RI Health Director Alexander-Scott resigns: Led state’s COVID-19 response from the beginning

RI Department of Health Director Nicole Alexander-Scott announcing the first case of COVID-19 in the state on Mar 1, 2020, with Gov. Gina Raimondo to her left.
(Source: https://www.facebook.com/motifri/videos/599954260585364)

Dr Nicole Alexander-Scott, MD, MPH, who has served as director of the RI Department of Health (RIDOH) since 2015 and spearheaded the state’s response to the COVID-19 pandemic from the beginning, has resigned effective two weeks from today, according to a statement from Gov. Daniel McKee, and the governor “regretfully accepted.” She will continue in a consulting role for three months following her departure to assure continuity, the statement said.

Alexander-Scott had her own encounter with the virus, testing positive on Dec 12, 2020, leading to then-Gov. Gina Raimondo, Commerce Secretary Stefan Pryor, and vaccine expert Philip Chan, MD, of RIDOH and Brown University School of Medicine observing a precautionary quarantine as close contacts.

A native of Brooklyn, NY, Alexander-Scott is a nationally recognized expert in her field. She completed a four-year combined fellowship in infectious diseases of adults and children at Brown University, after finishing a combined internal medicine and pediatrics residency at SUNY Stony Brook in 2005 and medical school at SUNY Syracuse in 2001. She obtained a master’s degree in public health (MPH) from Brown in 2011. The statement from the governor noted that she is one of the five longest-serving state public health leaders in the nation.

“Dr. Alexander-Scott has been a steady, calm presence for Rhode Island as we’ve worked together to fight the COVID-19 pandemic,” said Governor Dan McKee in the statement. “Her leadership has been crucial to our whole of government response – helping Rhode Island become number one in testing nationwide and getting more people vaccinated per capita than nearly any other state in the country.”

“Serving as the director of the Rhode Island Department of Health has been the most rewarding experience of my career,” said Dr. Nicole Alexander-Scott. “I would like to thank all Rhode Islanders for their trust over the past two years as we have navigated this unprecedented public health crisis together. It has been an honor to serve you. I would also like to thank all the healthcare providers and community partners who have supported the work we have been doing at RIDOH since 2015 to ensure that everyone has an equal opportunity to be healthy, regardless of their ZIP code, race, ethnicity, sexual orientation, gender identity, level of education, or level of income. And finally, I would like to express enormous gratitude to the members of my RIDOH family. They embraced me, taught me, challenged me, picked me up when I was down, and had my back every step of the way.”

In addition to co-leading the state’s response to the pandemic, the statement noted, Alexander-Scott established the Health Equity Zone program that has become a national model for how to situate needed health care facilities in underserved areas in collaboration with local community leaders, led the response to the opioid crisis by getting naloxone (Narcan) into the hands of first responders and private individuals as well as opening some of the first harm reduction centers in the country, and arranging $82 million in financing to replace the state health laboratory with a “new Rhode Island Center of Excellence for Laboratory Sciences [that] will make Rhode Island better prepared for any future epidemic or pandemic with improved public health services, be an economic driver for the state, and foster more collaboration with private industry and academic institutions.”

News Analysis — RI ignored weeks of COVID-19 warnings: Latest surge almost all Delta, not Omicron, so far

At time of writing, RI is in bad shape for COVID-19, with a surge of cases unprecedented over the course of the entire pandemic. RI is weeks behind where it could have been if it had taken into account clear warning signs.

At a Woonsocket press conference with Gov. Daniel McKee and others on Dec 30, Department of Health (RIDOH) Director Nicole Alexander-Scott offered a blunt assessment of the situation: “I want to share what we are expecting January to look like. It indeed is going to be a difficult month from a COVID standpoint. It’s not only here in RI, it’s regionally and it’s nationally. 

COVID-19 variant tracker by region, Dec 26, 2021 to Jan 1, 2022.
(Source: https://covid.cdc.gov/covid-data-tracker/#variant-proportions )

“We’re in an unprecedented moment within an unprecedented two-years-plus period of time. The shift indoors with the colder weather, the heightened transmissibility of the Omicron variant that’s double what we were already seeing is occurring with the Delta variant, the holiday gatherings, and the general increased levels of social interaction all mean that we could sustain case numbers through the middle or end of January that will well exceed the peak we have ever experienced throughout this entire pandemic.” 

She continued, “This week, we have already had three days with more than 3,000 cases each day. And we believe that what we’re seeing now is still predominantly Delta variant of COVID. Our rough estimate is that only approximately 10% or so of infections in Rhode Island right now are Omicron variant cases.”

One week later, on Jan 5, RIDOH spokesman Joseph Wendelken told Motif, “The proportion of our infections that are Omicron is now likely close to 45%. This is a rough estimate.”

It was widely misreported in the press that the US Centers for Disease Control and Prevention (CDC) estimated that 73.2% of US cases were the Omicron variant as of Dec 18, but this was not any kind of direct measurement but just a projection from a mathematical model whose boundary condition assumptions had been exceeded, and the estimate was later revised down to 22.5%. For samples collected the week of Dec 26 to Jan 1, the CDC estimates 95.4% were Omicron, but that it has been somewhat slower to spread in the Northeast with only 82.4% of cases in that same week.

RI COVID-19 daily cases (blue), 7-day moving average (red), 7-day moving average per 100,000 population (yellow); from Jun 5, 2021, to Jan 5, 2022. (Source: https://covid.cdc.gov/covid-data-tracker/#trends_dailycases_7daycasesper100k)

After a prior gubernatorial press conference on Dec 15 at the State House, Alexander-Scott told Motif in a private interview that indications suggested the Omicron variant was two to three times more transmissible than the Delta variant. That early expectation has been generally confirmed since.

RI COVID-19 case counts: columns are date, daily cases, 7-day moving average, 7-day moving average per 100,000 population.
(Source: https://covid.cdc.gov/covid-data-tracker/#trends_newtestresultsreported )

However, Gov. McKee said he didn’t see signs of a surge before Thanksgiving. In response to a question at the Dec 30 press conference from Boston Globe reporter Brian Amaral about why the state was, only a few weeks ago, talking about closing rather than opening testing and vaccination sites, McKee defended the timeline of his administration’s response to the surge, claiming that it took them by surprise. “I think that we always tend to look in the rearview mirror on things. Perhaps if you had a crystal ball, you could have done that. But remember, we didn’t: Until coming up to Thanksgiving [Nov 25], this issue was not on the table. Infection rates increased on Dec 4, and then did again on Dec 11 weekend, and Dec 18.”

I pushed back at that press conference: “Governor, I respectfully would not characterize the data that way. It looks to me that we’ve been seeing a significant increase just on the state’s own data… getting back to about the middle to the end of October. I specifically remember asking that question at a press conference at around that point.”

McKee responded, “I’ll look at those numbers again out of respect to the question, but I don’t believe that’s accurate. …When we get back together again, if I’m wrong I’ll certainly admit that.”

Amaral reported in the Boston Globe on Jan 4, 2022, that he had obtained a copy of the “State of the Spread” dated Nov 16, 2021, a regular internal report circulated to state leaders, that showed an alarming increase in cases and predicted a surge in a matter of weeks.

The date of that report was the same day as another gubernatorial press conference where I directly raised the spiking case loads with Alexander-Scott and McKee after they emphasized percent positivity from testing, and I cited specific RIDOH data trends indicating that the RI seven-day moving average was then up around 240 daily cases per 100,000 population, up from 130 in October and 10 to 20 times higher than June and July.

RI COVID-19 daily cases (blue), 7-day moving average (red), 7-day moving average per 100,000 population (yellow); from Jan 23, 2020, to Jan 5, 2022. (Source: https://covid.cdc.gov/covid-data-tracker/#trends_dailycases_7daycasesper100k)

Alexander-Scott responded, “It’s a true reflection on the Delta strain that we have been talking about. The Delta variant is significantly more contagious than earlier versions of COVID-19. It’s why we need vaccination, testing, masking, distancing, ventilation, all of the tools fully activated. 

“It is possible to get us through what we are anticipating as the winter is approaching. People are going indoors, it’s colder outside. … Rhode Island is a population that is more densely populated. We have seen throughout the pandemic that our numbers in terms of cases per 100,000 are higher in general, connected to some of those demographic factors, which is why we balance it with percent positivity, but all of it is going in the direction that is anticipated. We hoped not but we knew we would be ready. We’re well vaccinated. We’re still seeing cases that are higher among those who are not vaccinated. So that’s true evidence and indication of how important it is to get vaccinated. And then making sure all of the other mitigation steps that we’re talking about are followed as a critical approach.”

According to CDC data, the seven-day moving average of daily cases per 100,000 population in RI was 143.95 on Oct 31, 256.19 on Nov 16, 727.51 on Dec 15, 1,377.62 on Dec 30, and 2,346.89 on Jan 5; by contrast on Jul 1, that number was 10.48. Almost all of this surge was the Delta variant, as the Omicron variant was only assigned a Greek letter in late November and the first case in RI was announced only in mid-December (“Omicron in RI: First patient identified”, by Michael Bilow, Dec 11, 2021). 

Of course, the official numbers generally do not reflect at-home tests that have become increasingly common in the last few weeks and therefore almost certainly represent an official undercount. RI does lead the nation in testing, but it still is not enough.

COVID-19 deaths (blue), cases (yellow), and testing (green) per 100,000 population, by state; as of Jan 5, 2022. (Source: https://coronavirus.jhu.edu/testing/states-comparison )

None of this should have come as a surprise. My question at the Nov 16 press conference explicitly cited data released by RIDOH and CDC on the web, hardly a secret from anyone who bothered to look. 

There is no question that McKee is guided by a tension between needing to keep open the economy and the schools and preventing the spread of a deadly virus. But by missing warning signs of the coming surge for weeks, he has imperiled those key goals. 

In a few weeks there will be only two situations in schools: planned closings and unplanned closings. Keeping bars and restaurants open will not do any good if customers are too scared to go out. With COVID-19 prevalence in RI literally more than 200 times worse in January 2022 than July 2021, being scared may just be basic prudence.

Health, Consolidated

Lifespan and Care New England, the two biggest healthcare networks in RI, have signed an agreement stating their intent to merge. They’ve submitted a letter of intent and application to the Attorney General’s office – the AG, Federal Trade Commission and RIDOH still need to sign off on the project and will be assessing the application, most likely for at least another two months. The combined entity is called the integrated Academic Health System and would also heavily incorporate academic resources from Brown University.

The RI Foundation has publicly submitted an independent assessment and list of recommendations to keep the AHS responsible to the communities it serves and equitable to communities with a variety of healthcare access and affordability needs.

Those supporting the merger cite benefits in quality of care, although the specifics of that seem to rely on the spectrum and geographic availability of care, which already exist with two systems. Other predicted advantages lie in consolidation of purchasing and labor, creating greater financial efficiencies, and in better integration of information and medical records for those patients who otherwise might be crossing from one network to another.

Opponents are concerned about the monopolistic potential of a single network that will control the vast majority of healthcare services, with little competition on prices, few alternative options for patients seeking most types of care, and less competition for employee wages, which might result in lower pay for some categories of employees.

We’re sure to hear more about this as the agreement moves through its approval process.

Whose Bodies? Every-Bodies!: Every-Bodies Fitness aims to make fitness accessible for LGBTQ+ youth

When Melissa DeLuca was in high school in the 1980s, she was banned from the field hockey team because she was gay – an experience that now fuels her unique exercise program for LGBTQ+ youth.

Melissa DeLuca

Every-Bodies Fitness is the non-profit DeLuca formed in 2019 to make the experience of exercising and staying healthy inclusive. She partners with area gyms for space to teach free classes. Now she offers boxing, a personal exercise favorite, and plans to expand to crew in 2022 by partnering with the Narragansett Boat Club. She also envisions future classes in dance, fencing, golf, tennis and horseback riding.

“Every Saturday, kids ages 14 to 25 come and learn how to box. More than 65 youth have participated,” DeLuca said of the classes, offered at a Warwick gym for LGBTQ+ youth as well as allies and supporters. “These are sports most urban LGBTQ+ youth don’t have access to, mainly because of money.”

The vision for an organized athletic program began to gel when she worked as activities director at Youth Pride Rhode Island. When kids learned she boxed, they wanted to join. She finds similar interest from youth through her current work as a clinical social worker based at Mt. Pleasant High School.

Her passion comes from feeling left out herself. After her negative field hockey experience, DeLuca wanted to join the college crew team but was told she needed to lose weight.

“That led to an eating disorder,” she said.

Eventually, however, she began to appreciate her body and “what it can do, not what it can’t do.”

“I developed more positive body image concepts and began working on mental health approaches like cognitive restructuring, mindfulness and motivational interviewing,” she explained.

Those lessons linger and provide structure to Every-Bodies Fitness. When working with young boxing students, DeLuca runs them through fitness circuits, asking what they feel they’re doing right versus what they need to improve.

It’s important for DeLuca, a lesbian from a biracial family, to help others feel like they belong. Physical activity, she’s discovered, can appeal to all sizes, identities and skill levels. She referred to National Institutes of Health research that indicated LGBTQ+ youth are two and a half times less physically active than their cisgender classmates, and calling for steps to engage the population in exercise more directly.

“We provide physical activity and positive mental support, surrounded by people who are nonjudgmental. You can be any size or ability,” said DeLuca, whose personal training side gig finances Every-Bodies Fitness. This includes transportation which started bringing kids to the gym in December.

“Kids who identify as nonbinary or transgender say they don’t feel comfortable in mainstream gyms, and a lot won’t join sports teams as a result,” she said. “These are vulnerable kids. They come and may not feel good about themselves, that they’re out of shape or not strong enough.”

Eventually, she’d like to secure a permanent space of her own where she can run a boutique gym that adults can join and whose fees would support the youth program. 

Every-Bodies Fitness is open to all LGBTQ+ youth. For more information on the program – as well as details on DeLuca’s income-based personal training work – go to everybodiesfitness.org/about

Health Innovation Policy for the People: Undercutting profit motive for better outcomes

For at least the last 25 years, Rhode Island has relied on the medical-industrial complex to serve as an economic engine.

The quest for patentable, scalable cures for the diseases of industrialism has taken up a huge amount of the energy and resources devoted to economic development in RI.

There are deep-seated problems with this strategy, the resultant neglect of public health measures, and the role this innovation-based economy plays in making the cost of healthcare astronomical – as well as its role in the gentrification of our communities and the increase in homelessness that follows from this strategy.

What may be among the biggest indictments against centering attention on the patentable medical-industrial complex is that, despite the miracle cures and information that flows from this system, life expectancy in the United States has increased much more over the last 100 years due to the provisioning of clean water and sewage treatment than from all of the miracle cures for industrial diseases.

But, of course, no one gets traction telling the folks focused on innovation and economic development that public health measures do more good than their innovations and that measures to reduce the harms of industrialism work better than cures after the fact.

What profit is there in the old idea that an ounce of prevention is worth a pound of cure? It has been a lonely and frustrating fight for an outsider, but recently something happened that gives me a bit of hope.

I read “Health Policy Innovation for the People,” by Dr. Shobita Parthasarathy, PhD, of the University of Michigan Gerald R. Ford School of Public Policy, where she is director of the Science, Technology and Public Policy Program.

By the time I had finished the introduction, I realized this was one of the most important articles I had ever read on the medical-industrial complex, and I started sending it out to everyone I know who works on these issues.

Dr. Parthasarathy reported on many of the problematic aspects of the innovation system, including the U.S. Patent and Trademark Office and the entire system built up around patents, the flow of research dollars, the panels of [mostly] old white men and representatives of drug companies deciding what research is acceptable, the monopoly basis of the big research universities, the disdain for the research on women’s health and public health measures, and how the system appears to funnel money to keep the big players happy.

The National Institutes of Health spends 500 times as much money on genetic research as it does on the effects of structural racism on health, despite the vast disparity in lifespan between white people and people of color in the US.

I cannot really do justice to the article in a synopsis, so I strongly recommend you read the 20 pages, but let me offer up a few examples of how the current patent-protected system has really failed our communities, especially communities of color, and the public’s health.

An egregious example

One of the most egregious examples of the current system floundering is the pulse oximeter, a device that clamps onto the end of a finger and measures blood oxygen levels. First produced by Hewlett Packard, the device is a critical tool in the struggle with COVID, as low blood oxygen levels serve as a definitive sign that more care is needed.

It turns out the original pulse oximeters did not read properly on dark-colored skin, something that Hewlett-Packard eventually figured out and rectified. But the current manufacturer is allegedly producing pulse oximeters with the original flaw and apparently shows no signs of rectifying this problem.

As a direct result of this flaw, many African Americans and others with dark skin did not receive prompt treatment for COVID-19 – and may have died in disproportionate numbers from the disease.

Thousands of people who could have received early intervention and been saved were not, allegedly due to protections by the patent system. The US Food and Drug Administration apparently considered this type of racial bias to be outside of what it could regulate.

In breast cancer research and treatments

The focus on patentable and scalable treatments instead of public health has also shown up in breast cancer research and treatments. Here is a rather lengthy quote from the article by Dr. Parthasarathy. Read it and weep:

“U.S. biotechnology company Myriad Genetics announced that it had identified two genes linked to these cancers, BRCA1 and BRCA2, and then applied for U.S. and European patents and began offering tests [Parthasarathy, 2007].

Citing these pending patent rights, Myriad then systematically shut down all other providers in the United States and tried to do the same in Europe. It offered its own “gold standard” test to U.S. consumers, which sequenced the DNA of both genes for approximately $2,500 and provided customers with information about whether they had mutations that might cause disease.

But European scientists and public health officials challenged the company’s proprietary position and continued to conduct research and offer BRCA testing through their health systems.

Soon afterward, French researchers announced that they had found a major flaw in Myriad’s approach: it missed large deletions and rearrangements in the genes that increase susceptibility to disease. [Myriad Genetics had halted similar research in the United States.]”

Upbraided and cajoled

The NIH had to be severely upbraided and cajoled to put women and breast cancer patients onto the panels that made recommendations as to what research to fund, and while it eventually created a program to fund research into the environmental issues around breast cancer, it has since shut down that program.

Providence has a major problem with asthma. South Providence neighborhoods have some of the highest rates in the country. The patent system has meant that many lower-income people may have no way to afford inhalers, and, of course, most of the research spending is on patentable medicines rather than the environmental triggers for asthma.

An ounce of prevention is worth a pound of cure, but the profit seems to be the motivational factor, despite the massive societal costs of asthma.

Here again, I offer up a couple of quotes from Dr. Parthasarathy’s article, because I could not explain it any better:

• The story of asthma, a disease that disproportionately affects Black children, is similar. [Alexander and Currie, 2017] In recent years, the cost of albuterol inhalers, which help to control the disease, have also increased considerably due to patent-based monopolies.

Albuterol has been available as a generic tablet for use in inhalers for decades, but in the 2010s, the tablet was altered slightly after federal regulators required the redesign of inhalers so that they did not emit environmentally dangerous chlorofluorocarbons.

The inhaler and tablets were re-patented. Likely as a result, the market price for albuterol tablets increased over 4,000 percent and triggered a decline in use, presumably due to insurer questions and limits and uninsured patients simply unable to afford it. [Kenner, 2018; Rosenthal, 2013]

• “Let’s consider again the example of asthma. Its cause is unclear and there is no cure, but many of its triggers are external and specifically environmental, including air pollution, chemical fumes, and dust. It is also strongly associated with poverty. [Kravitz-Wirtz et al., 2018]

More and more people are being diagnosed with the disease, but its prevalence is increasing much more rapidly among historically disadvantaged communities of color.

These communities are also likely to experience worse disease outcomes, including hospitalization and death.

In response, governments have increased research funding, but this work has focused primarily on genetic and biological mechanisms rather than on how to transform environmental and socioeconomic conditions necessary to prevent and mitigate disease. [Whitmarsh, 2008]

This approach fits with both the dominant concerns and approaches of scientists in this field as well as the private sector.

How to turn the system around

Parthasarathy then goes on to offer up a number of recommendations as to how best to turn this system around. These include having community members as experts on the panels determining what research should be funded, and making sure that the research money is spread around better. [Harvard, for instance, receives more funding than all of the Historically Black Colleges and Universities put together.]

And, by focusing much more attention and research on social and environmental determinants of health. Parthasarathy goes on to ask for serious reform of the patent system, which seems to be focused on profits rather than health.

Giving voice to my concerns

I have long voiced my concerns with a medical-industrial complex that delivers the most expensive [by far] healthcare in the world, but that ranks no better than 37th in the delivery of healthcare, systematically excludes vast swathes of the population from the latest advances and ignores the environmental hazards in the community because it would mean taking on powerful economic and political interests.

Dr. Parthasarathy has done us all a service by exposing it so clearly. I want to expand her thesis a bit by pointing out what I see as the problems of using the medical-industrial complex as a tool of economic development in Rhode Island – and what I believe is an exaggerated focus on the innovation system as a major focus of the entire economic development strategy in the state.

Rhode Island spends a considerable amount of money each year to promote and develop the innovation economy. The main supporter of this work is the Commerce Corporation of RI.

The economic development investments by CommerceRI appear to be looking for the next big thing, with a focus on patentable and scalable innovations. While they may have invested in a few programs that are focused on economic development in the neighborhoods, that is not their primary focus. They are looking for gazelles and unicorns.

Predictable results

In my experience, when you attempt to talk with CommerceRI and discuss ideas such as the ridiculousness of giving tax breaks to the rich or eliminating environmental regulations, they seem to be unwilling to listen, despite the overwhelming weight of the evidence pointing out that their approach does not work and that it promotes greater inequality.

So, the results are entirely predictable: growing inequality, gentrification [when you keep putting more money in the hands of the already wealthy, it always drives up housing costs and displaces lower-income community members], unaffordable healthcare, decreased longevity, failing public services and an obsession with real estate development.

The real estate obsession, in my opinion, is among the most troubling aspects of the agency’s investment strategy, as it is ownership, rather than wages, that drives most of the rapidly growing inequality in our communities.

The data is very clear that lower taxes on the rich and tax breaks for the rich do not contribute to general prosperity, and that strong environmental regulation is correlated with healthier economies.

This last point is important as stronger environmental regulations are correlated strongly with healthier populations, meaning people can be more productive and less money is spent on healthcare so it can be spent elsewhere in the economy.

Some day Rhode Island will understand that economic development works best as a bottom-up process, not a top-down trickle.

Investment could be funneled toward communities that need the jobs the most, creating jobs for the people who already live here and matching the skills of Rhode Islanders, focusing on whole systems rather than after-the-fact cures, and putting the new climate economy at the center of our work.

But until that day, the results will be the same as always, with growing economic inequality and division and a decline in life expectancy.

Greg Gerritt is the director of research at ProsperityForRI.com.

Embrace the Offensive: PVD’s Tara Morris finds catharsis through hot power yoga

On a cold December morning, Tara Morris opened her hot power yoga class with the words, “Today’s my mom’s birthday; she would’ve been 81.” Morris’ mother Maryann passed away in September 2020 after battling Parkinson’s for 27 years. 

“It was so brutal,” says Morris. “So fucking brutal to watch a big, strong woman lose all dignity like that.” 

Morris shares these painful truths and goes on teaching, holding Instagramable poses, telling us not to focus on where it hurts but to focus on where it feels good, to admit to ourselves we aren’t “total pieces of shit.”

The Love Offensive takes place in Olneyville, in a room adorned with floor-to-ceiling Aaron Santos murals. Composed of broad yet precisely layered brushstrokes, the murals bolster Morris’ energy – they are vibrant yet calming, depicting black-and-white snapshots set against sprawling scenic spaces; they are disparate and apart until seen from a new angle, and then what seemed at odds morphs into a harmonious blanket of time. The murals engage you, they make you think, just like Morris.

“Every single class, everything that comes out of my mouth, I’m just talking to myself,” says Morris. “I’m not saying anything I know for certain and have a leg up on someone, I’m literally trying to save my own life. I’ve got ruminating thoughts and this ridiculous absolute lack of self-worth… I’m a rage-fest, ya know, and I’m trying to spin it positively. It’s the hand I was dealt. This is what I look like. This is what my life looks like.”

Morris opened The Love Offensive in 2020 after quitting her job and running a successful GoFundMe campaign that raised $54k in 45 days from 175 unique donors. Now she teaches the class she always wanted to take: really hot, really hard yoga.

On special occasions Morris uses cannabis tincture as part of her personal practice – important detail here: her personal practice, not her studio teachings; for her teachings, she is fully caffeinated. She bounces around the room, stopping here and there to demonstrate intricate poses with ease. She flits from side to side, back to front cursing, pushing you, not letting you off the hook. Her teachings are a challenge, an interrogation; they dare you to trust yourself. There’s no try, only do. She says, “You can do it but you have to make the choice.” She believes in you. 

“We’re so fucking lucky, that’s the lesson I learned from my mom. She wasn’t like Yoda, she wasn’t like, ‘Tara, you see I am the Buddhist tradition of non-self…’ no, she just knew she had to split Parkinson’s in her mind, she had to make it a mountain to climb every day rather than a defeat. She didn’t have a career or anything, she was a manager at a storage unit place and this is what she did with her life: actively meet the worst fate with balls, just absolute fucking balls. And that’s what I teach in my class, because of her, with her really.” 

“The artist fire is who I am. Sometimes it makes me so fuckin sideways but it’s my fuel. I’m not content and I never will be and I never have been. I have a fucking rage inside of me and sometimes I appreciate it and sometimes I don’t and at the end of the day I think I like it more than I hate it, so it’s staying, which is wonderful news for self-acceptance.”

Morris began integrating cannabis into her personal practice when she found herself in the grips of a debilitating anxiety attack and the thought occurred to her, “I could smoke pot and go to yoga, I know people who do that.” So she did. Opting for whole plant infusion tincture because it’s healthier than smoking, Morris found cannabis gave her the space to ease her anxiety and settle her mind, it gave her the breath she needed to find the present moment and recall her good fortune: her able body and the supportive community that made her dream her reality. 

“Whatever chemistry is happening [with cannabis], the sensations are enhanced and it makes the practice come alive… like how music and food sound and taste better, it’s more interesting in that way, it’s more emotional, more of a release; it takes everything that’s good about yoga and dials it up.”

At the end of class, everyone is red-faced and dripping with sweat and Tara wants to know how we feel. We say we are not losers. We did it. We worked hard. We gave. We dug. We faced ourselves. We are thankful.

It’s easy to hate on yoga: its ubiquity, those rubber mats, that neon lycra. But if you need the comfort of a challenge, embrace The Love Offensive. Or don’t. As Morris says, “Everyone who’s not in on doing yoga, they’re sick of hearing it, just like anyone would be. And the people who love it – who’ve found emotional freedom from the habits of the mind, from the suffering of the mind – we can’t say enough good things about it.”

For more information on The Love Offensive, including Morris’ upcoming yoga retreats, visit theloveoffensive.com. For more information on cannabis tincture, speak to a retail associate at your preferred cannabis dispensary.

FDA shortens wait for COVID-19 vaccine booster to 5 months, expands eligibility down to age 12

Major changes were authorized this morning to increase access to booster shots for the COVID-19 vaccine from Pfizer-BioNTech by the US Food and Drug Administration (FDA).

There are three main changes: (1) the time between completion of the primary vaccine series until eligible for a booster shot has been reduced to five months from the prior six months, (2) booster shots are authorized for ages 12 to 15 under the same conditions as for those 16 and older, and (3) children ages 5 to 11 who are unusually immunocompromised are eligible for an additional third dose as part of their primary vaccine sequence.

The FDA said in a statement, “The agency has determined that the protective health benefits of a single booster dose of the Pfizer-BioNTech COVID-19 Vaccine to provide continued protection against COVID-19 and the associated serious consequences that can occur including hospitalization and death, outweigh the potential risks in individuals 12 through 15 years of age.” The FDA said the decision relied upon safety and effectiveness data, including a study of 6,300 Israelis ages 12 to 15, that showed no appreciable risk of adverse reactions, and in particular “The data shows there are no new safety concerns following a booster in this population. There were no new cases of myocarditis or pericarditis reported to date in these individuals.”

“Throughout the pandemic, as the virus that causes COVID-19 has continuously evolved, the need for the FDA to quickly adapt has meant using the best available science to make informed decisions with the health and safety of the American public in mind,” said Acting FDA Commissioner Janet Woodcock, MD, in a statement. “With the current wave of the omicron variant, it’s critical that we continue to take effective, life-saving preventative measures such as primary vaccination and boosters, mask wearing and social distancing to in order to effectively fight COVID-19.”

“Based on the FDA’s assessment of currently available data, a booster dose of the currently authorized vaccines may help provide better protection against both the delta and omicron variants. In particular, the omicron variant appears to be slightly more resistant to the antibody levels produced in response to the primary series doses from the current vaccines,” said Peter Marks, MD, PhD, director of the FDA’s Center for Biologics Evaluation and Research. “With this in mind, the FDA has extended the range of individuals eligible to receive a booster, shortened the length of time between the completion of the Pfizer primary series for individuals to receive a booster and is authorizing a third protective vaccine dose for some of our youngest and most vulnerable individuals.”

The three-dose primary vaccine for young children is a very unusual situation, the FDA emphasized: “Children 5 through 11 years of age who have undergone solid organ transplantation, or who have been diagnosed with conditions that are considered to have an equivalent level of immunocompromise, may not respond adequately to the two-dose primary vaccination series. Thus, a third primary series dose has now been authorized for this group. This will now allow these children to receive the maximum potential benefit from vaccination… Children 5 through 11 years of age who are fully vaccinated and are not immunocompromised do not need a third dose at this time, but the FDA will continue to review information and communicate with the public if data emerges suggesting booster doses are needed for this pediatric population.” When appropriate, this third primary series dose would be administered at least 28 days after the second dose.

UPDATE Wed, Jan 5, 2022: The RI Department of Health issued a statement that practices in the state will adopt the new FDA guidance for the Pfizer vaccine: “The booster interval recommendations for people who received the Johnson & Johnson vaccine (two months) or the Moderna vaccine (six months) have not changed.”

RI app shows verifiable vaccination status: Generates trusted secure QR code

(App download links at end of article.)

RI has updated and renamed its “401Health” app (previously “Crush COVID RI”) for Google Android and Apple iOS, the office of Gov. Daniel McKee announced today. The main purpose of the update is to add support for displaying the user’s vaccination record via a securely trusted QR code, which can be read by another app, the SMART Health Card Verifier, also available for both Android and iOS. The updated app continues to support previous features such as maintaining a private diary that the user can choose to share with contact tracers should that be necessary, links to schedule tests and vaccination doses, and access to display published statistical data about the COVID-19 situation in the state.

The two components, the record holding app and the verifier app, depend upon cryptography to assure the record comes from a trusted issuer, such as the State of Rhode Island, and has not been tampered with or modified. The system is similar to how web browsers handle sensitive information, such as credit card numbers for on-line purchases. In theory a QR code record could be printed out onto physical paper to be scanned by a verifier, but it is unclear at this time whether the RI apps or web sites will support this in addition to dynamic on-device display.

In order to make this work, RI has joined the SMART Health Card Framework administered by the Vaccine Credential Initiative (VCI), a non-profit coalition of government and non-government health care and technology organizations headquartered from Boston-based MITRE Corporation (formerly “MIT Research”) using an open-source public protocol specification licensed by Boston Children’s Hospital. The Framework is supported worldwide, including in the US, Canada, the UK, Japan, and Israel. The full technical specification details, as with many open-source projects, are publicly downloadable from GitHub.

The Framework is only a set of specifications, and it is up to the SMART Health Card Verifier App, published by the Commons Project, to implement the verification process, scanning and testing presented credentials (a QR code) against the CommonTrust Network’s Registry of trusted record issuers, also maintained by the Commons Project.

VCI publishes a “Code of Conduct” that “expects verifiers to adhere to the following core set of requirements in order to protect and properly interpret SMART Health Cards: Verifiers shall not store SMART Health Cards, or any data included within them, beyond what is required for verification at the time of presentation. Verifiers shall check SMART Health Cards against a list of trusted issuers. Verifiers shall comply with all applicable laws, including the California Consumer Privacy Act.”

According to the Computational Health Informatics Program (CHIP) at Boston Children’s Hospital that licenses and administers the underlying system, “SMART Health Cards contain just the information required to display your vaccination history and/or test status, and the choice to share your Card is up to you. In most cases that means: They contain: Your legal name and date of birth; Your clinical information; Tests: date, manufacturer, and result; Vaccinations: type, date, and location. They should not contain: Your phone number; Your address; Your government-issued identifier; Any other health information.”

The governor’s office said in its statement, “The VCI coalition prioritizes privacy and security of patient information, making medical records portable and reducing healthcare fraud.”

According to the Commons Project, their SMART Health Card Verifier App will “Quickly scan a SMART Health Card to confirm COVID-19 vaccination using the Verifier app at your small business, live music venue, school, or sporting arena. Scanning a SMART Health Card QR code reveals: Whether the SMART Health Card is valid; Whether the issuer is in The CommonTrust Network’s Registry of trusted issuers; [and] Key information on the SMART Health Card (issuer name, vaccine type, dates of vaccine doses, and name and date of birth of vaccine recipient).”

“By embracing the open-source SMART Health Card Framework, Rhode Island joins seven states, numerous countries, and pharmacies such as CVS, Walgreens, Rite Aid, and Walmart that are already utilizing the secure SMART Health vaccination technology for record standardization. The State looks forward to partnering with Connecticut and Massachusetts as they onboard in the coming weeks and months,” McKee’s office said in its statement.

“Rhode Island has administered close to 2 million doses of COVID vaccine and almost 300,000 booster doses, and our neighbors deserve a convenient, safe, and efficient way to access and store their vaccination record,” McKee was quoted in the statement saying. “I have downloaded my vaccination card to my phone and it was very simple. If you haven’t gotten vaccinated yet, it’s not too late. If you haven’t yet, get boosted.”

“We want to make it as easy and convenient as possible for you to securely access your vaccination information,” Department of Health Director Nicole Alexander-Scott was quoted saying in the statement from the governor’s office. “This new app is a great way to verify for others that you have received the critical protection that comes with a COVID-19 vaccine primary series and booster dose.”

401Health RI app
Google Android play.google.com/store/apps/details?id=com.ri.crushcovid
Apple iOS apps.apple.com/us/app/crush-covid-ri/id1511308593
SMART Health Card Verifier app
Google Android play.google.com/store/apps/details?id=com.thecommonsproject.smarthealthcardverifier
Apple iOS apps.apple.com/us/app/smart-health-card-verifier/id1572691390

Monoclonal Antibodies (MABS) Delays: Effective COVID-19 treatment faces logistical obstacles

Treatment with monoclonal antibodies (MABS) is recommended and authorized to keep patients who test positive for COVID-19 out of the hospital, reducing the severity of mild to moderate symptoms. The treatment is done on an outpatient basis by a one-time infusion that takes several hours. In RI, however, there is a logistical backlog on quickly delivering MABS treatment to patients.

Motif was approached by a reader who tested positive on Friday, Dec 10, but was told the earliest opportunity for MABS treatment would be Wednesday, Dec 15. In response to our inquiry, RI Department of Health (RIDOH) spokeswoman Annemarie Beardsworth confirmed that “most MAB providers are scheduling three or four business days after a patient’s/provider’s request. This time-frame is due to the very high demand occurring currently, but is also exacerbated by patients and/or healthcare providers calling multiple MAB infusion sites to see where they can get an appointment soonest, scheduling multiple appointments at different MAB infusion sites, and then not canceling appointments they don’t attend. This causes a tremendous amount of unnecessary administrative burden on the MAB providers and slows down the scheduling process.” She continued, “Unfortunately, when patients do not cancel appointments they don’t plan to attend, it prevents other patients from using that appointment slot. Some MAB providers tell us they can see as many as 8-10 no-show appointments per day. RIDOH reminds all patients to cancel any MAB appointments they are not planning to attend so that other patients can get their needed treatment.”

There are logistical obstacles beyond just patient no-show appointments, Beardsworth told Motif. “Rhode Island has an adequate supply of MAB product in Rhode Island and we have been administering at a very high rate of our biweekly federal allocation. Like most other states in the country, Rhode Island is experiencing a healthcare worker shortage, so there are fewer providers than we’d like who can administer MAB. RIDOH is actively working to recruit and onboard more MAB providers. The MAB that is the easiest and fastest to administer is in short supply federally, so combined with fewer providers who can administer MAB, each administration takes longer when using the other infusion (IV) products.”

While three or four business days is still within the 10-day limit after onset of symptoms, almost a year ago when the treatment was first made available in RI, on Friday, Jan 8, 2021, RIDOH Director Nicole Alexander-Scott said, “Rhode Island now has a doctor-recommended treatment for COVID-19 that is extremely effective at preventing people from developing severe disease and from being hospitalized because of COVID-19. The key, though, is starting early: The earlier you start treatment after testing positive, the better and more effective this can be. After completing a simple infusion, intravenously, of this treatment, many people with COVID-19 start feeling better as early as the next day. The treatment does not require hospitalization, and it’s intended to help prevent people from actually having to be hospitalized.” (See “New Treatment Available: Monoclonal antibody treatments for all eligible RI patients”, by Michael Bilow, Jan 9, 2021.) At that time, she said the plan was to have infusion sites co-located with larger testing sites, so that eligible patients can get the new treatment immediately after testing positive by a rapid test. “We’re working to build out as many different infusion sites as possible, particularly at places where there is a lot of testing already occurring, so that you can just go to the next room if you’re at one of our testing sites that’s able to accommodate this and get access to the treatment. We want to get at every element,” Alexander-Scott said.

It stands to reason that patients would benefit from following longstanding RIDOH advice to get tested as soon as possible after symptom onset and to seek MABS treatment, if indicated, as soon as possible after a positive test result.

The RIDOH website – covid.ri.gov/covid-19-prevention/treatment – has information about who is eligible for MABS: “You can use MABS if you test positive for COVID-19, started having mild to moderate symptoms in the past 10 days, and are at high risk for progressing to severe disease.” It also describes who should not get MABS, how to obtain MABS if you have no primary health care provider or no health insurance, and lists – covid.ri.gov/mabs-infusion-services – MABS infusion service providers.

Omicron in RI: First patient identified

Omicron has been detected in RI, according to an announcement this afternoon from the office of Governor Daniel McKee. “The individual who tested positive is a person in their 20s who lives in Providence County and recently returned from travel in New York. The individual completed a primary vaccination series and had no record of a booster shot. Contact tracing on this case is ongoing,” the statement said.

Omicron virus variant detected by state as of Dec 8, 2021.
(Source: US CDC https://www.cdc.gov/mmwr/volumes/70/wr/mm7050e1.htm?s_cid=mm7050e1_w#F1_down )

Classified as a “variant of concern” by the World Health Organization and assigned the Greek letter “Omicron” as a mnemonic, the variant (also known as “B.1.1.529” in the PANGOLIN nomenclature) of the SARS-CoV-2 virus that causes COVID-19 was first detected in South Africa in a specimen collected on Nov 9 and has since been observed worldwide, in the US first on Dec 1 and in 22 states as of Dec 8, according to an early release issued yesterday in the flagship Morbidity and Mortality Weekly Report (MMWR) by the US Centers for Disease Control and Prevention (CDC). The CDC said that of 43 Omicron patients so far identified in the US only one had been hospitalized (for two days) and none had died. (See “Omicron virus ‘variant of concern’: More transmissible, unknown if otherwise more dangerous”, by Michael Bilow, Nov 26, 2021.) While the scope of the threat may not be assessed for a few more weeks, the CDC warned that “Mutations in Omicron might increase transmissibility, confer resistance to therapeutics, or partially escape infection- or vaccine-induced immunity.”

In general, viruses mutate frequently but most mutations have no practical effect while a few mutations can give the virus a reproductive advantage, which first happened with the variant designated as “Alpha” (B.1.1.7) and later with the variant designated as “Delta” (B.1.617.2). (See “Don’t Panic: Explaining coronavirus mutations”, by Michael Bilow, Dec 26, 2020.) Despite the heightened concern about Omicron, the CDC said, as of the week ending Dec 4, nationally the Delta variant is currently estimated to account for 99.9% of infections because its significantly greater transmissibility allowed it to supplant prior variants.

Chart of SARS-CoV-2 variants detected in RI, cumulative as of Dec 9, 2021.
(Source: https://ri-department-of-health-covid-19-variant-data-rihealth.hub.arcgis.com/ )
Number of SARS-CoV-2 variants detected in RI by week, as of Nov 20, 2021.
(Source: https://ri-department-of-health-covid-19-variant-data-rihealth.hub.arcgis.com/ )

The statement from his office quoted Gov. McKee: “We fully expected that Omicron would eventually be detected in Rhode Island as it has been in our neighboring states. I want to be clear: Rhode Island is prepared. This is not cause for panic.” The statement also quoted RI Department of Health (RIDOH) Director Nicole Alexander-Scott: “Given the recent findings of the Omicron variant in our region, it is not at all surprising that we have identified this case in Rhode Island.”

“The case was identified through the ongoing genomic surveillance program coordinated by RIDOH’s State Health Laboratories,” the statement said, quoting Alexander-Scott: “I want to thank the staff at our State Health Lab who have been working diligently to sequence more test results than ever before. Together, we can keep each other safe and healthy throughout the holiday season.”

Both McKee and Alexander-Scott emphasized that the best protection measures against the Omicron variant are the same as against the Delta variant: get vaccinated including a booster shot if eligible, practice proven public health measures such as wearing a face covering indoors and in crowded public places, maintain physical distancing, use proper ventilation, and be tested regularly. The statement said: “COVID-19 vaccine helps protect against the Omicron variant of COVID-19. However, booster doses are particularly important in providing additional protection. Everyone older than 5 years of age should get a primary series of COVID-19 vaccine. Everyone older than 16 should get a booster dose. (If you got Pfizer or Moderna for your primary series, you should get a booster dose at least six months later. If you got Johnson & Johnson [Janssen] for your primary series, you should get a booster dose at least two months later.)”

The statement said that Gov. McKee “will be announcing a comprehensive set of actions early next week to address the increased number of COVID-19 cases and alleviate pressures on our hospital systems while at the same time keeping our schools open for in-person learning and preventing economic disruptions to our small businesses. The comprehensive set of actions the governor is focused on are vaccination, testing, masking and staffing capacity. The governor is continuing to meet with his whole of government team over the weekend to finalize the executive actions he will undertake.” Although McKee said at his regular weekly press conference on Thursday that he was reluctant to resume restrictions from earlier in the pandemic such as lockdowns or indoor masking mandates, he was clear that all options were on the table.