 World Junior Ice Hockey Championship in Edmonton. Starting on Christmas day, and culminating on 5 January, it will be held behind closed doors, in other words no spectators allowed. All teams are held in an Edmonton bubble with strict regulations.

This week, eight German players tested positive. Germany’s training matches against Austria (21 Dec) and Czech (23 Dec) are cancelled. Two members of Sweden are also in isolation. Two American players were sent home. Three weeks ago, Hockey Canada had to suspend its selection camp and quarantine all players for fourteen days, after two players tested positive.  

These are the under-20 players. As we know, the coronavirus has little impact on the young. Moreover, these are some of the fittest kids in the world. But ice hockey has been plagued by an astoundingly high number of cases. 29-year-old Tyler Amburgey was the coach of two hockey teams. In August, he initially caught a cold from the chill of the ice rinks. This was not unusual, he had it every year. It progressed to a headache, fatigue and shortness of breath. Thirty kids he had coached had tested positive. On the third day, 29 August, Amburgey died.

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Scientists are studying hockey-related outbreaks to learn why hockey players are getting infected so often. Several theories have been suggested.

Hockey players are sprinting the whole time on ice. This leads to heavier breathing resulting in more particles being inhaled and exhaled.

One theory is that the spaces occupied by the rinks keep the virus suspended, possibly at the height of six to nine feet above the ice. Similar outbreaks were documented at other super-cold venues like meat processing factories.

This is an indoor game. The rink is surrounded by plexiglass to prevent errant pucks and keep the game dynamic (unlike soccer which pauses once the football goes beyond the marked line). The plexiglass keeps the airflow stable, and ice cold. Ice rinks are designed so that there is little ventilation or humidity. It seems like an ideal ground for the coronavirus.

Lab experiments have shown that at 86F (30C) the airborne virus takes 52 minutes to decay, at 50F (10C), it takes 109 minutes, more than double the time.

When humidity is high, the virus attaches itself to bigger droplets and falls to the ground due to the heaviness of the humid drops. (if true, I am happy about the high humidity levels in Mumbai). When the air is dry, the droplets evaporate into small size particles and stay in the air. Lingering at a height of six feet above the ice, they can easily enter the nostrils of the hockey players. Research has also shown that in general, cold temperature and low humidity can make some people more susceptible to viruses, possibly because of lowered immunity.

I must emphasise these are theories and speculations at this stage. But the high number of cases among the ice hockey players is a fact. The tragic death of a 29-year-old coach is also a fact. Ice hockey involves vigorous physical exertion accompanied by deep, heavy breathing. During the game players frequently move from the ice surface to the bench while still breathing heavily.

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Although the International Ice Hockey Federation has cancelled most events by now, the World Junior Championship starting next week is an exception. Governors of seven American states, including New York, New Jersey and Connecticut have banned competitive hockey until the end of January.

Investigating the case of ice hockey is essential because it may offer valuable clues about the behaviour of the virus. It may explain why things are so bad in Europe and America in winter time, and so dramatically improving in hot and humid Mumbai.

Ravi