The ‘petri chief’: Under the COVID-19 microscope

Fire departments are under the microscope, so we must follow the rules and provide accurate information

If you’ve never felt like a specimen in a petri dish before, take a step outside of your comfy office and look around.

The world is watching.

It’s watching how we respond to this challenge, how we manage our patients, how we share our messages, and so much more.

Uncertainty grows misinformation

I will freely admit that I initially didn’t understand all the hype over COVID-19 – back when we hadn’t started calling it that yet; it was still just a coronavirus in our lexicon. But I do now fully understand the meaning of novel-virus – a virus that has never before been experienced in human beings, meaning we have no immunity.

It’s clear that no one really knows what’s going to happen next with this virus – how far it will spread, how many lives it will claim. What we do know is that the virus’ impacts on the human anatomy bring this petri dish experiment to real life in our overrun ambulances and hospitals. Signs and symptoms initially seemed comparable to the flu, then some patients exhibited stomach pain from lower-lobe pneumonia, often with no other symptoms.

As the novel-virus began sweeping through the country, fire and EMS departments quickly became strained and stressed to the breaking point – and uncertain how to proceed, too. Quarantine confusion, misinformation and disinformation, and ignorance began feeding the frenzy on all sides – in the community, politically and from within.

Fire chiefs are accustomed to keeping the community informed and providing analysis about the services they provide. Fire and EMS community communications are decentralized and fairly transparent. Public Health, on the other hand, operates off of a strictly centralized communications model, used as a way to control public disinformation and hysteria.

There is no debate that controlling the message is very important in a public health emergency; however, the pre-internet model of centralized state-based communication, where there is a lack of quick “official” information, allows “keyboard epidemiologists” to take to social media, spreading an information fungus over the quality information that people need.

Fire and EMS chiefs need to work with both Emergency Management and Public Health officials to get the right information in the hands of the right people. But we have not yet achieved this goal. In fact, I didn’t speak to a single chief who felt comfortable with the information they had available to them from a health perspective during the first two weeks of the pandemic.

HIPAA confusion

HIPAA was originally and categorically intended to stop third-party information-sharing that would violate patient confidentiality. HIPAA gives the federal Health & Human Services (HHS) Office of Civil Rights wide-ranging authority and fine capability to enforce HIPAA regulations. Since its inception in 1997, there have been broad additions, however, the basics of information protection remain unchanged.

Well before this pandemic, there have been, and there are now, thorough misunderstandings and independent interpretations about the role of HIPAA in patient care, which makes the chief’s job exponentially more difficult. There needs to be a verified trust built between all of the public safety agencies, including health department and emergency management, to be able to share information that will keep transport units in service and service available to our communities.

Although the HHS Office of Civil Rights, which enforces HIPAA, has issued important guidance to medical facilities that should help clear the way for better information-sharing about COVID-19-infected patients with first responders, paramedics and EMS agencies, health departments were not uniformly recognizing the guidance – leading to frustration and confusion among first responders.

Thankfully, changes to the Ryan White Act have been written into the Federal Register to specifically include COVID-19 on the list of conditions requiring public health agencies to notify first responders. While COVID-19 was not specifically mentioned in the Ryan White Act, coronaviruses as a group are, which should have permitted healthcare providers and public health professionals to share COVID information with first responders from the outset. Unfortunately, like so much else in this uncertainty-filled experiment, first responders didn’t know what information they would receive, if any, about patient COVID-19 status. While it is nearly impossible to prove, it is highly likely that this delay resulted in multiple first responder infections and potential transmissions while information flow slowly evolved from the centralized stovepipe.

It’s time we get at the table and solve this issue so our healthcare workers and first responders understand what information can be shared.

The voice of reason: The chief and the CIO

Fire chiefs are used to being the voice of reason in a sea of chaos on emergency scenes. Properly trained and polished chiefs bring a calming influence that reassures their members and their communities.

Even though the fire and EMS services are on the front lines, fire chiefs generally can’t provide the medically focused reassurance their communities need in this moment of COVID-19 chaos. During this crisis, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, has filled the unofficial role of chief information officer.

“Chief” Fauci has done what fire chiefs usually do. He has provided realistic and reassuring briefings that the community can understand, even if it’s not always the most popular message. Unfortunately, often by the time we get to see Fauci on the evening news, the local information fungus has already manifested three or four other, non-official stories filled with misinformation.

There is so much we DON’T know about COVID-19, but we should continue to listen to the experts. For example, reinfection and immunity? Fauci says, “If it’s like every other virus we’ve studied, yes, you will build the immunity. However, it’s never been seen before, so we just don’t know.”

Fauci also reminds us: “There is no proven direct therapy for COVID-19. There are lots of clinical trials in play, several therapies that people THINK work, but no studies prove it.”

The future and our moral responsibility

We ALL must continue to do our part to see COVID-19 through. Handwashing, constantly cleansing the things you grab (doorknobs, rails, etc.), coughing/sneezing in the crook of your arm, and social distancing – all easy things to help reduce the spread.

We don’t understand the kinetics of the outbreak enough to determine when the curve will start coming down. Watching the other countries navigate the petri dish themselves suggests an eight-week duration to be on the downside.

The petri dish experiment we’re all in right now – ALL OF US – won’t last forever; however, it will likely grow more fungus before it’s all over. Control what you can control, manage the best you can manage, and seek help from others where needed.

It is clear that as a society, we haven’t yet mastered the “stay home” message part of the experiment. A friend of mine reminded me of President John F. Kennedy’s immortal words, “My fellow Americans, ask not what your country can do for you, ask what you can do for your country.”

Encourage everyone to stay home, separate yourselves from others, cleanse and cleanse again. It really is not that difficult – it’s not even courageous. It’s simply the right thing to do!

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