Month: May 2020

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Letter to County Executive Marc Elrich and Members of the County Council

May 22, 2020

Dear County Executive Elrich, Members of the County Council and Dr. Travis Gayles:  

Balancing the impacts from a highly contagious virus and the shutdown is a difficult task and we appreciate your efforts to do so.  While I understand the council’s primary goal is to save lives from covid unfortunately the decision to prolong the shutdown will put other lives at risk.  While a letter could be devoted entirely to the negative impacts of the shutdowns (one of which is attached for your reference) suffice it to say that many people and businesses are seriously suffering.  The data suggests that a balanced, targeted approach is possible. 

During the press conference Wednesday, Mr. Elrich said his top two metrics for lifting the stay at home orders were total case numbers and ICU utilization rates.  Mr. Elrich suggested that death rates are not going to be changed much by testing and contact tracing.  He also stated that death rates are the hardest numbers to change.  How can any metric have a higher priority than who dies from the disease?  Does this suggest Mr. Elrich believes that regardless of what we do, the vulnerable will die from covid?  Eventually we will all die of something, but a targeted approach can help protect the vulnerable from dying of covid and allow the rest of us to get back to work.  

Who is at the greatest risk of dying from covid and might benefit the most from an effort to lower death rates? Nursing home patients.  This group comprises 74% of the 465 total deaths in the county.  But please also note that 85% of all deaths are folks over 65.  Who has a low risk of dying from the disease? People under 65 especially those without underlying health conditions.  Only 0.007% of county citizens under 65 have died from covid with or without underlying health conditions. What other name does this low risk group go by?  The workforce.  

Only total case and death numbers are provided in the dashboard which is not helpful for understanding risk or evaluating a targeted strategy.  Deaths of nursing home patients and those over 65 with serious underlying conditions should be eliminated from any trends that will impact the decision to reopen.  While the lives of nursing home patients are as important as any other life, these folks are not the ones who are shopping and operating businesses.  Plus nursing homes are highly specialized environments that are not found in general office and retail.  If it is not possible to segregate the data this way, please add charts to the dashboard for under and over 65 daily fatality rates and you will find as I did with Maryland data that the trend has been flat for over a month.  

Data charts that only include nursing home stats should also be created to guide decisions and strategies to protect patients and staff.  This segregated information will also allow the citizens and county to monitor results. 

Hospitalizations are a key metric.  The dashboard states that in order to reopen we must achieve 14 days of acute bed utilization rate of 70% or less of the total number of acute beds.  We have had 0 days under 70% for acute beds.  Are we to assume that if nothing changes we will have at least 14 more days before we can reopen?  Please note that the top utilization rate for both covid and noncovid patients was 83% and only 6 days since April 30 have been over 80%.  In other words, we have been able to accommodate all patients since the beginning of the pandemic with beds to spare. 

Only a notable spike would cause a shortage of acute care and ICU beds.  If a spike were to occur, when would that be?  Well after reopening.  Therefore waiting another 14 days to reopen achieves nothing but negative health, emotional and financial impacts to the citizens.  Rather than passively watching the numbers, is there an approach that balances the needs of all of the citizens utilizing advance planning?  For example, is it possible to transfer patients between hospitals to balance the load or develop a plan to increase beds immediately in the event of a spike?  

Antibody testing and other situations such as the aircraft carrier Roosevelt suggest as many as 50% of covid positive people could be asymptomatic and far more of the population has been infected than indicated by current testing.  This suggests that increased testing will result in increased cases for some undetermined period of time.  While I completely support the County’s new programs to increase testing, even if 5% of the population is tested monthly, many folks could still be walking around unaware they have covid.  The only way to manage that is through physical distance, good hygiene and masks when within 6’ of another.  Why should small businesses be held hostage while testing ramps up when the same avoidance practices must be instituted regardless?  Considering that county essential workers are not required to quarantine when they have been exposed to covid, the health department must have high confidence that these practices will stop the spread.  Let’s extend this confidence to the entire workforce and reignite demand in the county.  

The statement in the meeting Wednesday that when stay at home orders are lifted, the county might only allow stores to do curbside pickup was extremely troubling.  Certainly all the members of the council have noticed that people are not staying home.  They are out shopping in big box stores.  Does science dictate that we are only safe in big corporate retail and at greater risk in small independent stores?  No. Science does tell us how to stop the spread and small business owners are very capable of maintaining physical distance and instituting appropriate hygiene standards. Therefore, why should government officials decide which businesses live and which die?  The County should stop giving big box retailers a crushing advantage over our small businesses and open fully.  

Every day matters. Each minute we remain closed, the consequences will pile up exponentially from deferred medical treatments, unemployment and financial devastation.  Suicide rates have increased as has substance abuse, physical abuse and depression.  The fact that we now have food lines in the county speaks volumes.  Small businesses are genuinely suffering which will have its own long term health impacts.  Many businesses will not survive.  Has the county examined what will happen to its tax base if small business is decimated? 

Regardless of the council’s good intentions, continued stay at home orders will not deliver us from covid.  We implore the council to proactively balance the needs of all the citizens and implement a targeted approach that protects the vulnerable and allows the healthy to assume personal responsibility and get back to work.  Any business that can maintain physical distance guidelines should be allowed to open fully.  The data supports that action and the new guidance from the CDC regarding the transmission of the virus should give all of us more confidence to move forward.  And finally, please obtain input from the people of the community who will explain how both covid and the shutdown have impacted their lives and livelihood.

Sincerely,

Sue Seboda

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A Picture is Worth a Thousand Words

Sue Seboda, May 7, 2020

Let’s examine the curve that Governor Hogan has used to guide reopening decisions.  Does it make sense?  Here is my latest dive into the data and it is disturbing at best.

As of May 7, 2020 nursing home patients accounted for 57% of all corona virus deaths in Maryland. While there is much discussion of these numbers, we should take this one step further and also ask why any decision to reopen should be based on data that includes nursing home stats. While the lives of the elderly are just as important as any other life, they are not the folks who will restart this economy. Ideally two curves would be examined, daily death data for people over and under 65 net of nursing home stats. Unfortunately Maryland has not provided that data and is unlikely to do so. The best we can do is use the info that Maryland posts daily and create charts for under and over 60 and under and over 70.

To that end, I gathered the daily data by age group from April 1 to the present and with simple math determined the number of deaths each day.  With that information, data was collated and charts created.

The trends speak volumes. The under 60 and 70 charts are not the ominous curve that Governor Hogan has used to maintain economy crushing stay at home orders. Instead we see flat death trends for those under 60 and a very slight uptick when include deaths between 60-69. The frequently discussed curve can only be found for those over 70. The bottom line? For the majority of the workforce, the curve has been essentially flat since at least April 15.

What do we learn from these charts? The first thing is that we have failed the elderly in nursing homes. The second is that Governor Hogan has based his decisions on the wrong curves. This data suggests that we should have changed course some time ago and put a serious strategy in place to protect the vulnerable and let the young kickstart this economy. But no, Hogan never looked at things this way or, if he did, he ignored it.

We will debate forever why Governor Hogan and others ignored commonsense strategies in favor of extended lockdowns even after they knew that the much feared curve only applied to the elderly. We will wonder why they never shared this information with the citizens. We will wonder why they simultaneously crushed small business, added untold debt and failed to protect the vulnerable. What a total failure of government. And how disgraceful that we let them do it.

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  • Even though the curve is flat for younger people, the corona virus is still with us. At every age, we must continue to maintain physical distance, use proper hygiene and stay away from the vulnerable.
  • Maryland only releases number of cases and deaths by age group.  I did not chart cases because the testing rate has increased so it is not an apples and apples comparison.  In my view, since the hospitals have capacity, the only measure that should guide decisions is how many people live and die from the disease.
  • On April 15, Maryland changed how they accounted for deaths because there was a reduction. From that point on Maryland included confirmed and “probable” deaths. For this reason I assume that death counts prior to April 15 included probable deaths.  Because probable deaths are too ambiguous, the charts begin on April 16 and only include confirmed deaths.  
  • Please note that the data Maryland publishes daily is silent on comorbidities.  Therefore the data includes folks who died with or without a serious underlying condition. This is important because many have said we should stay shutdown because a large percentage of the population have a serious underlying condition. This does not appear to be a valid argument because the data shows that there is a flat trend for those under 60 regardless. Between 60 and 70, I suspect underlying conditions play a larger role but without more data it is difficult to speculate. Ideally, we would know how many people died in each age group with a comorbidity. 
  • It would also be excellent if we knew how many people with underlying health conditions survived corona virus.
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Open Letter to Governor Hogan, April 14, 2020

You have a very difficult job. We understand and appreciate your effort. But now is the time to agree that the curve has been flattened. We cannot keep the State closed in a quest to eliminate the curve. If you and other politicians insist on an extended shutdown, you can add millions of ruined lives to your resume. The economic destruction is and will be enormous to both private industry and government. Why is corona virus the only illness exempt from a reasonable risk analysis? Where is the perspective? Next will politicians eliminate sugar from the food supply to combat diabetes? Ban all environmental factors that are known to cause cancer? Force all citizens to get a flu vaccine every year? Quarantine all people susceptible to HIV until a cure is found? Permanently evacuate all areas where mosquitos carry malaria? Ban suicide? Ban motor vehicles? Ban humans? The absurdity is beyond comprehension.

Unlike some other governors, you understand how economies function and the destruction occurring each day Maryland remains closed. So why are you not taking concrete steps to open immediately? Is this about federal funds? What can be more important than the lives of all of the constituents? The fastest way to increase the State’s coffers is to open back up.

Politicians are destroying this country. Please be bold, stop the insanity and open. Everyone can wear masks and maintain social distance. Restaurants can reduce seating. Vulnerable people can remain at home. No doubt there are many solutions that creative minds will find if you just let them. The people have a choice. It is time for us to make it.

Yes, sadly, some people will catch the virus. Presumably the hospitals have used the past month to prepare. We mourn for those who have succumbed to this virus and worry greatly for the health care workers on the front line. We must strike a balance, however, between those at risk from the virus and those at risk from shuttering the economy. This is not a case of “money vs lives”. It is “lives vs lives”.

I do have a question that requires an answer. Does the State have the constitutional authority to order a business to close for an extended period of time? And to determine what is an essential business and what is not? And require these businesses to pay taxes while they are closed?

Again, I appreciate the pressure you are under. Imagine what it will be when the Federal government can no longer bail everyone out.  

Sincerely,

Sue Seboda

Annapolis, MD

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Open Letter to the Citizens of Maryland, May 4, 2020

Does someone have control of Governor Hogan?  A big corporate winner in the corona games?  A myopic medical advisor?  His campaign manager?  His words are right but his actions are wrong.  It is perplexing.  

For example, Maryland stonewalled the release of nursing home data until last week.  Perhaps it is because nursing home deaths comprise 55% of the total deaths in Maryland.  While this raises many questions on the management of aggregate care facilities, it also raises a serious question about data.  Hogan has stated he will only reopen after 14 days of flattened or declining hospitalization and death trends.  Which trends?  Trend curves that include nursing home data?  That doesn’t make sense.  Will nursing home patients be on the front line of our economic restart?  No.  Therefore only trends that include the demographics of those who will kick start demand and the workforce should be included.  Nursing home trends should only dictate safety guidelines for nursing homes. 

To that end, Maryland should immediately release case, hospitalization and death trends for people 65 and under, net of nursing home data, with and without underlying conditions.  The citizens have the right to follow the trends that impact their lives.  Aside from evaluating Hogan’s performance, this data will mitigate fear by outlining the actual corona risk to the new frontline assuming proper physical distance and hygiene.  Certainly this is not a novel thought.  It is, however, an important one and it is disturbing that it hasn’t been considered publicly.  

Along these same lines, data from highly specialized environments, such as poultry plants should result in unique safety requirements applicable to those businesses.  Under no circumstances should data from these locations influence the reopening of the rest of the state. 

Governor Hogan stated “there is nothing more important to me than getting our economy and our people back on their feet”. If this were true, why hasn’t he examined the appropriate trends regionally?  Some areas probably already have 14 days of flattening if indeed there ever was a curve.  Could portions of the eastern shore and the west go to phase 2 now with strict guidelines in place?  

A leader whose top priority is keeping citizens safe from both the virus and an economic meltdown would dispense with the benevolent dictator schtick.  His actions are anything but benevolent to small business.  Hogan clearly feels empowered to willfully kill one business over another.  For example, why has Hogan allowed people to buy flooring at Home Depot but not at a small independently owned business?  Why does Hogan insist that you can only buy spice at a corporate grocery store but not at a small business dedicated to spice?  We don’t need 14 days of anything to open these stores up, they should open now.

At this point in the outbreak, a leader dedicated to reopening would also be brutally honest about the consequences of the stay at home orders.  Hogan barely mentions them. Based on what is known now about the virus, if the public balanced current corona risks against the risks of the shutdown, they would demand an immediate, safe opening of all business that can maintain physical distance and/or implement hygiene standards known to stop the spread.  For those who only watch nonstop corona news or avoid all news, let’s hit a few highlights.  Note each item below results in its own cascade of serious additional consequences.  Maryland faces an estimated 2.8 billion shortfall.  Over 30 million unemployed. Loss of life due to delayed health care and suicide. Sharp decline in economic activity and consumer confidence. 401ks in the tank.  A frightening surge in credit card, rent and mortgage defaults. Hotels at 20% capacity if open.  Travel and airline industries crushed. Manufacturing plants shuttered or crippled.  Hospitals hemorrhage cash and lay off tens of thousands jeopardizing our health care industry. Empty storefronts and failed businesses. Restaurants gone. Livestock slaughtered. Troubling international incidents.  Consumer spending, which accounts for about 70% of GDP, plummeted at a 7.6% rate in the first quarter, the most since 1980.  Economy shrank at 4.8% rate in the first quarter.  The reduction in second quarter GDP will likely be staggering. US government set to borrow a record $2.99 trillion in the second quarter. The American dream crushed for many.  The list goes on and on and this is just the beginning.  For those who still claim the demand to reopen is for our convenience you are wrong, it is for our lives, figurative and literal.  

In closing I ask Maryland citizens, does it make sense that a reopen strategy is strongly influenced by what is happening in nursing homes?  Should our reopening be delayed due to outbreaks in highly specialized environments that demand unique safety guidelines?  Should we ignore that the majority of states have begun the process to reopen?  They can’t all be wrong.  Should Hogan have the right to decide which businesses live and which die when either can be safe?  Why should we accept arbitrary edicts that have zero impact on the spread of corona? Does it make sense to delay reopening when commonsense approaches that protect the vulnerable are possible?  Does it make sense to delay when the consequences of doing so present a clear and present danger?  No.  With the curve flattened and hospital capacity sufficient, none of this makes sense which brings me back to the beginning.  Who is in control?  

Details

  • The photo of the slaughtered pigs was posted on facebook.  I removed the poster’s information for privacy purposes.  The airport photo is DCA.