Vaccine supply isn’t the long term problem – it’s the lack of community connections

It’s been exceptionally hard to get public health concerns about distribution heard over the din of people who work in hospitals assuring everyone that the issue is supply. That’s because that is what they see, especially when housing super cold storage for the two available vaccines. But, that is just the first step..for anything that happens outside of the hospital. For public health, all the work is the invisible parts after the storage.

The truth is, the short term limitation is supply. The long term problem is where the rubber meets the road, and that, my friends, is a public health infrastructure issue.

Vaccine distribution long game is going to be infrastructure. This linked article from Harvard talks about the issue from someone who actually understands this, because she works in the community connections piece itself.

“The biggest problem right now is the state’s lack of engagement with the communities that have been experiencing disproportionately high rates of COVID-19—for the most part, low-income communities of color and immigrants. We really need to think about how best to strengthen communication about vaccines among these groups. We need to equip community leaders with education about the vaccine, as well as information on how to register for vaccines, so they can share it with their networks. By community leaders, I mean churches, elder-serving organizations, and grassroots groups like the Black Boston COVID-19 Coalition. We will not be able to overcome the legacy of mistrust of our government and medical institutions overnight, but engaging these community leaders is an essential first step that I wish had been part of the state’s strategy from the start.”

This is their concern in Massachusetts. Let me tell you, if you don’t know, that Massachusetts is well set up, because of their public health funding, resources of top universities with loads of experts, and connections between hospitals and universities in medicine, research and public health. There are very few states that have the funding they do. It’s not all blue states, I keep hearing people try to push this. People throw out CA as if it’s some bastion of public health. It’s not. It suffers from extreme issues and difficulties given its size and variety of climes, it’s immigration issues and both multiple urban densities as well as wide swaths of rural.

The states with great infrastructure and funding (Better than most anyway) are Minnesota, Michigan, Massachusetts, Washington, and on down from there. These also have the top schools in public health in our country.

So what does this mean? It means that, regardless of supply issues, the main problem will be what other states, those that do not have the investment in connecting communities to state resources and experts, are going to do. It cannot be created out of thin air by National Guard or loads of money. It requires engagement from communities with state and local health – that is what creates trust and gets minority communities involved in accepting vaccines.

This is fundamentally an infrastructure issue, and it will especially affect states with poor connections to local low-income and minority communities, where state health departments don’t have lots of grant funding to create those public health programs throughout their states to connect with groups in need. They don’t get those big grants because they don’t have a ton of expertise at the state health departments to manage these big grants. So states like Indiana, Mississippi, Alabama, just continue to land at the bottom in rankings of metrics of public health and wellbeing.

We have to start admitting this, and stop allowing those who live and breathe hospital or research to dominate the discussion of what this will look like. Frankly, they have no idea what it takes to do anything in these communities. It takes work, and lots of coordination most states don’t have time or connections to make, in order to build trust, to get Black and Latino people to want to come out to a vaccination clinic that may require them to find transportation and take time off work (these clinics that only go 9-4 in largely white suburbs nowhere near a bus line are killing me, this is not equal access).

The people who need these vaccines are not getting them right now. The small portion going into arms of non white people is not acceptable. The vaccine hesitancy is real, but so is the major obstacle to getting the vaccine into arms, and that is a state coordinated program in minority communities. It requires creating, staffing, organizing and orchestrating making mobile clinics happen. It requires partnering with whatever available community transportation is there to go out and drive people to a clinic. It requires residents to use connections with local barbershops and religious groups to advocate for their neighbors to go ahead and get the vaccine. It requires it to happen from the inside and be coordinated from the outside, and those relationships just are not nearly as readily available as people think.

Community health is hard. There is a reason people like me do this work for very little pay, though, and that is because when you finally create something that gets to people, it makes a huge difference. And you get to see it and be a part of something bigger than yourself, and sometimes you get to meet the people it helps. Every program matters. But every program takes monumental efforts to create. It’s why so few of us remain in state and local public health. It’s so so hard and it’s underfunded.

So please, for the love, community health work experience really should be your main resource for information about what this will look like. Talk to the community agencies, talk to your local public health friends, talk to the program managers at the state health department. Ask the people who do the hard work on the ground.

If only the media would do that perspective some justice by actually interviewing real public health workers about public health.

This is going to take some time and there are going to be many many bumps in the road, especially if we want to get to 85% vaccination coverage. It’s in the interests of everyone to get all communities covered, but it’s not solely fixed by federal intervention. That will help, but it won’t solve it. We need connections in communities. If you are connected, reach out to people at your local health department to work together to create vaccine clinics in places where minority communities can access them. If you are a religious leader, reach out. If you are a well-connected leader in your community, reach out. We need all the community help we can get. So also volunteer. Myself and a friend are going out to volunteer this weekend to give vaccines and I couldn’t be happier to be able to do something.

But even if you aren’t a healthcare professional, they need helpers. They need people to check folks in and manage traffic. Maybe there are possibilities of helping Connect the clinics to those who are shut in. Maybe you could be a translator. Did you know Indiana has a huge Burmese population? Also, always in need of Arabic translators. There are things you can do to serve your own communities, but you have to start by digging to find your local health department. See what you can do!

Please get engaged. This effort will be so much more successful if everyone tries to participate, to get community acceptance up, to help in whatever way you can. We can’t do this from a federal level. It’s got to be grass roots if we want it to reach everyone.

Take care of each other. This doesn’t have to be passive, you can help in your own communities. And please, make it sustainable. Don’t just do one shift, make it weekly if you are able. Let’s make sure we can make this work, even if our system isn’t really set up well for this.

Novovax and some population health thoughts on implications for effectiveness in the real world

This STAT news article describes the Novovax vaccine data in the company’s press release.

Remember, we don’t have much of the data at this point. But the read was a good one and introduced some good points to think about. Namely, let’s remember that how these vaccines work will determine how they are affected by the new variants.

But I caution those folks pointing to insanely high efficacy in a clinical trial (like Moderna and Pfizer) to remember that actual effectiveness in real life is often lower. And it bears mentioning that those now coming out have had the variants in their data analysis, and circulation now is different than when the first two mRNA vaccines came out.

Listen, we aren’t used to having vaccines be developed during a pandemic, but the need for them is strong, we need any vaccine that offers protection at a reasonable level against a mutating virus that is potentially going to require boosters.

An added note, vaccines work and when more folks are immunized, they will work better, and at this point, we need shots in arms that offer protection. The longer we go with lots of unvaccinated folks out there, the more likely we are to see mutations that affect transmissibility and severity. Here is a Great look at issues of efficacy and how those will be difficult to compare in one trial vs another. In addition, the effectiveness in real life, with the myriad of ongoing factors in population uptake and mutations, will simply not reflect the efficacy found in trials. Let’s not focus on comparisons of effective vaccines, but let’s roll them all out to decrease the likelihood of mutations.

I am not one who will be concerned about any of those with efficacy in the 80s or even 70s. The efficacy will likely drop in real life situations, You can read a quick piece on that here. Very few vaccines remain as high as 90% in effectiveness, the flu is only 40%-60% effective and that still makes a huge impact in population health. I get my flu shot annually because I have comorbidities and I want to reduce my risk of severe disease if I do get the flu. Because I’ve had pneumonia and I’ve been in the hospital on and off for a year and a half due to autoimmune disease. I will take my 40-60% effective shot HAPPILY every year. If it reduces my chances of ending up sick as hell, I’m in. So if it’s over 60%? I’m taking it. If I have a choice, sure maybe I’d sit there and have some academic discussions about it…but honestly? I went into boots-on-the-ground public health intentionally. I made the choice to not pursue a PhD in order to not work myself out of a community health job. Many of us chose to do the hard program work because that is where we can see the change. Perfect cannot be the enemy of good here. We create so many programs in public health around much lower uptake and effectiveness because the blight of poverty and inequity carries such a burden to the health of our communities. Same here. I’ll take it happily.

So, there it is. I’m grateful for effective vaccines, even with efficacy in the 60s.

CDC evaluating school spread

This story came out today. Welcome news! Now, we need to put it into context.

IF schools do the right things, schools can minimize transmission…they can transmit at the rate of the community, and not contribute to increased rates over community rates. Think about that. When your community has a positivity of 15%, your school can as well. This piece is becoming clearer: namely that you can’t keep community spread out of schools. But they may not contribute to increased spread IF THEY MITIGATE. Those of us who have been in and dealt with school systems who don’t are really harping on this. Because if you want to keep kids in, you have to distance, and you have to strictly cohort, in addition to masking and handwashing. That means no mixing classes in cafeterias, kids must be eating in classrooms, staggering passing periods or keeping kids in one place and having teachers move.

But if they actually put in place real mitigation, they can limit it.

Here’s the actual Publication in JAMA. Let’s call out that they don’t describe subgroup analyses. Hybrid with 3 kids in person vs 30 kids in person should not be analyzed together for tendency to increase spread, since spacing and masking and other factors will differ within that one category of hybrid. So let’s be careful at how far we take these studies. And I think they know this, because they do finally call it out in the last few paragraphs. It’s a hard call, but schools before everything else is what they are saying here.

“Decisions made today can help ensure safe operation of schools and provide critical services to children and adolescents in the US. Some of these decisions may be difficult. They include a commitment to implement community-based policies that reduce transmission when SARS-CoV-2 incidence is high (eg, by restricting indoor dining at restaurants), and school-based policies to postpone school-related activities that can increase risk of in-school transmission (eg, indoor sports practice or competition). “

So, without reducing community transmission, we won’t be able to ensure safe schools. We can’t have sports and school at the same time. Maybe indoor cheerleading championships aren’t great for spread in Indy. Maybe March Madness isn’t great if we want kids in schools. That’s what CDC is saying here.

CDC updated some guidance to schools this week. I encourage everyone, but especially school administrators, to read it. There are good qualifications and recommendations. I sure hope more will come out in toolkit form that is far better than the useless vague stuff put out in July and August.

And also, please, for the love of God, don’t blindly believe all is fine when you haven’t heard anything from your school on this. It depends on contact tracing and without clear guidance to schools on this, in many places I continue to be mortified at the absolutely nonexistent tracing that happens. Remember, we can’t see the asymptomatic spread, and kids with mild or no symptoms are transmitting. Ask questions of your schools, ensure you have the information you need to feel empowered to send your kids. Really. It’s your right to know.

Day 1 of a new era

Take a look at the new CDC website!

Transparency.

Dr. Walensky is a welcome change to leadership here. The day she was announced as the new director, she promised she would never lie to us. Importantly, nothing in her background would lead us to expect anything but integrity and science first. A far cry from the former CDC director Redfield, who had been embroiled in controversial HIV vaccination research which you can read about here.

This is what my page has been about. So many of us in public health have been horrified at the lack of leadership and flat out misinformation that came out of our top health agencies over the last few years, but most especially this last year.

The CDC site will be changing. So much will be changing. I hold out hope that a federal response will be as successful as we need it to, with the healthy dose of reality I am now notorious for providing: that state public health infrastructure and relationships are where the rubber hits the road here. And it’s going to be bumpy, and it’s going to have some major potholes. We just have to be prepared and warn folks, so expectations are based on what is actually achievable. Only those of us in public health can share this perspective, so I encourage you to talk with your local and state public health friends. Academic and hospital lenses are useful, but this is not their lane. Those of us with this experience know the history of how often federal funds are thrown at states in other situations and responses like H1N1, and how often these are not used or misused or redistributed at the state level.

This gets back to the major lesson for everyone about our public health infrastructure in this country: It all depends on where you live.

Biden’s vaccine plan depends on your local health infrastructure

Gotta say, at the first whiff of Biden’s new approach, I was like YEAH! And then 0.03 seconds later, I slapped myself reallll damn hard upside the head.

Listen. Leana Wen said it best here. Doing this really involves a few issues.

1) Supply. How do we guarantee 2nd doses? We can invoke the Defense Production Act but by no means is that a guarantee that we’ll have the doses or have them distributed.

2) Public health infrastructure in America is about the same, sometimes worse, than middle income and far less developed countries. We can have this stuff churned out per #1 above, but where the hell is it going to go? It requires cold storage, it requires organization and state and local health to get a hell of a lot more funding to be able to handle storing, distributing, managing dose counts and follow ups. Guys, we can’t even manage 30k 80 yr olds signing up without the really poor IT infrastructure showing itself in all its glory. This is a bad idea in most states, and a fully atrocious one in ours.

3). Scientifically, we just don’t have any evidence to back up saying 1 dose is fine, or pushing out the 2nd dose could be fine. We don’t have data on this. We would be holding a national experiment here, and that should scare you all a little bit. We need to know what we know before we go all nuclear on ideas that can have an impact on lives, such as leaving people partially immunized or potentially allowing virus to alter and mutate more efficiently. We don’t do things like this in science, see #4.

4) Ethics. We were told the safety and efficacy of this vaccine in a controlled, clinical trial environment. This almost never turns out to be real-world effectiveness, which is lower when in…well…reality. So, we’d be seriously compromising trust in future scientific endeavors if we said “no I know we said it was safe and good at that level and that you came back for a 2nd dose, causing great sacrifice to arrange transportation etc, but we want to do this and we’ll do it and see what happens to these other poor saps”. This might leave a lot of us poor saps trying to figure out if we will get a second dose, since after all, isn’t that what we agreed to, what the “numbers” are based on?

It might be much harder to really ever say what the efficacy is at 1 dose once it’s out and about in the real world, mixed in with 2 doser folks. We can do some prospective studies, but we are in the thick of the transmission now, and that level of transmission really does change a lot about effectiveness of vaccines. When you are completely covered in it and your community has it coming out of its pores like here, then those vaccines can’t work as well. Your exposure is just really high. It’s not like measles, with very low numbers of actual virus floating around. That’s what herd immunity does, it protects us from it, making it impossible for it to spread. When everyone has some glorious immunity, it protects even people who can’t get the vaccine or choose not to (up to a point).

I think it’s exciting but I think we need to see the details on the logistics of the rollout. Like so many other of my posts, you’re gonna see my public health first approach and I’m going to say that a vaccine is no good if we don’t have the program to get it into arms. That was missing nationally and definitely not robust here in our state.

We already know that our public health system is a disaster, and it’s just far worse in our state than most. You can thank our governors for that, since they have a history of poaching funding for pet projects. Yep, federally our infrastructure is really bad. But in some states, and then even more regionally, the infrastructure can be nonexistent. I’m really worried about our rural communities in this scenario. The inequalities in wealth and healthcare in these areas are significant barriers, and it has driven the economic issues and the political divides in this country. We need to be able to take care of rural people as much as urban environments. Yes, they are totally different in many ways, but people are equally deserving of fair and equitable vaccine distribution. But if your small rural healthcare facilities have gone bankrupt and closed their doors as so many of them have in the last 20 years, you already will have a much harder time accessing a vaccine requiring this kind of storage. Many rural local health departments won’t have these capabilities either. This matters. These people matter.

We need to be extremely vigilant about this in our public health work moving forward, and so do our local, state and federal governments. Maybe we can start opening up the vaccines by prioritizing BOTH the old and the people we keep throwing to the wolves without appropriate PPE, like Minnesota is doing. Want an economic recovery? Get those teachers vaccinated so we can get those kids back in school.

Love you all. Sorry for delays in communication, trying for more of a balance in life, less social media, and actually absolutely feeling the difference. Also, my new community rocks and people have been more welcoming than I even have words for. I don’t think they all know my job or about this page, though some definitely do, so I think it’s safe to say they just are incredibly kind people who bring care packages and reach out to go on walks. Mental health is important and sometimes you have to make big life changes to get to it. This was absolutely the hardest thing to uproot the family again, but also already the absolute best choice ever. When your kids have been moved around as much as mine, it takes a toll. It also tends to make them more resilient. So when we were midway through day 3, and my eldest threw her arms around me and said “Yes, mom! This is awesome!”, well, that just made my mom heart sing. It’s everything to feel settled already, even with boxes. Though I’m about 2/3 unpacked already. #movedtoomanytimes

Vaccine rollout feel like a mess? Yeah, it sure is. And it is worse in poor states like ours.

I am so unbelievably happy to see SOMETHING to address the systemic issues in public health in our very poorly funded state.

See this just coming out of the Fairbanks school of public health

It’s been part of the struggle in decision making at the state level:

*extremely poor funding

*no strong public health advisory board

*no strong school of public health because ours is young (and it goes hand in hand with an actual solid public health infrastructure statewide, which is missing here)

*no comprehensive community- wide advisory council on vaccine distribution, as states like Massachusetts convene.

The piece above is awesome. Here is a snippet of what is missing and has greatly affected our abilities to respond to the pandemic.

“Further, Indiana’s communities receive less public health funding compared to neighboring states, companion states, or exemplar states. Funding for local public health departments
(LHDs), where many of the essential, community-facing public health activities are conducted, is typically shared across federal, state, and local sources with the average US LHD receiving a quarter of its funding from local funds. However, Indiana’s LHDs rely on local sources for the majority of their budgets, unlike most other US communities that rely equally on state and federal (passthrough) funding in addition to local funding.
This ensures that less resourced communities that likely have a greater need for the protection and preventive services public health provides also have less funding and less capacity to ensure that they receive them. Although there is value in having direct local connections in every county, the current structure ensures that many of the 94 LHDs are able to provide only a fraction of the necessary public health services and expertise that should be available to all communities. Epidemiologic expertise, data analytics to inform education and services relevant to the needs of communities, emergency preparedness capabilities, and an information technology infrastructure that allows for an efficient and effective system are skills and tools that are not present in many of Indiana’s local settings. This missing expertise and resources translates to paper-based reporting systems and delays in routine outbreak identification for diseases like syphilis and HIV – triggers that should alert officials about acute crises earlier rather than later. It also means that public health is often not factored into local policymaking or community decisions. While it may be difficult to imagine, during the early response to the COVID-19 pandemic, there were LHDs in Indiana that literally closed their doors and were not participating in the response or available to their communities. It cannot be more obvious that the public health system is not functioning as a system when LHDs are not seamlessly plugged into a statewide response to a pandemic.”

Our vaccine distribution is a mess. There is no way around it. The state health department is doing what it does, which is the best it can but likely without significant advice from experts who actually have spent their careers in these areas, or who have ties to those who have in previous federal pandemic responses, because we just don’t have many here in our state. We don’t have expertise at our state health department. That benefit comes with funding and a strong connection to Schools of Public Health. We also don’t have strong community connections, and that’s a pretty significant drawback to trust in anything coming out of the state, especially in communities of color and in those living in poverty, which are the communities we most need to reach.

We have to do a better job in Indiana overall. The rollout has been painful, it has everywhere. But, it is significantly worse in poorly prepared states like ours.

But what I think would make the most sense breaks down into what your goal is.

If it’s to stop transmission, you aim at the areas where people are forced together in congregate settings like jails and nursing homes, you aim at essential workers (and teachers were magically put in this category in order to push them to work and yet they are no longer being prioritized and that chaps my ass for sure). You aim at high risk hospital workers…ALL hospital workers. That includes CNAs and environmental and dietary. They are surrounded by it too.

If your goal is to protect hospitals, which is what this governor has signaled with the highly questionable pause on elective surgeries ( while doing nothing politically to stop the community transmission and thus the tsunami building and crashing over our hospitals), then you aim at the significant illness and deaths. Then it makes sense to prioritize elderly over non-hospital essential workers.

In reality, it should be happening light years faster so that we don’t have these long phases, so it shouldn’t make a huge difference. So that we don’t feel this so heavily. Minnesota is vaccinating nursing homes and healthcare first, then 75+ and frontline essential workers at the same time. Testing is widely available because Mayo helped prioritize it from the start.

States with solid public health infrastructure and relationships have a better shot at rolling things out. Every place has its issues, but some have the deck stacked against them from the start. We just didn’t have the same resources to mount a public health response from the get go. And we need to fix this in the future. We absolutely shouldn’t let this pass, and go back to the status quo. Even if you don’t care about all the other things we do that provide you with clean water and air and protect against a myriad of ills, you have to understand that another pandemic will be coming. We have to do better.

But. Federal distribution is a mess, state planning is far from robust, and we have a lot of deaths. Of people of all ages, but yes it is worse in the elderly. My own mom is 69, and desperately in need of this. She lives alone, she needs more help, and I can’t even see her with our daily exposure. She can’t have a surgery, or her therapies. For her and so many others, including anyone with any disability, this vaccine is a key to moving forward with the some of the most basic of human needs, movement and socialization, right down there near the foundation of Maslow’s Hierarchy.

So, for all of those asking me what I think, I think it’s a hard call. I’m not surprised at our state’s poor handling of it so far. I’m reminded of the poor funding, the lack of expertise, and the fumbled response by ISDH throughout this. Starting with a mess of a contact tracing attempt and followed by the far too quick reopening and absolute lack of action in response to increases in disease. And it’s something you may not understand if you haven’t worked in public health, if you have only seen this poorly funded state, if you don’t know how different it *could* be, how different it should be. If we lived in a state that prioritized public health and community AT ALL. Yes, the vulnerable ages are important, but so are our workers. So are our teachers. It’s a tough call, but not having a broad infrastructure and relationships with experts is a clear detriment to our public health baseline, and it’s made a pandemic impossible for our local health to manage.

I get prioritizing the older, more vulnerable. It’s not wrong, but it’s also not taking into account the community transmission. Which is what causes those hospitalizations and deaths, after all.

But man, we needed a better plan early on here. We have more vulnerable people in hospitals that aren’t being vaccinated. And with the sheer number of unused appointments at the vaccination sites for weeks up until now, we really needed an effort to work in those vulnerable communities to develop trust and a plan, so that those essential workers in hospitals who are environmental services and dietary did in fact learn about and understand why they should get the vaccine. There should have been an all out effort in consulting minority and religious groups to bring an advisory group together to build a network among barbers and pastors to help educate. Because these folks are exposed a whole lot and have a higher risk of significant morbidity/mortality from this.

But, we are now here. I don’t think it’s wrong to vaccinate elderly, but I think the poor planning federally and at the state level is more evidence of how much our state health department needs expertise and can’t get it in a state that doesn’t fund it. And how much support we really need from federal leadership, federal guidance.

So. There it is. It’s not great. I hope we can stop sitting on vaccines and actually move these older folks through quickly. They need it. I wish our teachers were going to get that benefit too, and certainly hope they will be included sooner rather than later. This plan seems fluid. We should keep our eye on it.

To schedule your grandparents vaccines (because this is hard for some folks in older age groups to manage) , go to http://ourshot.in.gov.

Rationing care in the field

See this wrecking piece in the LA Times About the choices paramedics and EMS now have to make, to save resources.

Reports of Community North without any available beds yesterday, and some seriously questionable ICU availability in downtown hospitals. Places on and off diversion.

You know, the whole argument about hospitalizations drives me bonkers, people continuing to watch the numbers and comparing to the summer as if this is a fair comparison. News flash, what we would normally have admitted people for is no longer anywhere near enough to get them a bed now. Admissions are down because our standard for admission is so much higher. This is rationing care, ok? That’s what that is. Also, our “capacity” is so so so much higher than it was in the spring because we’ve made units out of thin air, we’ve opened closed or unused wings, we’ve turned parts of EDs into ICUs. What we say we have in percent capacity now would be welllll over what it was pre-covid. And by the way, again, beds won’t save you without humans. We don’t have the staff. I’m getting reports of burnout by ICU docs, ICU nurses, nurses on PCUs. There is so much death. So let’s focus on that, on these humans, and not on the numbers that cannot be compared to the previous numbers as if it is apples to apples. It isn’t.

My soul hurts watching this. Much of the work I am proudest of was in the systems of care space, and that is largely about preventing this crumbling of the triage and transport.

I’m sorry, to all my EMS and hospital colleagues, to all my exhausted friends everywhere.

Vaccine roll out is too slow. Stay home, stay away from each other, and if you have glorious immunity, please know it doesn’t protect others, we don’t have data on whether it stops transmission. Please model good behavior. We have enough selfishness everywhere, this is not a free pass to change masking or distancing behavior. Be strong, and know the vast majority don’t have access right now, and the benefits to the society occur only once everyone has access. Get vaccinated! Send pics! Keep masking and distancing!

The Happiness Project

This series comes from a Harvard professor.

Yeah. This guy works in The Business school. Cool, right?

What’s weird is that I saw this post pop up on my feed today and remembered what I was doing last winter and early 2020, you know, the #beforetimes when up was up and things made sense. I would walk my dog for miles, and I’d listen to this one podcast, by this Yale professor Dr. Santos, about her project and course she taught, the most popular course in the history of Yale. It’s that big. The podcast is called The Happiness Lab. It’s amazing. Click here to link to the podcast.

I was about 4 episodes in last January. I listened to them multiple times, because back then I had allllllllllll this glorious time. Too much damn time.

I stopped working when we moved to Fishers from Minnesota. And it was horrendous. I was a person who spent my whole career juggling work and childcare and doing most of it solo while my husband got through training and then worked the many hours surgeons do. That never really ended. And that’s ok, it’s as it should be.

But my work was a big part of my identity. I enjoyed working on a team, leading and creating and analyzing and evaluating and making a difference in public health at a state level. It was my purpose. And then it was over when we moved.

I kind of went through some weird midlife crisis, I think. I was trying to figure out what the next step in my life should be. Should I get really serious about Pilates and yoga and train to be a teacher? Should I go back to school for a PhD (no, that was clearly a psychotic break moment)? Should I try to fit into this weird Stepford wife mold that exists where I live (another psychotic moment, clearly), or somehow find obsession with makeup and hair and plastic surgery and starvation “body building” bikini modeling somehow less revolting than I do?

Let’s not be ridiculous, I will never understand that side of this culture. It’s their thing, but it will never be my thing. I enjoy having a few extra because I’ve been on the other side with an ostomy and weighing 113 lbs and being 6 feet tall. No thanks. I’ll have some carbs and be a happy girl.

So it was eye opening to see the above linked article in The Atlantic today. It’s dated April. It’s another author with another course, and I’ll be going back to read this column and the subsequent other posts. But it brought it all back. And it reminded me of feeling lost here in Geist, from day one.

I remember walking my dog for miles, listening to Dr. Laurie Santos talking to me and feeling this total cognitive dissonance. What this place wants me to be so isn’t me, but how do I get to this place where those things that make me happy are front and center? How do I get away from all of this grossness?

Turns out it took a pandemic…boy did that draw it all into sharp relief. I’m still learning about all the pieces to happiness, but this page became my passion, my happiness project. And as things changed and I started working in the new health department, and then quit and hopefully held them accountable and built some education and activism into this community, this page changed right along with me.

Now, as I prepare to leave this place, which never felt like home, I feel like I’m taking this page on a new arc as well. So that while I continue to blow up the bullshit everywhere, I can also make some community for people who have woken up to a desire to be activists in the health and life of their communities.

This wasn’t where I thought I’d be a year ago. And in so many ways, it’s tragic. But it’s also life-giving to have learned something and built something during this incredibly horrendous period of our lives, something that brought people together l. It is a place where facts matter and science and data drive things, where concern for our neighbors makes our choices no longer just about us, and where that love for community can make us all better humans, together.

I’m finding this happiness thing in places I didn’t expect. I watched the movie “Soul” tonight. I maybe needed that to put pieces together, that my purpose is in many places and in doing many things and helping many people in many ways. No one could have planned this, and that’s when you know you’re really living. Life happens every day, but that’s where it matters, too. In every day things.

So, you know, take the bull by the horns, do the thing you’ve wondered about or dreamed about. Trust yourself and know that you might hate where you are, but damn you’ll still be there in a year unless you do something out of the ordinary, you’ve got to take that step. You might not even see it as a thing, but it might turn into a thing, and that matters too.

Pandemicing is hard. Find your happiness. It’s everywhere. Im sure you can find it with a mask and from 6+ feet away right now, too.

Oh goodie, school is about to start and you have to make choices about your kids. Again.

Click here for story on increased number of MIS-C at Riley

We don’t know if this is the new variant, we don’t know much about that and any differences it may or may not have to the previous in terms of severity in children. We do know it’s in two states. We can safely assume it’s likely everywhere by now, because of the great genomic research done in the UK on this variant.

We do know that some people listened to public health warnings to stay home this Christmas…but many, many did not. Huge lines at testing site at Fishers today.

I hoped we’d learned but honestly, a not small number of relatively otherwise really covid-conscious folks did gather this holiday and are wishing they hadn’t already. We are seeing the infections now, so in the next week or two we can expect to see it hit the hospitals, where we are already way over what max occupancy used to be in January of last year.

But, I’m considering sending my youngest to school in person (if school does go back) because of some needs we have identified since he’s been home. I am considering a few things, I thought I’d review here in case it’s helpful. It’s painful to even think about but I wanted to share what we are going through, as I always have, in hopes that you can see yourselves and know you aren’t alone.

1) Size of school. This school is twice the number of grades and half the size of our last elementary
2) Size of classes/ability to distance
3) Mitigation plans: ability to improve ventilation
4) Cohorting in theory vs actual practice. It doesn’t count if classes are mixing at lunch in a cafeteria
5) General approach of school/community to health and protecting each other
6) History of transparency of school building and administration
7) Involvement by students and teachers in process

It still feels like an impossible choice. I know so many of us have been facing these choices since August and the disease is far more prevalent now. So for those of us in this bind, I hear you and I see you. It’s all impossible.

I honestly wouldn’t trust some of the school systems in Indiana, while others are doing the best they can. But, in high transmission, schools cannot keep this out. We all know this. I hate the choices we are all forced into. I don’t want to send him, but if the school goes back, I just don’t want to end up as the only virtual kid again and the absolute hellscape that was. Then again, it sounds like that wouldn’t happen in his class, since it is like other inner city public schools nationally where more kids from at risk populations and multigenerational homes are staying virtual. It’s just something I wanted you to know I’m dealing with, too.

Because these choices don’t happen once. You get to relive them at every holiday and quarter and you get to feel like shit no matter which choice you make.

We can be mad at this, but we don’t tear each other apart, remember. It is a lack of federal response that has led us here. I have hope that much, at least, can be remedied soon.

Healthcare workers, PLEASE sign up for vaccine spots!

Hey y’all, I have to say that getting an email today from the licensing board was exciting. But, worrisome. Because while I am immune compromised and have worked bedside and at state and in local health, and my husband is in the hospital daily himself as a doc, I am not keen on jumping in front of anyone who provides care. So I wanted to make sure all those on the frontlines are getting the info they need.

If you take care of patients, go get the vaccine. You do NOT have to do it through your employer. In Indiana, if you are a licensed healthcare worker, you got an email today with a link attached. You can go to ANY site to get your shot.

For the last week, I’ve been seeing loads of spots left going unfilled. This concerns me. I want to know why so many are open, and here are some thoughts below. And a concern about this below that.

1) First, I want to make sure people know they can work for a place like Community and still go to IU Health sites for their vaccines. It’s open to anyone, any site for anyone providing care to patients. Just click the link in the email you received and search around the city. Pop in diff zip codes to view all options. Really. Get in there, it’s your turn!

2) I don’t know how many people are currently positive for covid, so this might be why some aren’t signing up.

3) I don’t know how many folks had covid in the last 3 months and assume they don’t need the vaccine because of temporary immunity. This is not wise, because temporary immunity varies and some don’t mount enough of a response. A vaccine will give you enough of a response to be protective, which is what all those clinical trials were for. You want to make sure you are protected, and no one really knows how long or how much that temp immunity is good for.

I also want to make sure to note that, while I hope they are not doing this, if people aren’t showing up for or aren’t filling appointments, I would *hope to God above* that we aren’t thawing too many doses and then having to waste if not used quickly.

Here are some screenshots of the availability in next two days around the city.

So, for the love, PLEASE don’t give away your shot! Get it. You deserve it, and all of us want to make sure you get first dibs.

Much love,

Eileen