Slowing down the pandemic

The pandemic will eventually touch many of us. What matters most is the speed of the pandemic.  If the virus spreads too fast and too many of us are sick at the same time, we will overwhelm the health care system.  People may not be able to get the care they need – for the virus or for any other health problem.  That’s what is starting to happen now in Italy. Doctors are discussing how to make brutal triage decisions effectively condemning weaker patients to die.

We need to slow the virus down. Since none of us are immune and there is no vaccine yet, we have only one way to protect our community:  To reduce unnecessary contact. I’m not shaking hands. I’m not calling public meetings. I am reducing my attendance at public meetings. I’m pleased to see so many responsible organizations cancelling public meetings. I’m pleased to see colleges going online. I’m switching most of my private meetings to phone calls. I’m exercising outdoors or at home, not at the gym. I’m not traveling and I’m discouraging family members from traveling. And I’m trying to stay off the MBTA at rush hour. To the extent we have a choice, we all owe it to others to step back and reduce crowding.

As a legislator, I will be part of a team considering all possible responses, including stricter measures to limit spread of the virus. While we may yet dodge the worst scenarios, I am personally convinced that we should be eliminating as many crowd settings as possible. Following health advice from the CDC and our department of public health we can limit risk of infection in one-on-one transactional settings, but in group settings of any size, it is much harder to avoid spreading the disease.

I fully expect that many businesses will be hard hit by the response and I think government has a responsibility to cushion the impact for the workers that are hardest hit. This is the other fundamental public policy challenge we need to contemplate.

Below, I paste a Google translation of a page from an Italian newspaper which published a Facebook post from Dr. Daniele Macchini, a doctor at Humanitas Gavazzeni a hospital in Bergamo, Italy (northeast of Milan). The post was apparently provoked by complaints by people about restrictions on going to the theater and the gym. The post is intended to convey what is stake.

The rough translation, which I have edited lightly for readability, appears below. It deserves a read from beginning to end.

In one of the constant emails that I receive from my health department more than daily now these days, there was also a paragraph entitled “being sociable responsibly”, which made some recommendations that I support. After thinking for a long time if and what to write about what is happening to us, I felt that silence was not at all responsible. I will therefore try to convey to people “not involved in the work” and more distant from our reality, what we are experiencing in Bergamo during these pandemic days from Covid-19. 

I understand the need not to panic. I also understand the economic damage and I am also worried about that. After the epidemic, the tragedy will start again. However, apart from the fact that we are literally also devastating our National Health Service from an economic point of view, I allow myself to raise the importance of the health damage that is likely throughout the country and I find it nothing short of “chilling” for example that a red zone already requested by the region has not yet been established for the municipalities of Alzano Lombardo and Nembro (I would like to clarify that this is pure personal opinion).

I myself looked with some amazement at the reorganizations of the entire hospital in the previous week, when our current enemy was still in the shadows: the wards slowly “emptied”, the elective activities interrupted, the intensive therapies freed to create as many beds as possible. Containers arriving in front of the emergency room to create diversified routes and avoid any infections. All this rapid transformation brought into the corridors of the hospital an atmosphere of surreal silence and emptiness that we still did not understand, waiting for a war that was yet to begin and that many (including me) were not so sure would never come with such ferocity . (All this was done in silence and without publicity.)

I still remember my night watch a week ago that passed anxiously as I waited for a call from the microbiology unit. I was waiting for the outcome of a swab on the first suspect patient in our hospital, thinking about what consequences it would have for us and the clinic. If I think about it, my agitation for one possible case seems almost ridiculous and unjustified, now that I have seen what is happening.

Well, the situation is now nothing short of dramatic. No other words come to mind. The war has literally exploded and the battles are uninterrupted day and night. One after the other the unfortunate poor people come to the emergency room. What they have is nothing like the complications of a flu. Let’s stop saying it’s a bad flu. In these 2 years I have learned that the people of Bergamo do not come to the emergency room without cause. They did well this time too. They followed all the indications given: a week or ten days at home with a fever without going out and risking contagion, but now they can’t take it anymore. They can’t get enough breath, they need oxygen.

Drug therapies for this virus are few. The course mainly depends on our organism. We can only support it when it can’t take it anymore. It is mainly hoped that our body will eradicate the virus on its own, let’s face it. Antiviral therapies are experimental on this virus and we learn its behavior day after day. Staying at home until the symptoms worsen does not change the prognosis of the disease.

Now, however, that need for beds in all its drama has arrived. One after another, the departments that had been emptied are filling up at an impressive rate. The display boards with the names of the sick, of different colors depending on the operating unit they belong to, are now all red and instead of the surgical operation there is the diagnosis, which is always the same cursed: bilateral interstitial pneumonia.

Now, tell me which flu virus causes such a rapid tragedy. Because that’s the difference (now I’m going down a bit in the technical field): in classical flu, apart from infecting much less of the population over several months, cases can be complicated less frequently, only when the VIRUS destroying the protective barriers of the our respiratory tract allowing BACTERIA normally resident in the upper tract to invade the bronchi and lungs, causing more serious cases. Covid 19 is mild in many young people, but in many elderly people (and not only) it causes a real Sudden Acute Respiratory Syndrome because it arrives directly in the alveoli of the lungs and infects them making them unable to perform their function.

Sorry, but to me as a doctor it shouldn’t reassure you that the most serious are mainly elderly people with other pathologies. The elderly population is the most represented in our country and it is difficult to find someone who, above 65 years of age, does not take at least the tablet for pressure or diabetes. I also assure you that when you see young people who end up in intubated intensive care, pronated or worse in ECMO (a machine for the worst cases, which extracts the blood, re-oxygenates it and returns it to the body, waiting for the organism, hopefully, heal its lungs), any comfort you might take from being young passes then and there.

And while there are still people on social networks who pride themselves on not being afraid by ignoring the indications, protesting that their normal lifestyle habits are “temporarily” in crisis, the epidemiological disaster is taking place. And there are no more surgeons, urologists, orthopedists. We are only doctors who suddenly become part of a single team to face this tsunami that has overwhelmed us. The cases multiply, we arrive at the rate of 15-20 hospitalizations a day all for the same reason. The results of the swabs now come one after the other: positive, positive, positive. Suddenly the emergency room is collapsing.

Emergency provisions are issued: help is needed in the emergency room. A quick meeting to learn how the first aid management software works and a few minutes later they are already downstairs, next to the warriors on the war front. The screen of the PC with the reasons for the access is always the same: fever and respiratory difficulty, fever and cough, respiratory insufficiency etc … Exams, radiology always with the same sentence: bilateral interstitial pneumonia, bilateral interstitial pneumonia, bilateral interstitial pneumonia. All to be hospitalized. Someone already to intubate and go to intensive care. For others it is too late …

Intensive care becomes saturated, and where intensive care ends, more are created. Each ventilator becomes like gold: those of the operating rooms that have now suspended their non-urgent activity become places for intensive care that did not exist before. I found it incredible, or at least I can speak for Humanitas Gavazzeni (where I work) how it was possible to put in place in such a short time a deployment and a reorganization of resources so finely designed to prepare for a disaster of this magnitude. And every reorganization of beds, departments, staff, work shifts and tasks is constantly reviewed day after day to try to give everything and even more.

Those wards that previously looked like ghosts are now saturated, ready to try to give their best for the sick, but exhausted. The staff is exhausted. I saw fatigue on faces that didn’t know what fatigue was despite the already grueling workloads they had. I have seen people still stop beyond the times they used to stop already, for overtime that was now habitual. I saw solidarity from all of us, who never failed to go to our internist colleagues to ask “what can I do for you now?” or “leave alone that shelter that I think of it.” Doctors who move beds and transfer patients, who administer therapies instead of nurses. Nurses with tears in their eyes because we are unable to save everyone and the vital signs of several patients at the same time reveal an already marked destiny.

There are no more shifts, schedules. Social life is suspended for us. I have been separated for a few months, and I assure you that I have always done everything possible to constantly see my son even on the days of taking the night off, without sleeping and postponing sleep until when I am without him, but for almost 2 weeks I have voluntarily avoided my son nor my family members for fear of infecting them and in turn infecting an elderly grandmother or relatives with other health problems. I’m happy with some photos of my son that I regard between tears and a few video calls.

So be patient too, you can’t go to the theater, museums or gym. Try to have mercy on that myriad of older people you could exterminate. It is not your fault, I know, but of those who put it in your head that you are exaggerating and even this testimony may seem just an exaggeration for those who are far from the epidemic, but please, listen to us, try to leave the house only to indispensable things. Do not go en masse to stock up in supermarkets: it is the worst thing because you concentrate and the risk of contacts with infected people who do not know they are higher. You can go there as you usually do. Maybe if you have a normal mask (even those that are used to do certain manual work) put it on. Don’t look for disease masks. Those should serve us and we are beginning to struggle to find them. By now we have had to optimize their use only in certain circumstances, as the WHO recently suggested in view of their almost ubiquitous impoverishment.

Oh yes, thanks to the shortage of certain devices, I and many other colleagues are certainly exposed despite all the means of protection we have. Some of us have already become infected despite the protocols. Some infected colleagues in turn have infected family members and some of their family members already struggle between life and death. We are where your fears could make you stay away. Try to make sure you stay away. Tell your elderly or other family members to stay indoors. Bring him the groceries please.

We have no alternative. It’s our job. In fact, what I do these days is not really the job I’m used to, but I do it anyway and I will like it as long as it responds to the same principles: try to make some sick people feel better and heal, or even just alleviate the suffering and the pain to those who unfortunately cannot heal.

On the other hand, I don’t spend a lot of words about the people who call us heroes these days and who until yesterday were ready to insult and report us. Both will return to insult and report as soon as everything is over. People forget everything quickly. And we’re not even heroes these days. It’s our job. We risked something bad every day before: when we put our hands in a belly full of blood of someone we don’t even know if he has HIV or hepatitis C; when we do it even though we know it has HIV or hepatitis C; when we sting with the one with HIV and take the drugs that make us vomit from morning to night for a month. When we open with the usual anguish the results of the tests at the various checks after an accidental puncture hoping not to be infected. We simply earn our living with something that gives us emotions. It doesn’t matter if they are beautiful or ugly, just take them home.

In the end we only try to make ourselves useful for everyone. Now try to do it too though: with our actions we influence the life and death of a few dozen people. You with yours, many more. Please share and share the message. We must spread the word to prevent what is happening here in Italy.

L’Eco Di Bergamo, March 8, 2020, translation from Google Translate, lightly edited for readibility.

To the point of what the epidemic means to health care workers, a doctor just sent on this note from another doctor at MGH who is in touch with doctors in Italy .

More deaths among doctors and nurses in Italy- now so many healthcare workers home with pneumonia or symptoms (a few with ARDS intubated in ICU). The president of the Lombardy region of Medicine (something like the Mass AMA President) just passed away this morning for COVID-19. He had symptoms yesterday, intubated at night and cardiac arrest few hours later. He was a PCP and kept working for directing people either to the hospital or keeping them home.  

The great lesson from Italy to protect healthcare workers was the lack of identifying ahead of time areas in the hospital strictly devoted to COVID-19 patients and sending COVID patients in different parts of the hospitals so that many healthcare providers got infected and eventually quarantined jeopardizing functionality of the units/departments and loading of extra-work to those non-infected. Centralization of these patients is key. They have now COVID-only hospitals for hosting those 6,000+ and more in hospital patients in the city of Milan (of which 400+ intubated with ARDS).

For another compelling post on the situation in Italy, see this twitter thread.

There is no other challenge remotely as serious before us as legislators. I hope that we are able to rise to it. In the Senate, we are already taking the internal measures that we can to control the spread and are working with the House to appropriate initial funds to support the response. But there is much more to do.

More coronavirus resources here.

Published by Will Brownsberger

Will Brownsberger is State Senator from the Second Suffolk and Middlesex District.

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67 Comments

  1. I wonder how many of the illegal aliens coming over the southern border of the US have coronovirus.
    Oh well, no matter.
    They’re entirely welcome, say liberals.

    1. Practically no coronavirus has come from the southern border.

      It started in China, and left China on airplanes and cruise ships, and arrived in the US on airplanes. From here on out it’s our choice; if we shut down transmission (avoid crowds, cancel meetings, cancel classes, cancel sporting events, work from home, wash hands often, use sanitizer strategically) we will suffer a manageable epidemic and maybe even stop it. We’ll do even better if we start testing contacts widely so we know who to quarantine and who not, but for that we need tests, and the tests need to be cheap or else people who can’t afford them won’t get tested.

      If we don’t do those things, we’ll overwhelm our medical system, and instead of killing 5 people per 1000 who catch it, it will kill 25 or more per 1000 because we won’t be able to care for everyone who is critically ill.

    2. I am very concern about this as well. Everyone should be checked for the virus when entering our country.

    3. Dee, why are you such a hateful person? You only comment when you have something racist or otherwise hateful to say. I have yet to see something intelligent or useful come from your comments.

    4. Dear Dee,
      I would be the last person to defend illegal immigration. That said, don’t try to blame COVID on it, either.
      So far, most of the affected people in the USA are from the formidable and (thus) well-travelled background. Think ski vacation in Italy Alps type.
      Don’t be silly and stay healthy.

  2. Thank you for this information although it is reading like a bad play.
    My heart is breaking as I have many friends in that area of the world. I am cancelling all my writing classes, my dinner at my Synagogue, and am having a freezer delivered tomorrow, while I cook up a storm. I am thinking of the stories my parents would tell of the terrible Depression of the 1930’s. Poor, hungry and looking for work throughout this country, they only remembered the kindness, the community and the fellowship and their deep connection to their families.
    Take care of yourself, and hopefully, Ed and I will be able to wait this out as we prepare our garden for spring.
    Barbara Moss

  3. Meanwhile we’re in an eerie calm before the storm and there is vacuum in leadership at the national, state, and local levels. We cannot just talk about interventions in general, suggestive ways. We need clear state guidance protocols (national, ideally) on social distancing, not what we’ve got now, which is community-by-community, company-by-company suggestive approaches. We have to think of our collective response as national defense, which is a mind shift that’ll only happen with exceptional leadership and clear communication on the actions that we each must take. It’s not business as usual anymore. I’m old enough to remember the gas lines in the ’70s and only being able to get gas on the ‘even’ day if your license plate ended with an even number. That’s the kind of guidance we need now to buy time with this virus spread. Close everything now (but grocery stores, pharmacies, and banks, like Italy has just done). K-12 schools need to close. (And yes we need to figure out nutrition alternatives and child care for health/caregivers but that can’t hold up our need to prioritize delaying transmissions). Here’s why I think we need to act ASAP: 1) we now have data to show you’re highly infectious [contagious] before you even show signs of illness – that’s a game changer (think Biogen meeting – why/how did it spread so efficiently, it wasn’t just handshakes). 2) we don’t have capacity to do ‘sentinel testing’ – basically random testing – to assess the spread, so the # cases being reported is like counting the flies on your sandwich and saying that’s how many flies exist in your town or state — of course there are many more cases already and we don’t have capacity to measure it. 3) We don’t know enough about kids as transmitters because not enough children showed symptoms in China for there to be a lot of data collected on their role in the spread. 4) Italy is about 3-4 weeks ahead of the US in terms of the exponential curve of cases, and as your blog graphically illustrates, we need to learn from them, not follow them. What’s it going to take for drastic measures to be put in place NOW for all social distancing/ quarantine? Moral courage and leadership.

    1. Thank you for your comments! I can’t understand why the Governor is canceling all group meetings, but our kids are right next to each other in school? I understand the nutritional aspect and needing to take care of vulnerable children. However, there has to be a solution to provide meals for people in need. What can we do to help?

      1. I really appreciate these comments. It’s not enough to tell individuals to wash their hands or avoid public gatherings. I work at a school and I’d really like to keep my job, so unless the schools closes I’m stuck deciding between staying employed and protecting my family/community health. And I am someone who can afford to stock up on groceries and has another income in the house. Another example: If your teen is concerned about school performance, grades, and how they look to colleges, how can we ask them to decide between health and education/future? Yes, each person has a responsibility here, but we need a coordinated, decisive response with visible leadership. And widespread availability of Covid-19 tests. Thanks for this post, Will.

  4. Will — Thanks, but I’m afraid sI find the translation mostly incomprehensible. The only positive thing is the idea of areas of hospitals to be used for Covid-19, or only certain hospitals for it — but it’s probably too late for that.
    that
    As an Older person (pun intended) I have made the decision not to go to my favorite gathering (semi-annual) which I never, ever miss (Peoples Music NetworkhatI have decided that it’s not safe for someone of my age — I’m a senior. Alas, I will miss it! That’s assuming, of course, that we actually hold it this June — we will decide that later on.

  5. Thanks for posting this. Is there anything the state can do with regard to the following:

    – Working from home. No one whose job involves simply sitting at a computer and answering emails or making PowerPoint presentations should still be in an office. Period. All the easy cases like this need to be sent home. Yet many businesses are dragging their feet. Senior managers who think WFH is an indulgence need to be set straight YESTERDAY.

    — Test kits. The CDC cannot be depended on. Qualifications for getting tested are still ridiculously restrictive. Can’t we sign our own contract with Quest and get these to doctors ASAP?

    — Much better communication on what to do. If you have fever, the shakes, a deep cough and malaise on a Friday night, who do you call? Should you just go to an ED? Should you ride the T to get there? What if you feel sick and your boss says to come in anyway? In some cases we actually do have relevant policies and resources available but no one knows where to start. This is not a situation where we want people to have to “research.” Hire a damn ad agency.

    —Why can’t we tell every professional organization licensed by the state to get a decent policy together now? How do hairdressers keep people safe? Tattoo artists? Housecleaners? Food delivery services. Sewer work is likely to be a vector of transmission. Do they even know it yet? Even if the legislature obviously won’t have time to delve into every sector we can still make all businesses aware of their obligations.

    —Making it easier to stay at home. It’s actually worth getting on the horn with Uber Eats and Caviar and DoorDash and Instacart etc. and working out a plan to ensure driver and customer safety while helping home delivery become a dominant channel for commerce until this is over. This could help save small businesses.

    The consistent lesson of this plague has been *never* to wait until something happens. Act as of its already happening.

  6. Dear Senator Brownsberger,
    Thank you very much for your information on Covid-19, and your sensible advice.
    I am stunned by the heartfelt letter from the Italian doctor. What an incredible, giving person; there are no words to express the horror he and his colleagues are experiencing.
    Let’s honor him and his colleagues, and all medical staff, by taking all the precautions we can to protect them, ourselves and our fellow citizens.

  7. Schools need to close. Places of worship need to stop having services.
    Most of them have refused to do so because they are shortsighted, unjustifiably optimistic (“It can’t really be THAT BAD, can it?”), and afraid of upset parents and congregants.
    The governor should ORDER them to close.
    At the very least, the DPH should RECOMMEND that they close; that alone will be enough to spur many of them to finally do it.
    Italy is now at the point where the only public accommodations allowed to continue functioning are grocery stores and pharmacies, for obvious reasons. We should be going to that model NOW, not waiting until the virus explodes. The whole point is to AVOID that explosion.

  8. For once I completely agree with your thoughts and plans. Government can only do so much in a short period of time and it is up to us to do our part. Thank You

  9. During this epidemic, the state of Washington is requiring health insurance companies to cover the cost of one early refill on any prescription where that wouldn’t endanger the patient, so people won’t need to go out and get refills while they’re sick, or go without things like blood pressure medication. Massachusetts should do the same, especially for Medicare patients, most of whom are in a high risk group.

    As individuals: we can limit our shopping trips. Don’t go out once for milk, and the next day for eggs and cookies, and yet another trip for shampoo. That can be one trip–one bus trip if you shop by bus instead of three, one wait in line and trip through the checkout instead of three, and so on.

    Those of us who are retired or set our own hours can and should avoid transit during rush hour, as Will suggests in his letter.

  10. Great post and I don’t disagree.

    I will say I am absolutely terrified at the economic implications of this. Many, many, many people will lose their jobs and have already lost their income if they depend on a gig economy job. People that work in restaurants have already begun to suffer. The economic fallout has the potential to ruin lives and I hope that MA is also exploring what can be done on the state level to try and mitigate the damage. I have given up hope on the federal level.

  11. Thanks Will, definitely worth reading. As I work at a cemetery, let me say we can wait for everyone to join us. It is chilling to see the number of tombstones from the 1918 flu pandemic. Memento Mori.

  12. Thanks Will. This is a terrifying account. As individuals we all need to act responsibly, but is anything being done to bolster hospitals, specifically increasing the number of beds and related equipment and supplies to meet patient needs. We all watched in amazement as China built a temporary hospital, something the letter from Italy validates. What is being done here to address the possible need for expansion?

  13. The doctor from Lombardy puts the situation in stark relief. Thank you, Will for sharing it.

    Nobody has mentioned restaurant and fast food workers. Their employees be vectors for Covid-19 whom customers can infect and then vice versa. I fear many eating places will have to shut down, and some may never re-open.

    Already, supermarkets and pharmacies are running out of certain items, either because of supply chain disruptions or hoarding. Citizens can’t fix the former but we can refrain from the latter.

    Theaters and movie houses need to shut down until we are past peak danger.

    Citizens, especially state and local officials, must tell the Trump administration to stop denying the gravity of the threat and streamline distribution of test kits, and provide supplemental funding for vaccine development and expedite its testing until effective prophylaxis results.

    “Social distancing” is already a fact of life, especially for young people and others who live by their phones. It should not be hard for many people to take it to the next level.

    And if you have been anywhere near a locus of infection, become a pariah; avoid coming in close contact with anyone for a week. Wherever you must go, carry hand sanitizer and several handkerchiefs. Masks, I don’t know; are ordinary surgical ones effective? Does wearing them instill fear in others?

  14. Thanks,Will. Many good ideas in this thread. I would only add, Paid Sick Leave – NOW. For all. We can sort out the economics later. Just get all those sick minimum wage folks home. A few years ago a Colorado senator tried to make all restaurants etc without paid sick leave for their employees post a sign on the front door saying so. Too bad it was voted down. Time to revive it.

    1. As an independent contractor, I’m used to being utterly ignored in discussions like these. However, we now make up between 20-30% of the workforce, depending who you ask, and a third of the US workforce relies at least partly on some kind of alternative arrangement. Any solution that ignores us now will not avoid economic catastrophe.

      1. The current flu season has been milder than last year’s,

        with the vaccine protecting about half the people who

        were inoculated and a less severe strain of the virus

        causing most of the illnesses that do occur.

        However, there have been more deaths than usual from

        that milder strain, and there is evidence a more severe

        strain of the influenza virus is causing a growing percentage

        of illnesses.

        Last year, more than 80,000 people died of the flu and its

        complications in the United States, the highest death toll

        for the disease in at least four decades.

        Automatic Signature Block

        We get strains of flu every year.

        In 2020, NO deaths in MASS,

        yet I have to put up with these cancellations:

        2 St. Pat Dinners,

        1 Sun. morning breakfast,

        bus trips to Casino’s

        1 Dental Appointment

        All activities in a retired men’s club

        My library is closed

        Whole country affected and

        EVERYTHING CANCELED.

        Thanks to the press.

  15. This is frightening and the inability of our government to provide quick access to testing is appalling. Why does Washington State have drive by testing while Mass patients are being turned away? We’ve wasted two precious months when we might have stopped the pandemic.

  16. Thank you, Senator, for your usual thoughtful, incisive summing up of the critical issues. We all need to think deeply about what we are willing to risk if it “really is this bad” and weigh the consequences. The letter from the doctor really put things in perspective for me and made me think about the issue in a clearer light. Stay healthy, all.

  17. Thank you for this thoughtful post. I feel very lucky to have a job that allows me to work from home and am doing all my meetings from home from now on as a precaution. I believe schools need to be closed now. Can you provide an update on this when you get a chance? I also am shocked by our country and state’s lack of preparedness when it comes to testing. Can you also share more updates on when we will be ready to provide testing en masse, similar to what South Korea and Australia have done? Thank you again for all of your service and especially your hard work on this issue!

  18. Thank you for sharing this Information. We are lucky to have such thoughtful leadership. The note from Italy was especially helpful.

  19. Just as the state needs to be firmer about closing down places where people gather, the state also needs to afford assistance to those affected. Paid sick leave, and unemployment assistance, for a start. Small businesses and non-profits will also need help.

  20. Dear Will,
    Thank you for your post. I wish schools were disinfected more frequently and intensely. MBTA cleans their fleet several times a day now. If our local universities felt the need to switch to virtual teaching, I don’t see any reason our K-12 schools remain open.

  21. One thing I saw being done in a photo from Italy was to increase awareness of social distancing in public places. The health authorities in Italy required places where people frequent to mark floors with 1 meter lines to show how far apart people aught to stand to reduce person to person transmission. I would think that our health departments should be asking places that have large numbers of customers, malls, stores, supermarkets, to mark there floors to show how far apart you need to remain to effect a similar effort. It is not a fancy or expensive move to implement. And it could reduce transmission.

  22. One particularly vulnerable group that merits our attention is people in jail and prison. We know that many incarcerated people have underlying health conditions and that most institutions of incarceration have problems with ventillation, sanitation, and timely access to health care. The thing I’ve heard most often is that prisons and jails plan to limit visitors as a response to the virus. Yet we know that visits are a lifeline for people inside. At the least, now is the time to make phone calls free, by passing pending legislaiton or executive action.

    Senator Brownsberger, do you know what the DOC and sheriffs are planning to do to keep people in their custody as safe as possible from the virus? The Prison Policy Initiative recommends diverting people from jail into mental health and substance use programs, releasing older people, and stopping the practice of sending people to jail or prison for technical violations of probation or parole: https://www.prisonpolicy.org/blog/2020/03/06/pandemic/
    The ACLU National Prison Project also has a list of questions for officials:
    https://www.aclu.org/news/prisoners-rights/are-our-prisons-and-jails-ready-for-covid-19/
    Thanks for keeping us informed and I welcome any response you may have.

    1. Excuse me? When imprisoned you lose your rights to anything, I thought.
      Oh but of course AC and TV are must have’s!!!!

      1. You don’t lose your right to a lawyer and you don’t lose your right to be treated when sick. You get to watch TV because it keeps you occupied and quiescent. It’s not a right, it’s a privilege. Our prisons are not like Abu Ghraib for a reason—we have constitutional rights, even prisoners.

  23. The NYTimes notes that “A direct order from the government can in many cases determine whether insurance covers institutions closed down by the virus.” A shut down mandated by the state of Massachusetts for a period of time would certainly slow the spread of the virus at this critically important moment. I wonder whether arts and entertainment venues and are holding back from cancelling performances and gatherings because they don’t yet have this economic safety net.

    Thank you, Senator Brownsberger, for this sobering and informative email.

    https://www.nytimes.com/2020/03/06/arts/covid-19-movies-theaters-concerts-museums.html

  24. Unfortunately, this is a political situation. When the economy dumps, our President will be blamed so Dumbocrats can gain an advantage at the polls.

  25. Thanks, Will for your thoughtful post. We all need to work together and to do our part to help ourselves and our neighbors. We in Massachusetts are lucky to have great healthcare staff and hospitals here. I have confidence that they will do their best and we need to help as well. No politics on this subject, just all united as we should be. Any lessons learned here could be shared with others. We need to pull together to get the job done as we did when we had 109 inches of snow on the ground or the day of the Marathon bombing We work best as a team.

  26. I am so angry and disappointed in all leaders of MA from governor to our local leaders. This inaction/denial/wait and see approach will go in a history of MA and USA as a complete and utter failure of government and elected leadership on literally every level. So far there has been non existent to extremely lame response to this grave threat. MA is smaller then Italy.
    We had an amazing gift of ample time and scary examples, all over the world, for weeks now, to help us prepare and understand what to do, or what not to do. We have squandered any advantage by now and will soon, unfortunately, see what price we could be paying our arrogance, for not having functional government and humane economic system, and above all, what is the price for selling health for profit?

    As this terrifying reality and dysfunction coming to light, we are arrested by impotence.

    How it is even possible that we still don’t even have enough life saving tests 4 months after the known fact and strong possibility that virus is coming!!? This is terrifying fact.

    I think we should immediately close everything and stop pussyfooting around, pretending that we know or control anything at this point.

    God help us all.

  27. Can MA contract with labs to create more testing capability the way NY is doing? At this point, does it matter what entity handles the testing or creates the test as long as it is reliable?

  28. Will, thank you for sharing this and for your commitment to keeping your constituents safe. It is time to lock down what we can for two or three weeks. Who knows if this strain can mutate into another virus that incubates longer or has worse effects? I have been scared a few times in my life – 9/11, the Boston Marathon Bombing and subsequent search in my ‘hood for the bombers. COVID-19 makes those events feel like a day at the beach.

  29. I am 84 years and 4 months olde; I work 5 days a week for about 5 hours per day, delivering motor vehicle parts to local automotive repair shops in and around Watertown (Arlington; Belmont; Newton; Waltham; Allston; Brighton; Brookline; Cambridge. I
    do not have to work, but we have a team and the workload would fall on them. I recently acquired a underlying problem beginning late October that has involved coughing and excess mucous production something about sineuse issues; scheduled for surgery 2 April. I really didn’t take this pandemic seriously until reading Wills’ posting. There are 5 other drivers with my dealership that deliver parts beyond the local area. We obviously come in contact with many individuals on a daily basis; if we do not work, we do not get paid. The auto repair shops will not shut down; customers expect that their motor vehicles will be repaired and returned to them in a timely manner (imagine yourself w/o your mtr vehicle). And we are just one dealership! There are hundreds like us in close proximity in this part of Boston and suburbs. No business is going to close unless ordered to do so. After reading this posting, I will stop going to the gym although at my age it is what keeps me mobile, agile and healthy, I will miss those 2-1/2 hours every other day, but hopefully the weather will be warm enough to motivate me to walk out doors. How are we going to motivate all hands to remain home for a period of 2 to 3 weeks? The Chinese could do it because they do not tolerate defiance. And that brings up an odd observation: I am a retired U. S. Marine officer; I have not seen or heard of the Red Army being involved in this pandemic, they have always been front and center during Chinese national emergencies. Either their Army is suffering a wild pandemic, or they are beine “saved” for some other function: think about it. Good luck to all, and God Bless everyone. And Senator Will, thank you for this posting.

  30. This comes from a member of the Stanford hospital board. Some important items are highlighted.
    By the time they have fever and/or cough and go to the hospital, the lung is usually 50% Fibrosis and it’s too late.
    …a simple self-check that we can do every morning. Take a deep breath and hold your breath for more than 10 seconds. If you complete it successfully without coughing, without discomfort, stiffness or tightness, etc., it proves there is no Fibrosis in the lungs
    Ensure your mouth & throat are moist, never dry. Take a few sips of water every 15 minutes at least. Why? Even if the virus gets into your mouth, drinking water or other liquids will wash them down through your throat and into the stomach. Once there, your stomach acid will kill all the virus. If you don’t drink enough water more regularly, the virus can enter your windpipe and into the lungs.
    Items:
    2. Coronavirus pneumonia is a dry cough with no runny nose.
    7. Drinking warm water is effective for all viruses. Try not to drink liquids with ice.
    Symptoms:
    1. It will first infect the throat, so you’ll have a sore throat lasting 3/4 days
    2. The virus then blends into a nasal fluid that enters the trachea and then the lungs, causing pneumonia. This takes about 5/6 days further.
    3. With the pneumonia, comes high fever and difficulty in breathing.

    1. I haven’t seen a single report of associated sore throat. And even most people who enter the hospital, even those who enter an ICU, survive. Link?

  31. Now that area public schools are closing, I’ve seen several conversations in FB involving parents wondering whether to allow their kids to get together with their friends while the schools are closed. It seems to me that practical advice from state and local health officials is needed urgently. We canceled a social event for a handful of adult friends this weekend because it seemed like the prudent thing to do.

  32. Nice post Will. Now the hard part- places of public accommodation- gyms, restaurants, bars, public events must close. Doctors offices should have skeleton staffing for urgent care only. Government has had several good financial years. Allow unemployment benefits for the four weeks this is going to take to pass by us. Without strong government measures and dramatic government aid, we will have a public health issue that is drastic. There is plenty of data already to produce a very high level of concern for public safety. Government must step up.

    1. I agree that this will not be over in four weeks, but also agree that all those steps should be taken. If they are, we’ll be in a much better place four weeks from now than if they aren’t.

  33. Thank you for posting the letter, Senator. It’s really the first time I’ve heard a description of the effects of Covid-19. I really did labor under the mistaken impression that it’s just a bad flu. I feel as if everyone should be aware of what the doctor wrote. It really drives home the severity of this crisis.

  34. Thanks, Will. The Boston area is one of the US epicenters. Seattle is on track to follow Italy, and we are not that far behind. The cases are out there and growing exponentially; without intervention they will double every week. That means that every bit of distancing today is worth at least twice as much as it will be in a week. In one model, a one-day delay in lockdown leads to a 40% increase in total number of cases. I now agree that the governor should close schools state-wide and take other aggressive actions. This piece is long but I found it very convincing: https://medium.com/@tomaspueyo/coronavirus-act-today-or-people-will-die-f4d3d9cd99ca. Thank you for your leadership on this unprecedented challenge. Stay well.

  35. The current flu season has been milder than last year’s, with the vaccine protecting about half the people who were inoculated and a less severe strain of the virus
    causing most of the illnesses that do occur.
    However, there have been more deaths than usual from that milder strain, and there is evidence a more severe strain of the influenza virus is causing a growing percentage of illnesses.
    Last year, more than 80,000 people died of the flu and its complications in the United States, the highest death toll for the disease in at least four decades.
    We get strains of flu every year. In 202 0, NO deaths in MASS, yet I have to put up with these cancellations: 2 St. Pat Dinners, 1 Sun. morning breakfast, bus trips to Casino’s, 1 Dental Appointment, All activities in a retired men’s club, My library is closed, Whole country affected and EVERYTHING CANCELED.
    Thanks to the press.

  36. Wow, that was an eloquent post that hit home. My husband’s family is in lockdown in Italy. So far they are fine. Question: how will the state process the huge wave of applications for unemployment insurance? The agency was slow before this crisis hit. If they need to contact employers, it won’t be easy since so many are working from home. Thanks for the information.

  37. Side question here: What’s the difference between people’s names that appear in black vs. blue on these posts?

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