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Commuting Zones As A COVID-19 Exit Strategy

Commuting Zones As A COVID-19 Exit Strategy

Fear and Fatigue Barriers

FEAR has overtaken the logic that should be connected to our strategies in dealing with this pandemic.

  1. We are afraid that if we contract the virus, we will possibly die.
  2. We are afraid that if we contract the virus, our family members will get sick from us, and die.
  3. We are afraid that we will be the source of a spike in our community.
  4. We are afraid to disregard the current federal or state strategies that are focused on a continued policy of social distancing/separation/prevention.
  5. We are afraid that we’ll get sick and miss work, suffering more economic hardship.
  6. We are afraid to gather with friends, family, or faith community members due to our newly minted social anxiety about health and safety.

At the same time, we are FATIGUED.

  1. Tired of hearing, watching, and reading about this virus.
  2. Tired of trying to discern the trustworthiness of our information sources about the virus.
  3. Tired of watching our political leaders posture and prance divisively over talking points that sling mud at their opponents, or cast a positive light on their over-confident speeches.
  4. Tired of sacrificing our liberty for the sake of federal, state, or municipal mandates that are still based on strategies related to our first mitigation stage.
  5. Tired of not being able to work, and feeling helpless to do anything about it.
  6. Tired of wearing a mask.
  7. Tired of placing all of our plans on hold.

Footprints and Zones

Our footprints represent our “commuting zone”. 

I essence this is the social and economic circle that we operate within.

As I pointed out in an earlier blog post,  I believe our country should embrace a policy that divides our country into commuting zones that would be either designated as “green zones”(unrestricted)” or “red zones”(restricted) based upon COVID-19 activity in those zones. Mathematically, linking green zones would eventually eliminate red zones.

Green and Red Zones

Due to multiple factors,  some green zones will inevitably have a resurgence of infections, and thus cease to be “green.”When this happens, the green labeling of the entire area is lost, and it goes back to the previous red zone lock-down position.  Using contact tracing and quarantining, new cases can then be confined and monitored, until the inhabitants of a commuting zone meet the green zone criteria.

This zoning strategy will help avoid a large surge of the virus this fall in our country.  A surge that will be the inevitable outcome of our current approach.

Now is time to pivot and begin a zoned approach as our exit strategy with COVID-19.

Under-Documented Infections

In the US the rates for asymptomatic infections are estimated to be 2-3x more than the current documented national rate of 3%.

This higher percentage than the officially documented infection rate is due to two primary factors.

  1. Testing Issues. Due to supply chain issues, antigen testing has been limited primarily to the symptomatic, and at times, even only the severely symptomatic.   In regards to antibody testing, rapid tests have not met the standard for reliability, and serum testing is expensive and difficult to deploy in a mass strategy.
  2. Asymptomatic infections are common. We know for instance that studies are showing  OB patients, pediatric patients, and the general population demonstrate asymptomatic infections at higher levels than even our best studies can document.

Between symptomatic and asymptomatic, our country may be as high as a 10% infection rate for the country at this point.

We need an estimated 60-70% infection rate to reach herd immunity.

Disconnect From Hot Zones

The truth is that while most of the country has experienced disruptive socio-economic effects of our national strategy, outside of several well-documented red hot zones, most of us feel a disconnect between what we see on the news each day, and what we see in our community daily.  This is especially true in non-urban America.

The Big 3 Understand Our Patterns

The truth is that most of us are organized into large and dynamic networks of economic and social structures includes cells and zones of activity.   It represents our movements and interactions. Our social media and device powers are very aware of these movements. Due to the ubiquitous nature smartphones, Facebook, Google, and Amazon know our footprint.

If private businesses have this data, why couldn’t our federal and state governments gain access to the same data?

The majority of Americans exist in defined zones, or footprints of socio-economic patterns that are not fully defined by State or County designations.

Thus our current governance system acts as a barrier to effectively managing the modern movements and vis a’ vis the public health of citizens of our country. This is because the state’s jurisdictions are too broad and are not mapped out effectively to mirror our geosocial commuting zones. States are left in the unenviable position of having to manage all of its citizens through the keyhole of its worst red-zone. It is a recipe for failure when the majority are forced to comply with the minority’s restrictions.

Crazy Cycles

Our current state-driven strategy is most certainly going to lead to a roller-coaster-like cycle within each state. The cycle will follow the stages of

  1. Open activity
  2. Spike of infection
  3. Fearful shelter
  4. Shut down activity
  5. Recovery
  6. Back to re-opening. 

Each cycle will last 2-3 months as we have seen in the first cycle. Each state’s cycle will likely not be uniform to the cycles of the neighboring states. This will have a massive negative effect on regional and national commerce.

It’s only a guess at how many cycles like this we’ll have to endure over the pandemic, but conservatively it will be 3-5.

I call this the COVID-19 Crazy Cycle.

These crazy cycles will unfold in the sports, entertainment, business, education, and government sectors. Start, stop, rinse, and repeat.

With each cycle, our economy, liberty, and well being will be further eroded.  With an estimated 10% immunity associated with each cycle, it will be a miserable and extremely costly journey to hit the 60-70% herd immunity mark.

Freedom Restored

Now is the time to move past the fears and fatigue associated with COVID-19, and unfold a new approach that accounts for our commuting zones. With this strategy, our country can fully emerge from it’s socio-economic slumber as it thoughtfully takes into account the uniqueness of each commuting zone within the US.

This would address the frustrations of millions of Americans who intuitively know they are in green zones, but are forced to live as though they are in red zones.

Time For A New Approach

As it stands, the current federal position of continuing to socially distance while each state interprets its own phased return to normal policies is doomed for failure.  This will especially become evident once the crazy cycles set in throughout the country.  It will lead towards mass responses from each state that will arbitrarily throw each citizen in the same red zone bucket with rigid sheltering.  Frustrations will rise even higher from those who in green zones who are forced to watch their socio-economic lives destroyed, again.

It’s now time to deploy a blended approach that allows for novel strategies while simultaneously protecting the vulnerable.

By doing this, we can avoid the inevitable crazy cycles that will result from our current state directed policy.

The first cycle has been painful enough, can you imagine 3-5 more cycles like it?

Our Socio-Economic Footprints Are The Secret To Winning The Pandemic War

Our Socio-Economic Footprints Are The Secret To Winning The Pandemic War

Moving Past Lock-down

It feels good to finally begin moving out of lock-down, while the world awaits a vaccine.

The next step is a debatable matter in the organized exit strategy for our country when it comes to COVID-19. At this point, it has primarily been left in the hands of the states.

Novel Strategy Needed

I believe the most successful strategy will require a novel approach to managing our socio-economic zones that are not defined by Federal, State, or County organization charts, especially the latter two.  The reason is that our socio-economic patterns of movement and interactions in the US are not confined to a specific county, nor are they all uniform in any given state.

 The Trump Administration strategy of leaving the post-lock-down COVID-19 management largely to the states has created chaos.  This is primarily because states are progressing through asynchronous phases of unlocking their citizens.

But the real issue is that the phased state policies reflect the worst-hit cities/areas in their state, while the rest of mildly effected socio-economic zones are required to follow the same set of rules as those hard-hit zones.

The Commuting Zone Model

French strategists have proposed a model worthy of our consideration that involves breaking socio-economic regions into either a green zone (safe) or red zone (locked down) designation. This does not follow the normative channels of social or economic profiling, but rather is a mathematical model that involves our patterns of movement.

By partitioning our nation into cells or socio-economic groupings with an average of 10,000-20,000 inhabitants, we can more accurately organize and manage the movement of people within “commuting zones”.  These zones represent our primary social and economic movements in an area. They represent our socio-economic footprint.

Green Zoning

Zones that do not record new infections despite thorough randomized testing are labeled green after seven days, After seven additional days, neighboring green zones are merged to form a larger green zone. Within these zones, interactions are again progressively allowed, albeit with some restrictions.

Red Zoning

When a new infection is detected in a cell that is part of a green zone, this zone is progressively broken into its smaller constituents, until each red cell is isolated. The inhabitants of red cells remain isolated (i.e. under strict monitoring or on a lock-down policy)

This fundamental difference between Green and Red zones within geographic regions is recognized by most citizens in the US.  They may not call it a “commuting zone” but they understand the core idea that some regions are less risky than others.

Frustrations With Statewide Mandates

Unlike antiquated governance structures, our “commuting zones” are not fully defined by State or County designations.

This structural dissidence represents the tension of the matter for most of us, including me as a physician and small business owner.

If I know my area is a green zone, it should have fewer restrictions. It’s that simple. It’s why so many small business owners are perplexed by lock-down policies that are applied to their green zone located businesses.

Many are frustrated that their micro-economy and liberties in a primarily green zone are forced to comply with the same rigid lock-down rules of the red zones.

Flaws With State Management

The tragic flaw with leaving states to manage this without any federal guidance is twofold:

  1. The citizens of each state don’t all uniformly fit into a green or red zone. Therefore the blanket approaches to unlocking them don’t allow for any zoned strategy. This will really become an issue when new outbreaks start to peak again.  The current “all or nothing” approach has massive negative social and economic effects.  This approach is crippling to the economy and isn’t necessary for a good portion of any state that is filled with numerous green zones.
  2. “Commuting zones” often straddle state and country boundaries. So these regions are governed as citizens who aren’t viewed as a zone, but instead are myopically required to follow the mandates of their geographic boundaries. The differing strategies used for each state leaves the citizens unclear about the rules required for compliance.

Need For Federal Policy

This flawed policy of state control is why a national green zone strategy is needed. Our federal government would need to vet the policy that each state, county, and city would administrate uniformly with the same sets of rules for green and red zones. 

The hardest part would be breaking down our country into “commuting zones” that are agreed upon by both parties, a seeming impossibility. Thus the White House could lead the charge in pushing this forward through its Corona Task Force.

The truth is that most of us are organized into large and dynamic networks of economic and social structures based on our activity.   This represents our movements and interactions. Our social media networks and devices are very aware of these movements. Due to the ubiquitous nature of smartphones, the giants like Facebook, Google, and Amazon all know about our socio-economic footprint, and use it for their purposes. This same data and information should be used by our government to help our exit strategy from this pandemic.

Benefits Of Green Zoning Policy

There are numerous benefits to a green zoning policy that have been summarized by  the French strategist that include:

  1. Minimize economic damage by allowing for re-opening zones with strong economic links, local micro-economies can still be allowed to thrive. This would be a major boost to small businesses.
  2. Non-invasive tracking. Both macroscopic and microscopic tracking methods can be used in tandem in Green Zones that convert to Red Zones.
  3. Minimize societal damage. Slowly restarting normal relational behaviors helps restore the well being and fiber of communities.
  4. Easily combined with other measures. The notion of a green zone is flexible, it can be adapted to fit the current possibilities of each region, e.g. availability of testing or immunity certificates, the practice of sanitary precautions, voluntary social distancing, etc.

The truth is that most of the country has experienced the disruptive socio-economic effects from our national lock-down strategy. A strategy that did save an estimated 100,000 lives or more.

But for those who reside outside of the several well-documented red zones, most of us feel a disconnect between what we see on the news each day, and we see in our community daily. For instance, in my rural Indiana region of 45,000 people, we have had <100 documented cases and only 1 death. So why am I still walking through a phased unlocking process?

It’s now time for our national leadership to work with states to deploy a novel lock-down model that will re-open our country in a more strategic manner, and allow for a more rapid socio-economic recovery.

The answer is found in carefully looking at our socio-economic footprints.

Employed Physician PC

Dr. Inc.

It’s Time For Herd Immunity To Take the Lead With COVID-19

It’s Time For Herd Immunity To Take the Lead With COVID-19

Three Defenses

There are three basic defenses that humans have against viral pathogens in the world.

  1. Herd Immunity
  2. Vaccinations/medications
  3. Social Distancing/personal protection

All three play a vital role in reducing serious illness, death, and socio-economic chaos on the planet.

When it comes to COVID-19, the vaccination/medication route is not an option yet. We just aren’t there,  but hopefully we will arrive at an effective vaccine or treatment in the next 12 months.

Two Remaining Options

This leaves two other broad categories for the management of  COVID-19. 

Social distancing/personal protection is where our country, and most of the world, has placed all of its early mitigation strategy. This was done for the dual purpose of saving the most vulnerable, as well as to steward our limited healthcare resources.  It has been modestly successful with a few outliers. 

For the vulnerable, social distancing and personal protection must continue, until we can adequately protect them with a vaccine.

Herd immunity has been perceived to be too risky.

Current State

Heading into Memorial Day, 3% of the US population has been infected, and an estimated 5%  has developed an immunity. We should pat ourselves on the back, through our mitigation efforts there were only 90,000 deaths, rather than the projected 200,000.  Laudable statistics based on good but imperfect public health policies with the pandemic.

But these percentages also reveal that herd immunity has also been stymied by our all-in social distancing strategy.  Even hard-hit NYC has only created an estimated 20% population immunity.

Time For Herd Immunity

I contend, while we await the development of effective vaccines and treatment, that this is the time to allow for herd immunity to develop among our non-vulnerable population.

I am not alone. Within Europe, Sweden is the leading voice for the controlled herd immunity strategy, and within the US Senate, Dr. Rand Paul from Kentucky is spearheading this position.

Beyond herd immunity,  I believe our aggressive social distancing is harmful to physicians and healthcare workers.  The economic harms have been well documented, but the harm to their health and herd immunity also a concern.

I worry that our critical healthcare worker population is at greater risk due to toned down immune systems from our current mitigation strategy, especially if it continues.  The normally revved up immune surveillance system for healthcare workers has been placed in a plastic bubble, so to speak.  Ultimately, I fear this will lead to more severe cytokine storms secondary to COVID-19 infection due to the shielded exposure. The longer we go with social distancing and maxed out personal protection policies, the greater this risk is to all healthcare workers.

Don’t get me wrong, I am all for using proper personal protection and universal precautions in the clinical setting. I also favor vaccines and treatments when they become available.  I think we should protect the vulnerable from the public & their healthcare team through measures like telemedicine, social distancing, and personal protection measures for those interacting with them.

But for the general population, it’s time to allow herd immunity for the non-vulnerable. The socio-economic cost of not doing this is far too high. The risks of prolonging the pandemic due to non-immunity is far too high.

Comparison to Spanish Flu Pandemic

Let’s use the Spanish Flu pandemic of 1918-1919 as a comparison to our current state where both only had two interventions at their disposal: herd immunity and social distancing.

The geopolitical dynamics of 1917-1920 led to its worldwide propagation in a tri-modal pattern, with the 2nd wave being the largest and most lethal as herd immunity set in.

This 3-year length of time and the trimodal pattern is what we are trying to avoid repeating.

But there are differences from COVID-19 and the Spanish Flu of 1918.

  1. The mitigation efforts in flattening the curve, and building barriers around the vulnerable were not even close to our current robust state. The factors that separate the two eras include our understanding of viruses, public health, as well as the speed of communication and data sharing.
  2. Having sheltered the vulnerable, we are now able to safely let herd immunity run its course among the non-vulnerable.  Aggressively protecting the vulnerable was not part of the program in the Spanish flu pandemic as the vulnerable were much more co-mingled.
  3.  Lastly COVID-19 and the Spanish Flu are both respiratory viruses, but their victims had differing profiles as well. The Spanish flu favored young people with half of the deaths involving 20-40-year-olds, and it especially seemed to ravage pregnant women and their infants.  COVID-19 favors those over 65 with co-morbidities and mostly is less harmful to pregnant patients, pediatric populations, and those under 50.

Tension In This Space

I get it, there is a real tension that exists in the space between herd immunity development and social distancing, as both strategies await the arrival of effective vaccination-treatment interventions.

Within that space, there are many unanswered questions.  It is interesting to watch as scores of nations deploy socio-economic-health policies that reflect their best guess at where to land in this space. Hopefully we’ll all learn from each other both during and after the pandemic. For example, as much as I like Sweden’s approach to herd immunity, they failed to protect their vulnerable populations like nursing homes, before deploying the policy. This led to many unnecessary deaths, which even Swedish policymakers acknowledge.

As much as Americans like to lead, I think our diversity and poorly aligned political system make us a poor leader in this space as well. Oh, we certainly have bright scientists and business people, but both Republican and Democratic ideologies prevent us from arriving at objective mutually satisfying policy positions.  With so many uncertainties, I think it’s not possible to have the exact right answer, although each party will claim that they do.

 The questions are not political, but are more germane to answering worldwide unknowns including how long it will take to reach herd immunity with COVID-19,  how long will the immunity last,  and how much disruption can each nation individually and corporately tolerate with either policy of social distancing, or herd immunity?

The Cost of Returning To Normal

Put another way, how many deaths is a nation willing to allow in exchange for a more rapid return to a normal pattern of socio-economic life?

Given that our current data demonstrates over 99% non-lethal immunity development among the non-vulnerable population, I think it’s time to let herd immunity run its course. 80% of those infected only develop mild symptoms and it is projected that herd immunity will be reached when 60% of the population has COVID-19 antibodies.

As much as I support that our aggressive mitigation process has saved lives, I can’t pretend that it hasn’t come without a net cost. Isolating humans, and sheltering them in place has dramatically inflicted social and healthcare fear into people so that now they don’t seek healthcare from TREATABLE illnesses. Whether it’s people dying from heart attacks, strokes, and pneumonia at home, or it’s the untold surge in suicide, delayed cancer diagnosis, and malnutrition-related deaths. These are un-counted deaths that are covered up by the COVID-19 numbers. Some even cleverly count these as “COVID-19 deaths” for a number of financial and politically motivated reasons.

Shelter and Herd Immunity Together

With the vulnerable now effectively sheltered, we are in a new phase. 

Death prevention is still a priority, but now the net from deaths prevented in an aggressive social distancing policy versus deaths prevented in a liberal herd immunity policy is likely getting closer to zero.

Failure to allow for herd immunity will continue to imprison the rest of the essential and non-essential US population, place our healthcare workforce at GREATER risk, and will destroy our country’s economy for years.

I conjecture the continued social distancing policy with it’s associated economic collapse will cause massive psychological-social-health related carnage.   This approach could lead to more morbidity and mortality than if we allowed for a policy of herd immunity while shielding the vulnerable.  The reality is that the 2nd spike in a herd immunity policy will be much larger in size.  But with the vulnerable shielded ahead of time, the number of deaths will be much lower by percentage.

Phased Approach to Herd Immunity

Lifting our social distancing policies to the general public, allowing for a phased return to normal, a continued protection of the vulnerable until vaccines and treatments are available, and allowing healthcare workers to develop their natural immunity (later to be boosted by vaccines) is the right next step.

I recommend herd immunity be embraced in 3 phases in the coming months.

  • Phase 1 opening public spaces, parks, beaches, restaurants, entertainment venues, all small businesses, and faith communities from Memorial Day to Labor Day

  • Phase 2 Allowing for a return of large spectator sporting venues in the summer

  • Phase 3 Opening schools and Universities in the Fall

These 3 phases, especially the 3rd phase, will quickly accelerate the development of immunity among our non-vulnerable population. Once that spike occurs in the fall, much like Sweden, we’ll be on our way to herd immunity by the end of the year.

Let’s rip the band-aid off, and prevent a prolonged sine wave-like staccato of prolonged socioeconomic disruption.

Dr. Inc.

how going to church will resolve the pandemic

how going to church will resolve the pandemic

I am a Christian and believe Jesus Christ has the power to intervene in our earthly matters whenever he chooses.

The absence of his intervention doesn’t necessarily demonstrate his support or opposition to the matter at hand, but rather it demonstrates his sovereign hand working individually with us to benevolently guide our personal experience with the matter. In essence, our Maker knows what is best for us.

The divine purposes for a pandemic like this will be debated for years, and I’ll admit I don’t really know the answer yet.  The answers will likely be both corporate and personal.

For many people of faith, global events like this are often interpreted through the prophetic writings of their faith. In my Christian tradition, for example, this pandemic and its global reactions are viewed by many as fulfilling the prophetic sequences that will unfold before the end of the world. Although it may be true, even Jesus once said “no one knows the time or the hour” of when the end will come. So I choose to not go to start something that will be pointless or a waste of time. 

For people of faith, gathering with their faith community can prove to be a very enriching process. Although our church has done online church service for weeks now, I miss interacting with my friends.  Our scriptures speak of how important “one another” is to our well-being, and online church just doesn’t allow for this.

I am thankful that most faith communities in the United States have followed the federal and state public healthcare mandates in the mitigation efforts. Along with shutting down schools, this strategy likely had some of the most positive effects in slowing down the spread of the virus. Although there are legitimate reasons for civil disobedience by faith communities, this temporary process was not one of them, in my estimation.

In our faith narratives, infectious mitigation is not a new subject.

A prohibition from individuals joining faith gatherings, due to public health concerns, is nicely documented in the sacred writings of my Judeo-Christian Old Testament scriptures in the book of Leviticus.

But now is the time to gather again, for two reasons:

  1. For faith enrichment
  2. For ending the pandemic through herd immunity.

Few things spread the virus better than unmasked people singing together in an enclosed space. Corporate singing is the ritual for thousands of churches every week in America and as we re-open our faith communities, herd immunity will begin. We have to take into account hand-shaking, hugging, praying, and sharing communion cups.

 

I am going to church and I believe this will help bring about the end of COVID-19 faster due to herd immunity.

Not only am I a Christian, but I am also a family physician.

I believe that now that we have successfully mitigated the first peak, spared thousands of deaths among the vulnerable, and successfully stewarded health care resources, we are now poised for the next phase.

In the ideal world, a combination of vaccines and effective treatments would be deployed to snuff out this pandemic.

Unfortunately, this is not on the near horizon.

The two pandemic control strategies that remain are continued social distancing/personal protection policy or a herd immunity policy. Human-to-human gatherings might need to stop, but diagnosing and treating your health is the best approach to not spreading the virus. 

I believe that a phased herd immunity policy in connection with the continued social distancing of the vulnerable is our best approach.

For the non-vulnerable, this virus has proven to be non-lethal in nearly 99% of the cases. Given the high infectivity rate of the virus, reaching the projected need for 60% of the population needed for herd immunity would seem possible by the end of the year.

Now enter faith communities, as they can and will play a critical role in helping our country reach herd immunity faster.

Ultimately opening our parks, restaurants, entertainment venues, sports venues, small businesses, and faith communities will push us deeper into herd immunity. The gasoline for the fire will be provided by the restart of schools and universities in the early fall.

Add all together this, and herd immunity will arrive sooner rather than later.

The earlier arrival may save our economy and certainly will lead us back to normal faster.

We simultaneously must protect the vulnerable with a persistent social distancing policy, then we’ll put ourselves in a position to turn the corner sooner than a persistent on-off again social distancing policy.

Right now, our non-at-risk citizens are asking questions about the true benefit of the social distancing and mitigation process for them PERSONALLY.

They also question if the risks of getting a mild infection that leads to possible lifelong immunity are better than getting a vaccine when it’s available.

There is no doubt that vulnerable patients benefit from robust protective and surveillance measures to protect them. Their inner immune surveillance is weak, so they need external assistance from these public health plans.

I believe the sequestered vulnerable benefit more from the masses getting the virus naturally all at once, with its associated immunity. One large peak with the relatively healthy, allowing them to convalesce at home, and we won’t overwhelm the health care system.

I believe this is much better than a social distancing strategy that will result in multiple peaks and valleys as the virus infects more and more of the population 5-10% at a time.

I am going to church and I believe this will help bring about the end of COVID-19 faster due to herd immunity.

It’s time to move forward in the next phase of managing the COVID-19 pandemic and our churches in America can take the lead in this process.

They can lead America into herd immunity.

It kind of makes sense to me as a person of faith.

 

Doctor Incorporated

Dr. Inc.

Ode to Walls in the New World

Ode to Walls in the New World

Walls to protect lead to imprisonment

Barriers surround us

The walls are intended to protect

6 feet please

Face mask required

Personal Protective Equipment necessity

Ventilators for survival

Tele-visits only, no contact!

Segregated medical office to shield the sick from the well

Screenings for suitability to enter healthcare

Medical visits in the car

Restricted access to public spaces

Waiting rooms no longer used for waiting

Checkpoints for hospital entry

Plexiglass separation

Restricted faith community gatherings

Take out only restaurants

Banks by appointment only

Public spaces, parks, and playgrounds closed

Non-essential business shuttered

No access to nursing homes

Paradoxes to protect the unsafe

  1. Prisoners set free
  2. Jails emptied
  3. Courts Closed

Truth, and who is trustworthy

Information control and censorship

Liberty or public safety

Business as usual, or jeopardize the vulnerable

Herd immunity dilemma

Bailouts, stimulus, politics, and elections

Globalization under scrutiny

Travel, vacation, and leisure shackled

Public transportation scrutinized

Life without barriers is a thing of the past.

Walls and self-imposed prisons are the new normal

Protection

From what?

Dr Inc

“Not In My House”                         Options for Healthcare Workers During The Pandemic

“Not In My House” Options for Healthcare Workers During The Pandemic

This post originally ran as a guest post on The Physician Philosopher May 8, 2020

Living Away from Family

I have been living away from my family for nearly 6 weeks now, in an effort to protect my wife and children from contracting COVID-19 from me. I don’t have the virus, I am not quarantined as a Person Under Investigation, and I hope to avoid contracting it like the rest of America. But as a rural family physician, I am on the front lines dealing with patients virtually every day both in the clinic and in the hospital. The risk is real and ever-present. Unfortunately, given the incubation period of this virus, I could unknowingly transmit it to my family. PPE protects me and my patients, but most of us don’t use PPE at home, and that’s the rub for all of us.

With nearly 10,000 healthcare workers in the US becoming infected with COVID-19 as of mid April, home transmission is a real ongoing concern within the physician, nursing, and healthcare professionals communities.

Concern For Family

Every day I wonder, “Am I bringing COVID-19 home to my family?”

Every day my family wonders, “Are we exposing him to COVID-19 when his guard is down?”

For most of us, home is our safe place. A location that provides us the needed reprieve from the demands of medicine and is typically filled with love, relaxation, and rest.

Now, however, home has become a place that we can’t relax, or let our guard down. Whether you have enacted a new set of entry and exit rituals aimed at reducing your biological footprint, there are land mines everywhere including the kitchen, bathrooms, digital devices, and remotes.

Housing Options to Protect Family

The following are some COVID-19 sparing housing strategies that have been organized with the safety of your family in mind. Choose what is affordable and makes sense in your home as you look at the options.

1. Within Your Own Home

This is the most common adaptation currently being used. Depending on your home configuration, one can partition off a “quarantined section” that becomes your domain for the duration of the pandemic. Some have used basements, garages, or other dividable spaces.

When it comes to social distancing from your spouse, couch surfing for sleep is the minimum separation, especially if you don’t have the luxury of a separate space. That is what my nurse does in her home.

Others have pro-actively sent their spouse and children to live with extended family in a different home. In this arrangement, the healthcare worker safely stays in his-her own home, but insures the rest of the family is safely separated.

If both spouses are healthcare professionals, this may become a rank order puzzle of who is the most “essential” to protect. Although this is not meant to undermine anyone’s egalitarian notions, it is a rather pragmatic discussion to entertain in your home. It’s especially challenging if the dual professional couple have children who need attention as well.

Frankly, some have found the idea of separation within their own home so unappealing that they take on various degrees of safe co-mingling, which they reason to be relatively safe. Those choices often include co-habitation without sleeping together, along with very limited physical contact. Others have taken a fatalistic approach – “if it happens, it happens”, choosing to take very few safety measures beyond the re-entry ritual of cleaning the vehicle, dis-robing, washing clothes immediately, and taking a shower. The latter sequence seems pretty universal at this point.

There is not set standard for doing this, and there certainly are not a lot of authorities speaking about this. It’s just a assumed each of us is doing something.

2. Your Other Property(s)

Many physicians own rental properties. If you have a vacant unit, consider moving yourself into this. This is a wonderful option that may even give you some added insight into the condition and atmosphere of your real estate holding. I would also add that this is free, and as most physician’s income is going down during this season, free is good.

I am fortunate that we own a guest house right across the street from our primary dwelling. It is used for family and friends who visit from out of town and will ultimately morph into a granny house. But for now it can serve as my new COVID-19 headquarters. Safely and comfortably away from my family, yet they are close enough to see every day.

Obviously, not everyone has a guest house, but some of you may have dwelling options in your portfolio.

3. Borrow From Family or Friends

In the Midwest and Northern part of the country there a large number of “snow birds” who go to warmer climates for the winter, leaving their dwelling vacant. Many of those same people are planning to wait out the pandemic by sheltering in place in their winter home. This is a perfect option for you, if it is near by. Most of the time it can be used for free, but it would be polite to at least offer to pay for the utilities, or more.

It’s surprising how many homes and condos sit empty all winter and spring.
When you think about it for a moment, you might easily come up with some names of people who would be delighted to feel like they are “helping the cause” by supporting you in this manner.

4. Hospital Call Room-Overnight Space

Yes, I have heard of some who are using those tight spaces in the hospital to hunker down especially if they dealing with high risk patients in their units. This practice does seem to reduce the risk of bringing it home. The arrangement can work, especially if you follow some sort of block schedule like 3 days on and 4 off, or the more common 1 week on and 1 week off cycles. Admittedly this may not be very restful, but it can be an option for some. Make sure you let your hospital administrator know what you are doing if you take this route, as hospitals are often very short on space during the surges.

5. RV-Trailer-Camper

A temporary and portable dwelling can be a great option, and many healthcare workers own portable living spaces such as an RV or camper. So, think outside of the box a bit, and do some backyard camping!

I love how “RV’s 4 MD’s” has organically sprung up within the RV-Trailer community in coordination with the medical community. This Facebook group works to coordinate doctors and Trailer-RV owners to work together to fight COVID-19. Whether the unit is parked at your house or the local trailer-RV park, it is a wonderful space to borrow-rent. The Facebook site has coordinators in each state, so reach out to them to check out this opportunity.

6. Free Hotel Space

Many hotel brands have stepped up in hot spot cities around the country to offer housing for healthcare workers. The Marriott and Hilton brands are examples of this. Contact them for housing if you are in one of the hot spot cities, or you are planning to travel to one of these cities as part of a medical relief team.

Hospitality for Hope is organized by the American Hotel & Lodging Association. They have partnered with over 6,500 properties to connect healthcare workers and first responders to temporary housing. You can fill out a form to be connected with a room, but the process does take 2-3 days. 

Local hospitality businesses should be checked out as well. With the travels bans, their business is likely down, and they would be more than happy to help the local community by offering free or reduced priced units to local healthcare workers.

7. Airbnb

This hospitality giant has also launched a new program to reduce fees associated with using their inventory.  Airbnb hosts are offering healthcare staff and first responders places to stay that allow them to be close to their patients — and safely distanced from their own families. Their goal is to help 100,000 workers who are engaged in the battle. Make sure you let the host know you are a healthcare worker fighting COVID-19 and they may even reduce their price a bit more. Check out the link to Airbnb

8. Dormitories

Some universities and colleges who are near hot spots have opened their dormitories (which are currently empty) for first responders and healthcare workers to find refuge. Harvard University is a good example of this. So give your nearby educational institution a call, and find out if they have a similar program.

The COVID-19 pandemic has forced many of us to view our family through the protective key-hole of their safety. We have now become our own unofficial Person Under Investigation, and it is forcing us to contemplate where we live, and how that affects our families. It should. I hope these handful of options provide you with ideas to ponder.

Dr. Inc.