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WPCNR IMPRESSIONS TAKEAWAYS TRANSITIONS. By John F. Bailey, December 19, 2022:

My father once told me in discussing job intervews, “You never have a second chance to make a first impression.”

I learned that again Friday at a photo shoot involving 36 persons from the White Plains High School and Middle School, including Mayor Tom Roach Council President Justin Brasch and State Senator Shelley Meyer.

Staff administrators from the White Plains School District, members of the police and fire department, the mayor, the state senator, and other dignitaries, along with other well-known individuals working in the White Plains participated.

The  non-profit Common Cause conducted an all-day photography shoot at the high school Friday, capturing 36  school employees in a variety of clothing of their choice.

Each participant was photographed in a variety of outfits of their choosing as part of a planned traveling museum “pilot” program. The program is being used to demonstrate to those looking at 10 different pictures of the same person, instinctively make a snap judgment what the person is as to character, safety, respect, attraction.

The program is named:

“We are White Plains: Bridging, Belonging and Building Community.”

It is scheduled to be unveiled in the halls of White Plains High School March 2023.

Photographer Bayete’ Ross Smith composed the compositions in the all day session.

He shot 10 portraits of each  of the 36 participants photographing them in ten distinctly different fashion presentations chosen by the subject who posed with  a blank expression in each outfit.

The blank countenance you encounter  when looking at the  10 photographs of each person, you were not swayed by a smile, a scowl, or grimace or a laugh, forcing you as an individual to discover that seeing the same person in a different outfit, you make a different judgment.

Sue Spiegel and Marla Felton of the non-profit, Common Circles, Inc. are using the arts, conversation, interactives and storytelling to help students in the White Plains School District and the broader White Plains community explore identity.

Superintendent of Schools Dr. Joseph Ricca organized the program with Common Circles

The dynamic revelation was conceived by Mr. Ross Smith as part of his “Our Kind of People” series. “Our Kind of People” examines how perception about someone’s identity, value and character is affected by appearance such as clothing.

The finished exhibition scheduled to appear at the High School in March consists of photos of each of the participants in 10 different outfits, such as this photo below. on Mr. Ross Smith’s website.

When I observed this Mr. Ross for the first time, I realized how right my father was about not getting a second chance to make a first impression.

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Your Local Epidemiologist

Long COVID: An update and gauging risk

Earlier this year I wrote a four-post series on long Covid: burden; impact on specific health systems, like the heart; long Covid among kids; predictors of long Covid and treatment. Today’s newsletter is meant to be an update—I’m picking up where I left off, so I highly recommend reading those first, if you haven’t already.

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The individual risk of death from a COVID-19 infection is now close to the flu thanks to vaccines, immunity, and treatment. However, death is not the only outcome of SARS-CoV-2. Long Covid—or the persistence of symptoms after an infection beyond three months—is still a threat to living a healthy and prosperous life.

Overall burden

A recent study pooled more then 54 long Covid studies (which included a total of 1.2 million people) and found that 6% of individuals who had symptomatic SARS-CoV-2 infection experienced long Covid in 2020 and 2021. This is consistent with a massive study in Sweden (2020-2021) that found the proportion receiving a long Covid diagnosis was 1% among individuals not hospitalized for their COVID-19 infection, 6% among those hospitalized, and 32% among those treated in the ICU.

Today, the U.K. estimates that 3% of the general population has long Covid. In the U.S., the population-level burden of long Covid has been historically difficult to grasp. But in August 2022, the U.S. Census Bureau added four questions about long Covid to its Household Pulse Survey. What did they find?

• 16 million working-age Americans (aged 18 to 65) have long Covid today. This equates to ~8% prevalence.
• Of those, 2-4 million are out of work due to long Covid.
  • The annual cost of lost wages is ~$170-$230 billion a year.
• The prevalence of severe long Covid is unequally distributed across race/ethnicity and age.

Economically, long Covid is a big deal to this country. The total economic cost is $3.7 trillion in the U.S., without accounting for future cases.

Changing risk

Just like the risk of death, the risk of long Covid appears to have changed over time.

In general, there are three things that are decreasing the risk of long Covid today:

1. Vaccines. A number of studies show vaccines reduce the risk of long Covid. The problem is that these studies greatly vary in the estimated reduction: some say vaccines reduce long Covid by 85%, others say 15%. The “truth” is likely somewhere in-between.
2. Paxlovid. One study found Paxlovid reduced the risk of long Covid by 25%.
3. Omicron. A very strong study in the Lancet found the odds of long Covid after an Omicron infection were significantly lower compared to after a Delta infection.

All of these help, but are not bullet proof.

Of course, the more the virus mutates to become more contagious, the risk of infection (and thus long Covid) increases.

Death from long Covid

The National Center for Health Statistics released the first long Covid mortality report yesterday. The scientists started with over 1 million death certificates dated from January 1, 2020 to June 30, 2022 that indicated COVID-19 as the underlying or contributing cause of death. Then they searched for clues that the patient had long Covid by looking for words like: “chronic COVID,” “long COVID,” “long-haul COVID,” or “post-COVID syndrome.” What did they find?

• 3,544 deaths—or 0.3 percent of the total—had text on their death certificates about long Covid
• Long Covid peaked in June 2021 (1.2%) and in April 2022 (3.8%)
• Long Covid death rate was highest among adults aged 85+, non-Hispanic American Indian or Alaska Native people, and males.

A simple search of words like this has major limitations, so we cannot make causal claims. This is more of an exploratory analysis to see if “long Covid” appeared on death certificates. My hunch is that this is a huge underestimate of long Covid deaths, but it could be an overestimate. More work needs to be done.

Increased death from SARS-CoV-2 is not limited to acute illness

We are at the mercy of time to see the impact of SARS-CoV-2 infection beyond symptoms, for example blood clots.

One rattling study in the Lancet found that people infected with SARS-CoV-2 had more than 3 times the risk of dying over the following year compared with those who remained uninfected. For COVID-19 cases aged 60 years or older, increased mortality persisted until the end of the first year after infection, and was related to increased risk for heart and/or respiratory causes of death.

An Australian report of excess death found something similar.

A report from Singapore also found an increase in excess mortality after infection (people without recent infections had no additional excess deaths), however it was not linked to cardiovascular events.

Implications

On a population level, it’s clear that the footprint of SARS-CoV-2 will extend for decades to come. But what this looks like is highly debated, and there are two camps of scientists:

• One camp thinks long Covid will be a mass debilitating event that will define the economies of countries for decades
• The second believes long Covid is real, incredibly debilitating for the people who have it, but, given the change in risk, will not be such a big event that our future economies or health systems will fail.

Time will tell.

On an individual level, assessing risk of long Covid is extremely difficult. How much should long Covid impact my daily decisions? To me, it’s easiest to understand a new threat by comparing it to familiar threats, like driving. I did this using MicroMorts a few months ago, comparing the risk of dying from COVID-19 to, for example, skydiving.

Here is what I found (keep in mind these are super rough estimates):

• Driving: The annual risk of getting into a car accident is 1 in 30 per year for the average driver. Of those accidents, 43% are likely to be injured. And, of those injured, 10% are permanently impaired. So, the annual risk of permanent impairment from driving is 1 in 700.
• Long Covid: The risk of getting an Omicron infection (asymptomatic and symptomatic) per year is ~1 in 2 (before Omicron it was ~1 in 4). If we take into account 3% of infections lead to long Covid and, of those, ~18% will have disease so severe that they are unable to work. So, the annual risk of severe long Covid (unable to work) is 1 in 370.
• Other annual risk comparisons:
  • Severely injured during a house fire: 1 in 20,000
  • Needing reconstructive surgery after a dog bite: 1 in 400

So, the risk of debilitating long Covid is double the risk of permanent impairment from driving. Risk of debilitating long Covid is much higher than getting injured during a house fire and about the same as getting a serious dog bite.

Of course, individuals can do a lot of things to reduce risk for all of the above: Wear seatbelts. Drive less. Make sure your fire alarms work. Don’t approach growling dogs. But, we also make conscious (or non-conscious) decisions to increase risk: texting while driving; unplugging the annoying beeping fire alarm. It’s an every day balancing act. But, just like speeding tickets, required fire exit signs, and leash laws, there are policy level initiatives that could help with long Covid, too.

Bottom line

Long Covid is an incredibly debilitating disease and millions are suffering. While risk is changing, we don’t know what the future will hold.

This leaves us with a difficult balancing act. I find myself not willing to take risks in some instances, and more willing in other instances—as with many things I do in my daily life, like driving. A person next to me will be very different. I think it will be years until this calculated decision-making becomes easier.

Editor’s Note: On Monday December 12, the New York State Covid Tracker reported 346 cases of new covid were reported (Lab Test verified) bringing the first two days of this week total to 645 new cases, continuing a third week of highly increased cases immediately after the weekend, putting the county on track for a third week of over 2,000 new cases.

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Si quiere leer la versión en español, pulse aquí.

Trust in public health is eroding, and the implications are far reaching. We, as a field, have to fix this.

Over the weekend

Any forward-facing scientist can tell you that receiving dangerous messages has been a common occurrence throughout the pandemic. But the hate, resentment, frustration, and anger was crystallized in one instance over the weekend: Elon Musk—the world’s richest man and new owner of Twitter—wrote the post below.

Elon Musk @elonmusk

My pronouns are Prosecute/Fauci10:58 AM ∙ Dec 11, 20221,176,815Likes177,693Retweets

Five words, that were wrong on so many levels, garnered more than 1.17 million “likes,” 177,000 retweets, and international attention in mass media. Anyone who dared to disagree received a wave of truly grotesque comments. Even Musk noticed as he followed up on his original tweet with: “Truth resonates…”

Of course, the viral reaction is due to many things: social media algorithms, a polarized country, politics, misinformation, disinformation, opinions about Twitter, opinions about Elon. I also think Musk is trying to deflect negative attention from himself.

It’s also a reflection of humans’ difficulty coping with randomness—people need someone to blame for the pandemic, the fear they experienced, the people they lost, or the jobs and livelihoods that were changed. The viral reaction was also an indication that people finally felt heard.

But all of the above also overlap with public health. And, their accumulation has been funneled into one sentiment towards our field: distrust.

Change in trust

Every year, the Pew Research Center conducts a survey with Americans on public confidence in certain groups. Overall, trust in scientists has decreased throughout the pandemic, but ever so slightly. Interestingly it remained higher than public confidence in business officials, the military, public school principals, religious leaders, police officers, and elected officials.

If we compare the responses based on political affiliation, though, the story becomes jarring: confidence in scientists among Republicans dropped significantly. In fact, 1 in 3 Republicans have no confidence at all.

Furthermore, declines in trust in science were most pronounced among White adults. Americans with higher levels of education expressed more positive views of scientists than those with lower levels of education.

This is a huge problem, as trust equals lives

An Oxford report continually assesses country-level factors that most strongly predict COVID-19 deaths. The answer?

Not pandemic preparedness. Not government. It was interpersonal trust—a measure of how much people think they can trust another citizen who they don’t already know. In other words, public health worked better in high-trust countries.

We cannot have one group trust public health and another not.

This is not how viruses work.

Infectious diseases violate the assumption of independence—what one person does directly impacts the person next to them.

This is unlike cancer or diabetes, for example. Everyone has to be against a virus, or the virus thrives.

Perhaps most concerning is that this isn’t going to be our last pandemic. Since the 1918 flu, we’ve seen diseases emerge faster and faster. Public health also touches on our daily lives beyond infectious diseases: what we eat, social problems, gun violence, and all other acute and chronic medical problems. We need the trust of the community to move the needle for any of these.

What to do?

As the field of public health copes, self-reflects, and digests the past three years and weighs how to build for a better future, we have to make it our goal, our opportunity, to improve trust.

As one scientist said, “You earn public confidence in small drops and you [lose] it in buckets.”

Bottom-up engagement is absolutely necessary. We need to enter conversations with humility.

A conversation about false dichotomies (lock down vs. throwing caution to the wind) is necessary.

A conversation about disease vs. the needs of a community is necessary.

An honest conversation on what we (CDC, state epi, local epi, leaders, communicators) got wrong, got right, and why.

What does this look like? I have a few ideas:

1. Listening sessions. Not hearing and not telling, but listening to people and trusted messengers who are not in “our world.” Bringing them into the solution. It will be painful. It will be time consuming. But it has to be done.
2. A COVID-19 commission that is congressionally mandated, like the 9/11 commission. There is text in the PREVENT Act, but it’s not clear if PREVENT will pass.
3. Preparation for the future. Putting communication at the center of pandemic preparedness. This is still not being done. Building capacity for effective scientific communication needs to be a core of our national strategy. As I’ve written before, a lot needs to be done in this area.

I’m sure there are more and even better ways. And I would love to hear your thoughts in the comments. But the fact of the matter is there is no one solution.

And this is going to take a whole lot of time.

Bottom line

We need to understand why five words in a Tweet carry so much weight in public health and threaten our entire profession. Will trust in science survive the pandemic? 

Maybe. It depends on what we, as a field, do next.

If we don’t win hearts and minds, we won’t win against this virus or the next. Trust is key in public health.

Our scientific work depends on it. Our health depends on it. Our lives depend on it. Now everyone needs to act like it.

That includes, you, Mr. Musk.

(Editor’s Note: Locally, on Sunday December 11 in Westchester County, 299 persons tested positive to start the week of covid surveillance. Rockland County had 72 new cases. Orange County, 56, Dutchess, 42 and Putnam County 37, Ulster, 17. The Mid-Hudson Region saw 540 person test positive for covid of 9,863 Lab-verified tests an infection rate of 5%. Nassau County and Suffolk County reported 1,158. Of 19,797 tested in those 9 counties (Mid-Hudson and Nassau and Suffolk) there were 1,678 positives in one day an infection rate of 8% . New York City reported 2,376 new cases. )

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WPCNR COUNTY CLARION-LEDGER. From the Westchester County Department of Communications. December 13, 2022:

Watch the Budget Signing Here: https://www.youtube.com/watch?v=5NlQ3grEN7E

Westchester County Executive George Latimer signed his 2023 Westchester County Budget, cutting the County Property Tax Levy by $6 million dollars, flanked by members of the Westchester County Departments of Emergency Services, Corrections, Probation and Public Safety. The Budget was passed by the County Board of Legislators earlier in the day, bipartisan 17-0.

Latimer said:“I am signing this budget today and thinking of all the families who are preparing for the holidays – this budget is for them. We have cut taxes again and have done so while also expanding the programs and services they have come to depend on. I am proud of this budget, and our collaboration with the Board of Legislators; this is what honest and fair governing is, that is who we are as an administration and as a County.”

The total budget is $2.365 billion and includes Latimer’s fourth County property tax cut in a row. 

Editor’s Note: The 2022 County Budget was 2.2 Billion. The new 2023 budget increases spending 9% to 2.4 billion. The inflation rate announced today by the U.S. government for the first 11 months of 2022 was 7.3%. If the budget continues on this trend of increasing at 9% the budget will exceed $3 Billion in 2026.

Closing 2022 with projected $65.9 million operating surplus

No borrowing for tax certs

No borrowing for pension

No use of fund balance

2023 Budget contains no borrowing or one-shots

No borrowing for tax certs

No use of fund balance

No borrowing for cash flow

County Board of Legislators Chairwoman Catherine Borgia: “Westchester County is stronger and in a better state financially, and we are paying it forward to our residents. We’ve prioritized meaningful investments in areas that affect our constituents every day. Parents receiving subsidies can now pay less out of pocket to afford better quality childcare. We’re closing the digital divide by expanding internet access throughout the County. We’ve increased funding for community-based organizations providing services directly to those who need them. I am excited for all that we will accomplish in 2023 through mutual commitment and collaboration with the County Executive’s Office.”

The 2023 Budget funds the Departments of Corrections, Public Safety, Probation and Emergency Services at the highest levels in Westchester County history:

·         Correction $156.6 million

·         Public Safety $59.1 million

·         Probation $50.2 million

·         Department of Emergency Services $13 million

Acting Public Safety Commissioner Terrance Raynor said: “I am pleased and proud to stand with County Executive Latimer as he signs a budget that not only fully funds our Department, but exceeds where we were last year. The 2023 Budget enables us to provide the critical law enforcement services that the people of Westchester expect and deserve.”

The County is also focusing on food assistance, the Budget has $2 million in funding for Feeding Westchester and food pantries around the County.  Additionally, for Child Care, the Budget reduces the parent share from 27% in 2018 to 5% in 2023. 

Economic Development accounts for $6 million in the 2023 Operating Budget, with a focus on the Life Sciences, Tourism and Healthcare Sectors. This includes $1.4 million for the Downtown Improvement Grant (DIG) Program.

Economic Development Director Bridget Gibbons said: “The County Executive’s consistent investment in economic development to support our existing businesses and inspire the launch of new businesses in Westchester creates a business friendly environment in the County. Life sciences companies, advanced manufacturing companies, tech startups and others are thriving here, and we are proud to provide training, education and other resources to support them.”

The Budget allots $218.7 million for the County Health Department, that includes $1 million for maternal mortality.  Additionally, the budget is expanding funding to Federally Qualified Health Centers/Neighborhood Health Centers by $1 million bringing the total to $3 million.

The 2023 Budget has $17.2 million for the Department of Community Mental Health (DCMH), specifically the Project Alliance Mobile Crisis Response Team, $6.1 million for Crisis Network and 988 Suicide Crisis Lifeline, $565,000 for Opioid Response and Overdose Prevention Initiative and $737,892 Early Childhood Mental Health Services.

DCMH Commissioner Michael Orth said: “Through County Executive Latimer and the Board of Legislators’ ongoing commitment to serving the people of Westchester County, they have made a statement that mental health matters. They have made a statement that addiction and co-occurring disorder need attention. And, they have told all of us here in the County that we matter.”

The Budget has $1.3 million for the Human Rights Commission, money that will be used to fund an additional investigator.

Youth Bureau funding is $4.7 million dollars in the Budget, including $3.1 million for Invest in Kids and funding for new programs based on the youth needs assessment.

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THIS WEEK EVERY WEEK ON WHITE PLAINS WEEK

SINCE 2001 A.D.