Monkeypox in RI: First probable case identified

RI has detected its first probable case of monkeypox virus. The state Department of Health (RIDOH) said in a statement that a male patient in his thirties who resides in Providence County is hospitalized in good condition after testing positive for an orthopox virus, which is a genus of viruses that includes moneypox. The case is awaiting confirmation specifically for the monkeypox virus from the federal Centers for Disease Control and Prevention (CDC).

The RI case is believed to be a result of travel to Massachusetts, where according to the CDC one case was previously identified. RIDOH said they are conducting contact tracing to identify individuals who may have been exposed to the RI patient while he was infectious, and contacts will be monitored for three weeks after their last day of exposure.

Interim RIDOH Director James McDonald said in the statement, “While monkeypox is certainly a concern, the risk to Rhode Islanders remains low – even with this finding. Monkeypox is a known – and remains an exceedingly uncommon – disease in the United States. Fortunately, there is a vaccine for monkeypox that can be given before or after exposure to help prevent infection. RIDOH continues to engage in active case finding and we have been communicating the latest information with healthcare providers so that they have the information they need to help us ‘identify, isolate, and inform.’”

States with cases of monkeypox as of June 8, 2022. (Source: cdc.gov/poxvirus/monkeypox/response/2022/index.html)

As of yesterday (June 9), the CDC had confirmed only 40 monkeypox cases in the United States. Worldwide there have been 1,200 cases across 29 countries primarily in Western Europe, including the United Kingdom, Spain, Portugal, and Germany, although 100 were in Canada. RIDOH said, “While anyone who has been in close contact with a confirmed or suspected monkeypox case can acquire monkeypox, people who have recently traveled to a country where monkeypox has been reported or men who have sex with other men are currently at a higher risk for monkeypox exposure. It is important to avoid stigmatizing any groups that may be considered at higher risk of exposure to the disease.”

Because the risk of exposure is so low, precautionary vaccination against orthopox viruses is recommended by the CDC only for clinical laboratory workers or researchers handling animals susceptible to infection, but for anyone actually exposed “CDC recommends that the vaccine be given within 4 days from the date of exposure in order to prevent onset of the disease. If given between 4–14 days after the date of exposure, vaccination may reduce the symptoms of disease, but may not prevent the disease.”

Monkeypox and smallpox

Smallpox is another orthopox virus and until its eradication a half-century ago it killed about 30% of those infected. Monkeypox has a case-fatality rate of 3-6%, according to the World Health Organization (WHO), but there are two known variants commonly termed Central African and West African, the former about twice as deadly as the latter. Monkeypox typically causes death or severe injury through complications such as pneumonia, encephalitis, or sepsis, all highly amenable to effective treatment with modern healthcare, and death outside of Africa is extremely rare. Usually monkeypox patients recover on their own within two to four weeks.

It is believed those vaccinated against smallpox before routine vaccination for the general public ended in 1972 likely retain significant protection against monkeypox even decades later; the US military continued routine vaccination against smallpox until 1991. “Past data from Africa suggests that the smallpox vaccine is at least 85% effective in preventing monkeypox,” the CDC said, but also cautioned that “Smallpox vaccination can protect you from smallpox for about 3 to 5 years. After that time, its ability to protect you decreases.”

Monkeypox ways of infection and symptoms

Infection with monkeypox usually occurs either from direct contact with infected animals (blood, bodily fluids, or lesions), especially rodents, or from close contact with infected humans (respiratory secretions, skin lesions, or recently contaminated objects). “Transmission via droplet respiratory particles usually requires prolonged face-to-face contact, which puts health workers, household members and other close contacts of active cases at greater risk,” according to the WHO.

Monkeypox can spread “through contact with body fluids, monkeypox sores, or shared items (such as clothing and bedding) that have been contaminated with fluids or sores of a person with monkeypox. Monkeypox virus can also spread between people through respiratory droplets typically in a close setting, such as the same household or a healthcare setting. Common household disinfectants can kill the monkeypox virus,” RIDOH said. “Monkeypox is not known to spread easily among humans; transmission generally does not occur through casual contact. Human-to-human transmission occurs primarily through direct contact with body fluids, including the rash caused by monkeypox. Transmission might also occur through prolonged, close, face-to-face contact. The time from someone becoming infected to showing symptoms for monkeypox is usually 7−14 days but can range from 5−21 days. Infected people are not contagious before they show symptoms.”

“Symptoms of monkeypox include fever, headache, muscle aches, exhaustion, and swollen lymph nodes. Infected people develop a rash, often beginning on the face then spreading to other parts of the body, that turns into fluid-filled bumps (pox). These pox lesions eventually dry up, scab over, and fall off. The illness typically lasts 2−4 weeks. Currently, there is no proven, safe treatment for monkeypox, though the limited evidence available indicates that smallpox treatments may be useful. Most people recover with no treatment,” RIDOH said. “Anyone who has symptoms of monkeypox should call their healthcare provider before going to the office for an appointment. Let them know you are concerned about possible monkeypox infection so they can take precautions to ensure that others are not exposed.”

Ice is Better in Drinks Than On Injuries: How to handle a summertime burst of physical activity

Summer is here and it’s time for fun. The last thing you want to do is put yourself on the sidelines by getting injured early in the season. Dr. Michael Zola, a chiropractic physician on the East Side of Providence who has been in practice over 30 years, has some tips on how to stay in the game.

Cathren Housley (Motif): Are there any unusual problems this year due to the pandemic?

Dr. Zola: Masks were important in helping to control COVID-19 transmission, but people shouldn’t be doing strenuous activities with their masks on. We rebreathe the carbon dioxide that we are exhaling and when this goes back into the blood, it shifts the pH to become more acidic. This affects every other function in our bodies. People aren’t protecting themselves by using masks during exercise – when we’re outside in open space there is no danger of spreading COVID-19.

CH: What are the most common mistakes that people make early in the season?

Z: Going too aggressively at the beginning – if you take up where you left off last year, you’re overdoing it. If you’ve led a sedentary life over the cold months, you really need to start again as if recovering from an injury because you are, in fact, recovering from deconditioning. 

Extra weight, another common by-product of winter inactivity, can also make you more prone to injuries. There’s more stress on the feet, knees and hips, and the arch of the foot is more likely to collapse.

CH: Even the most careful exercise enthusiast can get unexpected injuries. What then?

Z: First – you don’t always know that you’ve injured yourself when you cause the actual injury. It can take a day or so before you realize that serious damage has set in. 

CH: How do we tell if there’s a serious problem?

Z: Look at the injury – is there rapid onset of swelling or bruising? That’s when you see a medical professional. You can walk off plain old sore muscles, but if the symptoms go on, there is a problem.

CH: What is the best immediate treatment after any injury?

Z: Make sure you stay hydrated. Then, ice is good in the initial stages of an injury, but you’re only going to apply it for 10 minutes at a time. This prevents cells that were injured from dying off too fast. Afterwards, soaking in Epsom salts dissolved in warm water can be very effective in promoting healing.

CH: What about getting back on track?

Z: The old way was “you get injured, you rest.” Now we know that activity gets your heart pumping and the immune system circulating through your entire body. This actually helps the healing process.

CH: But what if something is torn or broken and cannot be moved at first… how do you know when to start moving, and how much?

Z: If you need emergency medical care, afterwards it’s best to put yourself in the hands of a chiropractor, physical therapist or trainer.

CH: That brings up the question of soaring medical expenses. They do so many tests just figuring out what is wrong that you can end up going bankrupt from a sprained ankle.

Z: A faster and cheaper way to find out what’s wrong is to see a doctor of chiropractic medicine. You can get a faster diagnosis – and get out of pain sooner.

CH: How can we manage recovery on our own?

Z: If you’re ambulatory, you don’t want to rest completely, but it’s best to start with short intervals of activity. You are going to have to go by what your body tells you – do an activity and then see how you feel in a day or two. It can take that long to realize you’ve aggravated something more. 

CH: What about using medication to reduce inflammation?

Z: NSAIDs such as ibuprofen and acetaminophen can inflame the GI tract and cause other serious problems. They actually delay healing by keeping inflammation down. Inflammation is a natural part of healing. Whenever there is an injury, inflammation reaches a certain point, then begins to resolve. 

Pain has a purpose – it’s intended to warn us when there is a problem.

CH: What else can speed healing? 

Z: Lifestyle is the biggest deciding factor. You want to rebuild yourself with the best materials. When you’re sedentary and eat crappy food, you are building with sub-par materials at a much slower pace. 

CH: We usually don’t see how that impacts our health until we’re older.

Z: From about birth to 34, 35, people seem immortal. Professional athletes retire by then – they can’t recover from injuries quickly enough to stay competitive. But the time to think about prevention is when you are young. Once people have decades of abuse piled on, it’s much harder to change. That’s why holding onto good habits in your 30s and 40s is so important.

CH: Any last words of advice?

Z: Prevention is the best protection. A healthier lifestyle – good nutrition, stress management, quality sleep and movement – is health assurance you can afford.

Find out more about Dr. Zola at drmichaelzolaonline.com 

Additional COVID-19 vaccine booster dose: For everyone age 50+ and immunocompromised age 12+

Today, the US Food and Drug Administration (FDA) authorized and the US Centers for Disease Control and Prevention (CDC) recommended a second booster dose of mRNA COVID-19 vaccine (that is, either Pfizer-BioNTech or Moderna) for everyone age 50 and older at least four months after their prior booster dose, with a strong recommendation for everyone age 65 or older and for those age 50 and older with underlying medical conditions.

For those who are immunocompromised, an additional Pfizer-BioNTech vaccine booster dose is authorized for anyone age 12 and older and an additional Moderna vaccine booster dose is authorized for anyone age 18 and older, at least four months after their prior booster dose of any authorized vaccine.

At the option of the recipient, booster doses can be of a different brand as prior doses, for example following a Pfizer-BioNTech dose with a Moderna dose.

For persons who are younger than age 50 and are not immunocompromised, the recommendation of a single booster dose after a two-dose primary sequence remains unchanged. According to the FDA, a first booster dose provides significant and substantial protection against hospitalization and death, including against circulating variants such as Delta and Omicron, for most people, but data from Israel shows that a second booster is of value for those whose immune systems are less robust because of age or other reasons.

Separately, regardless of age every adult who received both a primary single dose and booster dose of Johnson and Johnson (Janssen) vaccine at least four months ago may now receive a second booster dose using an mRNA (Pfizer-BioNTech or Moderna) vaccine.

“Current evidence suggests some waning of protection over time against serious outcomes from COVID-19 in older and immunocompromised individuals. Based on an analysis of emerging data, a second booster dose of either the Pfizer-BioNTech or Moderna COVID-19 vaccine could help increase protection levels for these higher-risk individuals,” said Peter Marks, MD, PhD, director of the FDA’s Center for Biologics Evaluation and Research. “Additionally, the data show that an initial booster dose is critical in helping to protect all adults from the potentially severe outcomes of COVID-19. So, those who have not received their initial booster dose are strongly encouraged to do so.”

Marks of the FDA held a media briefing available on YouTube, and among other issues said that in coming months there may be a need for variant-specific vaccines but this is not yet known.

CDC Director Rochelle P. Walensky, MD, MPH, said, “Today, CDC expanded eligibility for an additional booster dose for certain individuals who may be at higher risk of severe outcomes from COVID-19. Boosters are safe, and people over the age of 50 can now get an additional booster four months after their prior dose to increase their protection further. This is especially important for those 65 and older and those 50 and older with underlying medical conditions that increase their risk for severe disease from COVID-19 as they are the most likely to benefit from receiving an additional booster dose at this time. CDC, in collaboration with FDA and our public health partners, will continue to evaluate the need for additional booster doses for all Americans.”

In response to an inquiry from Motif, the RI Department of Health (RIDOH) restated the new federal recommendation and said, “If you have questions about whether a second booster dose is right for you, talk to your healthcare provider.” RIDOH confirmed that the additional booster dose, which is identically formulated to primary doses, would be available from any state-run facility or private pharmacy from which vaccine is ordinarily available.

RI COVID-19 Test Standing Order: Allows direct billing insurance at pharmacies

Under a new standing order, every person in RI with either Medicaid or private health insurance should be able to pick up COVID-19 rapid antigen test (RAT) kits from any pharmacy without having to pay up-front.

Despite a federal government mandate that health insurers must cover up to eight kits per month for every covered individual, carriers instructed pharmacies to require up-front payment for which customers could seek reimbursement unless they had a prescription. This policy applied even to very low-income insured persons, including those on Medicaid, for whom the cash requirement and paperwork hassle are prohibitive.

Standing Order for All Rhode Island Pharmacies Over-the-Counter (OTC) Home COVID-19 Tests All Types of Home Kits

As we reported previously (“News Analysis – Failure on COVID-19 rapid testing availability: Insurers game the system”, by Michael Bilow, Feb 6, 2022), to solve this problem the federal Centers for Medicare and Medicaid Services (CMS) “recommended that states issue a standing order for pharmacies for tests, including over-the-counter tests, as opposed to requiring a prescription per person to alleviate beneficiary and provider burden.”

The RI Department of Health (RIDOH) in response to repeated inquiries from Motif said that such a standing order was under consideration, but finally advised that it had been issued. (Download it from motifri.com/wp-content/uploads/2022/03/RI-COVID-home-test-standing-order-f.pdf.) The order states: “Suzanne Bornschein, MD, being an actively licensed Rhode Island physician, shall serve as the prescribing physician for this standing order… The general public may visit a participating pharmacy on a walk-in basis to receive any type of OTC COVID-19 test kit, up to 8 tests per individual per month.” The protocol per the order is: “Individuals shall provide their insurance information and required patient demographics to the pharmacist/pharmacy staff and request that the test be billed to their health insurance company. The pharmacist/pharmacy shall enter Dr. Suzanne Bornschein M.D. as the prescribing provider when submitting the claim to the third-party insurance carrier.”

Families on the same insurance plan are eligible for RAT kits on an individual basis, so a family of four would be eligible for eight each, or 32 tests, per month.

Motif has received reports that many pharmacies are out of stock on RAT kits, but has been unable to determine the scope of the problem.

Medicare (as opposed to Medicaid) patients are not covered for RAT kits but are eligible for PCR tests.

In addition, every residential address in the US can order four more RAT kits for free, even if they have previously ordered an initial four tests, through an official government web page: covidtests.gov (which currently redirects to a site operated by the US Postal Service special.usps.com/testkits). Persons need enter only their name and shipping address to place a free order, and optionally can enter an e-mail address to be notified about order progress.

Get Into The Rhythm: How seasonal changes affect emotional ones

Spring is on its way! RI has been shivering under the icy breath of winter, but the days are growing longer and the earth is tilting on its axis. Soon, buds will be bursting into clouds of bright green and crocuses will be pushing their noses up through the snow. A great number of people are going to find themselves horny as hell – and there will also be those who instead become antsy, anorexic or unable to sleep. We may attribute all of those things to various random causes in our personal lives, but there is a vaster, more universal system at play here which governs humans, plants and animals alike.

As far back as the 18th century, researchers noticed that certain plants would open their leaves at sunrise and close them at sunset even in the absence of lighting cues. But it was not until 2017 that three U.S. biologists brought international attention to the underlying phenomena. Jeffrey C. Hall at the University of Maine, Michael Rosbash at Brandeis University and Michael W. Young at Rockefeller University shared the Nobel Prize in Medicine for their discoveries of the genetic and biomolecular mechanisms by which the cells of all living organisms mark the 24-hour cycle of day and night: circadian rhythms. It is now known that the circadian clock is involved in every piece of human physiology; it influences everything from emotions to endocrinology to metabolism.

So – what exactly is circadian rhythm?

Circadian rhythm is the 24-hour internal clock in our brain that regulates cycles of alertness and sleep by responding to changes in our environment. Our physiology and behavior are shaped, in essence, by the Earth’s rotation on its axis. For example, your body temperature rises just before dawn, enabling you to feel alert and ready to start the day; it drops again at night to help promote sleep. This biological circadian system has evolved to help humans adapt to changes in our environment. With its help, we can anticipate changes in radiation, temperature, and food availability. When your body clock is disrupted or thrown off balance by changes in sleep patterns, increasing or decreasing light exposure or other alterations in schedule, your natural circadian rhythms can go off kilter, leading to an astonishing array of symptoms and behaviors.

One such disruption is the coming of spring.

In animals, seasonal changes over the year trigger phenomena such as breeding, migration, and hibernation. In humans, these changes are more complex – reactions vary widely from individual to individual and some are more vulnerable than others. About 6% of Americans have symptoms severe enough to require medical treatment for seasonal affective disorder (SAD).

The primary instigator is a small endocrine gland in the brain called the pineal gland. The pineal secretes melatonin, which influences our sleep/wake cycles. The production of melatonin is drastically affected by available light – in the winter, we produce more of it, which can cause depression, fatigue, oversleeping, weight gain, and irritability. In the spring when available light increases, we can experience anxiety, weight loss, and insomnia. And, like the animals, we can be driven by an overwhelming urge to mate.

Motif spoke with Dr. Gene Jacobs, a Warwick-based clinical psychiatrist who sees the effect of seasonal change every year. He told us that patients with bi-polar disorder are particularly sensitive to the effects of light, and added: “the balls in a male’s scrotum raise or fall with temperature –  in winter, when cold, they retract more into body, and in summer, when hot, they drop away from body.”  

But that’s not all – disruptions in our circadian rhythms can accelerate, or even cause, medical conditions such as asthma, cardiovascular disease, hypertension, and neurological disorders. 

Considering the possible consequences, is there anything we can do to protect ourselves from potential repercussions? Fortunately – yes. 

• Get out of the house! Expose yourself to as much natural light as you can, right now. This decreases the shock to your system when daylight lengthens. 

• Get up out of your chair and start moving! Walking and exercising through the winter and early spring months helps to keep your immune system healthy while increasing sunlight exposure. This will help you contend with the pollen and viruses which hit as soon as the plants wake up. Wearing a good mask is protection against both.

• Stay hydrated – this is a good way to keep your system in balance. And eating a healthy, well-balanced diet helps you to be your best year-round. 

• Perhaps, as Alfred, Lord Tennyson wrote, “in Spring a young man’s fancy turns to thoughts of love.” But unprotected sex can turn into an STD or unwanted pregnancy. In case of sudden overwhelming lust – carry condoms!

News Analysis – Failure on COVID-19 rapid testing availability: Insurers game the system

A federal mandate issued by the Centers for Medicare and Medicaid Services (CMS) requires health insurers to either directly cover or indirectly reimburse each insured individual for up to eight at-home over-the-counter COVID-19 rapid antigen test (RAT) kits per month, up to $12 per test. Families on the same insurance plan are eligible for RAT kits on an individual basis, so a family of four would be eligible for eight each, or 32 tests, per month. (See “Free rapid COVID-19 tests available: US government web page, pharmacies”, by Michael Bilow, Jan 18, 2022.)

On its web page, CMS poses the question “Will I have to pay for my test up front?” and then answers it: “The Biden-Harris Administration is strongly incentivizing health plans and insurers to set up a network of convenient locations across the country such as pharmacies or retailers where people with private health coverage will be able to order online or walk in and pick up at-home over-the-counter COVID-19 tests for free, rather than going through the process of having to submit claims for reimbursement.”

In RI, at least, the program is completely failing to work as intended.

Our visits to major chain pharmacies, including CVS and Walgreens, confirmed according to the pharmacists on duty that RAT kits must be paid for up-front by the customer, unless filling a prescription from a health care provider, who can then seek reimbursement from their insurer – but a critical public policy goal of the mandate is to get kits into the hands of as many people as possible with the fewest obstacles. (Both CVS and Walgreens did not respond to our inquiries.) Especially in the case of patients insured by Medicaid, who are by definition poor, requiring up-front payment and then waiting for reimbursement is effectively prohibiting access to rapid tests.

Motif asked CMS about this situation, and we received a reply on Jan 21 from their spokesperson saying “As outlined in our State Health Official letter released on August 31, 2021, the American Rescue Plan Act of 2021 requires states to cover COVID-19 tests, including at home tests. As part of their utilization management, states are permitted to require a prescription for at home COVID-19 tests. Utilization management techniques, including possible prescription conditions, should not establish arbitrary barriers to accessing COVID-19 testing coverage, but could facilitate linking the reimbursement of a covered test to an eligible Medicaid or CHIP beneficiary.”

Acknowledging the obvious difference between COVID-19 test kits and ordinary drug prescriptions subject to “utilization management,” the spokesperson stated, “CMS has also recommended that states issue a standing order for pharmacies for tests, including over-the-counter tests, as opposed to requiring a prescription per person to alleviate beneficiary and provider burden. CMS continues to work closely with states as they operationalize coverage requirements and will provide any needed technical assistance.”

In other words, insurers including Medicaid are allowed to impose massive barriers to access, totally circumventing the public health goals of the CMS coverage mandate. As a practical matter, how many patients will go through the hassle of submitting in some cases multiple-page forms and supporting documentation to seek reimbursement of a $12 item? Even worse, although CMS prohibits Medicaid from assessing co-pay or passing other costs onto poor patients, those often most in need of access to rapid testing are precisely those most unable to pay up-front.

Has RI followed the CMS recommendation to issue a standing order that would function as a general prescription, allowing patients to charge RAT kits directly to insurers when picking them up from pharmacies instead of having to pay up-front and seek reimbursement? Motif asked that question of the RI Department of Health, and spokesman Joseph Wendelken replied on Jan 24, “We don’t have a standing order in place right now, but this is something we are actively evaluating.” That was two weeks ago.

What is RI waiting for?

Alexander-Scott not running for Congress: Former RI health director bows out of politics for now

“Pandemic Groundbreaker” Dr Nicole Alexander-Scott on the cover of Motif, May 2021.

Dr Nicole Alexander-Scott, who resigned from her post as director of the RI Department of Health a few weeks ago (“RI Health Director Alexander-Scott resigns: Led state’s COVID-19 response from the beginning”, by Michael Bilow, Jan 13, 2022), sent Motif a statement ending speculation that she would be a candidate for the open seat being vacated by Rep. James Langevin who said he will not run for re-election.

Other than today’s statement, she has given no public indications of the reasons for her resignation nor of her future plans.

Gov. Daniel McKee said at his press conference on Jan 27, “The doctor said she had ‘a window of opportunity’ in more than one meeting. I asked her to stay, each time it accelerated… She felt as though she had ‘a window of opportunity.’ That’s her words. My word was ‘stay.’ But if not, let us do a professional exit strategy.”

“I am writing to let you know that after taking the time to fully explore the real possibility of me running for the seat opening up in Rhode Island’s second congressional district, I have decided to not enter the race,” Alexander-Scott said in the statement. “It was an honor to be contacted and urged to run by so many fellow Rhode Islanders over the last few weeks. I gave serious consideration to running because I saw this as a unique opportunity to advocate for change on the national level on the issues that I have committed my career to: health, equity, and the need to give every person and every community an equal opportunity to thrive. I also gave running serious consideration because diversity in representation matters. While a person from any background or gender could make an exemplary congressperson, we need to work to ensure that the group of people we elect is reflective of all of the communities served.”

Alexander-Scott is among the most widely known and recognized persons of African-American heritage in RI, appearing with then-Gov. Gina Raimondo at live televised press conferences first daily and later weekly and bi-weekly with Gov. Daniel McKee. Motif featured her on the cover of its May 2021 issue on the theme of “pandemic groundbreakers.”

“While I will continue to be open to opportunities like this in the future, I remain as committed as ever to building strong, healthy and resilient communities in every ZIP code from any position I am blessed to serve in. I look forward to still advancing this critical work and having a strong impact on policies at a national level that will benefit the public’s health, as part of the next opportunity that I take on, in this unique moment,” she said in the statement. “Hopefully, all Rhode Islanders will join with me in making sure we invest in better communities for all families.”

Fair Weather Pedaling: Winter shouldn’t stop you from using your bike to commute

When that first snow falls in winter, many believe that’s the end of using a bike to get around until temperatures begin to rise again in the spring. Even many cyclists themselves fall for this narrative – snow and the cold are commonly listed as the main reasons to not hop on a bike. Yet, cycling in the winter is not only possible, but can be a lot of fun and a great way to get around.

“Biking is a great way to shake off the winter blues: the fresh air and physical activity help a lot,” says Jonesy Mann, Operations Director at AS220 in Providence and year-round bike commuter. “Biking when it’s snowing is really fun! Zooming through the flurries is exhilarating, and you don’t get wet. [It’s] way better than biking in the rain.”

This isn’t to say you shouldn’t be prepared if you want to commute by bike this winter. “Layers are key in cold weather. I start bundled up, and as my body heat builds I’ll shed the scarf and unzip my outer jacket,” says Mann. “To figure out how many layers to put on, I’ll look at the temperature and dress as if I’m going to take a brisk walk in the park.”

“Skinny racing-style tires don’t grab the road very well when it’s slick,” Mann adds. “Wider tires, especially knobby ones, make me feel much more stable when there’s ice and slush on the road. Adding fenders to your bike will keep your clothes dry as your wheels kick up water.”

Mann is hardly the only one who uses his bike to get around no matter what time of year: Biking during the colder months is actually more common than one might think. The Winter Cycling Federation, an international organization dedicated to making winter cycling more accessible, has many projects to promote the activity, including a winter bike-to-work campaign and an annual February Winter Cycling Congress that’s been taking place since 2013. While the 2022 conference was unfortunately postponed due to COVID-19 and the surge of the omicron variant, the Winter Cycling Federation is already preparing for its 2023 conference.

The main reason cycling in the winter can be difficult is not because of the cold or snow as many assume, but instead inadequate maintenance of bike infrastructure. 

“This is our first snow with our new bike lanes,” shares Susan Mocarski, referring to an early January storm. Mocarski is the founder and designer of Cleverhood, a local Providence company that designs waterproof athletic outerwear for biking, walking, and traveling in all weather. “Providence is new to all of this, it might take a little time for them to understand why it is important [to properly clear bike lanes].”

Oulu, Finland, for example, has far more intense winters than most major North American cities, yet cycling barely declines at all when winter rolls around due to the city’s dedicated and creative maintenance of its bike infrastructure. When bike lanes are given less consideration than car lanes in snowy weather, biking can be a lot more difficult. 

“We have to keep trying to make our local legislators and politicians see that roads are not only for cars but they are for people,” adds Mocarski. “People that are walking, that are waiting for buses, that are in wheelchairs or walkers, people that cycle…These people all pay taxes too and should be considered and included in our road plans.”

While it hasn’t stopped Mann, the maintenance of Providence bike infrastructure leaves room for improvement. “The protected bike lane on Olney Street is too narrow for Providence’s snow plows, so it essentially doesn’t exist for much of the winter. I don’t believe our bike trails get cleared either,” says Mann. “It would be nice to see the city invest in a special plow that can handle these narrower spaces. If the city really wants to support year-round bike commuting, then the Department of Public Works has to take the upkeep of bikeways as seriously as they do for cars.” 

If you are thinking about commuting by bike this winter, don’t let the snow or the cold put you off. If you know that where you’ll be biking will be clear and maintained, give it a try!  

McDonald named interim RIDOH director: Part of new transition team

Dr James McDonald, medical director of the RI Department of Health (RIDOH) since Feb 2012, has been named interim director following the resignation of Director Dr Nicole Alexander-Scott on Jan 13 and of Deputy Director Tom McCarthy on Jan 18, both resignations effective Feb 1, according to a statement issued this morning by the office of Gov. Daniel McKee. “Dr. McDonald will assume the day-to-day responsibilities of RIDOH director while the search for a permanent candidate continues,” the statement said.

Dr James McDonald of the RI Dept of Health and Dr Philip Chan of the medical school at Brown University (L-R), in a publicity photo for their podcast “Public Health Out Loud.”

McDonald will be familiar to many from his appearances standing in for Alexander-Scott to give her a break from the grueling daily press conference during the first months of the pandemic. He is board-certified in both pediatric and preventative medicine, and served as a medical officer with the US Navy including as director of health services for the Naval Health Clinic New England in Newport. In collaboration with Dr Philip Chan of the medical school at Brown University, he has produced a weekly podcast series “Public Health Out Loud” since Nov 2020. McDonald, known for self-deprecating humor, posed in a publicity photo back-to-back with Chan — who is a head taller. In an Aug 2021 on-air interview with WPRI Channel 12, McDonald hurled jelly beans around his office to demonstrate the ease of contagion from the Delta variant of the virus.

In addition to McDonald, McKee named three others to what he termed the “Health Transition Support Team.”

Ana Novais currently serves as assistant secretary of the Executive Office of Health and Human Services and previously worked for RIDOH as deputy director, as education and outreach co-ordinator focusing on children’s health issues, and as minority health co-ordinator.

Ernie Almonte currently serves as chief of staff to Lt. Gov. Sabina Matos and previously served for 16 years as the Rhode Island Auditor General where he was responsible for the State of Rhode Island financial, performance and fraud audits.

Chris Abhulime is deputy chief of staff to McKee. He has a background in clinical laboratory science in addition to being board-certified as a psychiatric-mental health nurse practitioner, and he is a doctor of veterinary medicine.

“Our Administration has moved quickly to put an experienced leadership team in place at the Rhode Island Department of Health to ensure that our COVID-19 response remains strong,” McKee was quoted saying the statement. “I thank Dr. McDonald, Assistant Secretary Novais, Ernie Almonte, and Chris Abhulime for stepping up and I look forward to continuing to work with all of them during this transition. I also want to thank the career staff at the Department of Health who continue to do the work of ensuring access to quality health services for all Rhode Islanders.”

Free rapid COVID-19 tests available: US government web page, pharmacies

Every residential address in the US can order four rapid antigen test (RAT) kits for free, expected to be delivered in late January, through an official government web page: covidtests.gov (which currently redirects to a site operated by the US Postal Service special.usps.com/testkits). Persons need enter only their name and shipping address to place a free order, and optionally can enter an e-mail address to be notified about order progress. The ordering system opened publicly one day earlier than had been announced.

According to the web page, “the tests available for order: are rapid antigen at-home tests, not PCR; can be taken anywhere; give results within 30 minutes (no lab drop-off required); work whether or not you have COVID-19 symptoms; work whether or not you are up to date on your COVID-19 vaccines; [and] are also referred to self-tests or over-the-counter (OTC) tests.” It is recommended to take an at-home test “if you begin having COVID-19 symptoms like fever, sore throat, runny nose, or loss of taste or smell; or at least 5 days after you come into close contact with someone with COVID-19; or when you’re going to gather with a group of people, especially those who are at risk of severe disease or may not be up to date on their COVID-19 vaccines.”

The federal government maintains a web resource of physical locations where COVID-19 testing services can be obtained, often at no cost: hhs.gov/coronavirus/community-based-testing-sites/index.html

This free program is separate from and in addition to a federal mandate that private health insurers either directly cover or indirectly reimburse each insured individual for up to eight at-home over-the-counter RAT kits per month, up to $12 per test. Families on the same insurance plan are eligible for RAT kits on an individual basis, so a family of four would be eligible for eight each, or 32 tests, per month.

Coverage applies equally regardless of whether the private health insurance plan is purchased directly or as part of a group such as through an employer. Most insurers will pay directly for the tests at point of purchase, such as an in-network pharmacy, much the same as prescription drug coverage, but otherwise may require the insured person to pay up-front and submit receipts for reimbursement.

Each person covered by Medicaid (but not Medicare) or Children’s Health Insurance Program (CHIP) programs is eligible for direct purchase of up to eight RAT kits per month from any in-network pharmacy with no cost or co-pay.

Medicare (as opposed to Medicaid) pays for laboratory tests but not at-home tests, and may require prescription by a health professional; however, some Medicare Advantage programs may cover at-home tests, so it is necessary to check the specific plan.