Delivery of Care

How do you contact trace policy decisions?

A New York Times investigative story about how the Trump team’s efforts to intervene and change CDC recommendations, particularly around policies on the reopening of schools, raises questions about Dr. Deborah Birx’s apparent involvement with Rhode Island’s strategy

Photo by Genaro Servín, courtesy of Forbes Travel publication

Traditional costume at the Day of Dead celebration in Mexico City

By Richard Asinof
Posted 10/5/20
The recent New York Times reporting on the Trump administration’s efforts to push for reopening of schools, using strategies that mirror those deployed by Rhode Island, has raised questions.
How do you effectively contact trace policy decisions made around the reopening of schools in Rhode Island? Will the Raimondo administration be transparent about its dealings with Dr. Deborah Birx? How have layoffs at CCRI jeopardized the ability for a free dental clinic to perform its work? When will the R.I. General Assembly address questions regarding low reimbursements from health insurers for mental health and behavioral health services in Rhode Island?
As of Friday, Oct,. 2, some 1,118 deaths of Rhode Islanders have occurred in the last seven months as a result of the coronavirus, losses that continue to be devastating for families around the state. No amount of successful Halloween gathering of candy in trick-or-treating exercises can sugar coat what those losses have meant.
To try to ignore, repress or deflect or fail to recognize those losses and the emotional toll, mental health professionals will tell you, will only lead to further behavioral health issues.
It seems appropriate that Rhode Island consider creating a specific moment to honor those who lives have been lost to the coronavirus pandemic, as well as to begin the healing process.
In addition to celebrating Halloween, why not invoke a new tradition, a celebration of the “Day of the Dead,” or Dia de Muertos, as a way honoring those that have fallen victim, through no fault of their own, to coronavirus pandemic. Call it a way to say a mourner’s kaddish as a way to bless those of us who are living with abundant peace, grace, kindness, healing, sustenance and mercy.

PROVIDENCE – With the breaking news on Friday night, Oct. 2, that President Trump is now being treated in Walter Reed Hospital, after he and his wife, Melania, had tested positive for the coronavirus, a scramble should be underway to perform contact tracing for all the people who may have come into close personal contact with the President and his team in the week before his confirmed diagnosis.

The sad reality is that the news media seems to be doing a better job at this than the White House. [For instance, a dashboard has been created to track testing of recent POTUS contacts and attendees of White House events over the last 12 days, “COVID-19 at the White House Contact Tracker,” at public.tableau.com, a site recommended by Pulitzer-Prize winning journalist Laurie Garrett and praised by Dr. Megan Ranney.]

There is a constantly growing list of people close to Trump who have now tested positive for COVID-19. That list now includes: Hope Hicks, a top presidential advisor; Sen. Mike Lee of Utah; Sen. Thom Tillis of North Carolina; Sen. Ron Johnson of Wisconsin; the Rev. John I. Jenkins, the president of Notre Dame University; Bill Stepien, a top Trump campaign official; Kellyanne Conway, a long-time Trump advisor; and Chris Christie, the former governor of New Jersey and a Trump advisor who helped the President prepare for the Presidential debate held on Sept. 29.

What did they all have in common? They all were in attendance at the gathering to announce Trump’s Supreme Court nominee, Amy Conant Barrett, on Saturday, Sept. 26, at a White House ceremony in the Rose Garden, where the guests were videotaped hugging, kissing and shaking hands, all without masks, evidence of a potential super spreader event, all flouting the explicit public health guidelines around the coronavirus prevention. Many also participated in a private indoor gathering, without masks.

[The idea that they had all “tested” negative, as an emergency department doctor posted on Twitter, is the equivalent of depending on pregnancy tests rather than using a condom, an apt comparison. Further, the use of the Abbott ID Now testing device has been questioned, given that it appears to have a 20 percent rate of false negatives.]

It turns out that Judge Barrett had previously been diagnosed with COVID-19 earlier this summer, a salient fact that somehow was not, ah, mentioned, in her resume, as she blithely met with Republican Senators without wearing a mask.]

There are also serious questions being asked about the reasons why Trump’s immediate family refused to wear masks at the Sept. 29 debate, despite the rules, and whether they purposely avoided participating in the mandatory required testing before the event, arriving late. [The question asked by Sen. Howard Baker, a Republican from Tennessee, in the midst of the Watergate scandal, seems particularly apt today some 47 years later: “What did the President know and when did he know it?]

Contact tracing for policy
For the most part, we have become familiar with the processes known as contact tracing, an epidemiological tool in the practice of public health, in order to trace the paths of transmission of a disease, which serves as an important tool in understanding and arresting the spread of a deadly virus, ever since the work of John Snow detailed the sources of the 1854 cholera outbreak in London.

Here in Rhode Island, contact tracing has been a central component of the tools deployed by the R.I. Department of Health to help contain the spread of the coronavirus and is a key feature of the Crush COVID app promoted by the Raimondo administration.

What about contract tracing being deployed for policy decisions around the reopening of public schools in Rhode Island?

In a story published on Tuesday, Sept. 29, the New York Times documented efforts by the White House to play down the risks of sending children back to school. In the story, it was reported that Dr. Deborah Birx, in her capacity working on the White House Coronavirus Task Force, had in July “pushed the [Centers for Disease Control and Prevention] to incorporate a document from a mental health agency inside the Department of Health and Human Services [the Substance Abuse and Mental Health Services Administration] that warned school closures would have a long-term effect on the mental health of children and that asymptomatic children were unlikely to spread the virus.”

If that perhaps sounds familiar, it should – because it appears to mirror the strategic rationale pushed by Gov. Gina Raimondo, R.I. Education Commissioner Angélica Infante-Green, and R.I. Department of Health Director Dr. Nicole Alexander-Scott on the pressing need to reopen public schools in Rhode Island.

Beginning in late July and continuing through August, the focus of the Governor’s weekly Facebook forums often revolved around the desire to protect the mental health of children in Rhode Island, featuring pediatricians, child psychologists and social workers, including: Dr. Elizabeth Lange, the former President of the RI Chapter of the American Academy of Pediatrics; Jennifer W. Jencks, Ph.D., LICSW, the director of the Access Center at Bradley Hospital and assistant director of Lifespan Pediatric Behavioral Health Emergency Services; and Barbara Austin, LICSW, supervisor of Bradley Hospital’s Access Center .

As Gov. Raimondo hyped one of the forums in a broadcast email, “Our conversation will focus on how we can support students’ mental health and well-being as they return to school this fall.”

It should also be noted that the CDC authored a study at this time using Rhode Island’s experience with daycare centers to promote the safety of reopening of schools. [See link below to ConvergenceRI story, “Why is there a rush to reopen schools?”]

Asking the impertinent question
Perhaps it was mere coincidence that the push to reopen schools by the Trump administration, using a strategy advocated by Dr. Deborah Birx, which resulted in altering recommendations issued by the CDC, according to the New York Times, appeared to parallel the strategic playbook that was being followed by Gov. Raimondo, Dr. Alexander-Scott, and Commissioner Infante-Green pursued.

ConvergenceRI emailed Josh Block, the Governor’s communications director, sharing the information from the New York Times story, and asking: “Who, if anyone, from Gov. Raimondo’s staff and her team were in contact, either by phone or email, with Dr. Birx or with the CDC, related to pursuing this strategy? Can you provide any relevant documents pertaining to such conversations?”

Block responded: “While we are regularly in contact with the CDC, our decision to advocate for a safe reopening of schools was driven by data, science and expertise on the ground here in Rhode Island, including conversations with local mental health experts and pediatricians, and statistics on social, mental and nutritional impacts of the shift to distance learning in the spring [emphasis added].”

Block continued: “The Governor held a weekly virtual forum with these experts – doctors from Bradley Hospital, leaders at the Rhode Island Department of Health, and Dr. Fauci, among others – to address these issues and more.”

ConvergenceRI responded: “Thanks, Josh, for your prompt response to my questions, but it does not answer my questions about communications with Dr. Birx. I will ask again. Please provide that information, including records of all phone, mail, and email conversations with Dr. Birx. Thank you.”

ConvergenceRI continued: “Saying that ‘we are regularly in contact with the CDC’ avoids answering my direct questions. Further, the timeline you present in your response appears to be a bit skewed and telescoped, in my observations, about when the state mobilized different local resources to talk about mental health and school openings, events that were held in the summer, in August, not in the spring.”

[As best as can be determined by a search of the daily communications offered by the Govenor’s emails sent out regularly on Constant Contact, the earliest mention of “mental health of students” first occurred on July 24, which fits into a timeline that would match the potential influence of Dr. Birx’s strategy intervention.]

Further, ConvergenceRI wrote: “As such, I believe it is important to be able to provide the documentation I have asked for in order to put the actions by the Raimondo administration in a proper time perspective. You claim that ‘data, science, and expertise on the ground here in Rhode Island’ drove the decision to advocate for the safe reopening of schools. Without the documentation about contacts with Dr. Birx, related to the new reporting by The New York Times this morning, it is difficult to verify whether or not Dr. Birx's activities may have influenced your decision-making.”

Context and nuance
All of this may seem like a small story, a bit of past history, unrelated and irrelevant to the continuing crisis of the coronravirus pandemic and the reality that the President is now in Walter Reed Hospital being treated for the virus, after regularly flaunting precautions around public health preventions around wearing a mask and social distancing.

There are continuing “disturbances” in the forces around school openings, according to numerous sources. Providence Public Schools has still not purchased a curriculum designed for English language learners; they are still using Springboard, a curriculum designed for AP students, not English language learners, according to one source. The Providence Public School Department is perpetuating “systemic racism” through the use of Springboard for its low-achieving and English language learning students, the source alleged.

At the same time, the rate of positives in testing in some communities, rather than statewide, remains at abound 15 percent, according to two other sources. The reality, a third source warned, is that school precautions may not prove to be sufficient, despite efforts, because of “swells” of virus spread from communities known to be at risk.

Why was Halloween given a priority?
The focus on Halloween by the Governor at her most recent news conference on Wednesday, Sept. 30, giving the green light to the celebration if guidelines were followed, to ensure that kids get to “eat lots of candy,” according to the Governor, worried another source, who saw it as a distraction from the grave issues of the spread of the coronavirus at the community level.

In an email sent out on Sunday, Oct. 4, the Governor wrote: “In times like this, we need fun, levity, and a sense of community more than ever. In that spirit, there will be Halloween this year!” 

This year, perhaps a more appropriate holiday to celebrate would be “Day of the Dead,” or Dia de Muertos in Spanish, which is a traditional Mexican holiday that involves family and friends gathering to pray for and remember friends and family members who have died, and helping support their spiritual journey.

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