Zooming out on COVID-19
The events of the last 6 months are historic. How will they look from the future?
I’m setting out to re-report a lot of what has happened surrounding COVID-19, regulations and restrictions, and vaccines in the last six months to a year. I want to set the backdrop before diving into some more specific stories about individuals and businesses. As such, I’m starting with a couple kind of “zoomed-out” stories, after which I hope to dig into more of the “nitty-gritty”.
I’m also going to save my editorial for after this week’s feature story, since it relates.
I haven’t really processed the reader survey responses yet, but it looks like people are mostly interested in local government, economy, and COVID-19, in that order. Closely followed by hurrying up on the nonprofit. Because COVID-19 is (hopefully) a temporary story, I’m going to focus my efforts there, but with a close eye on local government and economic responses, too.
I was able to get a couple great interviews this week, but still a little shy on photos. It will probably remain that way until I can get vaccinated, at least. Industry consensus is generally that “getting the story” isn’t worth getting COVID-19, or spreading it.
The reader survey is still open if you haven’t offered up your thoughts yet.
And remember, any underlined text is a link to a primary source, an interactive element, or an interesting story. I highly recommend clicking on some.
Houghton County COVID-19 timeline
I built a really nice interactive timeline, but Substack won’t let me include it directly in a post or email. More on that later. I’ve added a little teaser image to give you an idea of what it looks like, but to see the whole thing, you’ll have to follow a link.
The timeline marks school openings and closings, potential exposure sites announced by the Western Upper Peninsula Health Department, and a few more things against the backdrop of new, confirmed cases of COVID-19 in Houghton County. With so much happening across different spaces and in such a short time, I thought having things laid out chronologically might help make sense of things a bit better.
Check it out by clicking right here.
I’d like to state clearly that I have not and would not draw any conclusions from this graph. This is an incomplete data set, and not all significant events are included, either. I can add things if you feel like something crucial has been omitted.
This is simply a visualization to help place disparate events in their chronological context, I thought it worked well with the story below on non-pharmaceutical intervention.
I really like building visualizations like this to help people understand stories. I hope you like them, too. I used JS Storyline from Knight Labs at Northwestern University for this one. They provide a suite of free, easy-to-use tools for storytelling.
WUPHD’s role in launching ‘non-pharmaceutical interventions’ in Copper Country
Before 2020, the Western Upper Peninsula Health Department wasn’t focused on surveilling and testing for highly-contagious viruses like COVID-19.
“I mean, those are definitely missions of the health department,” said Tanya Rule, WUPHD’s director of environmental health, who works out of the Hancock Office. “But this is a whole new disease we’re dealing with, and obviously nobody working here has ever dealt with a pandemic before.”
For almost a year now, many of their normal duties have been pushed to corners of the day while the bulk of Rule’s five local employees’ time is spent on COVID-19-related activity.
Rule’s environmental health department was mostly focused on well and septic permitting, system inspections, and building permits. Many other inspections, like for swimming pools, campgrounds, and tattoo parlors, are also done by contract with the state of Michigan. The health department also responds to emergencies like the 2018 Father’s Day flood, toxic spills, and does educational outreach for things like Lyme disease and radon.
Going into 2020, Rule had planned to be spending time outside of those regular duties digitizing her department’s records, speeding up E.coli testing at beaches, and updating the local sanitary code.
Paper records made response to the 2018 Father’s Day Flood more difficult as they were trying to figure out what water supplies and septic systems might be compromised. Rule said they purchased specialized software in 2019 to be able to lay those records out on a map.
“And so we are working on inputting all of our data into that, so it can be used for public health purposes and also just be accessible to the public,” Rule said. “Because people ask us for data all the time.”
The sanitary code revision has been a four-year project, all but halted due to COVID-19.
“The only local code that we have here is our Superior Environmental Health Code that regulates on-site septic systems,” Rule said. “Every other code that we regulate the public under is a state code.”
Other health department plans to expand healthy eating, asthma prevention, marijuana education, and substance abuse programs were all put on hold. Instead, they’ve been making sure the necessary things, like construction and operating permits, are taken care of while putting focus on the COVID-19 response.
When the first COVID-19 shutdown happened early in 2020, WUPHD’s staff was working to learn as much as they could and create website content and documents to share with the public and with schools and businesses to educate them on compliance and safety.
“Starting in March, my staff conducted 742 field visits at local businesses in our five counties,” Rule said. “These were not regulatory visits.”
Rule said they visited schools, restaurants, bars, grocery stores, hardware stores, campgrounds, pools—any public place—and brought information about COVID-19 safety and prevention.
Since there were not any safe drugs or vaccines available, education focused on ‘non-pharmaceutical interventions’, or NPIs.
Dr. Kelly Kamm has a doctorate in epidemiology from the State University of New York at Buffalo, and a master’s degree in microbiology from John Hopkins School of Hygiene and Public Health. She works as assistant professor of kinesiology and integrative physiology at Michigan Technological University. Among her research foci are rural health, hand hygiene, and the social determinants of health.
Kamm said that treating a sick person with an antiviral or antimicrobial pharmaceutical is a great way to keep them from infecting other people by shortening the amount of time they have the disease and are infectious. However, there’s currently no known safe treatment for COVID-19, so NPIs are necessary instead.
“So those are the things like hand washing, the social distancing—it’s all these behavioral things that we can do—wearing a mask, keeping ourselves healthy through other ways…” Kamm said. “Those are what we consider those non-pharmaceutical interventions.”
Kamm said Copper Country may have been spared early infection simply because there weren’t many people coming into the area at the time. Students weren’t returning from other areas, and there are no major airports like those in big American cities that saw many of the early outbreaks.
“So rural areas in that case were protected a bit,” Kamm said. “The problem becomes—in terms of safety—that rural areas are very underserved in terms of healthcare.”
Urban areas like Detroit, Grand Rapids, Milwaukee and Chicago have multiple hospitals in close proximity, so it doesn’t take long to get transferred from an overcrowded hospital to one with spare capacity. The hospitals of the Upper Peninsula are much more distant from each other, smaller, and have less of a labor pool to draw from.
“Our job market for anything is just much tighter and harder to fill in if people are out,” Kamm said. “If you want to have visiting nurses, where are they going to come from?”
Kamm said normally there are benefits to living in a smaller, close-knit community, too. During the Father’s Day floods, people came out immediately to help each other, because they know that other help is distant and could take a long time reaching them.
“I think with COVID, the problem is really that people aren’t recognizing this as a community issue that we need to address as a community,” Kamm said.
Once positive cases started appearing in their jurisdiction, the WUPHD staff switched to phone calls to ensure they didn’t catch or spread COVID-19. Rule said they made nearly 550 calls, focused on places like nursing homes, hotels, daycare centers, and private medical practitioners. Two health educators who manned the emergency call system at WUPHD, activated for COVID-19 response, were taking upwards of 100 calls per day through the summer, she said. One of her staff assisted them.
Contact tracers were overwhelmed with the number of calls they needed to make in early November, and prioritized those either more susceptible to the disease, or those more likely to transmit it because they were in a congregate situation like a nursing home or school. However, that doesn’t mean others were left abandoned, Rule said. They still got notified and are asked to quarantine and notify their own close contacts, but aren’t interviewed about potential contacts by WUPHD staff.
Rule said that while there are some people who don’t cooperate with the health department’s contact tracing, most of the community is very cooperative.
“People are honest about where they’ve been and who they’ve been in contact with because they want to protect their communities just as much as the next person,” Rule said.
Schools are a big part of the contact tracing and intervention efforts. WUPHD has 20 schools in its jurisdiction.
“And, since the pandemic began… we’ve had to quarantine just over 3,000 students and staff in our 20 school districts,” Rule said.
Someone from WUPHD is in contact with each district every day to discuss exposures, tests and quarantines, with the goal of keeping the schools open.
“Quick identification of a positive, and then getting their close contacts into quarantine and doing virtual school is really a way of preventing the closure of the entire school,” Rule said. “And we have found that to be effective.”
During the past year, WUPHD has also helped greatly expand testing capacity in the area, and offered rapid COVID-19 testing to all the emergency services, schools and other critical infrastructure employees.
“We want to make sure that our emergency services are maintained, and that they don't have an outbreak because we know that our first responder groups are very small,” Rule said. “We don't have the capacity for all the firemen or all the police officers in one agency to, you know, be part of an outbreak.”
Rule said the new testing lab at Michigan Technological University made a huge difference, cutting the wait time for lab results from 1-2 weeks to 1-3 days.
“When we were really backlogged and delayed of[sic] testing,” Rule said. “Sometimes by the time we would get the results, the person's quarantine would be over. So that became problematic with preventing spread.”
The lab was expanded with help from a grant WUPHD received from the Michigan Department of Environment, Great Lakes, and Energy. The grant also supported the wastewater testing pilot, which showed community outbreaks can be predicted in communities as small as MTU dormitories by detecting the increase of virus pieces in wastewater stream samples.
Rule said that 519 businesses in WUPHD’s five-county jurisdiction have been contacted about having a customer or employee test positive during the pandemic.
“So then they are obligated to notify their staff that they had an exposure so that they can further monitor themselves for symptoms,” Rule said.
A handful of exposure sites have been released to the public, but Rule said WUPHD tries to avoid doing that if they can. They release statements in cases where people were likely ignorant to their exposure, and unable to be contacted.
“If we have a way of knowing who was exposed, then there were definitely situations where we didn’t need to do a press release,” Rule said. “We would only need to notify the people who are at risk.”
Once COVID-19 became community-wide, she says the exposure notifications also became unnecessary. Everywhere became a potential exposure site.
“We were really then relying on everyone to do their part by masking, minimizing your exposure to the community, staying home when you’re sick, etcetera,” Rule said.
Rule also helped people develop COVID-19 safety plans for people’s organizations and events who wanted to be sure they were in compliance with the orders at the time.
She said that the small percentage of their time that has garnered the most attention has been consumer complaint investigations.
“We didn’t go out and do any surveillance as far as enforcement activity,” Rule said. “We simply just responded to individual consumer complaints.”
Kamm said that nobody interested public health would desire the shutdown of an economy.
“Poverty is one of the biggest risk factors for poor health,” she said. “But we also don’t want people needlessly dying.”
Kamm said it shouldn’t have to be one or the other, either. If NPIs are used in a way that is effective, no parts of the economy should need to be closed.
“If we can keep this under control, then they’d have more ability to be able to open things up,” she said.
WUPHD’s contract with MDHHS binds them to respond to consumer complaints against facilities they regulate.
“So, if a member of the public files a complaint against a restaurant, a bar, a swimming pool, campground, a body or establishment—or if it’s about a septic discharge or a contaminated water supply—we always respond to those complaints,” Rule said. “And we have to respond within five days per our contract.”
Rule said WUPHD regulated 427 food service establishments in 2020. Since March, they’ve received 492 COVID-19-related consumer complaints against 60 restaurants and bars.
She said on the first complaint, they would simply make a phone call. Often the establishment was just unaware of the current rule.
“The rules changed—like everyone has been frustrated with—sometimes weekly, every other week,” Rule said.
Rule said only four establishments through 2020 did not voluntarily comply with regulations after being called. After that point, the businesses were referred to the Department of Agriculture and Rural Development, who followed up with enforcement action, starting with a cease and desist order. Three businesses have been fined, one business had their liquor license temporarily suspended, and one facility has had their food service license suspended and continues legal action and appeal.
Asked a series of questions, including why restaurants and bars seem to be most heavily impacted, Michigan Department of Health and Human Services public information officer Bob Wheaton replied with this written statement:
COVID-19 spreads in indoor settings where individuals socialize without masks. When the order was first issued in November, there were 54 known outbreaks associated with bars and restaurants in Michigan. Because about 50 to 60 percent of all COVID-19 cases cannot be tied to a known source of infection, and because tying cases to places where individuals may spend only an hour is difficult, there is an unknown number of further outbreaks not counted in that total. Targeted and temporary closures that include restaurants have been part of successful strategies for containing COVID surges in Western Europe. Other states are now following this approach, and it is supported by leading public health experts nationwide. The department hopes that residents will do the right thing and follow these orders to save lives and protect their family, friends and community from further spread of COVID-19.
Wheaton also shared links to some studies:
This study, published by Nature on Nov. 10, uses mobility data to show that limiting maximum capacity inside “points of interest” like restaurants is more effective at limiting spread than uniformly reducing mobility (total shutdowns).
This article from Bloomberg, based on a Stanford study, highlights similar findings.
This study from the Centers for Disease Control that found, “Adults with positive SARS-CoV-2 test results were approximately twice as likely to have reported dining at restaurants than were those with negative SARS-CoV-2 test results.”
CNBC reported on analyzed credit card data that showed in-person restaurant spending was “particularly predictive” of a rise in new infections three weeks later.
This study, from the Journal of Korean Medical Science, found that under some conditions, SARS-CoV-2 could be transmitted to people as far as 6.5 meters away. That’s more than 20 feet.
MDHHS personnel did not grant me an interview.
Kamm said there are two kinds of “barriers” that keep people from using NPIs to prevent disease, structural barriers and psychosocial barriers.
Structural barriers can be something like the availability of a sink to wash your hands.
“We address that by having hand sanitizer all over the place,” Kamm said. “And that reduces that barrier so it’s convenient for you.”
However, she said in the Upper Peninsula’s climate, hand sanitizer dries out the hands and that can itself become a barrier that needs to be overcome. Some companies are trying to address it with better hand sanitizers that don’t dry out the hands.
Psychosocial barriers are more about feelings and habits.
“If it’s not your habit to wash your hands when you come home from going to the grocery store, it’s hard to learn that new habit,” Kamm said.
Developing new habits can be hard, and even harder when everything else in life is also pushing new stress on us, according to Kamm.
“Any behavior change, even something where we think that it should be easy to do, and it's something everybody knows they should do—It's not as simple as that,” she said. “We know in health behavior that just educating someone doesn’t work.”
She said part of this is just changing social norms. People push back initially but it eventually becomes normal, like when seatbelt use was mandated.
“And there’s always a bumpy road on doing that,” Kamm said.
Kamm said behavior change surrounding the HIV epidemic is a pretty good comparison. After being educated, each individual had to make their own risk-benefit analysis for themselves before deciding whether to change their behavior in any way.
“And when we look at those groups that were more likely to be okay with those behavior changes, those were the groups that saw all of their friends dying, that saw for themselves the horrible impact of HIV-AIDS,” Kamm said. “And we see the same thing in any disease.”
She said most people probably don’t know someone who has died of COVID-19, so that risk-benefit analysis hasn’t hit a tipping point for many. Particularly because those deaths are not evenly distributed in the population. This complicates getting across the message that NPI behavior protects everyone, not just yourself.
(Next week’s feature will be on vaccine development and distribution.)
MDHHS’s communication strategy is critically flawed
After working on the previous story all week, I have to say that I’m disappointed in the communications strategy at the Michigan Department of Health and Human Services. I don’t know who set the policy, so I can’t name any names, but the lack of communication from the state-level health authority is kind of stunning.
At a time when transparency is critical to maintaining the trust of the community, I expected MDHHS communications personnel to leap at the chance to speak to a local reporter for a chance to explain the science and the situation to their readers.
Pandemic information must be communicated in as many ways as possible, and frequently, if the message is going to reach people. The MDHHS is instead letting Governor Whitmer, Dr. Joneigh Khaldun, and the local health departments shoulder nearly the entire weight of that load. And they just aren’t enough.
This week, I set out to answer a question I’ve heard repeatedly from people frustrated with orders from the governor and MDHHS. “Where’s the science?” I heard over and over. Almost a year into this fight, the communications department at MDHHS should be able to answer that question off the cuff, with no preparation. This should be an answer that they all had memorized a month into the pandemic.
While COVID-19 may be new, the science that backs up non-pharmaceutical interventions is not. Hand washing has a long history of saving lives from communicable disease, sanitizing surfaces is standard practice in food service to prevent disease spread, and wearing masks was a key factor in the fight against the SARS-CoV-1 virus in Asia, which was discovered more than 15 years ago. You can’t tell me there’s no science to support these things, just because SARS-CoV-2 is new.
I could perhaps understand this shortfall if it was just Late Edition being left in the cold, a small newsletter with an unknown reporter in a small, rural town. But a Google news search shows that the MDHHS communications staff has been fairly tight-lipped with all the major media, too. Rather than granting interviews, they’ve chosen to rely mostly on statements and press releases.
This is a fine way of getting information to officials and reporters, but it is not engaging to their audiences. It’s a treatment more often received from shadowy corporations and law enforcement agencies, not government departments supposedly focused on an informational outreach campaign.
Why a professional, state-level communications department, staffed with experienced individuals, would leave this critical messaging up to politicians, and local health departments with no dedicated communications staff, is beyond me.
The local health department is clearly already overworked, having released a statement in November announcing they could no longer keep up with contact tracing. And politicians, particularly in an election year, are going to be disbelieved by at least 1/3 of the population by default.
Getting the message of how to stay safe and reopen the economy faster should have been done by an small army of professional communicators talking to reporters about the importance of NPI’s as often and as loudly as possible from day 1. Nearly a year later, it is still being sent in a brief email nearly a week after an interview request.
MDHHS is bungling it.
Houghton County Board passes resolution to support local businesses
The Houghton County Board of Commissioners met briefly on Jan. 22 to discuss and pass, unanimously, this resolution supporting the immediate reopening of bars and restaurants.
I’ve uploaded the audio from the meeting here.
Karl Dresch complaint and facts documents from court
The story is already out there, but if you haven’t seen the court documents for yourself, here’s a link.
More COVID-19 Data
I’d like to add that for national level data, HealthData.gov’s Community Profile Reports are really comprehensive and presented in a fairly understandable way. Data is from the White House COVID-19 Team.
Here’s a link directly to the report for Jan. 22. They’re frequently updated.
The New York Times also has a great collection of COVID-19 maps and information, and it is free, but you have to navigate a somewhat complex subscription system to get to it without paying. I can’t wholeheartedly recommend something like that to you.
These are articles (and a couple podcasts) I’ve found that I thought should be shared. None of the work is my own, but it comes from colleagues and organizations that I find trustworthy, or am personally a member of. These are not sponsored, but they are endorsed. Click on the headline to be taken to the story.
No answers about the reason for his resignation, immediately on the heals of signing orders allowing restaurants and bars to open to 25% capacity on Feb. 1.
The 18 Republicans who pushed to decertify or overturn the presidential election all received influential committee assignments from Republican leadership.
Upset over a law that would force them to pay for the news content they use, Google threatens to leave Australia. Australia’s PM practically says, “Go ahead, make my day”.
Several companies included in $9.4 million fine, but only Steam’s owner, Valve, was ‘uncooperative’. Valve has also been fined in Australia over its refund policy.
There’s still no evidence to support this. China is faring better through the crisis largely due to their experience with the first SARS virus. He also has said militias are getting a bad rap, after allegedly advising them on messaging (that story here).
They’ve censured him for voting to impeach Trump, saying it ignored the voters and was against their interest.
Recapping the Trump presidency isn’t something I was eager to do, but it was cathartic. Trump, Inc has followed Trump’s presidency closely since the start.
AP photographers have captured stirring, and disturbing images from inside Los Angeles hospitals. This collection focuses on the work of the hospital chaplains.
Smaller shares of Americans in rural areas are sure they want the COVID-19 vaccine.
Michigan’s treasurer says vaccination is the best way to return to a normal economy.
This story is a month old, and this isn’t a typical source of mine, but the Weather Channel did the best job explaining the phenomenon that I could find for free.
Know any sea shanties?
Sea shanties are spiking in popularity this year, and this was a video I found that I thought was nicely produced and displayed a pleasant sense of community, despite being produced during the pandemic.
I see the appeal to sea shanties. They’re widely accessible and participatory. Listen to the video, and you’ll see what I mean. Whistling, humming, or singing along is encouraged.
The Longest Johns are a folk music group from Bristol, England.
(The things in this section won’t continue to be a part of Late Edition in the future.)
The future of Late Edition
I have to admit, I’m working a bit too hard.
As much as I love doing this, and think that it’s important, there are just not enough hours in the day for me to keep up this pace, work another job, and take even decent care of myself. I have to give something up, and unfortunately it can’t be taking care of myself anymore.
I’m hoping that I can give up some of the work at another job, rather than Late Edition. Here’s how.
Later this week, I’ll debut my Patreon page. It’s a way for people to support me in exchange for some exclusive content. I decided to go with Patreon for a couple reasons.
First and foremost, they don’t tie me to their platform. If I used a paid Substack newsletter, I would have to deliver all of my content through Substack. Patreon allows for (and even partners with) other companies and sites, enabling Late Edition to utilize more varied technology—like the code for the timeline I wasn’t able to embed directly here. My goal is to make a digitally-delivered Late Edition as accessible as a print one and as engaging as a magazine, but I can’t do that relying on hyperlinks for everything.
Second, it means I can keep Late Edition itself free. I want you to support me, but more than that I want you to read what I write. I wouldn’t write it otherwise. Hiding my best work behind a paywall just seems antithetical to what the end goal is; an informed public. Patreon allows me to instead offer incentives to supporters like behind-the-scenes access, exclusive Q&A or panel discussions, and even some merchandise, while keeping my central product, the newsletter, free of charge.
Third, and maybe most exciting, are Patreon’s community-building tools. In addition to the aforementioned potential for Q&A sessions and panel discussions, there are other tools to enable the building of a private community around people supportive of local journalism. It’s tough being a reporter some days, and having a group of people I can count on to offer encouragement (or a little pressure) would mean a lot. It would also be a group I could safely voice new ideas to before investing a wealth of time into something that holds no interest.
Finally, it makes Late Edition scale-able. Launching a solid nonprofit news source will take a few months at least, if Late Edition takes off in the meanwhile, Patreon support would allow me to bring other, paid employees onboard easily. Journalism is better when people work as a team.
I hope my supporters are happy with this decision. Keep an eye out mid-week for a special Late Edition Update with details on how to sign up.
P.S.—If you want to support me now with the intention of transferring your support to the nonprofit once it is formed, I would not be offended by that. Late Edition will likely be dramatically scaled back at that time, in any case.
I’ve hit the point in my reading where I think some brainstorming and modeling is in order, and I’ll be contacting several of the people who have shown interest in being involved. If I don’t contact you and you feel like you’re missing out, send me an email at email@example.com and we’ll get you involved.
I recognize my ‘About Me’ section last week wasn’t very thorough, and that my social media profiles are, at best, out of date. If I’m going to be a community journalist, I think it’s also important you know who I am. At the same time, I feel like I have better things to write besides an autobiography.
If there are things about me you’d like to see added to the “About Me” section, shoot me a comment or email. Assuming it’s appropriate, I’ll throw it in there and republish it next week.