Patterns & Paradigms | The Pattern Podcast
Patterns & Paradigms | The Pattern Podcast
Patterns & Paradigms | Season 2 Episode 01: Winning the War on COVID? with Diana Mason
Are we winning the war on COVID? What of the wounded who have survived the illness but are dealing with lasting impacts? This week we're exploring the other effects of COVID-19, as well as vaccinations and masks, nursing, healthcare, and the pandemic, with Dr. Diana J. Mason, RN, FAAN.
This week's episode features Diana J. Mason, Senior Policy Service Professor for the Center for Health Policy and Media Engagement at George Washington University School of Nursing. Nurse, Journalist, Writer, Consultant, she is Professor Emerita and Co-Director of the Center for Health, Media, and Policy at Hunter College, City University of New York, where she was the inaugural Rudin Professor of Nursing until 2016. Dr. Mason is the immediate past president of the American Academy of Nursing, former editor-in-chief of the American Journal of Nursing, and co-producer and moderator of a weekly radio program on health care issues since 1985. She is the lead editor of the award-winning book, Policy and Politics in Nursing and Health Care, now in its 8th edition and the author of over 200 publications. Her scholarship focuses on health policy and what can be learned from nurse-designed models of care.
We are experiencing a paradigm shift, a fundamental change in the way we usually do things. We are intentionally choosing to see the silver lining opportunity arises. We can shine a light on the things that weren't working well on those things that weren't really working at all, we can regroup reevaluate and re-engineer it's time to explore new patterns and paradigms those that inspire us to rise above the chaos and explore how the conditions of today can take us to a better tomorrow
Speaker 2:Patterns and paradigms the pattern podcast from Hudson Valley pattern for progress. You're listening to season two episode one, winning the war on COVID with your host pattern, president and CEO, Jonathan Dropkin. Hi everyone, and welcome to a new season of patterns and paradigms in this, the first episode of our second season, we start by exploring the status of issues related to healthcare and the pandemic. Our guest is Dr. Diana Mason to continue to listen to us. All you need to do is continue to subscribe and download patterns and paradigms wherever you find your podcasts, such as Apple, Amazon music, Spotify, and Google. If you have any ideas for future topics and episodes, please send them to pattern for progress.org/podcast. As we try to use our crystal ball to ask, how do we combat of the pandemic and economic disruption in a better place? We are pleased to report that the results are in. And one of our first predictions was correct. In fact, with so many of us wearing masks, washing our hands and practicing social distancing, there has been this enormous side benefit in a rather otherwise horrible situation of the pandemic that there has been a major reduction in the transmission of germs that can lead to the common cold and flu the data points to dramatic reductions in both cold and flu season. We hope that some of the practices that we have learned will continue into the future. Before I introduce Dr. Mason, we are back with our popular segment. What's up Joe, with patterns zone, Joe Cheika, as pattern moves into a new year highlighted some of the issues we thought made our top 10 lists of what needed to be focused on in the Hudson Valley. So, Joe, you got your two favorites.
Speaker 3:I do Jonathan, all 10 of these items on the list are really important. Naturally I gravitate towards housing and housing is really linked strongly with the changing nature of work. So housing, why is housing so critical? Well, everybody needs shelter. Right? Last year we did this entire housing seminar on, on shelter from the storm. It was all about housing. And if we take a look at what happened last year in the market, and we try to look at our crystal ball of what's going to happen in 2021, who knows, we do have a couple of facts that are really solid. One interest rates. They're not going anywhere. Anybody can walk into a bank and get an interest rate on a mortgage of less than 3%. There are still mortgage products out there with 5% down, 3% down. And so home ownership really is achievable. However, not everybody can become a homeowner if you don't have a job. And that's the tricky part about 2021. As we look towards the future, what will happen with employment? The other item within housing that's really critical to understand is what's going to happen with real estate taxes and insurance insurance will likely go up. Homeowners policies are gonna get more expensive taxes. This year will likely be about the same, but next year, as we[inaudible] get into a little bit more hot water, so to speak with their budgets, they're likely going to be raising taxes and that's going to impact not only new buyers, but the existing homeowners in a negative way. Yeah.
Speaker 2:Let me ask you this. So I thought I heard over the break that, um, actually it's become overall more expensive to buy a new house and I'm sitting here going, how could that possibly be interest rates are so low, but what they were getting at was that with a reduced supply of housing, the cost of each, um, new home was going up. Then they were adding the items that you were just talking about, whether it was taxes, you know, and other issues. If we don't expand supply, then I fear that yes, there's going to continue to be a housing shortage.
Speaker 3:The housing inventory is one of the most important parts of the formula in housing and inventory is way down, you know, as people move into the Valley, as people move out of the Valley, as housing, older inventory is absolutely critical, uh, to, to, to keep pricing low and it's, and the inventory is low. So prices are high, um, inventory, you know, you take a look back at the tri County housing needs assessment that was done some 11, 12 years ago.
Speaker 2:And that was for Duchess Olster R and counties here in the Hudson Valley,
Speaker 3:Correct. All three counties. And it was actually an allocation by municipality of the number of housing units, both rental and, and for home ownership that were needed, not a single municipality came even close to what was needed and that was 12 years ago. So if you look at today's market with the ever-increasing prices and lower inventory, municipal officials, town planning, boards, zoning boards, all, all your municipal boards and councils, they really need to take a hard look at housing, understand that inventory is low, and if they want to attract and retain the population, they've got to do something about that
Speaker 2:And all that's happening and is exacerbated by this. I think we'll continue through 2021 people from New York city who are looking for some other alternative than living in the five boroughs.
Speaker 3:Absolutely. We're we are seeing an influx of people, the data on the exact number. We're not there yet. We don't know. We'll, we'll probably have a lot more data points in about two or three months, and we'll be able to take another very close examination of that.
Speaker 2:All right. So, so I took from you saying that the one I wanted to touch on, which is related to this is the changing nature of work. Absolutely. Now there was an article in the wall street journal over the weekend that just did, um, that had the results of several surveys on whether people like remote work, Joe, this is here to stay. There is no question that people, um, in large percentages, see the benefits of being home productivity was increased. They like to be, you know, be able to be, um, able to run an errand quickly. They, a lot of it had to do with not having to commute. Um, and they found themselves at their desk earlier and they were working more hours. And so employee ERs are going to be happy. Is this the case for everybody? No, absolutely not. There are some sectors, you know, tourism restaurants, et cetera. We retail where you have to go to work, to interact with people, some aspects of retail. But I think that the way in which we worked is absolutely to change. And one of the things we're going to have to track
Speaker 3:Absolutely. And the tricky balance about the changing nature of work is having that, that boundary between work and personal life. And so if you take the changing nature of work back into the housing component, people are looking for housing on a home side with extra rooms. And if there's no extra room that may lead to a boom in construction and renovation, putting on an addition, converting a basement, adding a bedroom or changing a bedroom from that particular use into an office space. So I think you're going to see some economies actually doing a little bit better and the renovation remodeling may be one of them.
Speaker 2:All right. So take a look at our blog from, uh, this past Sunday and the last issue of Paul's in which we gave a list of 10 things that we trends that we wanted people to look at for 2021. And Joe, and I just highlighted two of our favorites that we're going to be keeping an eye on, feel free to contact us about others. I've actually joked gotten, um, two emails today on broadband, which is on the lists saying, have you spoken to such and such? And I think broadband is one of the 10 on that list, then it's going to be important. So Joe, thanks for being with us. And, um, as always look forward to speaking to you next week, thank you now onto our guests, Dr. Diana Mason is the senior policy service professor at the center for health policy and media engagement at George Washington. University's school of nursing. She's also the program co-director of the international council of nurses at the global nursing leadership Institute. Diana is the professor emerita at Hunter college's center for health media and policy, which is part of the city university of New York. Diana is the lead editor of the award-winning book, policy and politics in nursing and healthcare, and has authored over 200 publications. Finally, on her behalf, a special shout out to our listeners in the Catskills. Diana is the producer and moderator of health cetera in the Catskills on w I O X radio@wioxradio.com. Hi Danna. How are are you and how were the holidays different for you this year? Hi Jonathan, thank you so much for this opportunity to talk with you. Um, my holiday was lovely. I have a pod, I have a group of friends
Speaker 4:That we're all very careful. We're all at high risk for serious illness. If we get the virus. And so we are not out and about. And so I will have people though that pod over to my house for dinner, I open up the windows, even in the cold, I turn the fans on, I turn the heat up. It's not heat, we're not being very efficient energy wise and I have a HEPA, um, uh, filter, air filter. And so with all of that, if, if one of us has a little bit of the virus, it's not going to linger long, doesn't have much of a chance, but, uh, we're all very careful. And we even considered, should we invite a couple other people who we've invited in the past and decided not to, because we didn't know what they did. So, um, that was, that was fun. And I appreciated it and I appreciated them staying safe and, uh, having, having this pond be safe.
Speaker 2:All right. So let's use that as a way to elaborate a bit more on your background. I have already told our listeners the basic CV, but maybe you can explain that you're not just your, you're not just the nurse. I mean, I almost said average nurse, and that would have been a horrible mistake in the sense that most nurses that I know of very special people
Speaker 4:And actually most would take offense to even saying you're not just a nurse. I actually feel very proud that I'm a nurse and I've done all kinds of nursing, but my, my focus really has been on community health, public health. And so I am a registered nurse, uh, but my focus is one of population health of health policy. And I I've done journalism for gosh, over 35 years, I've had a radio program in New York city for a, for a number of, for almost 30 years. And, uh, it was a weekly life program on health and health policy. And I now do it up at Wix radio in Roxbury, New York it's health center in the Catskills. I was also editor of the American journal of nursing. So I really have an interest in the issues around health and healthcare and health policy, but I am in preferment. Uh, I am a professor Meredith from Hunter college and people would say I've retired, but, um, I am in what we call preferment where I'm doing what I prefer to do. And I gave some thought about what I wanted to do with my time in preferment. And I really want to focus on helping people to understand that we don't need more healthcare. We need a better healthcare system. We need a smarter healthcare system, but we need to be preventing people from needing healthcare. We need to move upstream and be looking at promoting healthy communities. So I've spent a lot of my time writing about talking about and being active on that issue of how to promote healthier communities and how to get health professionals to realize we don't need more healthcare. We don't need more acute care. We need more primary care. We need more health promotion, and we certainly need more public health as the virus is showing us. So that's what I'm spending most of my time on.
Speaker 2:Well, I think all of us should, at some point, have the ability to choose the things that we really want to do. So this, this I'm going to have to remember this word preferment and see if I can integrate that into what I'm doing. All right. So obviously I have, um, reached out to you as an expert in the healthcare, especially community health care, and the pandemic has made this issue front and center, and more people have learned about healthcare nursing, the, the genuine respect that should be shown to frontline workers in the healthcare community, nine 11. It might've been the emergency responders like police and fire, but here it was doctors and nurses. And so where are we as we begin the new year with addressing the pandemic, we are in a very bad
Speaker 4:And, and, uh, the virus really is winning at this point. And so we have this spread of the virus as was predicted, as things moved into doors in the winter. And we have the second and sometimes third surges of the virus in communities that are overwhelming our health care system. And even if you are somebody who feels like, Oh, let me get it. Don't worry about it. You need to think about the fact that you can spread it. And that if you're overwhelming our healthcare system, when you have a heart attack or you have a stroke, or you're in an accident, that hospital is not going to be able to give you the care that you need and that you will want. And so there really is reason to be concerned. We are now at almost 21 million confirmed cases, which is 25% of the world confirm cases that is stunning and deaths. We're almost at 360,000. And that is almost 20% of the world's deaths from the Corona virus. The coronavirus, the COVID-19 is the leading cause of death in this country. Right now it is superseding heart disease and it is superseding cancer. And so for people to say, Oh, it's just a flu. It's not, it's, it's worse than the flu. And there are these new variants and we've a lot of people have heard about a variant from, from the UK. So a little bit of mutation as the virus spreads through a millions of millions of people that virus has more opportunity to mutate. And so the UK Virgin a mutation of the virus, they're saying at point it's more contagious, but it's not producing more serious illness. Well, the impact of that means that if it's more contagious, you're just going to overwhelm the hospitals even more. And there is some evidence that in California, in Colorado that's what's happened, but there's also now a South African variant that they're thinking may also produce more serious illness,
Speaker 2:A sec, a second version now.
Speaker 4:Yes. And a, a more, uh, it may, it may be more contagious, but it's looking like it's also producing more serious illness. And so we cannot be complacent about this. And these next three months are going to be very difficult. I'm hopeful with the vaccines. That's, it's a very hopeful sign that we have vaccines, but they're going to have to respond to a mutation like the South African, uh, virus mute, uh, variant that variant, uh, may require a new vaccine. They don't think the UK version will require a new vaccine, but it means that we all really need to be vigilant right now. We cannot hold out for the vaccine because we can't vaccinate everybody in this country. We probably won't have everybody vaccinated until the end of the year and not everybody's going to get the vaccine I'm discovering. Um, and, and that's a concern. And so for people who can't get the vaccine, it's a real,
Speaker 2:What does that, when you say not everyone will get the vaccine, do you mean because there are not enough? Or do you mean that some people are not? Could you just expand on that?
Speaker 4:So some people can not get it, um, because of their health conditions. Uh, they're still question about people who are immunocompromised and what will happen with them, with the vaccine, the second P. So that's why herd immunity is really important to them. It's really important that 70 to 80% of the people in this country eventually become a protected against the virus. So they can't spread it to those who can't take a vaccine or who would get seriously ill and probably die if they got the, um, the virus. But the other is that I'm hearing from people, including some healthcare workers who are saying, I'm not going to get the vaccine
Speaker 2:Now. Y Y yes, Y I think there's three reasons. Okay. One
Speaker 4:First and foremost is politics. We have politicized the public health response to, uh, despite us, we have, we know we've got an issue with anti-vaxxers and while I've had some concerns about a lot of vaccines out here, and we're looking to vaccinate everybody against everything. And, you know, I I'd like to see some long term studies of that. This virus is so harmful that, um, right now, uh, I will, I will get the vaccine reveling. Uh, so politicalization of, of the public health responses and issue. The second issue is that some healthcare workers remember 1976 when there was the swine flu, when there were 10 or 11 cases at Fort Dix, New Jersey. And there was a lot of concern that this was going to be the 1918 flu done over. And so Ford rushed a vaccine in production before it was ready. And as they distributed that vaccine, one of the terrible adverse effects is what's called Guillain-Barre syndrome, which is where your body starts to become paralyzed. And it usually starts at the feet and gradually moves up your body. And then it, if you survive, it will gradually reverse itself. But when it reaches your chest, you, it affects your breathing. And so you end up on a respirator, um, or worse you die. And so more people died from Guillain-Barre syndrome than from the swine flu in 1976. And it's attributed to this rush to produce a vaccine. So now some people have seen, we've got this vaccine and we've gotten it quicker than we've ever gotten a vaccine. And so that's been a concern. However, what they're not realizing is that the mechanism of the vaccine for the Pfizer and Moderna vaccine, that's out of the, both are out. Now, it relies on what's called messenger RNA. And it's just a fragment of genetic material that is used to stimulate an immune response in someone. And that messenger RNA has been part of cancer therapy now for some time. So it's not like it's a totally new approach as a therapy. We don't know the longterm effects of the vaccine. However, and that's, I've, there's a pharmacist at the CVS in Margaritaville who told a friend of mine. He wasn't going to get the vaccine because we don't know the long-term effects. Well, we do know the effects of the COVID vaccine and my friend who will die if she gets, it was appalled that he would advise her not to get it because of long-term effects. It's either she stays isolated for the rest of her life, or she gets the vaccine and figures. If there are long-term effects, maybe I'll live to see them she's in her eighties. Maybe I live to see them, maybe I won't, but she should be getting it. So I think it's, it's one of, of, of those three reasons. I think why health professional would, again, I went to get new tires sometimes the other day. And I went to a place called Ritz tires and the woman behind the counter had no mascot. And she had a flexi glass shield in front of her. That was only about two by three feet in front of where she sits with the cash register, this long calendar counter in a very small space though. And she had no, she had no mask on. And I said to her, you know, I'm a nurse and I really highly recommend you wear a mask because the number of cases in our region are really going up. And she said, I know I'm an EMT. And I said, you're an emergency medicine technician. And she said, yes. I said, don't you wear me? She said, yes, I wear a mask. And I said, well, why didn't you wear it when you're here? And she said, because I can't, uh, I have to leave that mask with, with the ambulance essentially. And I said, well, why wouldn't you wear one here? Well, I just, she smiled at me and I said, so will you get the vaccine? And she said, no. And my conclusion was that it was a, not an evidence-based mindset at all. No, at all. And there was not a concern for, is she spreading it to the people who walk into that business. So I will no longer use that business out of my word for what I need.
Speaker 2:So it, it seems almost every night, evening news, they managed to find a nurse in a hospital who said, who completely drained, completely overwhelmed and makes that appeal. And it's in, it could be in any of the 50 States now. Right. And yet it doesn't seem to change behavior. And yet, so if you could put me in the position of that nurse, what's their day like, and, and what is their experience and triaging people. And, you know, in Southern California, they're at the point of saying, you're gonna be able to get a bed and you're not.
Speaker 4:Yeah. So I, it's hard to imagine why the public is no longer moved by about 3,500 deaths a day. And so if you're not moved by that, then you're probably not going to be moved by a nurse saying, I can't do this anymore. I'm exhausted. Please wear a mask. So we know the public trust nurses. We are the most trusted profession, 19 years in a row, uh, in a Gallup poll that's been done every year. And my colleagues who are in working in hospitals on the front lines, including nurses in New York city are telling me they can't go through this again. They can't do this again. So, so what they're feeling is total exhaustion. When you go from, first of all, in an intensive care unit, you should only have one or two patients. That's what the norm is. That's what the standard is. There are now nurses taking care of eight and 10 intensive patients with 12 and 20 Ivy drips. I mean, it's just an imaginable to me and I've been an intensive care nurse. And so I, I think people don't understand it's exhausting. It's morally emotionally exhausting. So you're going from bed to bed with people dying. Your resuscitation efforts are going nowhere. So you watch one person die, even though you try to resuscitate them. And then you have to leave and go to the next room with a patient who's now arrested. So what's happening and not just with nurses, with physicians as well, is that the moral distress, the anguish is so, and the exhaustion is so overwhelming. The depression post traumatic stress syndrome is, is setting in and the suicide rate among healthcare workers is now going up and healthcare workers are leaving. So a colleague of mine, who's a chief nursing officer in an academic medical center in New York city told me that she now has that. Now this was about a month or so ago. So it's probably worse. Now. She now has 120 vacancies in her intensive care units, nurse vacancies. And they can't fill them because where before in the spring, they could bring in travel nurses. Those travel nurses now can go anywhere they want, and they're making eight to$10,000 a week and more. And so they're in demand. There's not enough of them. And the nurses who are at retirement age are retiring as soon as they can. They can't go food anymore.
Speaker 2:When we went through it in the spring and we were the first day in March, April, may, and governor Cuomo put out that appeal. And it really was a beautiful thing to see healthcare workers from other States coming here. You're saying that if we get into a, if we already are, we're in a bad state, if it gets even worse, there is no one coming to the rescue because the rest of the country.
Speaker 4:Right? Okay. There's there's, there's no felons. Now. There are no felons. I mean, and, and you've found some places in the country where there are no ICU beds available. And so any other patient who comes in, you're going to have patients in the halls for that matter. So what are, what is the public expecting? If you're not wearing a mask, what do you expect if your loved one has to go to the hospital or you have to go to the hospital, just makes no sense.
Speaker 2:And so the, the, I think the point you made before is sometimes lost on people, which is so you're in a car accident. You have a heart attack, you have some other medical emergency. If we're not paying, if we're not vigilant, then there is no place to have your, the person in that accident in that medical condition treated.
Speaker 4:Yes. Yes. And what my, my colleagues are saying repeatedly is, okay, you tell us, you trust us. Now, listen to us, wear the mask, listen to us if for no other reason, because we can't take more cases. We can't take more of this. And, and, and Jonathan, I think the public doesn't realize what a long-term impact this is going to have on our health care system, because we're losing healthcare workers for a variety of reasons. Some are getting sick, some are dying, some are saying I'm retiring early. Some are saying I'm out of here and, or I'm switching to some other, some other aspect of healthcare. And so we've already, we were already projecting a nursing shortage as the population was aging. This is just going to make it worse. And it's going to make it almost intractable. I think we're going to have a very hard time coming back from, from this in terms of the workforce.
Speaker 2:Well, and that is, as the baby boomers are getting into that age where they're going to need more healthcare, even if we could get the vaccine in to everybody, there is this exhaustion, there is a lack of people going into the profession that we have to really pay attention to. What are we going to do to attract the larger workforce? Um, I, I guess I was hoping Diana that somehow there was going to be that magical moment, but it's so exhausting that, you know, following nine 11, people want it to be a policemen, firemen. They wanted to do something, you know, to stop, you know, some forms of terrorism that, but I don't know where the people are going to come from in the workforce, which was already stressed, pre COVID.
Speaker 4:I agree. I don't know where we're going to get them from. I mean, there was still these people who want them enrollments in schools of nursing are still happening, but, uh, you're going to have, you've already, we're already seeing a slight of nurses leaving positions, and I think you'll see it with physicians.
Speaker 2:So, so let's turn to a minute. I have had this notion that, you know, there are many elected officials that have used wartime analogy to the number of deaths. So we count the number of deaths and we count the number of people that have been infected. And I just had the I'm old enough to have this image of Walter Cronkite talking about the Vietnam war. And it was the number of deaths, but it was the number of people wounded. And maybe you can help explain to us that just, you know, yes, people could die, but people who have gotten sick are exhibiting symptoms for months now. And they're, that's one category let's just start, start there. Sometimes they're small articles that refer to long haul what is happening with that? And what is it?
Speaker 4:So what's happening is that the symptoms are persisting for, for weeks and months. These are symptoms like cough, difficulty, breathing, body aches, joint pains, headaches, uh, the loss of smell, the loss of taste. And what's called a brain fog feeling like you're just in this fog. And so the, the long haul or symptoms, um, that's, what's being reported. We don't know enough about it. So there is, there are some major efforts going on to study. How long are these symptoms persisting? Are there any lasting effects? Are people, are they gradually diminishing? So I have family member who offered the holidays. I discovered, um, has never worn a mask. And my family member and their spouse both had COVID. And, um, they, uh, believe the precedent that this is all a hoax, but they lost their smell and they lost their tastes. And it was like, okay. And we, they have flu like symptoms and, and, and their feeling was that, well, you know, we survived it. It's not that big a deal. Their sense of smell and taste is not yet come back. Now, I haven't spoken with this family member to find out to what extent the person still has. Fatigue has brain fog, et cetera. But, but people aren't paying attention to the fact that even if you don't have serious illness, even if you have mild and sometimes no symptoms, initially there are people who are starting to have these enduring symptoms. And what's even worse is that some, for some people they're having a permanent damage, that what looks to be permanent damage in critical organ systems. So a 20 year old woman who ends up with congestive heart disease, her, she realizes she can't walk. She had COVID, she survived it. She didn't wasn't seriously, seriously ill, but suddenly she couldn't walk her dog a block. And they discovered that indeed, she had heart damage. Now, whether the damage is from the virus or whether it's from your immune response, we're not quite sure, but there's that there are strokes. There are there's long-term kidney problems, long-term lung problems. This is a serious and new virus. So we don't know enough about what these long-term effects are going to be. And I think you're absolutely right. I think we should be reporting who are the wounded among us?
Speaker 2:Absolutely. I mean, and, and so are there obviously, you know, this better than I, but are there hospitals setting up units if they have the capacity for the, we're not even there yet for the continuing treatment of the long haulers, let's say, or are there other separate studies that are trying to, yes.
Speaker 4:Studies are going on, uh, the, it was either the CDC, I'm not remembering the CDC of a national Academy of medicine that convened a meeting to talk about. What do we know about the long haulers? What do we need to know? And how do we pay attention? What is this that's going on? And so I am expecting a lot more attention to this as the months move on. It is a significant issue. And, uh, when you think about a stress healthcare system, the idea of having people who may have longterm disability think about really severe fatigue and people who are trying to work and can't, um, the, these are serious issues.
Speaker 2:Well, and so that the, the employer who you know, is asking for their employee to return to work is going to have to say, well, wait a minute. You know, maybe she, she, he has a legitimate complaint that they don't feel up to speed. And I don't even think we have remotely the idea of how will we deal it? Are they keeping them on pay? How long can they, but there are if 360,000 people have died, I got to believe that there's at least
Speaker 4:There's hundreds of thousands, hundreds of thousands,
Speaker 2:All right. That's, that's one traunch. Then there's the, there is the mental health effects of those people who were not able to be with their, the, the gent, the larger family that couldn't be with their family when they died. And then there are, there is yet another category of people who have been dealing with this isolation. And those are two more categories of people that this disease is just mushroom Ming in terms of impact. But we don't really count those.
Speaker 4:We don't. Um, we do know that the rate of suicide, the rate of drug overdoses has increased
Speaker 2:Right problem before this.
Speaker 4:And, and, uh, one of the, the silver lining of this, although is that we're being more creative with how to deliver care. So for example, there was an organization called reach medical based in Ithaca. And I am co-chair of the Catskills addiction coalition, um, to look at preventing and improving the treatment and recovery services for people with substance use disorder and medical reach is using tele-health to get people who have, who are in recovery, or want to go into recovery, want to go into treatment, getting them on medication assisted treatment. And before that was not allowed. So we've thrown out some of the old barriers, uh, to people being able to access care, but mental health services have grave concern. I mean, here, even in our region, we know that, um, the health Alliance of the Hudson Valley had been, uh, criticized and full disclosure. I'm on the board of Margaretville hospital. That's in that health Alliance of the Hudson Valley. They shut down their Kingston, mental health, inpatient, and substance use services in the hospital in Kingston, the acute care services, move them over to, uh, mid regional hospital. And, um, that's really been of concern to people in our region who feel like we're losing our mental health services. Now, they, they say they got rid of those services in the Kingston hospital because they had to build out their big capacity for COVID, but that capacity never got full. And so the questions are why aren't we bringing that back? So we've got a lot of work to do with making sure that we are investing in mental health services. We're investing in the mental health providers. Uh, we don't have enough mental health providers, particularly in rural areas now. So there's a lot more that we need to do on that.
Speaker 2:All right. So I think we've given our listeners a good taste for the impact of the pandemic. And, but let's part of this podcast is also about trying to say, could there be any good that comes out of this? And so let me start with, I just saw it. And I thought this was possible that the cold and flu season appeared to be in well, less incidents of it. And that we've actually had a very mild now, is that a statistical or in reality?
Speaker 4:And it, it makes sense. So if you germ theory, if I can get COVID, if I'm out here and I'm getting COVID, I can also get the flu and I can get the cold when I have people tell me, Oh, I just have a cold. I say to them, you could, all right, now you can also have COVID. If you were able to get a cold, you're able to get COVID, it's the same kinds of transmission through air, through touch interaction with people, et cetera. So the masks are protecting us from other people who might have the flu might have a cold. Um, I do think, and I have long been a proponent that the Japanese bow is the way that we all need to go in the world because the handshake is a major route of transmission of germs for the cold, for the flu and other conditions. And so I think it's going to make us more aware of, um, just how diseases can be transmitted, how germs can be transmitted and have us, I think, modify our behaviors. I also think, you know, the Asians have long been wearing masks. Um, if in, in Asia, if I feel like I have a cold, I put a mask on, if I'm out in the public and I'm high risk for some kind of comp lung complication, the flu, or what have you. I wear a mask when I go out, it's very common. You see it all over Asia. And I think you're going to see more of that in this country. Um, and I think we'll see some advances in, in the quality and the production of masks.
Speaker 2:Well, that, that, that's interesting because obviously there's been a political was aching of the wearing of a mask, which I thought were all in this together. Boy was I wrong? And I found out how we could be so polarized on the wearing and not wearing, but you're suggesting Diana that there are major health benefits from the, from making decisions, um, individual decisions to wear a mask when there's no pandemic that might in fact may give us reason to have better flu seasons in the sense that there are just less. And that could be a real change in our behavior to the better. Yeah.
Speaker 4:I, I think, I think it could be any, none of us want to go around wearing a mask if we don't have to. Um, but, uh, when you're somebody who's, you know, older, you're at high risk for serious illness that you get just the flu or even a cold, um, it's, I think we will see more and more people wearing the masks under those circumstances. The other thing with the mask is that it's been stunning to me that there is this resistance that it's my right to not wear a mask, knowing that you're not wearing the mask. Not only puts you at risk, but it puts other people at risk. So you're saying really on you on me. I don't care. Um, you know, I don't care who gets it. I don't care if you get it and you get seriously ill and die. And, and yet we have seatbelt laws, right? And those seatbelt laws, if you don't wear it, you get fined. If the policeman stops you and you're not wearing the seatbelt and decades ago back, I want to say in the early, at the turn of the 20th century, so late 18 hundreds, early 19 hundreds, there was a snow spitting law. And you can see their signs still in places, no spitting. And it was because tuberculosis was rampant and you spitting was a major way that it was transmitted. And you got fined if you spit. And so, uh, you know, when I've got a godson of mine who would go around to and tobacco and spitting, it made me crazy. But, but it's the idea that yes, there are consequences for your behavior. You, you don't have the right to beat your wife or your kid. You don't have the right to harm other people. And if you're not wearing a mask could be harmful to other people, you should be accountable. And I think you should be fine. So I'm really hoping that the Biden administration will issue a mask mandate to the extent that they're able to accomplish that at the federal level and the governors who really care about this issue will go along with it.
Speaker 2:All right. Here's another one for that. We've had to use the virtual waiting room where you have a lot of places simply don't allow you sit in your car. You wait until your cell phone tells you to come in. Well, there's a part of that that I think is really good in the sense that you're not sitting among lots of people that you don't know what their condition is, is that's something else that possibly, you know, some, maybe it's certain healthcare providers will say, this is our policy. Is that possible?
Speaker 4:I think absolutely. And I think the use of telehealth for, for most primary care visits should be allowed. Um, there's no reason why I have to physically go there all the time.
Speaker 2:Well, I always think that the, the one that has always driven me crazy is that, um, in dermatology, there's an, I see something I call and they say, yes, we can get you in. And about 90 days, three months from now, and I'm going, what am I supposed to do with this? And yet is I could show you here it is. And you could go, Oh, that's this? Just, just put this on it. But what are the other ethical issues or all sorts of things that would bar some of that from happening, do you think?
Speaker 4:Well, certainly a major barrier to that kind of thing happening is access to broadband access to internet and the, the technology to do it. And so in poor communities, certainly in these rural communities, broadband is a major issue. Um, it's also an issue in poor communities where they can't afford to pay for the internet. Um, and, and so that that's of concern, are we creating more health disparities, um, by moving more care online? Um, and so that's something that I think we really have to look at. There have been people who have called for broadband to be considered a public utility. Right?
Speaker 2:Absolutely. Yeah. Completely agree with this. And, um, it pattern has made it actually one of their top issues for 2021 is because more than half of the communities we serve are in rural communities. And as we're even finding out that broadband coverage in Westchester, a wealth, you know, you would think a wealthy County can be quite shoddy at times, depending how many people are trying to access it at the same time, or you're in a house where you're paying for it. And now there's young child at home that needs it, and there's only one computer. And then if there's multiple computers, it may interfere with the broad band, um, ability to, for people to have their screen, not go fuzzy on them and all sorts of other things. So true, you know, till we get it to be like electricity, which I absolutely concur, we have, we have learned through the pandemic that this is no longer a luxury. It is absolutely necessary. All right. So let's, let me bring you to another one, which is, since you deal with community health, a lot of the comorbidity that I've heard about it, and, you know, the relationship of obesity, uh, diabetes and things like that have contributed if I have it right to the, those are the underlying
Speaker 4:Surfacing. So it makes you a greater risk for serious illness and death in general before, well, before, but also now during COVID. Okay. Okay. So it's a great, it's a huge concern. Um, again, though, I would say for those who have the means, um, so I've always had a weight issue. I'm doing new, I'm paying a monthly amount, a fee to participate in nuMe, which is a cognitive behavioral approach to weight loss. Right. And I, I feel very good about it. Somebody else can't afford that. There's somebody else. I know who's a farmer who would love to do that, but she can't afford it. And so the same thing with where is there a safe place to exercise the here, up in the mountains, I can go out and take a walk if I'm in an urban area and it's not safe, where am I exercising? Uh, so the disparities, it also highlights the disparities in our conditions of living and how that affects our health access to healthy, affordable food. If you go to the supermarket and look at what costs the most money, it's the affordable, it's the healthy foods. And then the cost of fruit is ridiculous. And so we've got to, I think we orient ourselves to what's most important. How do we promote health and healthy communities? And how do we get the resources to the people who need them? And certainly during this time, we've seen people because of unemployment, um, you know, who are on the food pantry lines, uh, and the number of people who are going hungry in this country doesn't mean you're not eating. And it doesn't mean you're not obese. You're, you're able to get cheap food that is not good for you. Right?
Speaker 2:So pre pandemic, you know, we had plenty of places in the Hudson Valley that we referred to as food deserts, because didn't have access to quality food. And so that becomes integrated in this, but absolutely this is about equity in terms of so many of these issues that we're going to have to think, yes, we could do this, but it can't just be for those people that can afford it. Um, when we find out that in community health, there is this parities based on the community.
Speaker 4:If I could just say though, that one of the reasons why I am so committed to moving upstream, so to speak, looking at how to promote healthy communities is because we spend so much money in this country on healthcare, more than any other country, we are spending so much money on health care. And yet we don't have the outcomes that we ought to have with all the money we're spending. If we took a fraction of that money and put it in to ensuring that everybody had healthy food to ensuring people have broadband, we wouldn't need the kind of healthcare system that we had created. We would have a healthcare system that was much saner that focused on primary care, health promotion, public health. And when you needed the acute care, you got it. But we weren't, overscreening, over-treating over medicalizing things. So, um, yeah, that's my stick.
Speaker 2:I think that's a really valid point because I think it's only been recently that some healthcare providers have said the wellness visit and, you know, would insurance pay for it? So what role does the, it, I know this is a little off topic, but what role does the insurance company play in potentially re prioritizing what we're going to do?
Speaker 4:It's huge payment drives action. And so we have had a fee for service payment system in this country for way too long. And so you get rewarded when you do the surgery, you get rewarded. When you do the procedure, you don't get rewarded. We're not paying for the counseling that you need on living a healthier life. That that payment has only come recently and it's it's negligible. And so there's a movement to foot to move to. What's called global payments where instead of paying my primary care provider or the hospital for me by procedure, they're getting a fee for me every month, essentially to keep me healthy. If I need care, I get it. And they're accountable for the outcomes, but if I don't need the care, they get to pocket that money. And so it's in their best interest and my best interest to have a global payment method that will ensure that I get the care I need without getting unnecessary procedures, be mindful that hospitals right now are in deep financial trouble because they had to cut their electrical surgery, surgeries, and electric procedures. And that is their bread and butter. The more that they could do those procedures, the better. And I will tell you that I recently had a procedure in which the physician wanted to do more of these procedures. And I said, no, we're not doing anymore. I don't need them. And if I didn't know what I know, um, I, I probably would have gone in for another procedure. So who,
Speaker 2:Yeah, trying to think, ha is there an example of a country, a community somewhere you want to point to about whether it's global payments or you really have to look at the way ax treats healthcare? Where do we want to look?
Speaker 4:Well, we already have some examples in this country. Um, the Kaiser health system on the West coast, um, pretty much takes this approach. Uh, they, they, uh, you know, you get the care you need and if the provider is able to keep you healthy, they get the reward of that. Uh, there's also, what's called the pace program, which is the program for all inclusive care for elders. And it's under Medicare and Medicaid. And, uh, to me, they should be expanded. Every community should have a pace program, but where an entity could, um, it takes responsibility for people who are enrolled in the pastry in Medicare and Medicaid. They take responsibility for this population. They provide in-person services, like, uh, almost like a daycare setting for older adults to keep them out of nursing homes. The whole idea came out of nursing homes, give them the care they need, and at less of a cost than if they were in a nursing home, but it also gives them more independence. It gives them a healthier life. And so if they can, and they're responsible for the care of the person needs and they've been highly successful. So, so we have examples of this in our own country. And it's, I think having the political will to take the big step to do it. Now, having said that I have real concerns, I'm on Medicare and I have real concerns about I don't do Medicare advantage. Um, I have real concerns about what I'm hearing about some of those advantage plans, really making it hard for you to get the care that you need. They'll give you, they'll say, we'll give you free vision care. We'll give you free hearing AIDS, but when you're really needing the advanced care, that's when they're saying, Oh, no, we don't cover that. Or no, you don't need that. So, uh, I think we'd need to put in place a system that is not being rewarded for denying you care, but rather is being rewarded for, for keeping you healthy and having good outcomes.
Speaker 2:Um, okay. Before we end, I want to give you an opportunity for a shout out
Speaker 4:To all your fellow nurses, who I, I can't believe the job they're doing. They are truly the frontline workers and they're going into yet another round of surging. Yes. So anything you want to say to your fellow? I mean, I am deeply grateful for every one of them and whether they're in the intensive care unit, in the emergency room, in a primary care clinic, I don't care where they're at. I'm grateful for every one of them. Um, I, I, I have this deep gratitude for what they're doing, but I also on their behalf want to say, that's not, that's not where we should be focused. We should be focused on telling the public, quit calling us heroes. We're not heroes, we're doing our jobs and we want to do it well, quit with the hero stuff. And listen to us, listen to us. And we are telling you, wear the mask, do the social distance, pay attention to the air quality when you're inside and do the hand-washing. Um, this is not the time to politicize a public health response. This is the time to be respectful of those people who, if you get sick, are the faces you're going to be looking at and you want to make sure there's a facial looking here. Diana Mason, thank you so much for your time. Um, I wish this was a, a happier discussion, maybe someday you and I can get together and have a discussion about how to improve community health outcomes, but there's absolutely the discussion that has to happen on January 4th in the midst of a surging pandemic. So thank you so much for your time. Thank you, Jonathan. It's been my pleasure. Stay well. Stay safe.
Speaker 1:Thank you for tuning in to patterns and paradigms the pattern podcast. For more information about this episode, visit our website pattern for progress.org forward slash podcast.