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Communicating about racial equity and COVID-19: Connecting data to context

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Reading Amanda Windle's briefing note I was struck by the question of trust and authority, particularly its absence, and the challenges that raises for crafting a communications strategy for The Simon Community and, by extension, other communities.

In watching the US Senate Panel question public health experts, the inherent distrust toward science and scientists by many republican senators and Lt Governors remains alarming. Conversely Goldman Sach's recently issued a report that wearing masks could save the US economy a 5% hit to the GDP. If this report has an impact, will it signal that economists are more trustworthy that public health officials, or simply that monetary value is the only value that counts in COVID communications. 

I am thinking about the interplay of these differing scales of authority and trust and how difficult it is for individuals, families and local communities and care groups to make sense of the competing messages in order to craft a reasonable, sensible strategy for negotiating risk.

The policy was the multi-tiered approach designed by New York City officials in the event of an Ebola case. This included designation of eight hospitals as being care centers for Ebola cases, teaching non-designated hospitals or care centers how to identify Ebola candidates, communication with transportation services (both EMS and non-EMS), and running unscheduled drills to practice handling scenes with an Ebola candidate (the example given was someone falling ill in a subway car). The poly aimed to standardize the approaches and protocols used when dealing with a possible Ebola case. It focused on minimizing the excessive risk to citizens, EMS personnel, and healthcare workers in the event of a patient with Ebola. The policy also sought to train and drill these protocols, including unscheduled calls (mentioned above) and continued inspections to ensure preparedness. The obvious end goal was to minimize the possibility of wide-spread infection, either through improper handling or failed detection of an Ebola case.

Several leaders from various New York State agencies convened to outline plans for this policy. This included Governor Andrew M Cuomo, State Health Commissioner Dr. Howard Zucker, State Police Superintendent Joseph D'Amico, Port Authority Executive Director Pat Foye, and representatives from health care centers and agencies around the state.

The policy applies to New York state citizens, health care workers, EMS personnel, and leadership within health care centers. Additionally, the policy has parts that effect transportation agencies and their employees. In many ways, due to Ebola's nature and the nature of New York as a major metropolitan area, these policies will also have a global effect.

As described by Governor Cuomo, Dallas was the first major US city to see an Ebola case. This, in turn, allowed New York leadership to have some semblance of what methods did or did not work when trying to contain the disease. Moreover, the policy was implemented in response to the major Ebola outbreaks occurring at this time. This included those within Africa, Europe, and cases seen in Dallas. Moreover, the policy follows the city's "Safe-than-sorry" methodology discussed by Governor Cuomo; he, along with other state and city leaders, believed assuming an Ebola outbreak would occur within the state would give them the best chance of mitigating its effects and minimizing disease spread.

The Ebola outbreak is, by its very definition, a matter of public health. The outbreak presented a danger to the global health community and resulting policies dealing with this epidemic were public health policies. That being said, the policy in place mostly served as a protocol mostly for agencies of New York in the event the epidemic spread. It focused on standardizing the practices of health, transport, and government agencies in the event of an outbreak; it did not focus on individuals already effected with the disease, but more so on preventing the spread of the epidemic. 

The policy does not make any specific mentions of how to deal with vulnerable populations. However, if one were to consider the nature of New York, it can be argued that the city's entire population is vulnerable to outbreak. As a hub of trade, finance, travel, and business, New York is at a considerably higher risk than a city without this high metropolitan activity. The policy does include measures on how to treat individuals who show signs and symptoms in public locations, but does not mandate testing or health checks for individuals involved in transport, travel, or who have limited access to health care (the homeless).

While there was criticism of the policy (see the Washington Post's rebuttal), the policy appeared to be well received until implementation of quarantine for returning health care workers. This, and the backlash, caused the policy to be revised and invited confusion about guidelines. Leaders may have lost political points by staying firm with their guidelines, but chose to revoke their initial decisions-- leading to confusion and worry in the general population. 

The policy specifically includes elements directed specifically at first responders. This includes testing of various scenarios that contain possible Ebola cases. One of the main highlights of the taped press conference seemed to be communication between main health centers deemed fit to treat Ebola and urgent care/transporting facilities. This includes knowledge of first responders about which of these facilities can handle Ebola cases and how to treat a scene with a possible Ebola patient.