Innovation Ecosystem

Late for the sky

As the front lines keep shifting, as the number of cases and deaths keep spiraling upward, as disruption of our lives becomes the new normal, as attempts to flatten the curve of the pandemic become more frantic, what are the questions we need to be asking

Photo by Richard Asinof

Shoppers waiting to enter Whole Foods on Saturday morning, March 29, which restricted the number of people allowed in the store at any one time, in adherence to the Governor's request. Translated, the world of grocery shopping has moved on line and online. How does the Governor shop for her groceries?

By Richard Asinof
Posted 3/30/20
As Rhode Island and the nation hunkers down in social and physical distancing in response to the coronavirus pandemic, what are the questions that need to be asked and answered?
How will our political world change as a result of the coronavirus pandemic, in the way we hold elections and conduct legislative business? What kinds of new victory gardens can be tended to help relieve food insecurity? What kinds of community-based investments can be made to jumpstart the economy following the pandemic? Are there movies that Rhode Islanders can watch together in a streaming mode to create a sense of an engaged community, as is being done in Philadelphia? How will the Rhode Island congressional delegation advocate for investments in the work on vaccines being done by EpiVax? What does it say about Gov. Raimondo's priorities when she declares gun shops to be an essential business but book stores are not?
The world does not stop turning because of the coronavirus pandemic. There are still ongoing medical needs, for instance, that need to be met. The run-around that many people in Rhode Island and elsewhere have experienced in trying to get tested for COVID-19 is symptomatic of larger “command and control” issues.
Getting approval for an MRI, for instance, recently required one surgeon to argue with a nurse at an insurance company for nearly 30 minutes before the nurse relented and approved the procedure. As a result, the MRI detected what was actually wrong with the patient, identifying a serious condition that requires immediate attention. The officious nature of the bureaucratic state of health care and insurance companies needs to change, and to change quickly, if one of the first outcomes of the pandemic does not become the rapid adoption of a single payer plan for all residents of the U.S.

PROVIDENCE – I read the news today, oh boy. Every day, sometimes twice or even three times a day, it seems, we are held captive by a never-ending barrage of news briefings attempting to narrate the latest churn in the worldwide spread of the COVID-19 pandemic.

The “facts” are detailed: an ever-escalating number of confirmed cases, rising death tolls, and new interventions and interdictions around travel, physical distancing requirements, restrictions on what businesses are now being forced to close, and worrisome reports of dire shortages of personal protective gear and supplies that keep threatening to overwhelm hospitals and health care systems, putting health care workers at greater and greater risk.

The most gripping stories are those told by the nurses and doctors themselves, in self-made videos, leaked to the news media, detailing the scenes from the inside of the struggle on the front lines against COVID-19, eyewitness testimony that vanquishes the happy talk about how "we are doing a tremendous job" being offered up at White House briefings.

People are dying at alarming rates, including: health care workers, police officers, first responders, and ordinary Americans. The virus does not discriminate. [At the White House briefing on Sunday, March 29, President Trump said that as many as 100,000 Americans may die from COVID-19, and if that was the total, it would be because his administration was doing a tremendous job.]

The reality is that COVID-19 is now everywhere; there is no safe oasis. It will peak in different areas of the country at different times, with hot spots cropping up and bursting like infected boils all across the nation. The disliked reality is that the federal government, under President Trump, has terribly mismanaged the pandemic from the start. No amount of political spin can change the facts.

With the “breaking news” chryon flowing across the bottom of our screens, we are inundated with much too much information to swallow or digest. We are “lectured” repeatedly by the voices of authority about how we should conduct our lives, like a mantra: Stay home. Stop the spread. Save lives. [And the more impolitic, “Stay the f*** home.”] As if we didn’t know that, as if we were not already hunkered down in our living spaces, as our world has been forever disrupted.

Lyrics from songs keep playing in my head, much like songs from the new TV series, “Zoey’s Extraordinary Playlist”: Don’t stand so close to me… Reading the news and it sure looks bad…. I want to be sedated… Who do you think you are, Mr. Big Stuff… Tracing our steps from the beginning, until they vanished in the air, trying to understand how our lives had led us there...

Another disliked reality: we have a petty, petulant President who blithely lies and distorts what is happening on the front lines; still the networks continue to give him airtime. [So far, only one radio station in Seattle, Wash., has courageously decided not to cover his briefings, because the radio station says the White House news briefings feature unchecked, misleading and false information served up by the President.]

Different realities, different narratives
There is a conundrum with testing: without testing, we can’t know the extent of the community spread of COVID-19. A lack of supplies – such as swabs – has limited the capability of Rhode Island, for instance, to conduct tests, resulting in health officials having to “triage” who can actually gets tested. Who gets tested and who doesn’t is often determined by wealth and status. All of the health inequities in a health care market that serves as a system of wealth extraction have become visible. As poet Tomas Transtomer wrote in “Elegy”:

I open door number two.
Friends! You drank some darkness
And became visible.


The strategy of containment has given way to mitigation. While new tests are being launched to measure antibodies to the infection [which are done by drawing blood and will show if you have been infected in the past, as opposed to the current testing using swabs, which determine if there is any of the virus' genetic material present in your nose and throat], such tests will prove to be most important in six to eight months when the next wave of the virus circulates in the Northern Hemisphere to help identify who should receive a vaccine first.

Still, there are promises that testing are being ramped up by government officials and hospital executives and even the President, but those false “promises” have been contradicted by ordinary folks who continue to tell their own stories about the frustrating inability to get tested, experiencing a run-around.

Without testing, we are flying blind into the fog of the pandemic. No quarantine, no interdiction of traffic on the Interstate, no federal rescue plan can prevent the spread; they can only provide a flimsy safety net to delay what happens next.

What testing can accomplish, however, is how we plan for our future. There is much common sense in a recent post by Sen. Elizabeth Warren, worth repeating: “Restarting our economy will require one thing above all else – testing. Testing to show who has currently infected. Testing to show who has had the virus and is immune. Social distancing won’t end because it’s Easter. It’ll end when we have sufficient testing. Here’s how we do it.”

Needless to say, Sen. Warren has a plan: “Congress can put its foot down and force President Trump to use the Defense Production Act to develop tests, the raw materials needed for those tests, and the protective equipment necessary for health care professionals to administer them.”

Warren continued: “Congress can also help end the testing logjam by creating a dedicated test fund to issue guaranteed contracts with public and private manufacturers. And it should provide grants for cash-strapped public health labs and doctors’ offices to purchase test equipment.”

Further, Warren said: “Congress should require the U.S. Department of Health and Human Services to report demographic info for people tested to make sure tests are being distributed equally. And manufacturers should have to report their test capacity and resources daily so our federal response is accurate and communities aren’t being left behind.”

Woke up, got out of bed, dragged a comb across my head
We have become a nation of spectators, glued to our screens, watching as our world and our economy fall apart, in real time. We are urged to stay at home and remain calm. Most of our conversations and workplaces and schools have moved to online platforms. In public, if we are bold enough to venture outside to go shopping for groceries and by happenstance encounter another brave soul, we tend to acknowledge each other from a respectful distance of at least six feet, with a “Kramer wave” – a ritual of brief acknowledgement made infamous by the Seinfeld TV show.

There are competing narratives for sure, and competing messaging: President Trump had envisioned churches filled with people by Easter Sunday, as he projected his dream of a nation open for business again; meanwhile emergency rooms are flooded with sick, dying patients. “Beautiful,” he described his far-fetched vision. The bleak reality is that there will still be refrigerated trucks at hospitals to store the bodies awaiting burial on Easter Sunday. [At the White House news briefing on Sunday, March 29, the President extended the federal directive to stay at home until April 30.]

Too many of us are waiting for a league of superheroes [or CEOs] to appear, to rescue us, to slay the dragons, to set the world back on its proper rotation, but the reality is sinking in: we will have to rescue ourselves if we want to survive. And, it is bottom-up innovation, not top-down innovation, which will emerge to save us from the greed at the top.

Dissonance
As a member of the news media in Rhode Island, I have had the privilege, if I choose to do so, to be both a participant and an observer in the local news briefings, now being conducted on a daily basis, with an alleged opportunity to pose questions of elected officials such as Gov. Gina Raimondo and appointed agency directors such as Dr. Nicole Alexander-Scott at the R.I. Department of Health.

The daily news briefings have moved to a virtual online platform on Facebook, and the opportunity to ask questions has been even further constricted: instead of trying to shout your questions to be heard above the din of a media scrum, reporters are now required to submit questions in advance, to be reviewed by apparatchiks on the Governor’s communications staff, and then hope, against all odds, that one of your questions submitted might actually get chosen. So it goes.

From a “management of the messaging” perspective, it gives the illusion of transparency: a recitation of the latest numbers, updated daily, which are then dutifully reported by the Greek chorus of news media as breaking news. This is what oligarchy looks like. This is what oligarchy looks like.

And when Gov. Raimondo announced that she had called out the National Guard and the R.I. State Police to stop all cars with New York license plates and go door-to-door in coastal communities, the news media dutifully reported on its rollout. Why New York and not Massachusetts? Was this a dramatic first step to revoke civil freedoms? [The executive order was rescinded within 24 hours, under apparent threats of lawsuits by New York and the R.I. ACLU, in favor of a new executive order applying to all out of state travelers to Rhode Island, and not just New Yorkers. Because it was just "information gathering," the Governor claimed that it was not an abrogation of legal rights.] Stay tuned.

What is missing?
Some questions, however, never seem to get asked or answered. Something important is missing. Simple answers seem elusive.

The questions we all want answered are: When will this all blow over? When can we return to normal lives again? The truth, if are willing to be honest with ourselves, is to admit that no one knows the definitive answer to the first question, and worse, that our world has been disrupted; our lives will never ever be the same again.

So, let’s make that the starting point: Admit that we do not know what is going to happen. Admit that things are going to get much worse before they get better. Rhode Island, if it holds true to the epidemiological curve, is about to overwhelmed by hundreds of cases of COVID-19 , many requiring hospitalizations, with a mounting death toll.

On Monday, March 9, there were 3 cases of residents who had tested positive for COVID-19, with 53 negative tests, and 6 people with results from tests pending, with approximately 290 people in self-quarantine. [See link below to ConvergenceRI story, “As the world churns.”]

Less than three weeks later, as of Sunday, March 29, there were 294 cases of residents who had tested positive for COVID-19, a jump of 9,800 percent. The worst is yet to come. At her press briefing on Sunday, March 29, the Governor admitted that the 294 cases were an undercount, because there were many more cases ini the community that had not yet identified by testing.

Not being heard
As a reporter, I find it a tiresome chore to ask questions and then not get called upon, my questions ignored, and my inquiries shunted aside. As Thomas Pynchon once wrote in Gravity’s Rainbow: “If they can get you to ask the wrong questions, they don’t have to worry about the answers.”

So, instead, I have decided that ConvergenceRI will conduct its own news briefing, talking with nurses, epidemiologists, and vaccine researchers, asking what I believe are the most important questions, and posting the answers, based upon the best evidence available.

Question: How long can we expect the coronavirus pandemic to last?
ANSWER:
The coronavirus pandemic will likely be with us for the next 14-18 months, with a second wave of infections sweeping the world later this fall. It will never go away; rather, it will be controlled through an active vaccination campaign. The virus will set the timetable; not the President, not the news media, not Congress, and not Gov. Gina Raimondo.

As Dr. Peter Simon, a retired epidemiologist with the R.I. Department of Health and a frequent contributor to ConvergenceRI, recently wrote on a Facebook post. “It will be over when A, a large-enough quantity of us have caught the disease and become immune; and B, when we have a vaccine. The combination of A + B is enough to create herd immunity, which is around 70 to 80 percent.”

Simon added: “The longer Step A takes [by flattening the curve of infection over time], the fewer people will die.”

That’s about as direct and straightforward answer as you can get, gazing into a sky of unknowns.

Question: When will COVID-19 reach its peak in Rhode Island?
ANSWER:
New York Gov. Andrew Cuomo, in his daily news briefing on Friday, March 27, said that New York City, which has now emerged as the epicenter of the disease, predicted that the pandemic in New York City would reach its peak in 21 days, in three weeks’ time.

On the epidemiological curve, Rhode Island is about two to three weeks behind New York. It is a projection, and projections can be wrong, but it is likely that the pandemic in Rhode Island will peak during the week of April 27.

[No matter what the President purports, some nonsense about the cure being worse than the problem, and believing that he will soon be able to sound the “All clear” and the U.S. will soon be open for business again, the development and testing and then introduction of a vaccine is at least six months to a year away, at best, according to public health experts working on developing a vaccine.]

Question: How long will it be before a COVID-19 vaccine is developed and introduced to the market?
ANSWER:
At the very earliest, six months, if the U.S. government and other foundations are willing to invest the money in a series of efforts now underway. Longer if the money is not invested promptly. In addition, safety trials and restrictions on manufacturing may add months to the timeline.

Dr. Annie De Groot, CEO and CSO of EpiVax, a local biotech company, has pivoted her firm’s resources to work on developing a new COVID-19 vaccine, utilizing the firm’s computational, immuno-informatic tools. There are two avenues of work on vaccines that are being pursued in which EpiVax serves as a key partner.

The vaccine, however, will not emerge without massive investments of funding. The Coalition for Epidemic Preparedness Innovations, or CEPI, has called for $2 billion in immediate government funding for the expansion of vaccine candidates to be brought to clinical trials, increasing the changes of success.

EpiVax has submitted a request for funding to the MCDC [the Medical CBRN Defense Consortium under the U.S. Department of Defense] to serve as part of the solution in driving the vaccine science forward.

“EpiVax is developing an epitope-based vaccine that could be ready in as little as six months,” De Groot recently wrote. “Scientists at EpiVax have a plan in place for carrying out this rapid development.” The work on a peptide-based vaccine is being done in partnership with Generex Biotechnology Corporation, announced on March 4.

Using the epitopes predicted by EpiVax, Generex will manufacture a series of synthetic amino acid peptides that mimic the epitopes of the virus and send them to China for testing.

Here’s the plan: In collaboration with a team of researchers in China, Generex will test the reactivity of these peptides in blood samples that have been collected from patients who have recovered from COVID-19. Because these patients recovered from the coronavirus infection, their blood most likely contains immune cells and antibodies that recognize the peptides, proteins, and nucleic acids that represent antigenic epitopes of the virus.

When the synthetic peptides are mixed with the blood samples, we can confirm that the sequences predicted by the EpiVax algorithms will be good vaccine peptides, according to De Groot. Through a matrix assay that tests a series of peptides against the blood from recovered COVID-19 patients, the team can select the best hybrid peptides to create a commercially viable vaccine that can proceed to human testing.

A second partnership, announced on March 23, seeks to produce a vaccine that can be administered intranasally for high-risk populations, such as health care workers and families of confirmed cases. It is also being designed to be protective against future variations of the virus. The partners in the interational consortium include: The RNA Immunotherapies, EpiVax, Nexelis, REPROCLL and CEV. The goal is to accelerate progress toward clinical trials with patient enrollment expected in 2021.

Steven Powell, The RNA Immunotherapies' CEO, explained the aims of the consortium in a recent news release: “Viral variation means traditional medicinal and preventive vaccine approaches may fall short when confronted with seasonal or outbreak situations,” Powell said. “A vaccine to defend against current and future outbreaks of coronavirus and other respiratory viral pathogens should be robust against viral genome changes, provide a platform that enables rapid introduction of a new viral target, be easy and safe to administer and be scalable and suitable for stockpiling. The innovative vaccine program we have started with our partners incorporates all of these essential features.”

Question: What is the relationship between the vaccine development, testing, and the length of time that we will need to endure disruption of our lives and workplaces from the pandemic?
ANSWER:
At the news briefing conducted by Gov. Raimondo last week [on Monday, March 23], there was some noise about if and when Rhode Island can ramp up testing to 1,000 tests a day, the possibility exists that it might be possible to consider loosening the restrictions around social distancing.

Once again, I cite Dr. Peter Simon. “We have a new test for antibodies to COVID-19 that will help identify people without evidence of previous infection. They are a priority for vaccine.”

“We will have a vaccine in a while,” Simon continued. “Those who made it through the first wave without illness can be identified using new ELISA test for antibodies [the FDA gave New York State to move ahead with this effort]. They will be protected with vaccine and the force of herd immunity will make us protected from future waves until the virus changes.”

Simon continued: “When our labs can put in place new testing for protective antibodies, people can be identified who can return to work because they are immune.”

Question: What is missing from the state’s current economic strategy moving forward after the pandemic?
ANSWER:
In less than a month, Rhode Island went from being a state with one of the lowest unemployment rates to having one of the highest rates of unemployment, as workers have been laid off, fired and furloughed in record numbers.

Almost all of the investment strategy assumptions of Rhode Island’s future economic prosperity, based upon investments in advanced industries, have been blown up by the coronavirus pandemic. The Wexford Innovation Complex and the Venture Café will no longer serve as a physical place of “collision” for entrepreneurs, at least for months, as the world moves to Zoom.

Nonprofit agencies, such as the Childhood Lead Action Project and CODAC, have been leading the way in figuring out the ways of the new workplaces, in redefining community engagement and provision of care to vulnerable patients. [See links below to ConvergenceRI stories, “ Acting locally,” and “In a time of pandemic, CODAC revamps its delivery model.”]

The Rhode Island Foundation has launched a new fundraising effort to support local nonprofits, as a kind of financial emergency intravenous drip.

What’s missing from the dialogue is that there is no strategic plan being developed to invest in Rhode Island’s public health infrastructure, so crucial to the state’s future prosperity, as the coronavirus has demonstrated.

Much of the R.I. Department of Health’s funding is dependent on federal resources, because both the R.I. General Assembly and the Governor have consistently failed to make investments of state funds.

In her budget proposal, Gov. Raimondo chose not to invest $1 million in Health Equity Zones; perhaps now, as communities become the front line in rebuilding the state’s economy, that decision will be revisited in a supplemental budget.

Investments in Rhode Island’s public health infrastructure were inexplicably left out of the RI Innovates 2.0 strategic plan, published in January, that focused on investments in the state’s advanced industry clusters. All the economic assumptions contained in the top-down, CEO-driven strategic plan – about the research enterprise, about deal flow, about industry clusters – have been blown up by the coronavirus pandemic.

At this point, there appears to be no desire on the part of Commerce RI to consider writing an addendum to RI Innovates 2.0, including a discussion of public health investments. Why not?

Public health investments – and place-based health built around health equity – offers the best chance to restart the economy after the recession caused by the pandemic, moving it from a market of wealth extraction to a system of health based upon a community’s needs, not a corporation’s desires.

The massive investments in public health in response to the coronavirus pandemic also can serve as a kind of working model for how a single player plan for health care in the U.S. might succeed.

As Dr. Peter Simon wrote on Facebook: “Perhaps not essential to understand what is happening now or what will happen later, I want all of you to know the origin of the current struggle of our public and private health care system, [which has been] weakened over the past 40 years. We sacrificed public health over the last 40 years as the “medical enterprise” commercialized the concept of “health.” COVID-19’s silver lining is that perhaps we will learn, again, what health really is and where it comes from.”

Simon continued: “Pandemics have been predicted for more than 10 years since MERS, etc. We will have more. We have been sold down the river by our leaders on both sides of the aisle.”

Question: Can you give an example of how Rhode Island could redirect its growing innovation economy to create responses to the pandemic?
ANSWER:
Rhode Island, could, if it chose to, mobilize its existing academic research and manufacturing enterprise to address ongoing shortages of personal protection equipment and swabs for testing.

One of the questions submitted by ConvergenceRI to the powers that be controlling the March 22 news briefing by the Governor was: “Has the new innovation campus known as “401 Tech Bridge” with its focus on advanced textiles been activated to produce needed medical supplies such as swabs and protective masks for Rhode Island health care workers, deploying their local resources?

As ConvergenceRI reported in its Oct. 7, 2019, edition: “The 401 Tech Bridge will receive $1 million in state funds, and in turn will leverage $5 million in matching investments from other sources, including the U.S. Department of Commerce. The partners include: Polaris MEP, Toray, Composites One, Hope Global, the International Yacht Restoration School of Technology and Trades, the Composites Alliance of Rhode Island, the Rhode Island Textiles Innovation Network, the Rhode Island Manufacturers Association, and DESIGNxRI. The goal is to create a “catalytic center” focused on innovation in advanced textiles and composites.

The “401 Tech Bridge” project will also receive support from the U.S. Department of the Navy, according to Susan Daly, the vice president of Strategy at the Rhode Island Marine Trades Association. The project will be developing a new headquarters for its ongoing operations in Portsmouth; a potential location has been identified but not yet been made public.

Is Rhode Island willing to mobilize its “innovation campuses,” paid for by taxpayer dollars, to serve as a hub to fight the coronavirus pandemic? Good question.

Envisioning a future Rhode Island
The strength of Rhode Island is its relative size and its sense of connectedness. Much like soldiers serving on the front lines in conflicts – in Iraq, in Vietnam, in World War II, in Korea – when impromptu solutions to battlefield dilemmas caused by bad leadership often made the difference, the same, hopefully, will be true in the Ocean State, as residents rally to devise a new world, a different world, than the one we are leaving behind.

At some point it will be safe to venture out and talk to people again, to socialize, to gather in groups larger than five people, to engage in shopping and dining out and listening to live music and drama. The question looming is: will the leaders be willing to learn and listen and to follow the people, rather than dictating from above? Stay tuned.

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