Global Body Warning Covid-19 Koan Interlude with the truth of my personal relationship with risk management. Please join me for a cup of zazen.

2/21/2020

Cover Up

While the learning curve for some health workers to consistently and correctly use protective personal equipment (PPE) was high in one nursing home I worked in, it was not a high bar for Dr. Kentaro Iwata whose specialty is infectious diseases and control. In a YouTube video he spoke of his alarm at the breaches of infection controls or lack of them on the Diamond Princess Cruise Ship. I lump together cruise ships, airplanes, nursing homes, high rise apartment buildings, dormitories, prisons, military barracks and similar places as playgrounds for germs and viruses. I got up from my cushion where I sat as the thought of a cruise ship turned on its bow. There it was a high rise docked in the bay. Dr. Iwata said that appointed officials seemed to be in charge of quarantine on the ship instead of health care professionals. This did not surprise me as we have seen the global trend to place administrators and political appointees in positions above the actual practitioners. This is across the board in all professional fields. Health, Science, Economics, Environmental Action etc.

Expensive Teatime

For a long time, I questioned why it is necessary for anyone with a few hundred dollars in their pockets to plunk down the cash to fly, fly, fly, away to exotic places, to stomp through them and oh and ah. Well if that’s your cup of tea then have at it. According to PBS “In China, travel restrictions and quarantines have decreased carbon emissions by 100 metric tons over the past two weeks”.  I was once asked did I ever want to go to China. That time came and went with the Tiananmen Square Democracy movement and the clampdown on Americans traveling there for five years afterword. I said to my questioner, “China does not need my ass there, they have too many people already. Do they need me there too?” I prefer my ass to be sitting zazen. From that position I can travel anywhere. The point is to be here not there. But you know, the mind does wander. It needs to have safety valves like a faraway place, time, emotion, people, things and nothing but a breath. Teatime.

What about all the people on this planet? I attended a recent seminar taught by esteemed experts on the climate crisis. I realized afterword that the reality of overpopulation was not brought to the table. Is this reality not in vogue anymore? Don’t we need to talk about it? Is it not trending? Is it considered taboo to bring it up? Isn’t overpopulation still an issue?

Not One but Two

Overpopulation is back in the limelight. When cities have 20 million people, they need to eat. Why can’t China which produces field hospitals in ten days produce enough protein foods, so their people don’t need to cling to medieval eating habits holding on to magical meat from hillside warrens brought into town?  The issues of people, food, behavior and public health are always in my face. Public health is a global reality. I know that the restaurants in Chinatown are empty. Is that really a racist response or is it one that is more about resilience? Look deeper.  People are worried about their families and each other. Chinatown is mostly a tourist haven. It is also my home base. Not eating in Chinatown because one is afraid of getting sick either from the annual flu or COVID-19 which has a complicated trajectory and defaming Chinese people are not one but two things. On Tuesday my husband and I took the M9 bus which winds its way through Chinatown to get out of the apartment on a bright day. Our destination was Battery Park (formerly a land fill).  People on the streets were not tourists, they live in the community. Most of them do not work in the restaurants or own them. Every now and then there is brought forward the idea that perhaps tourism has been overdone. Trust me, it is. We can do with less tourists in my opinion. Notice I said less.

Risky Business

Mass migration of people for specific holidays is always a flashpoint for possible disease. Yet every time these viruses erupt in specific population the idea of some “ism” is brought up. We can be more nuanced than that. To disparage others is hateful in response to someone’s personhood. But a lot of Chinese people are staying out of restaurants too. Are they racist or do they care about public health? Did China close restaurants because they hate money and commerce? I think we know the answer to that.

In New York State, according to the American Hospital Directory there are approximately 60,000 beds. Because COVID-19 is endemic and evolving there is a subclinical infected aspect to the virus. It also spreads through just about every way possible. Through droplets, aerosol, oral fecal, and fecal aerosol, it lives on surfaces and is extraordinarily infectious. About 20% of cases require very expert and careful hospital care with breathing assistance, specialized medicine and staff. This resource demanding virus is a humanitarian crisis.

And who wants to get sick? The restaurants will eventually recover with financial assistance as a distressed area. There is no reason to risk lives.

As I write today, we are on the edge of pandemic COVID-19.

Subtle Light, Silver Bowl: Corona Virus Sars 2 COVID Koan Prelude:Consumer Se...

Subtle Light, Silver Bowl: Corona Virus Sars 2 COVID Koan Prelude:Consumer Se...: Corona Virus Sars 2 COVID Koan Prelude:   Consumer Service over Contagion Paradigm Global Body Warning 2/15/2020 I got the text “c...

Corona Virus Sars 2 COVID Koan Prelude:Consumer Service over Contagion Paradigm, Global Body Warning

Corona Virus Sars 2 COVID Koan Prelude:  Consumer Service over Contagion Paradigm

Global Body Warning

2/15/2020

I got the text “can you work tomorrow?” That hooked me into the reality of why I would say no. I love my work in health care. But the trade off is too risky. This year I have battled against the ignorance of our health care system which forces clinicians to be stupid about Public Health Policy and contagious diseases in relationship to what I call the “consumer service over contagion” paradigm. The patient comes first and what they and their families want takes precedent over what is safe for us and the general population.

Autumn 2019 I was at work in a nursing home. We were beginning to have a couple of C. Auris patients. I had treated one of the first in greater New York City a number of years ago. That was in Queens. At that time, I didn’t know what it was. A very kind and knowledgeable physical therapist saw the affected patient’s name on my treatment roster. She grabbed me by the arm and told me the name of this new disease and to be extremely careful. The patient was marked for contact isolation, which is nothing unusual in nursing homes. You gown, glove and mask up. But the physical therapist said keep your distance this is not safe for you or any of us. If it hadn’t been for her I would not know anything. She instructed me to look it up as soon as I got home. I did. Life on the front edge of new diseases is precarious for all clinicians, if they are not told what they are dealing with by administrators and other leaders. I often cite this example because we now know how dangerous C. Auris is for staff and how deadly it is for patients. It is highly resistant to antibiotics and is a fungus that sheds off from a person’s body into the air through air exchanges and lives fairly long on all surfaces.

By 2019 I knew what to and what not to do with C. Auris patients. The first is to wear all protective equipment and limit exposure time with the patient and keep them inside their room. Yet what happened is almost impossible to describe. All kinds of protocols were breached. I blew the whistle about it and other clinicians where actually going to bring this sick C. Auris patient to the public treatment gym. I said no, no, no she can’t come to Rehab. One therapist brought this deathly ill, highly contagious person down to the gym. Everyone just cleared a path filled with horror, amazement, incredulity and disgust among other revulsions. This supposed highly trained therapist was wearing a yellow gown, facemask and gloves. She clearly did not know public health, this disease, and did not want to listen to me. I also had the same patient but insisted on seeing her in her room. This therapist was pissed at me and wanted me to accompany her in her stupidity. That did not happen. I stood my ground and I was right to do so. In a short time, the New York Times had a front-page story on Nursing Homes and C. Auris infections. The administration and therapists quickly snapped out of their ignorance. The learning curve was high for some of them.

Global Body Warning Assorted Writings on Public Health. My Personal Risk Management Journey

2/17/20

Global Body Warning Assorted Writings on Public Health Care, My personal Risk Management Journey.

I have been following the Novel Corona Virus since the first inklings of a pneumonia outbreak in China in the beginning of December 2019. In the last 15 years I have also noticed that many people in this country don’t know the importance of Public Health practice, how their bodies work and how diseases spread.  I put that responsibility on our education systems across the United States. But this is not the time to go down that rabbit hole.

Why was I interested in some artifact of health news seeping out of China? I love history, and Asian cultures because they offer so much to the world. I also love and respect science especially biology. Why? In Junior High School we learned about Public Health, and gasp, Sex ED or as it was safely called “Reproduction,” disease and how to prevent or heal when and if possible.  We dissected fetal piglets, looked through microscopes at slides, outlined phylogenetics in relationship to vertebrates and non- vertebrates. We had to graph, draw, listen, and read. I went to a public school. To be interested in how the world continues to work, I keep alert to the places that are known to produce new viruses. By now we all should know of those places. The convergence of history in general, disease in specific and my interest in Asian culture and people kind of all started in my early teens. 

Here in New York City we have the Department of Health which offered a unique two-day training in the nineties which was taught by Dr. Vincent Coello. The topic was Risk Management and the example to apply it to centered on Pandemic Influenza. As a result of that FREE two-day class I learned that it would not be If but When a pandemic would happen again.  This was the only instance in which I was ahead of Bill Gates!

I find it alarming that people in this country put Health on the back burner unless they are research scientists or clinicians who see the results of not caring about health. Then when they are very sick, expect practitioners to come up with miracle cures. When you are laid out with 2019-nCoV is NOT the time to correct your diet. You will be lucky if you will be able to eat. There is no vaccine yet, only supportive care.  Guess what the result of poor public health practice is? The structures that support the cost of care fail. The enormity collapses in on itself. It is chaos with cost far beyond Medicare for all, Universal Health Coverage, or Affordable coverage.

The triangulation of History, Science and Public Health puts me in my seat studying the Novel Coronavirus of 2019 about six to twelve hours a day. Except of course during a winter retreat for a week.

Because I am not a research scientist but a clinical health care worker with front line expertise, I am not as knowledgeable of what could be next. But we have the internet and social media which when put to good use and tethered with technology is an open door, a mirror, an unknown realm intertwining or as Buddhist and others describe it Indra’s net.

We look back to history of Pandemic Flu of 1917-18, Polio, Swine Flu, SARS, MERS, and Wuhan 2019 nCoV or whatever its new name will be. We have our regular Influenza every year which kills thousands and sickens many more. I just wish the numbers of those cases could be tabulated to see how many of them availed themselves of Influenza vaccines as imperfect as they are. Many health care workers shun the Flu vaccines. They can spread Flu to their patients. There is talk of the enormous cost and burden that is put on Public Health care by those who do not vaccinate against the “regular flu” but are now scared of the unknowns in the Novel Corona Virus of 2019. Would they get vaccinated if a vaccine for it existed? 

In China the clampdown on those sick or not with the virus is creating a screen for the Chinese Communist Party to “disappear” people. This reminds me of the brutalization that occurred during what we know of Mao’s time by Red Guards and others. I am not alone with those thoughts. It is part of the continuing saga of China. Let me say the Chinese army is always ready to go. It is huge, it is always training. It can do good, but it is still an army, that carries out orders. At this time, it appears the orders are a travesty. A devolution of a culture. Building a hospital quickly is a marvel. Taking care of the health of a country requires a lot more than technical ability.

Germ Theory and Koch’s Postulate on how to define disease were discovered and implemented to save humans and sentient beings. They work to help us cross all barriers with compassion. The use of evidence-based science and biology to educate people about Public Health. That is a true cultural revolution.

Note: as of 2/11/2020; this Novel Corona Virus is called COVID-19 short for COrona VIrus Disease as named by the WHO.

People are going missing who reported on this disease. There is a mounting international out-cry.

It is spreading and may be able to be inhaled because it aerosols into fine mists in the environment.

There is a chance of quick turnaround of reinfection after the initial one is cleared.

Diana JiFu Lakis