William O'Leary: The view past the COVID-19 peak
RICHMOND — We are near the apex of the pandemic curve. In the critical early weeks, federal leadership dropped the ball. Despite science, and warnings it failed to define the threat, produce and scale testing, and mobilize a national response.
Governors, including Gov. Charlie Baker, and health experts moved to fill the leadership vacuum. Without a vaccine, treatments or capacity to handle an onslaught of infection, there emerged near consensus to implement social distancing measures. They will work together to gradually transition back.
I served with Gov. Baker in the cabinets of Govs. William Weld and Paul Cellucci. I saw the unwavering determination, the hands-on data-driven approach and insight that Gov. Baker brings to this crisis. He issued a stay-at-home advisory, ordered non-essential businesses to cease in-person operations. The state ramped up testing, developed ICU and step-down capacity, and focused on acquiring personal protective equipment and ventilators.
The Berkshires, identified as a hot spot for community spread, had high per capita infection rates. Some argued the proximity to New York impacted transmission. There may have been some asymptomatic transmission before both states adopted social distancing. However, in recent days, rates of confirmed cases is trending toward state averages. The fatality rate remains high. Age would seem to be a factor. The Berkshires have 40 percent more people over age 65 and slightly higher co-morbidity rates than state averages.
TESTING IS LYNCHPIN
COVID-19's initial infections will be limited to a relatively small percentage of the population. By fall, it will still be here, without a vaccine. Testing, which has been limited in the Berkshires, will be a lynchpin to opening "non-essential businesses," restaurants, shops and schools. It must be scaled to determine who requires quarantine. Antibody testing must be developed and scaled to determine who has recovered from COVID-19 and is immune.
To prepare for any additional waves, there must be a deeper dive into fatalities and their distribution among hospitals, nursing homes and the community, as well as bed utilization, impacts on workers and first responders, and the geographic isolation of the county.
Local businesses and the service, cultural and arts economy have been deeply impacted. Second-home owners provide major economic contributions. Their property taxes fund schools, police and essential services. They support restaurants, shops and other services. They will be needed to re-boot Jacob's Pillow, Mass MoCA and Tanglewood.
Donations, including those to Berkshire Medical Center, from present and former residents, James and Kim Taylor and Elizabeth Banks, are inspiring.
Credible information givers require support. The Berkshire Eagle is more important than ever. Watch the explanatory interview it is streaming with Berkshire Health Systems' Dr. Lederer. So, too, WAMC brings local context to national news, and like PBS, it provides both news and cultural events especially needed now.
Berkshire County's greatest assets are its residents whose social distancing and personal sacrifices are flattening the curve. Health care workers are at the forefront with first responders, grocery staff and other essential service workers.
Technology innovation, which is being leveraged to fight the pandemic, will impact health care and work distribution long after its demise.
In 2016, I spoke on a United Nations panel on the Ebola crisis. I drew upon Bill Gates' TedTalk, "The Next Outbreak. We're not ready." He posited that investment, data and digital approaches could reduce time to market of treatments and vaccines — post-coronavirus, this should occur. Mostly, my comments focused upon connecting caregivers through mobile and cloud technologies and by addressing the digital divide.
The U.S. has been beset by physician shortages. Chronic diseases comprise two-thirds of all health costs in older persons. Telehealth extends physician's reach, reduces emergency room overuse, and enables preventive care. Despite the increasing ubiquity of mobile devices, the promise of telehealth has been limited by regulatory, licensing and Medicare reimbursement limitations. Those impediments are now being removed enabling telehealth to scale.
Gov. Baker announced plans for a novel 1,000-person call center to track and trace contacts of infected persons. Some European nations will couple call centers and testing with proximity tracking technology. Leveraging Bluetooth technology, Apple and Google are teaming to build software into smartphones that would alert people that opted in, if they were in recent contact with someone infected.
Brookings suggests a lasting collateral impact of the pandemic will be greater adoption of telework. The pandemic has triggered exponential adoption of personal and business teaming technologies such as Zoom, Skype and Teams. Before retirement, I transitioned to three days a week telework, because at Microsoft we had used those technologies for years. Telework prompted my purchasing a second home and later moving my primary residence to the Berkshires. Likewise, I suspect we will see an uptick in second-home purchases.
William O'Leary is the former Massachusetts secretary of health and human services, and former executive director and chief health policy officer for Microsoft Corporation. He resides with his family in Richmond.
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