Category Archives: Public health

Inside the Hospital in the Time of Coronavirus

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It started last Thursday evening after dinner. By 8 p.m., suffering shivers and chills and fatigue, I retreated to bed, unsure what was affecting me but hoping a solid night of sleep might provide some respite. I was near the end of two busy weeks. The previous week, I had been deeply involved in a huge experiment by the American Planning Association, which it called NPC20 @Home, a three-day online professional conference that would replace its canceled National Planning Conference, which would have taken place in Houston April 25-28. Instead, on opening day, April 29, I was moderating a session with three speakers[i] on “Demanding Equity: Planning for Post-Disaster Recovery.” We had rehearsed our approach, and it came off seamlessly before more than 1,600 participants, which made all of us very happy.

The following Monday, as chair of APA’s Hazard Mitigation and Disaster Recovery Planning Division (HMDR), I led our annual business meeting, which also had gone online after the NPC was canceled. With the support of our executive committee, particularly Christine Caggiano, our secretary-treasurer, who played the Wizard of Oz for our Zoom controls, it too had been a remarkable success with attendance spread across four time zones. So it went through Thursday, when two other speakers[ii] and I presented a webinar for APA’s Michigan chapter on the 2020 update of APA’s Hazard Mitigation Policy Guide. That was over by mid-afternoon; we patted ourselves on the back, and I went on to other business, such as a blog post that remains unfinished. I will get to it, I hope.

It was only as the evening progressed that I sensed something was wrong.

My wife, Jean, began to share fears that I was the latest victim of coronavirus. She, of course, was simply reacting to visible symptoms and venting her worst fears. But as the night wore on, my intuition led me in other directions, and I was unwilling to succumb to simple answers. Only I could experience and report all of my symptoms, which included a few trips to the bathroom, and it reminded me too much of previous experiences with prostatitis. In April 2012, on a flight to Los Angeles, I experienced chills and fever somewhere over the Rockies. Chicago to Los Angeles is about a four-hour flight, so I had to endure two hours of personal deterioration before landing at LAX, where I struggled to hold myself together as I grabbed my luggage and found a taxi to the hotel, where I could check in for that year’s National Planning Conference at the nearby convention center. At the hotel, I was already sweating as I checked in and found my room, where I remained for the evening, under bed covers, skipping nearly every event at which I was expected.

I was basically a physical wreck throughout the five-day conference, but, on the advice of my primary physician, found my way to a nearby urgent care center, where I was diagnosed with prostatitis, an infection of the prostate gland that can, under the worst conditions, kill the patient, as my urologist in Chicago later explained. I will say it was one of the worst experiences of illness in my entire life, and people who saw me when I made an occasional appearance outside my room uniformly commented on how awful I looked, and asked what was wrong.

Thursday night was nowhere near that bad, but still, it reminded me symptomatically of that experience.

Yet, by Friday morning, I thought I had perhaps gotten past it all. I felt reasonably okay, ate breakfast, dressed, and joined an online faculty meeting for the School of Urban and Regional Planning (SURP) at the University of Iowa, where I teach a course on disaster planning. Our discussion with the dean of the Graduate College, John Keller, focused on what might happen with on-campus instruction this coming fall, a question for which the answer was indeterminate.

Somewhere in the middle of that discussion, the malaise began to reassert itself, and I felt weak and tired. I sent a chat note to Charles Connerly, the director of SURP, saying that if I disappeared from the Zoom screen, it was because I was not well. Less than an hour into the meeting, I did exactly that, and went upstairs to our bedroom to rest. My wife noticed that my fever was not abating and worried that I needed medical attention. By noon, she insisted on taking me to the emergency room at nearby St. Mary’s Presence Hospital, and I gave in, not because I had resisted the idea but because I needed to muster the energy to get up and do it.

At the hospital door, a small group of security and admitting staff sought to ensure that I was arriving as a patient as I exited the passenger door of our car. I explained the situation. My wife and grandson could not join me because, amidst the coronavirus pandemic, and with most of the hospital devoted to such patients, no visitors are permitted. They had to wait in the car or go home, which they eventually did after picking up take-out lunch at a nearby Wendy’s. Once inside and admitted, I was on my own.

The first step by the nursing staff was to administer a COVID-19 test, putting swabs deep into my nasal cavity; it later proved negative. However, my temperature was 100.6° F. They did a battery of other tests based on my symptoms and concluded over the next few hours, as I sat in an ER unit, that I was suffering from a urinary tract infection (UTI). How I acquired it, I will probably never know, just as I never learned how I acquired prostatitis. All that matters is the treatment. I learned, to my deep disappointment, that I would be kept overnight for monitoring because of my history of prostate issues, which has included an almost fruitless search for evidence of cancer. I say “almost” because elevated PSA scores triggered the search nearly a decade ago, before the incident in Los Angeles, and on one occasion a fusion biopsy discovered a tiny sliver of affected tissue. But that finding has never occurred in all the years since. As a result, no treatment has been necessary. But still, caution was apparently in order when a UTI materialized.

The one reservation, of course, is that most of the hospital by May 8 was occupied by COVID-19 patients. One floor was reserved for non-COVID patients requiring hospitalization, and by 9:30 p.m., that is where I was sent. In the meantime, as evening approached, the attending nurse, Jesse, offered the use of his cell phone so that I could call my wife and ask her to bring my cell phone, my Nook e-reader, reading glasses, and power cords to help me escape boredom. He could see that, with nothing to do during long spells when nothing needed to be done (I already had an IV in my arm for a broad-spectrum antibiotic), I was becoming slightly stir crazy. Jean obliged by delivering the goods to the ER door, where Jesse retrieved them. My Nook contains dozens of books. They would relieve my anxiety and let me feel connected to friends and family, so that we could discuss what was happening.

One situation that disturbed me early in the evening was that I had promised to be part of two online events from 5 to 6 p.m. The first was to host the Zoom “room” for HMDR as part of a much larger invitation for members of any APA divisions to participate in a virtual Divisions Happy Hour. Given that HMDR has more than 1,500 members, and APA now has 22 divisions and eight “interest groups,” the number of registrants may have been rather large, but I never had time to check. It was surely in the hundreds, though once they were dispersed to their own groups, each division may have had a few dozen attendees, at most. At the same time, SURP was hosting an online happy hour event for John Fuller, a 41-year veteran professor of the planning school who is retiring at the end of the spring semester. I had arranged to migrate between the two events by having two other executive officers of HMDR, Caggiano and Stacy Wright, our chair-elect, take over when I moved from the APA event to the University of Iowa event. John, in his early days, had hired me as a graduate research assistant when I entered the program, supported my career for its entirety, and played a role in my being hired as an adjunct professor at Iowa in 2008. Before Jean brought my iPhone, I felt guilty about my inability to let anyone know why I was not attending, even though I could do nothing about it. Once armed with the phone, I called Connerly to explain my absence at the university event, and he promised to inform John and Kathy Fuller. I also emailed Caggiano and Wright to let them know why I had not shown up. They assured me the event had gone well. My evening would have felt much worse if I had not been able to make those contacts.

I later learned that my two daughters had unwisely come to the hospital seeking information on my condition, which they could have attempted more safely by calling. One was put off by the cold response she got from the staff at the door, but I told her the staff had bigger concerns than her hurt feelings. It could instead be a lesson in using better judgment. She had also questioned Jean about why she took me to the hospital at all because she had come to understand that no one these days comes out alive. That is clearly not true, but probably not uncommon mythology among the public.

At one point while still in ER, I heard a PA announcement barking “Code Joy!” three times, followed by the opening bars of the theme song from Rocky. I wondered what that was about but could only make lame guesses. Later, from a nurse in my room, I learned it was a celebration of a patient who was being released from the COVID wards—someone who had fought the virus and won. Before I left the hospital, this happened five times. It became a reassuring indication that people do, indeed, fight the virus and win—every day. And not just every day somewhere, but every day in the same hospital. Five times in three days while I was there. I will surely never know who they were, but good luck to all, and God bless every one of them. The Great Virus is not invincible.

As noted, late that evening, I was wheeled out of ER, through the halls and onto an elevator, and up to the eighth floor, the only remaining non-COVID section of the hospital. After being tested for vitals, I quickly fell asleep. The next morning, I awoke early, around 5:30 a.m., and began a routine that would last for nearly two days. I would alternate between using my cell phone for a small number of e-mail and text messages, and occasional calls with relatives, watching one news channel or another, reading, and taking naps. With an IV in my arm and heart monitors on my chest, I could hardly be more adventurous.

The biggest commitment was to finish reading The Great Influenza, by John Barry, a 2004 book about the 1918 flu pandemic that killed tens of millions around the world at the end of World War I. That may seem a gruesome topic for someone in the hospital, but I had read three-fourths of the book before becoming ill, and I wanted to finish. Also, I approach such information more clinically, trying to understand what mistakes were made, what changes resulted, and how people were affected, and I enjoyed the opportunity to learn so much so quickly. By noon Sunday, I finished, even perusing the photo sections and some of the author’s acknowledgments. Certainly, I could not have been reading history more relevant to our current dilemma.

My selfie in a hospital bed. Nobody said such photos would be beautiful.

Then I was faced with the question of what to read next. I had no assurance that I was going home that day, although it was possible. The hospital had received the lab results by late Saturday evening, and they indicated nothing unusual or troubling that would make mine a difficult case. But there was some question of how soon an infectious disease specialist and the doctor would sign off on my release. At that point, it felt that the real issue was more bureaucratic logjam than substantive, and I began to voice some urgency both to the overnight nurse, Klaudia, and the day nurse who followed, Katorina, that I did not wish to waste space if my staying no longer served a legitimate purpose. They could only reassure me that it would happen sooner or later, but I must say that both were extremely attentive and remarkably pleasant, even when it was obvious how restive I had become about the need to be released. Given the pressures surrounding them, they seemed like angels.

It was Mother’s Day, after all, and I was also feeling regret about not only missing the Friday happy hour events, one to honor a long-time friend and colleague, but now draining the pleasure out of a day that should have been spent honoring Jean. It did not seem fair that my unexpected illness should rob her of this honor. I had planned to grill steaks and baked potatoes to accompany a lush salad for her dinner, but could do none of that. I could only wait.

I made an unusual choice of my next book—a 1950s theological essay, Your God Is Too Small, by J.B. Phillips. Despite its dated gender language in the introduction, it is remarkably lucid and straightforward in explaining how we “box” God into small roles in our lives because we cannot bring ourselves to understand God’s vastness and yet God’s importance to the minute details of our lives at the same time. There was something vaguely soothing about the message, given the situation. I did not finish the book in the hospital. That task still awaits. But I put a large dent in it.

Suddenly, around 6 p.m., Katorina came to the room to provide some medicine and the news that the doctor was authorizing my release, with the understanding that I should call to set up a follow-up telemedicine appointment with him a week later. Within the space of a half-hour, the nurse removed all the equipment hanging from my arm and chest; I changed clothes, packed up my limited belongings, signed the release papers, and she was walking me to the elevator, down to the lobby, and to the front door, where Jean had been alerted to find me. She arrived within minutes. Yes, non-COVID patients are also leaving hospitals these days, though far fewer than used to be the case. Non-essential surgeries, in many places including Chicago, have been pushed aside because those ill from coronavirus need the beds. But, clearly, they too often leave and return home, just as I was doing.

I took it easy on Monday. I was still a little light on energy, so I spent much of the day reading a few newspapers that had accumulated in my absence, but I had no special ambitions and no appointments. I did cook that steak dinner as a reward for Jean’s patience and a delayed Mother’s Day. But in the evening, I had difficulty sleeping because tension in my neck and shoulders, probably the result of stiffness induced by a lack of motion with all the equipment attached to my body in the hospital, was causing a mild headache. At Jean’s urging, I took two pain pills and a sleeping pill, but then she applied some massage to bring the congested energy around my neck down my spine to my legs and feet, and I felt some relief. In the end, I managed to sleep until 6:30, which is late for me, but very good in this instance. It was refreshing.

On the trail in Humboldt Park, a day and a half after release.

I have spent part of Tuesday composing this story, but part of it further releasing that pent-up energy by hopping on my bicycle and riding it to Humboldt Park, a 700-acre expanse of municipal open space just half a mile from our home. I wandered down one path after another, past lakes and lagoons and trees in the open air of a Chicago spring morning. I had written part of this before I left. I felt more energized to complete it when I came back, once I had eaten lunch. I learned you can enjoy nature much more when you have missed it for a few days. I can only imagine the restless agony of missing it for much, much longer.

Jim Schwab

 

[i] Shannon van Zandt, Texas A&M; Marccus Hendricks, Univ. of Maryland; and Chrishelle Palay, HOME Coalition, Houston.

[ii] Pete Parkinson and Kara Drane, who were also co-authors of the updated guide along with George Homewood, David Gattis, and myself.

Make America Mature Again

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What follows is an adapted, re-edited version of a Facebook post from today that seems to have struck a nerve, attracting dozens of likes, comments, and shares. As a result, I concluded that perhaps I should add it to this blog.

 

No pictures here, just observations:

We as a nation come from ancestors who nearly starved to death at Valley Forge but stuck it out to ensure the success of a revolution that created a new nation built on liberty, imperfectly at first, but expanding its range over centuries.

Some of the toughest Americans come from ancestors who endured slavery over centuries to help build upon that legacy of liberty when they finally won their freedom.

We come from ancestors who endured four grueling years of civil war to ensure that liberty and equality retained a fighting chance to become this nation’s hallmark.

We come from ancestors who endured long passages across sometimes rough seas to reach a land that promised them a better life, and when they arrived, many endured hard work and, often, discrimination to assert their role in building our democracy.

We come from ancestors who, toward the end of World War I, endured endless months of influenza pandemic, with shutdowns and deaths and illness comparable to those we are experiencing now, until the danger passed and lives could be rebuilt.

We come from ancestors who, just a decade later, underwent the grueling agony of the Great Depression. We elected a president who, riddled with polio, understood the virtues of patience and perseverance in solving problems that seemed daunting by any measure, then entered World War II to help save the world from some of its most vicious tyrannies in modern times.

I could go on. But . . . .

Someone forgot to teach these lessons to a narcissistic president with the attention span of a fruit fly, a spoiled upper-class brat who has never faced serious challenges in life until now, a man who never learned much history, judging from the evidence of his comments.

Someone forgot to teach those lessons to protesters who, after a single month of one of the greatest public health challenges in anyone’s lifetime, refuse to learn that life never promised them that everything would turn up roses at the flick of a finger, and who never learned to analyze and understand a problem to find out whether the reopening they say they want might produce more harm than good, that a temper tantrum never solved anything.

Millions of Americans, probably most, of course, despite everything, understand that sacrifice will be part of the solution. But others have never, apparently, been steeled by a personal Valley Forge and just want what they want. Isn’t it time for a little maturity to settle in? Thank God for some governors and mayors out there with common sense and fortitude.

This is America. We’re supposed to be tougher than just throwing temper tantrums. Let’s prove it, people.

 

Jim Schwab

 

Unequal Exposure

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On April 29, I will be moderating “Demanding Equity: Planning for Post-Disaster Recovery,” a 45-minute session in a special three-day virtual conference of the American Planning Association, NPC20 @HOME. The online conference is an attempt to replace the experience of the canceled National Planning Conference, which would have taken place in Houston, April 25-28. For the first time in APA history, the annual event will not go forward as planned. Like numerous other conferences, it was untenable to assemble thousands of participants in the middle of the coronavirus pandemic. But it is possible to provide a decent educational opportunity in its place by broadcasting and recording distance learning and letting participants ask questions remotely.

But why do I mention this one session, when APA is offering two dozen? Because it touches on some issues so central to the social and economic impacts of coronavirus, and speaks so directly to what planners and planning can do as we recover from this experience, that I wanted to highlight the subject in this post. It has been said often that the coronavirus does not discriminate. That may be true, but our society has done so and still does, often in ways people are reluctant to consider or admit. The result is that, as happens with most disasters, minorities and low-income people, those with fewer opportunities in life or greater exposure to danger, are disproportionately affected. And so it will be when the histories of this pandemic are written. The evidence is already stark enough for passionate discussion.

To give credit where it is due, the session was the brainchild of Adrian Freund, a veteran, semi-retired planner in Oregon. Before the NPC was canceled, however, Adrian was hospitalized (not because of coronavirus) and realized he would be unable to go to Houston. He reached out through a former president of APA, David Siegel, also of Oregon, to ask me to take over, and I agreed. We are on the same page on this issue. When APA decided to replace NPC with NPC20 @HOME, this was one of the sessions they felt must be included, and I reassembled the speakers to modify our plans for the new format.

All of them have a ton of wisdom to contribute on the subject. Shannon van Zandt is a professor of urban planning and department head at Texas A&M, and has authored numerous articles and led many projects on subjects related to equity in disaster recovery, particularly in the Texas context in which she works. Marccus Hendricks, an assistant professor of planning at the University of Maryland, is a Texas A&M graduate who has focused on infrastructure issues and environmental justice, writing his doctoral thesis on stormwater management in Houston. Chrishelle Palay is director at the HOME Coalition in Houston. Obviously, the panel has strong Texas roots, but there are few states where one can get better insights into the impacts of environmental inequities.

But it is the screaming headlines of the past week that have brought renewed attention to the issue in the context of coronavirus. In Chicago, we have learned that African Americans are dying from the virus at six times the rate of whites. Gary, a predominantly African American city, is the new coronavirus hot spot in Indiana. It is also where it gets personal for me. A 12-year-old granddaughter lives there and, as of yesterday (April 10), appears to have COVID-19 symptoms. Her mother called and was asked not to bring her to a hospital, but to isolate her at home. She will not be tested because, as everywhere else, this nation has not gotten its act together on testing. Will she even be included in the statistics, then, as a known case? Good question. I have no idea how Indiana is tallying such numbers. But she is in for a rough ride in the immediate future, and Gary and surrounding Lake County are certainly not fully prepared.

But what is happening in Chicago, as numerous commentators and public health officials have noted in the past week, is not only not unique, but to be expected. Detroit is emerging as a hotspot with major disparities in racial impact. State health data reveal that, while blacks make up 14 percent of Michigan’s population, they account for one-third of the cases and 40 percent of the deaths so far. In Louisiana, with one-third of the population, blacks account for 70 percent of the deaths. New Orleans has clearly emerged as a southern hot spot for coronavirus infections. Across the nation, one can find similar racial disparities.

Beneath those figures, however, are other disparities that weave in and out of racial and ethnic numbers. Age is perhaps the best-known factor, but so are many others. People in low-income service jobs, for instance, to the extent that they are still working, are more dependent on public transit and much less likely to be able to work from home like white-collar professionals. Public transit contributes greatly to mobility in urban centers, but does little for social distancing. It is still unclear just how transit will be affected for the long term, although it remains a vital link to jobs for many of the working poor. But coronavirus is clearly challenging the economic viability of many transit systems, one reason they were the target of assistance in the CARES Act.

It goes without saying that health care workers are significantly more exposed, but they are not just doctors. Their ranks include nurses, nursing assistants, and many others, some with much lower incomes, who nonetheless are risking their lives every day. Some of them work in nursing homes, which have not been the focus of any noticeable attention at the federal level. There are many ways to slice and dice the data to identify patterns of exposure, including those for access to health care, quite possibly the single most important factor driving disparities in this particular disaster. Lack of insurance coverage and inability to afford adequate health care leave many people untouched by the system and untested until it is too late. Poor or nonexistent health insurance coverage, especially for undocumented immigrants, accompanied by food deserts in many inner-city neighborhoods, endemic poverty in many rural areas and small towns, and exposure to job-related ailments, can produce numerous chronic conditions that make exposure to a new virus fatal or disastrous instead of merely survivable.

It remains remarkable, in view of these factors, that the Trump administration can maintain its drumbeat of opposition to the Affordable Care Act, including the recent refusal to allow newly jobless Americans to sign up for coverage. But this is one of many ways in which this nation, through both federal and state policy, continues to resist expanded, let alone universal, health care coverage to shore up health care deficiencies for the most vulnerable among us. There is both a meanness and short-sightedness that underlies much of this resistance. As I noted just two weeks ago, these health care vulnerabilities, with all the racial and socioeconomic inequities they embody, form the weak links in the chain of overall vulnerability for our communities when pandemic strikes.

And that brings me back to the point of the session I will moderate. One essential element of the planner’s skill set should be demographic analysis. The coronavirus pandemic highlights the critical value of addressing public health in comprehensive plans and other efforts to chart the future of cities, counties, and regions. Issues of national health care policy may be well beyond the reach of planners and their communities, but exposing the glaring disparities that have been made evident as the data on coronavirus cases grows is critical to knowing how resilient our communities are or how resilient we can make them. Access to health care is not merely a matter of insurance, as important as that is. It is also affected by the practices of local hospitals, the access to open spaces for densely populated areas, environmental regulations controlling industrial pollutants, public education around personal health, access to healthy food, the quality of our food distribution systems, and a myriad of other considerations that can be addressed to one degree or another through local or regional planning and through policy commitments to social equity.

That is precisely why, as the White House dithers, and federal management of the coronavirus crisis continues to fall short, dozens if not hundreds of mayors and governors and other local and state officials have stepped up to fill the gap. It is sad that there is not better national leadership in this crisis, but we are learning who our real leaders are. Enabling planners and other policy makers to support those officials with essential and meaningful data is an ongoing task, but if we are going to emerge from this disaster in a better place, identifying the inequities that weaken our communities and finding ways to build resilience across those weak links is going to be essential. There is no good alternative.

Jim Schwab

Test of Moral Imagination

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Okay, now I’m angry. I had not intended to produce another blog article quite so soon, but false prophets are rampaging through the vineyards of the Lord. Fortunately, there are only a few of them reported so far, two of whom have been cited for certain misdemeanor offenses. But with the coronavirus, it takes only two megachurch pastors calling hundreds of people to live church services to let loose the plague on not only their own followers but everyone around them. They need to get some common sense and knock it off.

In addition, Rev. Jerry Falwell, Jr., son of the founder of the fundamentalist Liberty University in Virginia, has called students back to the campus after spring break, ignoring the actions of almost every other college in the nation to forsake such close contact and take lessons online for the duration of the semester. With several documented cases on campus already, the question is how many more students and staff will be infected.

In Central, Louisiana, Pastor Tony Spell of Life Tabernacle Church was arrested after holding services on Sunday in violation of the emergency order by Gov. John Bel Edwards for Louisiana residents to stay at home for the coming month. Released after his booking, he proceeded to defy the order again by holding services on Tuesday evening. As on Sunday, curious onlookers wondered what he was doing. On Sunday, according to the Chicago Tribune, people in the neighborhood were questioning what made the people of the church think they were so special as to disregard Gov. John Bel Edwards’s stay-at-home order. No one is discriminating against anyone’s religious rights because the order does not prohibit online gatherings and similar modes of worship. It aims to limit large crowds to inhibit the spread of a deadly virus for which there is, as yet, no known vaccine or effective cure. That is a matter of public safety. Thousands upon thousands of other congregations nationwide are live-streaming church services as a substitute for assembling masses of people in a Sunday morning petri dish for coronavirus.

I write from personal experience. My own congregation, Augustana Lutheran Church of Hyde Park, in Chicago, suspended services more than two weeks ago, but provides recordings, readings, and other online and private opportunities for worship and meditation as we can. I serve as the coordinator for the Adult Forum, the Sunday school session for adults, which predictably draws its fair share of devoted seniors, who are at greatest danger of exposure, and about whom we are most concerned. We are not meeting until further notice. We may miss the interaction and the discussions, but we do not wish to put anyone’s life in danger. Our priority is safety. We want everyone to emerge from this in good health.

In Tampa, meanwhile, Pastor Rodney Howard-Browne of the River at Tampa Bay Church violated a stay-at-home order by holding services this past Sunday. He later turned himself in to authorities, but the law firm representing him maintains that the church practiced social distancing. Given the human interactions inevitably occurring in large crowds, that may be beside the point. However, USA Today reports that, in a Facebook post, Howard-Browne described coronavirus as “blown totally way out of proportion.” It is worth noting that Florida is nearing 7,000 confirmed cases with 87 deaths so far, and the trend is moving rapidly upward. One wonders if the families of victims share his perspective.

Mark my words: In the face of the pervasive concerns of neighbors and fellow citizens and fellow Christians, such defiance soon turns to arrogance. And arrogance demonstrates egotism, not faith.

New U.S. coronavirus cases per day, as of April 1, 2020, courtesy of Wikipedia: https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_the_United_States
(same for both graphs)
New U.S. deaths from coronavirus per day, as of April 1, 2020, courtesy of Wikipedia

Given several thousand deaths to date in the U.S., out of hundreds of thousands of confirmed cases, with untold suffering likely still to come, I have a simple question for these three ignorant gentlemen:

Who the hell do you think you are?

Pastor Tony Spell insists he will do it again because “God told us to.”

I’m sorry, but I don’t believe that. All those other pastors and rabbis and imams and nuns and priests, including Pope Francis, who is not asking anyone to come to the Vatican for Easter because he cares about the lives of fellow human beings, seem to be getting a very different message, which I suggest might sound something more like this:

Take care of my people. Save lives, especially those of my elderly servants, by taking precautions. This is your chance to show how you love each other, protect each other, and lead each other through the valley of the Shadow of Death. Use this opportunity to make your communities stronger. And, for my sake, think about the lives and health of my thousands of servants on the front lines–the doctors, the nurses, the EMTs, the social workers, the police—they are parts of your flock to whom I have assigned great responsibilities. Please do not think me so vain nor so cruel as to insist on the continuation of live worship services during this crisis. This is your opportunity to show that I have gifted you with moral imagination. Use it.

Jim Schwab

Isolated Adjustments

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I miss my gym already, closed just two weeks ago. There was a profusion of equipment to keep anyone in shape, whether you were working on legs, biceps, core, cardio, some combination, whatever. Here at home, I have small barbells, some ankle weights, and perhaps most importantly, a newly tuned 26-inch bicycle. There are other bicycles in our garage, mostly to accommodate grandchildren but also one my wife uses. We were out briefly yesterday for a ride in the neighborhood before the blustery spring winds brought more rain.

Closed entrance to the 606 Trail at California Ave.

A friend joked a few days ago that, after closing the Lakefront trail, adjacent parks, and beaches, and the 606 Trail plus park district field houses and playgrounds, Mayor Lori Lightfoot may have been praying for rain to enforce the stay-at-home, social distancing restrictions in effect throughout Illinois. If so, she got her wish over the weekend, but the weather is changing already, and Chicagoans are likely to take advantage of it. That’s okay, as long as we use those big park spaces that are still open to maintain social distance and help slow the spread of the deadly coronavirus.

Alex at a closed entrance to the 606 Trail.

Quite frankly, just one week ago, after picking up my bike from a nearby shop that performed the tuning, I used it to ride a portion of the 606 Trail, feeling the liberation that comes with such a small adventure. That was Monday afternoon, and the closures came on Thursday. I was not surprised. The 606, which is a great community-building amenity in normal times, seemed far too narrow and crowded for public safety in these times. I have not returned. Future rides will be on winding paths in the 700-acre Humboldt Park, where one can move past other human beings without encroaching on personal space. And I can still invigorate my body and spirit with some healthy exercise.

Humboldt Park is open, but the playgrounds are closed.

So, what is this blog post about, exactly? It is about adjustments in the time of COVID-19. But let me be clear. I am sharing the adjustments being made in our three-member household, and everyone else is making their own. Each set of adjustments is unique, yet many of us can learn from one another. I am also painfully aware that we are safer and in a better position financially than many people who have lost jobs or are suffering lost income, or have a sick family member. I can empathize, while knowing their experience will unquestionably be very different. And I wish such people the very best. Our nation is in for one tough slog against a ghastly microbial enemy.

My wife and I are both in our early seventies, but our three-member household includes an 11-year-old grandson, for whom we assumed guardianship two years ago. His mother has long faced mental health challenges. Two weeks ago, the Chicago Public Schools (CPS) closed, and as of now, they will remain so until April 20. After that? Who knows? At first, the closure was for two weeks, but that would have ended today. Officials at all levels of government have underestimated the scope and duration of this problem, but the important thing is that they are learning daily and adjusting strategies, as we all are. Universities have suspended semesters and moved classes online. A friend of mine who teaches at an area community college admits to being “dragged, kicking and screaming, into the 21st century” as he learns online teaching skills. I, on the other hand, have already been teaching online for the University of Iowa. My one class each year occurs in the fall, so the question is whether we enroll enough students to move forward by August. The odds seem good, but so much changes so quickly. Again, who knows? I will have to wait for the answer.

I practice what I call “alleged retirement,” which involves a part-time mix of teaching, consulting, public speaking, and writing. At worst, my wife, Jean, a retired teacher, and I can live off our pensions and Social Security. We would have to retrench if I had no outside income, some provided by the university, but we could survive. That makes us feel far more secure than I know is the case for gig workers, restaurant and hospitality workers, travel and tourism workers, and many others affected by shutdowns and restrictions aimed at containing contagion.

Jean in front of Moos School, now closed because of coronavirus.

Meanwhile, precisely because she is a teacher, my wife works with Alex on reading and math, so that lost school days do not translate entirely into lost learning. But that has involved its own learning curve. In the first week, we both noticed Alex’s ability to refocus his time on television and video games. We were busy figuring things out in that week of canceled St. Patrick’s Day events and the Illinois primary, in which Jean was an election judge. But we discussed the situation, and Jean quickly began to insist on specific hours for learning exercises. I am grateful, and hope Alex is, for her knowledge of teaching methods to keep him fresh on everything from multiplication to vocabulary expansion. I can only imagine what single mothers with four children no longer attending school must be doing to cope with the situation. Many in Chicago or rural Illinois or throughout America do not have Internet, or lack personal computers, and lack daily connection with the schools that kept their children busy until just recently. We have a 16-year-old grandson who is a high school sophomore. He is staying with his father, who works long hours in a warehouse to pay the bills. While we provided Angel with a small laptop at Christmas, I have noticed that CPS is not updating information on Aspen, its grade- and assignment-tracking online program, so we have no idea what, if anything, he should be doing in his classes. I used to help him with courses like Spanish, but now I have not a clue what he should be doing. It is as if CPS just vanished into thin air. The only solution from a learning perspective may be to extend the school year in June—but only if we have coronavirus under control by then. Otherwise, you could take his lost opportunities and multiply them by the tens of thousands across the city.

Jean works with Alex on spelling.

Then there is the drumbeat of coronavirus news to which people can subject themselves if they sit in front of the television all day long. I choose not to do that because I find that one hour of news tells me 90 percent of what I need to know, barring some breaking announcement, and the rest is repetition. I read the Chicago Tribune thoroughly each morning. My wife knows counselors and others who suggest limiting exposure to such news to reduce anxiety. She has taken to using some online meditation one of them has provided, and it works for her. I don’t share the anxiety because I am a different sort of person. My professional experience in the urban planning field is heavy on planning for disasters and disaster recovery. I read the news with an analytical eye, looking for clues to what we, as a society or region or city, can do better, and often turning that into commentary on this blog, but also applying it in various planning tasks. Since I retired from the American Planning Association (APA), many of those tasks have been pro bono activities, such as serving on policy guide task forces and chairing APA’s Hazard Mitigation and Disaster Recovery Planning Division. There is no shortage of opportunities, and I am grateful every day for the chance to contribute something through all those channels. It’s not all about earning money. Just helping makes our lives richer; how we do it depends on our skill set and interests.

But clearly, the precautions we are all observing can be frustrating and lead to adjustments. Travel, in most cases, is a non-starter for the near future. Little more than a month ago, I was in Rockport, Texas, assisting the APA Texas chapter with a Hurricane Harvey recovery event that allowed Texas planners to interact with planners from New York and New Jersey who could share perspectives from Sandy recovery. Two weeks later, after a quick recovery from a mild case of the flu, I was in Kearney, Nebraska, speaking at the annual conference of the Nebraska Planning & Zoning Association, sharing knowledge and ideas with colleagues there. The first hints of a truly serious public health catastrophe were becoming clear, and that became my last trip so far this year. By March 18, APA had canceled its annual National Planning Conference in Houston, an event that has typically drawn about 5,000 people. Not this year. As a division leader, I am involved in many of the leadership discussions about what comes next in taking many meetings and sessions and other events online, and moving forward. This is happening across the board to numerous organizations of widely varying sizes, with huge impacts on the hotel, airline, and convention industries not only nationwide but across the world. Caught in the maws of this economic and public health earthquake are millions of workers.

Yet, as obvious as this seems to me, with my laser focus on news that matters, I have learned that not everyone is fully aware of its consequences. Alex’s mother invited us to visit her apartment, and Jean declined because we have no way of judging how safe it is. Then, two other people visiting her apartment suggested coming to our house to visit Alex. Again, Jean said that would have to wait, but they seemed only marginally aware of developments like restaurant closures and social distancing. Meanwhile, my mother, whose resilience at an advanced age has been stunning, was released last week from a hospital in suburban Cleveland after a brief non-COVID illness to a rehab facility, where she is confined to her room for 14 days because she had been in a hospital. Visitors are not permitted, as they also will not be when she finally returns to her retirement home. In short, although I have two siblings who live near her, I could not visit even if I chose to drive there.

But that brings me to a closing note. I can stay home not only because I am “allegedly retired,” but because I am not a health care worker. Their adjustments have been the reverse of those of most of us, involving thorough engagement, exposure to life-threatening infection, and long hours of treating growing numbers of patients. And not just in urban areas. As of today, for example, Illinois has 4,596 reported cases, resulting in 65 deaths, spread across 40 of 102 counties. Small towns and rural areas will not be immune. I just heard New York Gov. Cuomo note that COVID-19 has spread to all but one county in his state.

Amidst all our concerns, the ducks in the lagoon at Humboldt Park are blissfully oblivious to human problems with the novel coronavirus.

We’re all making adjustments, most of us in our homes, but our public health workers, doctors, and nurses are making theirs at the front lines. We owe them a huge debt of gratitude and everything we can do to support them, especially those who have voluntarily returned to work from retirement, or serve in the National Guard, and didn’t have to take those risks. God bless them all, every last courageous one of them.

Jim Schwab

Weak Links in the Chain

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Resilience has become almost a buzzword with regard to how communities handle adversity and disasters, albeit a very useful buzzword. It focuses our attention on how we can better prepare for and cope with such events. The question of the moment is how the concept of resilience applies to our response to coronavirus.

One of many hospitals in Chicago, all of which have visitor restrictions in place due to the coronavirus pandemic.

I am not and never have been a public health expert, though, as an urban planner and adjunct planning professor, I have often worked with such people. I say this because I want to be clear about the prism through which I am viewing the coronavirus pandemic as a public health disaster. What I bring to the task is decades of work, particularly as a research manager, in the subfield of hazards planning. I am known for deep expertise in hazard mitigation and planning for post-disaster recovery. In this article, I am reaching into that toolbox to help identify what we need to learn from the current crisis.

Specifically, part of what has become the standard approach to hazard mitigation planning is vulnerability analysis, the process of identifying what in plain English are weak links in the chain of community capabilities and capacities to manage and recover from a disaster. Every community, every nation has strengths and weaknesses built into its systems, which are really an ecosystem of economic, social, institutional, environmental, governmental, and other elements of the community that comprise the way the community functions in both sunny times and days of turmoil and dysfunction. How well can that community or nation restore itself, rebuild, adapt, and learn from its experiences? One of the most fundamental elements of success, for example, is trust in government and community leadership, something that is being tested right now in the U.S. That leadership can either greatly enable and empower or greatly hinder the capacity for effective response to, and planning for recovery from, a given disaster.

But my focus here is on what a vulnerability analysis of our response to COVID-19, the disease caused by the novel coronavirus, might include. I say “might” because I do not pretend that what follows is comprehensive. It is merely suggestive. A more comprehensive list would best emerge from a summit of leaders and experts when it is time to decide on the lessons learned from this disaster. For now, leaders are rightly focused on using existing authorities and capacities to control the spread of the disease.

The main point of a vulnerability assessment is to identify potential points of failure relative to the hazard under consideration. For instance, with hurricanes or floods, we would want to know what roads or bridges would collapse or become impassable. We would also want to know the locations of substandard housing that might suffer damage or destruction or endanger its occupants. There are dozens of other examples of potential points of failure that I could list here, but presumably, you get the idea.

With the novel coronavirus, we are dealing with an invisible hazard that inflicts suffering and death on people, not buildings or structures, and—most importantly—for which there is not yet an identified cure or vaccine. Most people do not die, and many suffer only mild symptoms, but the spread of the disease is of radical concern in part through the slow rollout of testing kits in the U.S., which exacerbates an existing inability to know precisely who is infected, especially since many people test positive who are asymptomatic, that is, not exhibiting clear symptoms of the disease. Vulnerability depends on various factors, most notably, but not exclusively, age. Respiratory and other existing conditions can elevate that vulnerability, while some older people may be tough enough physically to weather the assault. Thus, identifying and classifying real and potential victims is a business fraught with uncertainty.

Given all that, where are the weak links in our communities? Many can be readily identified from the more routine aspects of vulnerability assessments, starting with governmental capacity:

  • To what extent has the city, state, or the federal government prepared and established capacity for anticipating the problem and quickly enabling the appropriate responses? It is perfectly logical to expect that greater capacity should exist at higher levels of government that have greater resources at their disposal.
  • What is the level of political maturity among the electorate, and the political will for undertaking and enforcing difficult but necessary decisions in a crisis?

The biggest questions surrounding coronavirus seem to relate to institutional capacity, some of which can obviously be enhanced or supported through governmental capacity, for example, in procuring and distributing the personal protective equipment, ventilators, and temporary hospital beds needed by the regional “hot spots” for virus outbreaks, which at the moment include New York, but also a frightening spike in confirmed cases and deaths in the last few days in Louisiana, possibly tied to the huge crowds attending Mardi Gras in New Orleans. These have led to Gov. Jon Bel Edwards issuing a stay-in-place order similar to those in effect in California, Illinois, and New York. Among obvious questions in a vulnerability assessment going forward:

  • What hospital capacity exists for treating large increases in numbers of patients in a future pandemic? This includes emergency room capacity, intensive care units, and other essential elements of the treatment process, as well as the ability to expand access to protective gear. It also involves the adequacy of skilled professionals to work with this increased patient load.
  • What capacity exists to monitor, work with, and even thin the population of crowded jails and prisons, where social distancing is effectively an oxymoron, and the potential for rapid spread of disease can amount to a death sentence for those confined behind bars?
  • What are the sanitary and patient care conditions in local nursing homes, and how effectively are they regulated? Nursing homes and similar facilities for elderly medical care have in some cases become virtual incubators for the spread of coronavirus, leading to situations where relatives can no longer visit.

Many of these questions also lead us to questions of economic vulnerability, which also pertain to social equity. Restaurants in states that have instituted closures of public places where people normally congregate in large numbers have laid off thousands, possibly millions of workers—the numbers change by the day—who often work for hourly wages and need every hour to pay the rent. Workers in the gig economy, the tourist economy, and the travel industry are all similarly vulnerable in varying ways. One result, even under normal circumstances, is that many of these workers, some of whom are also undocumented immigrants, are reluctant to take sick days because they have no paid sick leave. Often, they also have no paid health insurance, or cannot afford it.

That, in itself, needs eventually to be recognized by the United States as a source of pandemic at worst, or a threat to public health, at best. Take, for example, the story of a McDonald’s worker who shared the news that he went to work ill, vomited when he ran to the restroom, but was afraid to call in sick because a missed paycheck was a threat to his economic security. How often does that happen, and how reassuring can it possibly be to customers who even think about the potential consequences? Is anyone attempting to gather data on this problem? A worker rights organization, Arise Chicago, has been fighting for better protection for workers on this front for several years, and won passage of a Cook County ordinance in 2016, but the battle continues. At the moment, these workers either are laid off because of restaurant closures, or are adapting to the temporary new world in which their employers can sell takeout, drive-out through, or delivery.

But whether it is hotel, restaurant, or transportation workers (such as taxi and Uber drivers), among others, the vulnerability lies in the harsh facts that drive them to show up for work despite illness because of their lack of paid sick leave or medical coverage. Nowhere in America can an honest vulnerability assessment of future pandemics ignore these socioeconomic imperatives. Economic facts drive health impacts, which in turn drive at least some of the questions surrounding health care capacity. In this sense, one can see how identifying all the weak links in the chain of vulnerability means recognizing the interrelationships between the various categories of vulnerability I listed initially.

This description of the process could go on for many more pages, but it may be more important to let the complexity and interdependence of it all inspire further thought. With that in mind, let me offer a few other items for consideration:

  • Given the inability of some parts of the population to accept the necessity of temporary restrictions, how well prepared are we to control the wayward behavior of the few, even as the majority of our citizens show adequate consideration for others around them? What are we prepared to do about them?
  • In the event of a lockdown, what are we prepared to do for victims of domestic abuse who are suddenly trapped inside their homes with abusive partners, parents, or relatives? Do we have institutional capacity to remove them to safer quarters and the ability to answer their calls for help? Sheltering in place is hardly likely to make an abuser more sympathetic.
  • How well are we positioned to assist those suffering from mental illness, for whom isolation may increase propensity for depression and suicide?
  • In what ways can we respond to the needs of homeless people, for whom the spread of a pandemic disease may increase due to proximity and unhealthy circumstances?

There are some very hopeful signs of creative thinking on these issues in local and state governments, if not in the White House. For example, the City of Chicago has reached agreement with several hotels to use hotel rooms as isolation rooms for victims of COVID-19, with the city paying for the capacity in advance. This relieves hospital capacity, to some degree, but it also provides some employment for hotel workers who would otherwise be idling at home because of the shutdown of the hospitality industry as both leisure travel and conventions grind to a halt. The workers will provide food in the kitchens and undertake other safe duties, while trained public health personnel deal directly with the quarantined patients. The hotels stay open, some workers stay employed, and some strain is removed from medical facilities. Some members of the Chicago City Council are now calling for the use of vacant public housing units for the same purposes.

Likewise, some otherwise closed YMCA facilities will begin accommodating the homeless while providing necessary social distancing. All of these are creative solutions that can emerge from identifying the weak links in the chain, and can provide cornerstones for sound planning for resilience in the face of future public health emergencies.

In short, let’s all keep our thinking caps on. We’re going to need them not just this time, but for the future as well.

Jim Schwab

For the Love of Public Spaces

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If the doctor’s office had not called, I would not even have been here writing. I would perhaps have been on the CTA Blue Line on the way to my appointment, or more likely walking from the train station to his office. But they called less than an hour before the appointment. The urologist merely needs to follow up on a February 26 procedure, so could we just do a telephone consultation? Frankly, I had wondered why they had not offered that option already, so I accepted. The only difference it would make, I noted, was that I had planned to use the opportunity to shoot photos of the empty “el” cars, the empty streets as I moved up Michigan Avenue across the Chicago River, and perhaps the empty Millennium Park downtown, if it was in fact empty. Deprived of the need to go there, I simply walked the neighborhood, shot photos of restaurants open for takeout only, and took two shots of the empty el platform. Then the drizzling rain began, and it was time to come home and await the call, which came late as the doctor scrambled to maintain his schedule.

The Western Avenue Blue Line station platform, early afternoon, March 19. If you are not from Chicago, trust me: You have no idea how unusual it is for this platform to be so empty. This is the impact of the coronavirus pandemic. Ridership is down by more than half.

But at least I got that first paragraph written, before the nurse called, as I thought about a potent issue for urban planners amid the coronavirus pandemic. Under normal circumstances, there are few subjects most planners like to discuss more than the design and use of public spaces. These come in a variety of forms, such as trails, parks, and plazas, which are generally publicly owned, but they also include a wide variety of privately owned spaces that are nonetheless generally accessible to the public, such as restaurants, outdoor cafes, malls, stores, and recreational facilities like the YMCA. The latter category is more frequently available on a paying basis, but those lines can be blurred under specific circumstances, such as the rental of public spaces for private events. The one overriding factor is that planners are very much aware that the public life of cities is very much defined by the activity levels and density of use of these spaces. An urban park visited by almost no one is not a positive sign of urban vitality. A public concert in the park attracting hundreds or thousands of happy people dancing and swaying to the music is a sign of a city in love with life and alive with culture.

Margie’s Candies, a nearly century-old family and teen hangout and source of sandwiches, ice cream, and candy for residents of Chicago’s Humboldt Park, can only offer takeout sweets at this time.

In the midst of pandemic, however, especially in dealing with a disease for which no one has yet developed an effective vaccine, not to mention a disease that disproportionately slays the elderly and those with respiratory vulnerabilities such as asthma, crowded public spaces are an indicator not of prosperity and vibrancy, but of danger. Social distancing to protect ourselves from unidentified carriers of COVID-19 is now an essential element of survival and personal protection. Yes, it’s nice to greet a friend in the park, but only if they keep their distance, and no, I don’t wish to shake your hand. There is a certain weary loneliness about this that is undeniable. Most of us are highly social beings, even the introverts among us. We like to talk, to exchange news, to share ideas. Thank God for the invention of the telephone and the Internet.

Why order online? Because, for the time being, restaurants in Illinois are not permitted to offer dine-in service. Takeout, drive-through, delivery are your only options. Blow up the photo to see the sign on the door more clearly.

But it’s more than that. Public spaces often provide us, to one degree or another, with the opportunity to move, to exercise, to stay physically fit. I got word just two days ago that the X Sport Fitness gym at which I maintain a membership would be closed until further notice. The trainers, I learned, are left scrambling to determine how they could continue to earn a living. They are joining millions of others whose livelihoods are in jeopardy until this scourge passes. If you know someone in Chicago who can benefit from in-home fitness training, let me know. I can hook them up with capable trainers.  

Coffee shops and restaurants are no longer public meeting spaces. Just get it and take it home.

I will be looking to find other ways to stay physically active. As noted in posts of years past, I am fortunate to live near the 606 Trail. I need to get my bicycle tuned up for another season, and I can ride for miles. On my stroll yesterday, I could see that joggers were making generous use of the trail, as were walkers and others. Interestingly, the Rails-to-Trails Conservancy has posted information quoting medical experts suggesting that people should seek to maintain their exercise routines and use our public parks and trails for just these purposes. There is nothing worse for physical health than being cooped up in one’s house or binge-watching past seasons of whatever. Get out and move around. Just keep your distance.

The joggers, bicyclists, and strollers are still using the 606 Trail. This is near the Western el station shown above and the photo taken less than 20 minutes earlier.

That goes for the kids, too. Playgrounds, for the most part, are still open. If you’re worried about touching the equipment, make the kids wear gloves or use disinfectant wipes on metal and plastic surfaces before letting them ride or play. But, above all, let them run around.

What we are all, I hope, trying to do for the near future is to slow or halt the transmission of this dangerous new coronavirus. That does not mean we become couch potatoes obsessed with watching our favorite 24-hour news source feed us endless details about the latest announcements, as important as they may be. There is still plenty of opportunity for most of us to stay healthy and drink in copious doses of fresh air. But we can also follow the guidance about social distancing and sanitation practices. In short, most of us should be very capable of walking and chewing gum at the same time. Just don’t spit that gum out on the sidewalk, thank you very much. Think about the safety of those around you. Use the trash can.

If we can all learn anything from this disturbing experience, it is perhaps an increased attention to sanitation and cleanliness in public spaces and the need to respect others by maintaining the quality of those spaces. Too many of us have seen public restrooms that are poorly maintained or not cleaned with adequate frequency. Those are obvious examples, but we can discern many others, including coughing and sneezing away from others, using facial tissue or handkerchieves, and simply cleaning up after ourselves, and understanding why some people find it necessary, even critical, to wear face masks or take other precautions. Think about the safety of those who must clean up after us, who often earn low wages and have less access to medical care. Don’t put them in greater jeopardy than necessary. Those of us involved in planning for post-disaster recovery often talk about finding the “silver lining” in each disaster experience. With any luck, that silver lining in the COVID-19 experience is a greater attention to public health, starting with the White House and extending all the way down to our own house or apartment.

The other big lesson for planning is the value of readiness and preparation for disaster. The old saw that “they also serve who only stand and wait” may be far more applicable and relevant than we realize. When President Trump eliminated a White House office that President Obama had created to focus on global pandemics, following the gruesome lessons of the Ebola virus, the assumption seemed to be that those studying and preparing for the next big public health crisis were simply wasting time and money. If that is true, why do we have an army of emergency managers spread across the country, preparing for natural and man-made disasters that, according to that line of logic, “may never happen”? The answer is that we should know all too well that reconstructing such capabilities after a new public health crisis or disaster is already underway wastes weeks and months of valuable time that can never be regained, and in this case, may be costing thousands of lives before it is over. Let us be wise enough as a nation never to repeat that mistake again.

Jim Schwab

America’s Public Health Disaster

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Every day seems to bring shocking news. Restaurants and schools close, conventions are canceled, overseas travelers face unexpected obstacles in coming home. The United States of America, like much of the rest of the world, is facing a crisis unlike any in our lifetimes. While I understand many of the protocols because of a background in disaster recovery, my intellectual and professional focus has dealt with natural disasters, not pandemics, so I will not claim any special expertise. I’d rather listen to the medical experts who have studied the issue in depth.

But at 70, I can relate on a personal level to the concerns of older citizens who are most at risk in a way that I know I never could have done at a younger age. While I remain physically fit, I am also aware that maintaining that fitness requires real effort, sometimes more effort than it might for someone half my age. More importantly, I have become more aware that a fitness routine does not guarantee immunity or invulnerability to some of the impacts of aging. Consequently, while exercising, not smoking, and a sensible diet can afford me significant confidence about facing a challenge like the current novel coronavirus, or COVID-19, pandemic, it guarantees nothing. All the recommendations about avoiding unnecessary travel, social distancing, and sanitary precautions still matter greatly in improving the odds against illness.

Already, I confess, some of the simplest impacts of aging have slowed down my production of this blog or at times made it more irregular than I would like, and that is despite no longer working full-time. I do some consulting, some writing, and some teaching, in various proportions, and my days are full, although much of my time currently is also devoted to a volunteer job—serving since January 1 as chair of the American Planning Association’s Hazard Mitigation and Disaster Recovery Planning Division. That presently has me involved in trying to disentangle commitments for some of our events at APA’s pending National Planning Conference in Houston, scheduled for April 25-28, preceded by some leadership meetings I expected to attend. Tonight, the APA board of directors canceled the conference. Our division executive committee had decided to cancel our division reception in Houston, only to learn that the restaurant planned to close anyway. Life is like that these days. A colleague and I were scheduled, as part of our APA division’s outreach program to planning schools, to discuss hazards in planning at a university graduate class later this month, but that shifted to possibly remote to simply waiting for another school year as most colleges have adopted online learning for the remainder of the spring semester. As I said, life is like that these days.

But back to the subject of aging. One learns we simply cannot control everything, no matter how hard we try. As I detailed in a July 4 blog post last year, life for me had generally gone along well until I began to realize in late spring that my sight was becoming fuzzier and clouded. What began with a visit to an optometrist in April to see if my prescription for eyeglasses needed updating ended in late June with cataract surgery in both eyes, and considerable lost time due to an increasing inability to read a computer screen. That put me weeks behind in preparing a transition of the University of Iowa graduate class in urban planning I teach each fall to an online forum, and with other factors coming into play as the year went on, I never got completely ahead of the curve until the semester was over in December.

But at least cataract surgery, in most cases, is a one-and-done proposition. You get the implants, you have new vision with only reading glasses for assistance, and life goes on. But by late fall, I learned that another malady would force me into hemorrhoid surgery, which took place immediately after the holidays. With certain complications due to an enlarged prostate gland, it sidelined me for the first half of January until recovery was complete.

Now, it may well be at this point that I will not face further difficulties for some years to come. I certainly would be pleased if that became the case. These were the first surgeries of my entire adult life, but they stalled my activities to some extent, and they are a small glimpse of the sorts of things that make many other seniors feel far more vulnerable than I do. It is small wonder that many of them fall victim more easily to scourges like the coronavirus. The elderly and the physically challenged have predictably proven far more prone to the severest consequences of COVID-19, including death.

We also know, however, that many other Americans, and many citizens of other nations as well, will suffer serious economic dislocation as a result of the restrictions placed on economic and social activity in order to stem the upward slope of infections and death. While U.S. accounting is hampered by the lack of testing kits and public access to testing in key regions of the country, the alarm bells are ringing loudly. As I write this, the number of confirmed cases has quintupled in the past week to more than 5,000. We do not yet have any idea when we will reach the peak of this frightening mountain, and how high that peak will be. But we already know that the far smaller nation of Italy has, as of this moment on March 17, more than 31,000 cases that have resulted in more than 2,500 deaths, despite doing far more in an effort to contain the spread of the virus. It is not that we have a smaller problem, but only that we may have begun our steep ascent a few weeks later. Nearly every day, new nations report outbreaks. This is clearly not a “foreign” virus, but a global pandemic.

We have built-in problems in the American system, most notably the lack of universal health coverage as a result of endless political spats over creating a system that better protects the working poor. Many of the restaurant and factory workers who may face layoffs will lose whatever coverage they had, or may no longer be able to afford it, at the very time when they are facing an existential public health threat. This threatens all of us with the possibility that some workers, unknowingly carrying the virus, may feel compelled to work if they can or simply be unable to visit the doctors they need to see. Our myopic approaches to health care have set us up for massive vulnerabilities in this regard. We seem not yet to fully understand that we are no stronger as a nation than our weakest links. One result of this crisis, however, may be a profound rethinking of the role of the federal government in ensuring some form of universal health care availability. The consequences of making health care unaffordable to the poor have never been laid bare before for us in the way that the coronavirus may do. Disasters can force soul-searching under the right conditions. The question is how deeply we are prepared to think about the issue.

The other question we have never faced before is how we will emerge from this crisis. After weeks or months of social distancing and self-isolation, how will we decide the time is right to emerge from our mental caves and greet other again, and join large crowds again? And how will we feel when we do it, and how comfortable will it feel? My hunch is that the human race is highly adaptable, but that there will be no very clear demarcation point when it is okay to say that the war is over.

This particular disaster may end not with a bang, but a whimper, followed by some happy parties among the most extroverted but also the most fearless, perhaps the most reckless, among us. I like to count myself a “compulsive extrovert,” my invented self-description, but I also like to think I know when to exercise some social caution based on circumstances. This may be a disaster where people like me eventually start to poke our heads out of the foxholes we reluctantly entered, not out of fear of social interaction, but to be sure the landscape is no longer infected.

But when the day comes, it will surely be nice to join a big party where the beer flows and greetings are plentiful.

Jim Schwab

Details on Puerto Rico’s Struggle after Maria

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The most important feature of this post is simply the link. Clicking here will lead you to a newly published podcast about the recovery struggles of Puerto Rico following Hurricane Maria in the fall of 2017. The recording–an interview between me and Professor Ivis Garcia, of the University of Utah, lasts just over an hour, so set aside some time. What you learn will make that investment worth it.

The podcast is the seventh in a series called Resilience Roundtable, produced by the American Planning Association and hosted by the APA Hazard Mitigation and Disaster Recovery Planning Division. As of this fall, I have assumed the duties of moderator and interviewer, and this interview is my first. I hope you will find it worthwhile and a great learning experience. I won’t say more because I am confident the podcast speaks for itself.

Jim Schwab

“We’re Yesterday’s News”

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That headline is a quote from Mayor Tommy Muska of the town of West, Texas, in the Dallas Morning News of November 21, regarding the Trump administration’s rescission of U.S. Environmental Protection Agency standards for disaster prevention in chemical facilities, issued that day.

Aerial photo of the west explosion site taken several days after blast (4/22/2013). By Shane.torgerson – Aerial photo taken from my plane Previously published: Facebook and Flickr, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=25727808

So much news passes under the bridge in one month these days that readers can be forgiven if they do not immediately recall what happened in West on April 17, 2013, but my guess is that many do. Or they may if I nudge them by noting that the West Fertilizer Company suffered an explosion in a storage facility at the edge of this small city of 2,880. The explosion resulted from the combustion of ammonium nitrate, a common ingredient in fertilizer, which is notorious for its chemical instability. Still, the facility had been there since the 1960s, but West had over the years allowed a middle school, an apartment building (which was destroyed), a nursing home, and other structures to be built nearby. When the explosion occurred, 160 people were injured, 14 first responders (mostly firefighters) were killed, and one elderly man died of a heart attack as the nursing home was evacuated. All that triggered a bit of soul searching about loose regulations at all levels of government regarding the operation of such facilities, their disproportionate environmental impact on vulnerable populations, and how better to prevent future disasters.

One year later, in May 2014, I wrote in this blog about West following my own involvement on an expert panel for the federal Chemical Safety Board, which held a hearing in West on the anniversary of the disaster. I raised some pertinent questions about Texas chemical and fire safety regulation that were of interest to the board.

In the meantime, however, moves were afoot in the Obama administration to respond to the larger questions of chemical facility accidents. According to Earthjustice, an environmental advocacy group, in the decade up to the West accident the U.S. had experienced 2,200 chemical accidents at hazardous facilities, two-thirds of which caused reported harm, including 59 deaths and more than 17,000 people injured, hospitalized, or seeking medical care. As a result, President Obama signed on August 1, 2013, Executive Order 13650, “Improving Chemical Facility Safety and Security,” which set in motion a rule-making procedure at the U.S. EPA. By July 31, 2013, EPA issued a Risk Management Program request for information in the Federal Register, proposed new rules on March 14, 2016, and finalized the new rule, known for short as the Chemical Disaster Rule, on January 13, 2017, with one week remaining before President Trump took office.

The final rule is a bit complex, using 112 pages of the Federal Register, but among other items specifically required a “root cause analysis” as part of an incident investigation to determine what “could have reasonably resulted in a catastrophic release.” It would also require compliance audits after reported incidents and required all facilities with certain processes to conduct annual notification exercises to ensure that emergency contact information was complete. The overall idea was to improve effective coordination with local emergency responders. One problem that caused fatalities in West was a lack of firefighter awareness of the precise contents and dangers of the facility that exploded. Thus, the requirements in the rule for field and tabletop exercises. Finally, the rule aimed to enhance the availability of information about chemical hazards in these facilities including sharing such information with local emergency planning committees.

The rest is almost entirely predictable. With little grasp of public policy but considerable animus toward anything with Obama’s name on it, Trump put his appointees to work undoing his legacy. That included action by then EPA Administrator Scott Pruitt on March 16, 2017, in response to an industry-sponsored petition, to announce a 90-day stay of the Obama-era rules, followed by an extension to 20 months shortly thereafter. In the meantime, Louisiana and 10 other states, including Texas, petitioned for reconsideration of the Obama rules. The delay would last until February 19, 2019. However, the U.S. Court of Appeals for the District of Columbia, responding to a petition from environmental groups, vacated the Trump rulemaking. But now we have a final rule from the Trump EPA officially rescinding the Chemical Disaster Rule.

The public information aspect of the rule became a target, with the Trump administration claiming it was responding to homeland security and emergency management experts who feared that such information would become a target for terrorists. However, it would seem to me that far more people have been affected by routine chemical accidents than by any terrorist incidents at such facilities. The U.S. EPA also noted that the rules would not have prevented the accident at West because it was ultimately determined to have been caused by arson. It is worth noting, however, that most of the first responder fatalities in that incident were more credibly the result of a lack of training and information on the potential explosiveness of the materials involved, which might have prompted greater caution and different tactics by firefighters. And none of this answers the questions I raised in my 2014 blog post about land-use practices and limitations on fire safety codes in Texas.

So, back to Mayor Muska, who is reportedly disappointed with the outcome, and for good reason. His town has to live with the results of the 2013 explosion, which decimated the volunteer firefighter staff and obliterated a local business (and employer). Muska was mayor when the disaster happened and is now serving his fifth term. I think it is worth sharing the comments he made in the final two paragraphs of the Dallas Morning News story:

“The American people and American politicians, they have a short memory,” Muska said. “They’re going to say everything is fine, and every few years something like this is going to happen again, and ‘Oh, yeah, we need to look at this again.’

“We’re yesterday’s news. It’s not on anybody’s minds as it was in ’13 and ’14.”

Jim Schwab