by | April 9, 2020 · 9:20 pm

Resident Perspective: Ready or not, time for telehealth

This is the continuation of a series of journal entries depicting what it’s like to be a part of the COVID pandemic from the medicine resident perspective.

Wednesday, April 1st

Medicine residents work in the hospital as well as the outpatient office. Cleared to go back to work, I’m scheduled to see some of my patients in the office. In an effort to limit the exposure to coronavirus for both the patients and the office staff, as many appointments as possible have been converted into telemedicine visits. These are essentially video-chat appointments using a HIPAA-compliant app where I can talk to a patient, ask about their symptoms and have them show me any relevant physical exam information, like using the camera on their phone to show me the back of their throat. I complete the online training modules that all providers have to pass and I think I’m as ready as I’ll ever be.

Something is off as I arrive at my clinic prior to my shift. First, it’s nearly empty, no front desk employees are there to wave to, and there are new standing hand sanitizer dispensers everywhere. Magazines from February populate the waiting room tables which may not be alarming for most businesses, but for my clinic, not having new editions of Philadelphia Magazine on display is shocking and noteworthy. No patients in the waiting room and doors to individual offices are closed, preventing natural light from gaining entry to the normally well-trafficked hallways. This place definitely feels more bunker-like than I remember. The few staff and attendings that are present are all wearing scrubs and face masks. Recognizable but unfamiliar, the pandemic has now officially warped and invaded every facet of my life and there is no sanctuary for normalcy.

Previously, only a small portion of physicians were utilizing telehealth visits. Fewer than 1% of Medicare beneficiaries used it prior to the pandemic.  Presumably because there is a learning curve on both the provider and the patient’s end, you have the opportunity to be more thorough during an in-person visit, and the big one: it wasn’t fully reimbursed by Medicare. Recently, under the Stafford Act and National Emergencies Act, Centers for Medicare & Medicaid Services (CMS) announced its beneficiaries will now be able to use telehealth to access their PCP for non-routine visits. Important to note, this is only temporary, as once the crisis is over (whatever that means), CMS will go back to its prior payment structure. Notably, other providers like social workers, psychologists, dieticians, etc. that are also integral to a person’s overall well-being will be covered.

Many of my appointments for the day involved patients interested in COVID testing. There’s an algorithm providers are to follow to determine who should be tested given the scarcity of tests. Mainly if the patient has symptoms, has other elevated risk factors such as coming into contact with a known COVID positive person, or recent travel to a coronavirus “hot spot”, they should be tested. This doesn’t cover a lot of other vulnerable people or others who should be tested, but the algorithm is designed to only catch the most likely positive cases at this point. The rapidity with things like which screening tests are performed and whom to test are just part of the equation in this constantly developing situation. Someone who is not eligible for testing one week, very well may be eligible the next.

I’d never performed a telehealth visit but the obvious problems that come to mind, like poor internet connection and not being able to get a gestalt on a patient that you can by an in-person exam, were apparent. In my first session I immediately encountered an  issue with a patient which our staff couldn’t get in touch with to see if they could convert their in-person appointment to telehealth. The patient’s partner had lost their job and couldn’t pay their cell phone bill so they were splitting the phone and the voicemail-box was full. The current economic crisis will of course exacerbate issues like this. Additionally, most commercial insurance as well as CMS will pay for audio/video calls but not necessarily only an audio (traditional telephone) call. My next patient actually was having difficulty accessing the proprietary HIPAA-compliant app on his phone, necessitating a phone call appointment which ultimately won’t be billable. Other appointments went smoothly and were unremarkable but already it’s clear there will be growing pains in moving patients to telehealth.

I’m a big believer in the future of telemedicine for many reasons but primarily because it provides a lower threshold for patients to access their providers, and this will be beneficial to delivering healthcare. These next few months will be telling if we can make it work nationally from a logistical standpoint. I’m not as convinced from a reimbursement standpoint as I’m sure there will be many kinks to work out. If my first foray into telehealth has shown me anything it’s that for my patients telehealth is a generally welcome idea in theory– many of whom did not grow up with cell phone technology– but in practice it’s a different story. Since the beginning of the quarantine, there’s been a surge in popularity of video and teleconferencing software connecting co-workers and friends alike. This current crisis will hasten the public’s comfort with interacting over the internet.  We’ll see how long it will take to successfully adopt and integrate into daily medical practice but the test has arrived regardless of whether insurance, the public, or providers are prepared.

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by | April 6, 2020 · 9:22 pm

Resident Perspective: waiting for test results

This is the continuation of a series of journal entries depicting what it’s like to be a part of the COVID pandemic from the medicine resident perspective.

Sunday, March 29th

Although I’m a resident and I’m able to access my own medical chart through the electronic medical record, I’m not allowed, per hospital policy. I’m relegated to waiting for my results once “released” to me. While waiting for results in self-isolation, at a certain point you don’t really care whether it’s positive or negative, you just want to know something. Unfortunately, we still don’t know if being coronavirus positive prevents you from getting infected again so I’m not at the point where I would prefer to be positive just to get it over with.

Finally, five days after having the back of my throat swabbed I get an email saying my results are back: SARS CoV-2—undetected. Whew, negative. I was able to isolate for 5 days while my wife worked and took care of our baby simultaneously. Many other households aren’t that fortunate and either the other parent would have to take unpaid time off from their job (if they are able) or the person in quarantine would have to watch the kids and therefore expose the entire family to coronavirus. This is problematic for many obvious reasons.

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A picture of me and Jack at the tail-end of my quarantine. I still smiled under the mask for some reason.

The responsiveness from the government to obtaining and manufacturing tests was bungled from the very beginning. Quick turnaround time for testing is beneficial for giving patients a diagnosis promptly and is beneficial for epidemiologic prediction models that guide how much a region will be impacted and which locations that will be hit hardest next.

There are two main testing locations. In-patient testing for those that are hospitalized, where the test is performed in the hospital’s own microbiology labs (“in-house”) which have continuously improving turnaround times. Once the tests became available to hospital labs across the country, waiting times went from 48 hours down to about 4 or 5 hours (and in some hospitals turnaround is under an hour). The other main testing sites are commercial labs (LabCorp, Quest Diagnostic, etc.), where your test would be performed if your outpatient doc sent in a referral or if you went to a screening center. Unfortunately wait times are getting much longer as the public demand goes up for testing, and along with it, any part of the supply chain that is lacking—from swabs to reagents to protective gear for the providers—will back up everything.

The answer to better prediction models and better care isn’t just faster turnaround time for tests. The media has really honed in on getting quick results as a major issue in the epidemic because the news can show a long queue waiting to be swabbed or interview people frustrated by the lack of knowing their status. Arguably just as important is the accuracy of these tests. Swabs of the nose and throat are analyzed by something called polymerase chain reaction (PCR), which is designed to multiply the virus genetic material—RNA in the case of coronavirus—and detect the presence of the virus itself. A couple of problems arise from PCR as there have been reports of high rates of false negatives—meaning getting an inaccurate “undetected” reading when in fact, one is coronavirus positive. This is called low sensitivity in a test.

Because PCR looks for the virus itself from the swab, there have been studies in which essentially, if you go lower down the trachea (“wind pipe”) and obtain a sample closer to the lungs there are higher concentrations of virus located there so you will get a better sample and potentially provide more RNA material to amplify and detect with PCR. The issue with going down the trachea, in addition to being very unpleasant, can cause more of the virus to be coughed up during the procedure potentially infecting more people. So it seems not only possible, but likely that the swab going to the back of the throat either by way of mouth or nose just doesn’t pick up enough virus to be amenable to detection in many instances.

A blood test was recently approved by the FDA under Emergency Use Authorization which will test for antibodies (our own immune system response to the virus). These tests are already in use in China and other countries and can return results in under an hour. The benefit is that these tests aren’t dependent on obtaining an adequate swab and they could potentially tell us if someone’s been exposed in the past. It will also lead to more data regarding immunity to future infections with SARS CoV-2. The downside is that the test may not be accurate either and potentially detect non-COVID-causing coronavirus like CoV-1. There also arises questions like: is it better to know with 80% accuracy with one method vs 70% accuracy with another but it takes half the time to get the results back? There are no clear-cut answers because there are pros and cons to both.

The good news amongst all of this is that there is high “specificity” with these tests, meaning that if you get a positive result then you almost certainly have COVID, however comforting that may be. Keep in mind, for the time being these only apply to people that are having symptoms. I haven’t even touched upon the messed up screening guidelines and how they’ve morphed over the past few weeks. All of this is really to say we don’t know how many people are SARS CoV-2 positive currently for lots of reasons, and looking at the current positive cases on the news only tells part of the story.

At our institution there have been patients that we’ve been so sure are COVID positive that we’ve performed multiple PCR tests yet have all returned negative. Unfortunately, the answer to those that are so sure they are positive with coronavirus but have received negative testing is to assume the test is wrong. Given the rapidity with which this is all developing there just isn’t enough data regarding how accurate these tests are and how they should be employed.

I finally received a call from occupational health telling me the test results and to go back to work. Typically I’d be starting on outpatient weeks at this time, meaning I would be seeing patients in the office and go to morning and afternoon conferences with other residents. The pandemic has disfigured outpatient life for a resident, so now I start with telemedicine appointments and we’re given strict instructions to stay away from the hospital until it is our turn again—I’ll gladly oblige.

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by | April 5, 2020 · 5:12 pm

Resident Perspective: Who is “Essential”?

This is the continuation of a series of journal entries depicting what it’s like to be a part of the COVID pandemic from the medicine resident perspective.

Friday, March 27th

I’m not having any symptoms at all at this point, really itching to get back to work. All residents have been instructed to check their temperatures before and after every shift since last week, in the hopes of catching any early signs of infection. We were not supplied any thermometers by the program, local drug stores are all sold out, and checking online the cheapest thermometers that will arrive in fewer than 4 days are all over $50. Luckily, I have my son’s infant forehead thermometer but I’m pretty sure doesn’t really work—I use it anyway and consistently have a temperature below 95 degrees, whatever that’s worth. I hadn’t felt feverish so I continued to go in to work at the hospital.

I’ve been reading a lot of self-congratulatory posts on social media from those in healthcare, selfies with a mask on, a team posing for a picture in all their protective gear, etc. For the most part it’s pretty benign but important stuff—reminding people to wash hands and stay home. The other intention is to self-promote and remind others they’re putting themselves at risk for the greater good. A troubling type of post I’ve been seeing is from providers (often not directly taking care of any COVID patients) excited and proud at the prospect for the medical community to come together to defeat this invisible foe. Maybe these sentiments are posted because morale is low and physician burnout is even higher than typical at this time? Bully for those that go into the fight ready, willing, and able. This mentality seems to say that as healthcare providers we should all rush to the frontlines as it’s a commendable action. I suspect many people not working in healthcare may not realize that residents are not really given a choice whether to participate or engage with high-risk coronavirus patients.

Residents are at an even higher risk of burning out at this time because all “non-essential” employees are not permitted in the hospital and they are limiting the number of employees for the essential roles as a way to decrease overall exposure. Medical students typically make discharge appointments, obtain outside hospital records, and other vital tasks—but medical students are no longer permitted in the hospitals because in many ways they’re paying for the privilege of being there. That topic in and of itself could be another blog post.  Gone or restricted hours also apply to many case managers, social workers, patient transporters, nutritionists, physical therapists, drug or alcohol rehab representatives, etc. The burden of caring for patients and providing a safe discharge now falls more squarely on the remaining, smaller medical teams, which includes residents (and more specifically the interns—first year residents). This is time-consuming and no doubt will hasten burnout. In our program we’ve been fortunate enough to be able to take certain measures to mitigate this, like shorter duration spent on COVID teams for residents, but we may not have that luxury in the coming weeks.

Is this what we signed up for as trainees? My institution for now has been remarkable in being able to accommodate residents that are particularly vulnerable or have vulnerable household members; others may not be so lucky. Hospital administrations have to make the decision as to who to put in harm’s way. It’s not always cut-and-dry—should we protect older attendings or younger trainees? Is the duty to provide the best care for these current patients or to minimize exposure of budding physicians who will be practicing for decades to come? We have no idea if there are any long-term repercussions to the lungs or any other organ systems in people with asymptomatic coronavirus, and they may confer a higher rate of complications not seen for years or decades—we just don’t know. The vast majority of residents and clinicians in Internal Medicine are very hesitant to jump right in, and understandably so. Initially no med students, interns, or residents were to take care of COVID patients. As the epidemic grew into a pandemic more and more hands needed to be on deck. But still, the decision regarding which specialties will be taking care of these patients is growing. The public may not realize it either, but some residents and even attendings from subspecialties that don’t have much clinical patient exposure (e.g. Radiology) may have to dust off their stethoscope and start taking care of loved ones in your hospital.

Similarly to reports about physicians having to decide which patients get a ventilator, we are also making the decision as to which providers get greater amounts of exposure, which is a morbid endeavor. In Philadelphia, we’re fortunate enough that we haven’t had the same patient burden as New York so it hasn’t been all-hands-on-deck, but we may have to start asking which residents can handle more exposure than others, sooner rather than later.  Does taking care of an elderly family member, or a child at home come into consideration? What about providers with immune system issues? Where does my duty to provide for my patients trump my duty to keep my family’s risk of exposure at a minimum? Is it moral to ask a young, healthy, single resident to have repeated exposure or is it better to spread it out over several residents but lessen their daily exposure?

Although I personally hope to continue to be at or near the front lines, I understand those that are in a compromised position, and they shouldn’t feel bad for wanting to protect themselves or their family. There is no portion of the Hippocratic oath that implicitly or explicitly states that physicians have a duty to patients above their own safety. This is a nuanced situation that doesn’t have a blueprint in place. There are many features that as a society we’re having to figure out in real-time, which is just adding to our collective anxiety.

Healthcare workers are put in an awkward situation in these times. We need to be discussing this openly, with transparency about the treatment of healthcare workers, especially nurses and residents. How to improve the healthcare system is an important topic that hopefully will not be able to be ignored after we pass the emergency of the pandemic. It will not be easy to address this because the goals of the industry are not aligned with the goals of the public or those providing care. Even though we’re in the midst of the pandemic it’s a beneficial practice to reflect and think about the way we can improve the safety and efficacy of those delivering care.

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by | April 4, 2020 · 9:26 am

Resident Perspective: It Begins

This is the continuation of a series of journal entries depicting what it’s like to be a part of the COVID pandemic from the medicine resident perspective.

Wednesday, March 25th

Today was my first day of quarantine and now I feel like I’m a part of society. In the prior weeks, working on the general hospital floor I was constrained by daily ritual –nothing said on the news or by the government about isolating or “staying home” applied to healthcare workers, or residents, more specifically. Those working in hospitals are in the thick of it, but we have a completely different experience because we have to continue to go to work and do our jobs while everyone else has just had drastic changes dictated for their daily lives. I was working long hours every day so I didn’t observe any special social distancing; my daily routine recently had been to come home and only have about an hour before turning in for the night so I wasn’t doing much socializing. Now home and quarantined, I found out quickly how fast things could change as I spend most of the day sequestered in our bedroom away from my family and where they typically are during the day.

My wife’s mother watches our son but we’ve collectively decided that while I might feel fine, because of my high risk exposures it would just be best for her to not come until things cool off. We’re lucky that we have the opportunity to actually have this option as many families in our situation would either have to choose exposing a loved one to potential coronavirus or have the parent take time from work to watch their kid. I fully appreciate we’re privileged enough to even have that possibility.

I look out my closed bedroom window and think it’s a shame that the weather’s so nice as I’m sure everyone is itching to be outside. Spring is in full swing even on our street, as the trees are approaching full bloom, and I’m pretty sure a bird’s nest is being built in our gutter as I hear constant chirping with rustling of leaves and tin behind the upper corner of my bedroom. I can hear neighborhood kids outside playing. I look down and see groups of 4 or 5 parents awkwardly try to stay 6 feet apart on our narrow street. I’d like to kindly remind them to keep their distance, but like Jimmy Stewart in Rear Window, I just gaze at them from the safety of my newly shuttered life.

Hearing the kids play, I wondered, what are they thinking is going on? How much have their parents told them? I don’t know what age you go from being elated you’re off from school to being worried about whether or not you and your family will survive. Do they think this is a normal occurrence and something they’ll have to deal with frequently in their lives? This must have a major impact in many different ways on kids of varying ages. I remember getting talks at school about fire safety and going home every night and practicing an escape plan with my family because I was so terrified. I don’t know what 8 year old me would be feeling about the invisible yet much more real confrontation with a virus. I couldn’t imagine having a 2 or 3-year-old that doesn’t understand that they can’t go outside to play with friends and then have to keep them entertained throughout the day. Then do it again the following day indefinitely.

I’m now realizing there will be so many unforeseen consequences, namely impacting those on the lower socioeconomic scale. When you work in healthcare during a crisis all you care about is how it impacts you and your patients. When suddenly removed, I’m forced to take a step back and come to grips with how this affects literally everything and everyone else in society. Maybe it’s because I now have my own child to look out for, but children have been on the forefront of my thoughts related to the pandemic. They may not be medically the most vulnerable in this case but they are in terms of long-lasting impact. Every facet of their lives are being disrupted—psychologically, educationally, nutritionally, and overall developmentally. Many families rely on food provided for kids at school. Expansion of SNAP benefits under Families First Coronavirus Response Act, which recently passed, may lead to unhealthier food choices for children as well, as this isn’t regulated like nutrition guidelines for school lunches. I’d also have to assume that kids aren’t getting the same quality of education if it’s all strictly remote, let alone the meaningful and necessary bonding that takes place at school. No doubt there will be a wealth of data to supply research to tell us what we intuitively know, which is when society stops functioning as usual the most vulnerable among us are impacted the greatest.

This time away from the hospital is allowing me to reflect on the many facets of life that are touched by this pandemic, so I’ll treat it like sabbatical.

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by | April 2, 2020 · 10:47 am

Resident Perspective, cont’d

This is the continuation of a series of journal entries depicting what it’s like to be a part of the COVID pandemic from the medicine resident perspective.

Tue March 24th 2020

I couldn’t sleep. I knew I would have to get tested in the morning.

 

I called our occupational health hotline when it opened up and I was instructed to go to the “walk-thru” testing facility that was set up outside in a parking lot adjacent to the hospital. All the staff there were wearing full body suits accompanied by masks, face shields, and bouffants. There were traffic cones strewn about seemingly directing the patients to different locations, various designated lanes for people to register, and about 3 dozen empty folding chairs spaced out to preserve social distancing. There was an ominous large Winnebago covered in sheet metal for some reason, and tents with presumably more staff inside them. Also, there were police officers, about 4 or 5 huddled together but they weren’t directing traffic and I couldn’t surmise what role they could possibly play in all this. Cars making their way along pothole-riddled Sansom street would now slow down to gawk at the impressive sterile facility not only for the sole intention of protecting the integrity of their tires and suspension. As a patient now, I was sitting in one of the empty 36 folding chairs while I waited for my name to be called. Outnumbered about 15 to one by occupational health employees, I could imagine the public believing this was overkill.

 

I was told I won’t find out the results for three to five days, but there was a rumor about occupational health potentially getting a 24 hour test up and running the following day. I didn’t want to risk being in the same boat again tomorrow so I took the swab today. My name was called, I went to the proper lane then was summoned into one of the tents where the very back of my throat was thoroughly wiped with an elongated Q-tip. Per hospital policy, I was now on mandatory leave to be on quarantine in my home until the results returned.

 

I called my wife and updated her. I would stay in the bedroom by myself for the next several days, leaving only for bathroom breaks, grab food from the kitchen, and to sanitize anything I touched. If I were to leave the room I had a facemask ready. I didn’t come close to my 7-month-old son, which was probably the hardest part of all this. On my way home I thought about how it felt like the virus had been preoccupying everyone for months but in reality it was only a couple weeks. I was exhausted by it already but this was only the beginning.

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by | April 1, 2020 · 7:58 am

Resident Perspective

I was encouraged by my wife to keep a journal for thoughts and feelings surrounding the developing coronavirus pandemic because I may be able to offer a unique perspective as a resident in medicine who is also a new parent and attempting to overcome fear of the unknown and what’s to come. I will try to update as frequently as I am able.

Monday March 23rd 2020

I found out that the Attending Physician I had been working with all last week and who was coughing during rounds was getting tested for coronavirus last night in the emergency department. I can convince myself I’m having symptoms of fatigue, sore throat and maybe a headache but I’ve also been working in the hospital for almost four weeks straight and this could just be general exhaustion mixed with a touch of seasonal allergies. I try not to think about it too much.

I haven’t been wearing any masks or other personal protective equipment around the hospital yet. At this point I feel like we are still in the nascent stages of the impending unknown so wearing a mask right now seems premature. The practice isn’t mandatory but I see more and more random staff in the hallways with facemasks on, many of whom aren’t clinicians which is a greater indication that I should probably get on board. Every now and then I’ll check a supply closet or outside a patient’s room to see what the surgical mask inventory is like. There are constant rumors floating around that, like the N95 facemasks, other equipment will be locked up and parsed out by a charge nurse on an “as needed basis”. If a run-on-the-banks situation were to occur, I want to make sure I hit the sweet spot where I don’t contribute too much to the hysteria but ensure I’ve got a mask without having to fight for scraps. I’ll continue to assess the situation.

Meanwhile, I observe more PAPRs (Powered Air-Purifying Respirator—special protective equipment) next to rooms on the wards, awaiting their donning by newly trained hands. They’ll be used for all COVID patients but since there aren’t any confirmed as of yet in our hospital, the purpose is to be used by all COVID “rule-outs” for now–those that are being tested and don’t have results back. We have a three to five day turnaround for test results right now, meaning we simply don’t know if the virus is already in our presence. The increasing numbers of PAPRs seen daily act as a surrogate for the proximity of the disease to Philadelphia and as a gauge for the level of concern amongst residents.

Over the last several days quite literally every discussion between residents in the hospital is about the coronavirus. Either discussing potential treatments; rumors as to what’s going on in China, Italy, or New York; sending memes or chatting about our trepidation and general anxiety that has gripped the entire hospital. Even when seeing my patients, every TV seems to be tuned into the news, all of which are giving up-to-the-minute global figures alternating between death tolls and economic indices. Patients ask questions for which I don’t have answers. No families or visitors are allowed in the premises. No students or “non-essential personnel” permitted to the hospital. Residents are instructed to follow social distancing protocols and there are to be no gatherings of more than five.

I went to a stroke alert today at a patient’s room for a patient that I wasn’t directly taking care of, I just happened to be nearby. The patient was in a designated “rule-out” room meaning all personnel involved need to treat the patient with extreme caution, and to limit those in contact with the patient to only those “essential.” Two nurses and a tech were in the cramped room already while the neurology resident was outside the room, not wanting to unnecessarily expose herself, miming the actions for a neurologic exam to one of the nurses. She gave instructions through the patient’s door window and into a speakerphone in a patient’s room a mere 4 or 5 feet away. The nurse and the tech cautiously proceeded to ask the patient to perform the maneuvers coached by the neurologist. It was an odd scene as clearly the patient could hear the instructions from the hallway through the door as well as the speakerphone but was polite enough to not mention that to the nurse directly in front of him. The nurse dutifully relayed the commands, “can you follow my finger with your eyes and keep your head still?” and the patient dutifully followed them. It would be funny if it weren’t so bizarre. Turns out he wasn’t having a stroke but it was good to have the opportunity to work out kinks regarding the protocol for patient emergencies. Residents are instructed to make note of instances in which normal protocols can’t be followed given the extra necessary precautions we now have to take. No doubt there will be plenty.

The hospital is both quiet but buzzing lately. Most of the services only have a few patients on each team and I walk down the wards and can find four-five-six! rooms in a row without any occupants. I’ve never seen more than two consecutive empty beds during my years here. The hospital policy is to discharge as many patients as possible with the impending influx of COVID cases to come. No elective surgeries and if you don’t absolutely need to be hospitalized you’d be safer at home. The atmosphere was akin to the episode of Game of Thrones just prior to the final battle in the last season. Nervous and anxious, we have no overflowing wine to keep us preoccupied and stumbling about. The morale is low and the silence in the hallways and in the former resident-gathering areas from our lounge to the cafeteria forces it to reverberate. Philadelphia has the temporary advantage of being able to watch from the shore as the tidal wave from China picks up steam as it makes its way across Europe, to New York City and crashing down I-95.

That night at home I continued to mentally scan my body for any possible symptoms. I hardly ever get sick so I don’t know if I’m short of breath at the top of the stairs because I’m out of shape or because I have a deadly infection. Best to push it to the back of my mind as there’s nothing I can do about it at this moment.

Bedtime routine completed. I get a text message at 10:00pm from a co-worker saying that the Attending I had been working with came back positive for coronavirus.

Image from Getty Images.

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by | March 31, 2020 · 12:01 am

Governor Wolf and the Courts Must Act Now to Mitigate Public Health Threat

On Monday morning, the ACLU of Pennsylvania filed an emergency request to the state Supreme Court to order county courts to release vulnerable populations from city jails. Philadelphia activists amplified the call to action through an organized social distancing caravan targeted at key decisionmakers. These actions follow the first confirmed cases of COVID-19 in Philadelphia prisons and jails, which were reported last Friday.

For weeks, the ACLU, local activists, community organizations, the Defender Association of Philadelphia, and the Philadelphia District Attorney’s office have been urging the release of vulnerable populations from conditions where social distancing is impossible. The First Judicial District (FJD) courts and Governor Wolf, however, still refuse to step up to inhibit the rapid and fatal spread of COVID-19. Two weeks into the alarm being raised on coronavirus in Philadelphia, the FJD has released minimal numbers of immunocompromised and elderly individuals, far fewer than the hundreds or thousands that have been released in other jurisdictions across the country and world. The courts have also rejected emergency release petitions based on public health concerns for those detained on probation or parole violations, barring many youth and adults who pose no threat to society from returning safely home.

Despite a foreboding history of communicable disease outbreaks inside detention centers, Governor Wolf has also declined to proactively save lives by closing inhumane facilities and exercising his gubernatorial powers of compassionate release. People awaiting immigration cases in York County Prison are on hunger strike to protest insufficient measures for their safety. The Berks County Immigration Detention Facility in Leesport, PA, one of the nation’s three immigration detention centers for families seeking asylum, lost its state license to operate in 2016 due to dangerous conditions and ongoing human rights abuses of residents, including infants. Yet Governor Wolf’s administration reiterated last week that they would not issue an emergency removal order unless there is a serious threat to public health inside the walls, an irony not lost on advocates and immigrant families currently fearing for their lives at the prospect of COVID-19 entering the unsanitary facility.

Jails and prisons as institutions pose a greater public safety risk than any individual they cage. This was true before the pandemic began and is an even more urgent truth as the virus enters jails, prisons, and detention centers. These overcrowded facilities lack access to soap, sinks, paper towels, and hand sanitizer and put both those who are incarcerated and those who enter these facilities for their work at risk, as recently seen on a large scale in New York City’s infamous Rikers Island Jail. The FJD and Governor Wolf could immediately reduce overcrowding and mitigate this risk without any threat to public safety. Governor Wolf could enact massive compassionate release with just the stroke of a pen, which would free any elderly or immunocompromised person at increased risk for contracting and dying from the disease. He could also order the release of community members detained by Immigration and Customs Enforcement (ICE) who are held for no crime other than lacking documentation while they otherwise contribute robustly to our communities. The FJD could supplement these efforts by releasing all those charged on low-level offenses from county jails and discontinuing arbitrary bail amounts. There’s no good justification for wealth-based detention in general and it is particularly indefensible during a pandemic. The courts and the governor also have the power to extend compassionate release to individuals who are up for parole review, individuals within six months of their release date, pregnant individuals, and youth in county and state detention facilities – many of whom are medically vulnerable and in conditions violating the federal ban on solitary confinement of youth because of facilities’ attempts to follow social distancing.

Community members are anxious to welcome children, parents, siblings, aunts, uncles, grandchildren, grandparents, partners, and friends home, people they have often traveled thousands of miles and spent thousands of dollars in travel expenses and private prison phone company bills to stay connected to during the months, years, or decades of their incarceration. Precautionary measures for COVID-19 now forbid most visits to jails and prisons. Most facilities have not replaced those visits with video conferencing alternatives or lowered costs per phone call minutes to talk with lawyers and families. This strains already obstacle-ridden bonds between those behind barbed wire and those in the outside world. If and when our loved ones are connected to the basic resources and support systems they need to survive, they are less likely to commit crime and more likely to contribute positively to society when they come home, as so many returning citizens do. In the midst of this deadly pandemic, allowing them to sustain those bonds through early release also grants them access to health-sustaining resources and the ability to social distance, preventative measures mandated by the governor himself to ward off and slow the spread of the novel coronavirus.

Governor Wolf and the FJD must take immediate action before they risk condoning hundreds if not thousands of preventable deaths in the state. Government inaction on continued overcrowding of carceral facilities has already resulted in chaos and deaths in places such as Italy and Colombia. Our city and state have an opportunity to instead follow the example of neighboring states, to embrace humanity and public health common sense in mitigating the disastrous effects mass incarceration will lend to COVID-19’s rapid spread.

Hannah

About the Author: Hannah Prativa Spielberg is currently pursuing a Master of Social Work at the University of Pennsylvania. She worked for four years as a social service advocate for the Defender Association of Philadelphia. Hannah is inspired by the leadership and love-based activism of community members and friends who have experienced life from the inside of prisons, jails, and detention facilities, who moved her to write this piece.

Hannah recommends following @YASP2, @aclupa, @powerinterfaith, @DecarceratePA, @Closethecreek, @Phillybailout, @phillybailfund, @mediamobilizing, @BBworkers, @BLMPhilly, @LILACPhilly, @JustLeadersUSA, @AmistadLaw, and/or @reclaimphila for updates and ways to get involved in the fight.

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by | March 18, 2020 · 4:12 am

It’s Not Over

Even before the results in Florida, Arizona, and Illinois started rolling in on Tuesday night, pundits renewed their calls for Bernie Sanders to drop out of the Democratic primary. “It’s over,” the official Slate account tweeted after it became clear that Joe Biden won big victories in Florida and Illinois.

Pundits and Democratic Party operatives typically cite the need to “unite” or focus on “beating Trump” as the reason Sanders should drop out. But these reasons don’t make sense. Sanders has consistently said that beating Trump is his top priority and that he will campaign vigorously for Biden if Biden ends up being the nominee. The two major Democratic candidates are already united and focused in their desire to beat Trump.

The real reason the political and media Establishment want Sanders to drop out is that it’s not actually over. If Biden had this election all wrapped up and thought it was time to “unite,” wouldn’t he be asking his Super PACs to stop mailing anti-Sanders hit pieces to Latino voters? And is it really plausible that Democrats expect Biden to weather an onslaught of advertisements and lies from the Republican Party during the general election but don’t think he can handle relatively mild, accurate critiques of his record from a guy who repeatedly calls him a “decent guy” and “good friend?”

We’re currently in the midst of a worldwide pandemic that has uprooted American life. It highlights the need for the type of fundamental change to American policy that Bernie Sanders has spent his life fighting for, and that large majorities of Democratic voters now support. Joe Biden is also a deeply flawed candidate who is often incoherent and lies all the time. He has spent his career enacting racist, sexist, and classist policy in line with what both Republicans and his donors want. Biden is not quite as bad as Trump, as his campaign likes to remind us, but that’s hardly a compelling reason to vote for him. The more the Democratic electorate sees Biden and Sanders side by side and learns about Biden’s record, Establishment Democrats fear, the less likely they’ll continue to harbor the misconception that Biden is well-equipped to take Trump on and to deal with major crises.

That’s not to say that things look good for Sanders; they most certainly do not. After losing Florida, Arizona, and Illinois, Sanders now trails Biden by approximately 300 delegates. He would need to win in the neighborhood of 60% of the remaining delegates to have a legitimate claim to be the Democratic nominee. Given that he’s currently polling around 35% nationally, amassing 60% of the remaining delegates looks like a very tall order indeed.

At the same time, many millions of people in 23 states, 3 territories, and the District of Columbia still haven’t voted. A whopping 42% of delegates – or 5.5 times the amount by which Biden leads – have yet to be awarded. The next set of primaries isn’t scheduled until April 4, 17 days from now. It’s hard to believe, but 17 days ago, forecasters still gave Sanders and Biden about equal chances of winning the nomination.

In other words, we’re about five minutes into the third quarter of a football game, four games deep in a seven-game series, or halfway through July in a typical Major League Baseball season. Sanders is trailing and Biden is sitting pretty. Yet there’s a reason you play out the game, series, or season. The New England Patriots wouldn’t have won the 2017 Super Bowl if they had stopped playing when Tevin Coleman put the Atlanta Falcons up 28-3 over 6 minutes after the start of the second half. The Cleveland Cavaliers wouldn’t have won the NBA Finals in 2016 if they had thrown in the towel when falling behind Steph Curry and the Golden State Warriors 3 games to 1. And the Atlanta Braves wouldn’t have won the NL West in 1993 if they had packed it in when they trailed the San Francisco Giants by 9.5 games on August 7.

The probability that Sanders will win is low and nobody should delude themselves into thinking otherwise. Still, it’s probably higher than the probability the Boston Red Sox were going to win the American League Championship Series when they were down 3-0 to the Yankees in 2004. Baseball fans shouldn’t have called for the Red Sox to drop out then. Fans of democracy shouldn’t call for Sanders to drop out now, either.

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by | March 11, 2020 · 11:12 pm

The Wednesday Morning Speech Bernie Should Have Given

Thank you all very much for being here. Let me begin by acknowledging that last night’s results were disappointing. We lost in the largest state up for grabs yesterday, the state of Michigan. We lost in Mississippi, Missouri, and Idaho.

On the other hand, we won in North Dakota and we lead the vote count in the state of Washington, the second-largest state contested yesterday. With 67 percent of the votes having been counted in Washington, we are a few thousand votes on top.

Poll after poll, including exit polls, show that a strong majority of the American people support our progressive agenda. The American people are deeply concerned about the grotesque level of income and wealth inequality in this country. The American people want the wealthy and large, profitable corporations to start paying their fair share of taxes. And the American people want a single-payer national health care system that eliminates copays, deductibles, and premiums, guaranteeing health care to everyone in America as a human right.

Joe Biden is opposed to guaranteeing health care as a human right – on television just the other day, he said he might veto a single-payer health care bill if he is elected President and Congress sends it to his desk. This position is unacceptable, especially in the midst of the coronavirus pandemic we are currently facing. But many Democrats are voting for Joe Biden anyway. Why, you ask? Because they believe he is the safe choice to take on Donald Trump in November.

We need to correct this misconception now, before it is too late. If you want to beat Donald Trump in November, you should vote for me.

I want you to think back to 2016. The same people who are telling you that Joe Biden is the safe choice to take on Donald Trump today were telling you that Hillary Clinton was the safe choice to take on Donald Trump four years ago. We all know how that turned out. Let us not make the same mistake again.

I am the most electable Democrat for two main reasons. First, our campaign continues to win the vast majority of the votes of younger people. Young people’s votes and enthusiasm were a major reason why Barack Obama won in 2008 and 2012. Hillary Clinton’s inability to inspire young voters in 2016 was a major reason why she lost that election, and young people also do not trust Joe Biden. You may be committed to voting for either Joe Biden or me in November, but whether we ask them to or not, young progressives – a key constituency we need to beat Trump – can only be expected to knock on doors and vote if I am the nominee.

Why are young progressives uninspired by Joe Biden? It’s because he has been on the wrong side of important fights for decades. I have a 100% pro-choice voting record; Joe Biden has voted over and over again to restrict access to abortion and contraception. When I was in college, I organized to desegregate housing and schools; years later, in the Senate, Joe Biden stood with southern racists and opposed desegregating schools. I’ve fought for free college; Joe Biden helped create the student debt crisis. I opposed the Iraq War; Joe Biden cheered it on. On issue after issue, I’ve been on the right side and Joe Biden has been on the wrong side.

That brings me to the second reason I am the most electable Democrat: I am the polar opposite of Donald Trump. Trump is a pathological liar who is running a corrupt administration. I am recognized even by Republican voters who disagree with my policies for my honesty and integrity.

The contrast will not be so stark with Joe Biden. When Biden points out that Trump has spent his time as President enriching himself and his friends, Trump will point out that Biden’s Wall Street donors got the policies they paid for during Biden’s Senate career. When Biden points out that Trump lies repeatedly, Trump will point out that Biden has plagiarized speeches, fabricated stories, and lied about his record of supporting Social Security cuts. When Biden points out that Trump is a racist and sexist, Trump will point out that Biden was an architect of mass incarceration, advanced racist stereotypes about single mothers, and frequently makes women feel uncomfortable. Even when Biden criticizes Trump for putting kids in cages, Trump will point out that the cages were built and kids first put in them when Biden was Vice President.

Let us be clear: Donald Trump is worse than Joe Biden. But let us also be clear: being better than Donald Trump is not enough. It is not enough for the millions of people who need health care and it is not enough to win an election. Democrats tried it already, in 2016, and we lost. We should not try it again.

So if you live in one of the 26 states that hasn’t voted yet, please tune in to the first one-on-one debate of this campaign on Sunday night. You will see then what you already know now if you’ve seen Joe Biden speak recently or watched my Fox News town hall: in addition to being the only candidate who has fought for you for decades, I am also the candidate best-positioned to defeat Donald Trump.

Donald Trump must be defeated, and I will do everything in my power to make that happen. I hope you will, too, by casting your vote for me in your upcoming primary. Thank you all very much.

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by | March 8, 2020 · 7:03 am

Pro-Choice? Bernie Sanders is the Clear Choice.

On reproductive rights, the records of Bernie Sanders and Joe Biden are about as different as Democratic candidates’ records can be. “Biden over 36 years in Congress staked out a reputation as one of the Democratic Party’s most conservative voices on abortion,” as Politico summarized last year. According to the Planned Parenthood Action Fund’s 2016 review, on the other hand, “There’s no question: Senator Bernie Sanders has a strong record on reproductive rights.”

Here’s how Politico elaborates on Joe Biden’s record:

For decades, [Joe Biden] opposed late-term and so-called partial birth abortions, lamenting that one ban enacted in the 1990s did not go far enough. He supported Republican presidents’ prohibitions on funding for groups that promote abortions overseas, and backed legislation that would have allowed states to overturn Roe v. Wade. He even fought unsuccessfully to widen religious groups’ exemptions from the Affordable Care Act’s mandate for birth control coverage…

In public statements, interviews and recently resurfaced videos, Biden said he believed that “abortion is wrong from the moment of conception,” and said he doesn’t “view abortion as a choice and a right” but rather “always a tragedy.” He also said he did not believe that “a woman has the sole right to say what should happen to her body.”

Biden voted for the adoption of the Hyde Amendment in the 1970s and later opposed efforts to make exemptions and fund abortions for women who were victims of rape or incest.

He held that position until [the late spring of 2019, after he began his 2020 presidential campaign.]

Here’s how the Planned Parenthood Action Fund elaborates on Bernie Sanders’s record:

Sanders Has a 100% Voting Record on the Action Fund Scorecard
When the Action Fund started scoring congressional votes in 1995 (a few years after Sanders began his tenure in Congress), one of the first votes we scored was an amendment to allow over $190 million for family planning projects under Title X. Then-Representative Sanders was a key vote in moving that amendment forward. Throughout his career, he has continued to vote to protect access to safe and legal abortion, as well as federal funding for family planning and health care provided at Planned Parenthood health centers.

Sanders Supports Expanded Access to Birth Control
To this day, Sanders also has reliably and consistently voted to ensure women’s access to the full range of birth control options. During the fight over the Blunt Amendment, which would have allowed employers to opt out of providing insurance coverage of birth control, Sanders gave a speech on the Senate floor voicing his opposition:

“…there is growing anger that members of Congress, mostly men I should add, are trying to roll back the clock on women’s rights… Let me add my strong belief that if the United States Senate had 83 women and 17 men rather than 83 men and 17 women that a bill like this would never even make it to the floor.”

What’s more, he supports the Affordable Care Act, including its mandated coverage for birth control, and co-sponsored a bill that would protect women from bosses who want to block this coverage from them…

Sanders [also] signed onto a friend-of-the-court brief to the Supreme Court advocating against the Hobby Lobby’s decision to deny insurance coverage for contraception to their employees…

Sanders Supports Access to Abortion
To sum-up Sanders’ stance on abortion, just read what he had to say in a 2012 op-ed:

“We are not returning to the days of back-room abortions, when countless women died or were maimed. The decision about abortion must remain a decision for the woman, her family and physician to make, not the government.”

His strong position that we, as a nation, will never go backwards when it comes to access to abortion care is a major reason why Sanders is in our corner.

Sanders has also been a cosponsor of one of the most proactive pieces of legislation that would prevent states from chipping away at abortion access: The Women’s Health Protection Act, introduced in 2015 and 2013. This act would prevent politicians from passing laws aimed at shutting down health centers by imposing unnecessary building regulations and medical procedures such as mandatory ultrasounds — which have the sole intent of shaming women and making it harder for them to access safe, legal abortion…

On the campaign trail, Sanders boldly defended abortion access at the Christian institution Liberty University despite the fact that the university is so conservative that Ted Cruz announced his run for president there…

Sanders Has Stood With Planned Parenthood
The PPAF thanks Sanders for being an unwavering ally of Planned Parenthood patients and consistently voting in favor of protecting patients who rely on federal funds to access birth control, cancer screenings, and other basic health care at Planned Parenthood health centers.

If Bernie Sanders is elected, pro-choice women can feel confident he’ll have their backs. If Joe Biden is elected, regardless of what he says during campaign season, pro-choice women will have a lot of reasons to worry.

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