Tag Archives: pandemic

Going Viral

Posted on by
Reply

Now I know what it feels like, or may have felt like. Kind of. Sort of.

I will never experience, in all likelihood, the very worst the COVID-19 virus can inflict on human beings. I was lucky in many ways. First, the virus just never found me as a target until early October of this year. Second, I am very physically fit for my age, and I don’t suffer from any chronic conditions that often expose people to more severe reactions to the virus. Third, by the time COVID-19 found me, I had the two initial shots of the Pfizer vaccine, and later a Moderna booster. My only failing was not having obtained the more recently released Omicron booster, but there is no question that vaccines made my path far easier than was the case for those who suffered earlier in the pandemic.

I spent most of my COVID time not knowing I had it, though there were indications that aroused my suspicions—just a bit. Late Sunday, October 9, I experienced some mild cold symptoms, but I sometimes have sinus problems that become more persistent as Midwest weather changes in the fall. On Monday, I began to experience more of a cold and struggled through online meetings, two about a video project, one preparing for an upcoming online training workshop. In the evening, I was supposed to volunteer with

It’s a lot easier to get a test now than at the height of the pandemic, when tests were as scarce as the places that provided them. Now you just pull up for an appointment, take the kit through the window, tickle your nostrils with a swab, and hand it all back to the pharmacist.

signature collection to help place our incumbent Chicago alderman, Daniel La Spata, on the municipal ballot next spring, but I called it off because I was not feeling well. By the next morning, I took a nasal swab COVID test at Walgreen’s, but the test came back negative the following day. As a result, I assumed I simply had what I called “the ordinary crud” of a normal cold. Just deal with it for a few days, I thought, and get over it.

I made no real changes to my plans and tried to maintain my normal pace. The previous week, curiously, had included my participation as a consulting expert in two online symposiums, both lasting two and three-quarter hours, on Tuesday and Thursday for a project at Johns Hopkins University addressing pandemic community recovery. I moderated the final panel on Thursday, dealing with the use of metrics, which are essentially statistical targets, for tracking the many variables concerning social equity and public health factors that would guide such recovery. In other words, COVID-19 already had my intellectual attention. I had no reason to suspect It would seize my medical attention as well.

But I was wrong on that count. By that Tuesday, some of the infamous COVID-19 fatigue was settling in, and the cold was tightening its grip. I had planned to attend a program of the Society of Midland Authors at Cliff Dwellers in downtown Chicago that evening. As on Monday night, I never made it. It seemed wiser to stay home. It was becoming a pattern.

Nonetheless, I spent Wednesday morning at a dealership service department. While in the waiting room, I met online with two planned guest speakers for my online University of Iowa class, which meets in the fall semester on Thursday evenings. I was very much looking forward to letting Linda Langston and Kehla West take over the class a week later because, in my opinion, both are impressive members of the natural hazards professional community and could share valuable insights. “Planning for Disaster Mitigation and Recovery” offers graduate planning and public affairs students serious comprehension of the natural-hazard threats facing our communities. Linda is a former county supervisor of Linn County, Iowa, who had helped lead her community through the 2008 floods that overwhelmed Cedar Rapids and into the recovery that followed. She later worked nationally on resilience issues with the National Association of Counties before returning to Cedar Rapids as a consultant. Kehla works with Region 5 of the Federal Emergency Management Agency in Chicago. Although she was doing me a favor by sharing her federal government experience, she regarded it as a great honor to be asked to speak to a class in which she was once a student. I was enthusiastic about sharing my virtual stage with them for two hours. The meeting was a breeze.

All right, this is a simulation of what I may have looked like, but it’s probably close. I found myself waking up in a seated position on the couch more than two hours after falling asleep early in the afternoon.

But most days that week, with increasing frequency, the afternoon was not. I no longer even remember which day was which, but I know that on several occasions, I would hit a wall of fatigue by late morning or early afternoon, and work would grind to a halt. One day, this happened around 1 p.m., and to regain some energy, I went downstairs from my home office to sit on the living room couch. I simply disappeared into deep slumber, with no recollection of anything. Sometime well after 3 p.m., I woke up, looked at the clock, and wondered where my day had gone. For someone very conscious of pending deadlines and obligations, it was deeply frustrating. At the end of the day, I like to know what I have accomplished. I did not want to find that I had lost a major chunk of my day to exhaustion. It became hard to believe that a mere cold had done this, but I kept thinking about that negative test. It was not COVID. I was just worn out fighting a cold. But day after day, I watched in growing alarm as the number of tasks falling behind schedule kept growing. The will power and drive that sufficed in normal circumstances to overcome such deficits never materialized, and the gap widened instead. The spirit was willing, but the flesh fell asleep, day after day.

That Thursday evening, I taught my class as usual. But it was not so usual. It became patently obvious that I was struggling with my voice, with sinus difficulties, with watery eyes, with fatigue, but I plugged away for two hours. By Saturday, in a phone conversation with someone about a potential film grant proposal, I struggled again in the conversation because my voice was weak, but I pushed ahead because the call was important, and the proposal deadline was at the end of the month, just two weeks away.

And so it went. If a meeting was on the telephone or online, I could make it work even if I was exhausted after it was over. If it was in person, I would cancel. Fortunately, most meetings, including a debrief with Johns Hopkins about the symposium two weeks earlier, a HUD guidebook review panel, and a Midland Authors board meeting, were online, usually via Zoom. I had contacted my doctor over the weekend of October 15-16 through a patient portal, and he asked me to come in, which I did by Wednesday, October 19. He made some suggestions but accepted the negative COVID test result. Following his advice, I began using a Neti pot to control the sinus congestion—and it works, by the way. In combination with Flonase (after the Neti pot), it has been effective. The fatigue, however, took its own good time to fade away.

The next day, Thursday, I had class in the evening, the one at which Linda and Kehla would speak in tag-team fashion about local and federal perspectives on planning for disaster recovery. That afternoon, Jean tested positive, much to her surprise. In our pre-class banter on Zoom, I mentioned that to Linda, who repeated it to Kehla when she logged on: “Jim’s wife tested positive for COVID.” Kehla immediately expressed her regrets. They taught the class, I offered occasional commentary, and for the most part, I got to rest my voice and conserve my energy.

But I had also decided at that point that getting another test the next morning was imperative. By mid-day Saturday, a Walgreen’s e-mail informed me that I had tested positive. I discussed it with an emergency room doctor, and later my primary physician, who said the symptoms we discussed just a few days before sounded a lot like COVID to him at the time. The ER doctor stated that, based on our discussion of what led me to get tested again, I had probably had COVID all along and may unwittingly have infected Jean. The verdict of these two men made sense to me, but of course, it was now after the fact. I was actually near the end of my COVID experience before I ever knew for certain that I had it.

Alex, to right of candle, after baptism service, with me at far right, Pastor Nancy Goede, Pastor Matt Stuhlmuller, Alex, sponsor Kornelius, and members of my family, including Jean, far left. I later wondered about any unintended exposure I may have cause through unawareness that I even had COVID at that point.

If there was one situation that brought some regret–it seems not to have produced any adverse consequences that I am aware of–it was that, not believing I had COVID, I joined others at our church for our grandson Alex’s baptism on October 16. Mass spreader events were at one time rather scary propositions. But there I was, unaware, part of a ritual and celebration that was a happy event but could have infected others. The following Sunday, I stayed home because by then, I knew I had contracted COVID.

Although I am certain that skeptics of the vaccines (and I know some) would say this was just one man’s opinion, the ER doctor stated that the vaccines had surely helped make my case milder (and Jean’s was milder still), and that the vast majority of those now being hospitalized or dying from the virus are unvaccinated. The statistics I have seen on the subject seem strongly to suggest as much. But people love to argue from anecdotes, which are easier to understand than statistical data, and the resistance will surely continue. The COVID-19 pandemic seems closer to having run its course after nearly three years. All pandemics eventually lose steam.

COVID is no longer half as scary as the ghost lady and her companion on Halloween. Okay, just kidding. But that guy is freaky.

By the following week, with minor help from a cough suppressant the ER doctor prescribed, I was able to regain energy and focus on the tasks that I had neglected for almost two weeks. They were too important to me to do otherwise. One was completing a grant proposal for a film project I am leading under the auspices of the Hazard Mitigation and Disaster Recovery Planning Division of the American Planning Association. The deadline was October 31, and with significant money at stake, I was not about to blow it. We had been laying the groundwork for weeks, but I needed to write some powerful explanations of our project and submit all the necessary documentation, which I did by that morning. I was able to walk our grandson through the neighborhood for Halloween and pass out candy afterwards, while triggering the spooky voice of our alabaster “ghost lady” without being noticed. She impressed only the very young, drawing only amused yawns from tweens and teenagers.

But that was just the beginning of a list of tasks and projects needing my urgent attention. I had promised to create a case study of Hurricane Michael recovery to present to my students on November 10. I finally completed it just an hour before class. On Saturday, November 12, I hosted with Amanda Torres, formerly the city planner for Rockport, Texas, an all-day training workshop on hazard mitigation and disaster recovery, offered as part of my teaching commitment with the University of Iowa School of Planning and Public Affairs. I had two documents I had promised to review, for which I sought and received additional time.

During the illness, I stopped my exercise routine. I currently visit the gym twice weekly with a rotating routine of exercises. After the illness had run its course, I still missed the workouts in favor of catching up on work. Before Christmas, I will turn 73. I find the exercise vital to good health at this stage of life, and I became anxious about the six-week gap that developed before I finally resumed the workouts on November 16. I have taken to them with relish. I simply feel better because of it, and I can finally spare the time again. Two days after Thanksgiving, I ran into a former trainer I worked with at X Sport, Michael Caldwell, who told me about his new work with companies on employee fitness and ergonomics, noting the serious toll on many people of failing to pay attention to such issues. I wished him well in his new enterprise. He seemed pleased that I was returning to form, just as he had always respected my resilience in the past after some injuries and surgeries.

But I also know that I am very fortunate. I find absolutely no evidence that I have developed any long-term COVID symptoms. I never fell victim to COVID-19 in the early days of the pandemic despite a short-term hospital stay in May 2020 on the only floor with non-COVID patients. I have even discovered the accidental grace of hundreds of presumed strangers who, in successive waves in October and November, registered as new subscribers to this blog at a time when I was seldom posting anything. I wanted to change that but just could not get it done. Their attention to my blog despite several weeks with no new posts encourages me to get back into the ring. I must have offered something in earlier posts that still attracts readers, and I hope to keep it that way for a long time. I hope this humble story adds to the blog’s overall value. I shall certainly try my best.

Jim Schwab

Our Collective COVID Cabin Fever

Posted on by
Reply

I am not a doubter when it comes to the COVID-19 vaccines. All I want to do is sign up and let them put a sharp needle in my arm and inoculate me. Do it twice if the vaccine demands it. Even my experience in early February with the shingles vaccine cannot deter me. On a Tuesday afternoon, a pharmacist at the local Walgreen’s provided a shot that I requested at my doctor’s suggestion. It has been two decades since I experienced my second episode of shingles, but I vividly recollected the piercing pains in my shoulders and arms that made it nearly impossible to exercise my fingers on a keyboard, one of the most basic things I have long done to earn a living. I told the pharmacist that I “noticed it but did not feel it.” He put a bandage over the location on my upper left arm, and I left, thanking him.

It was that evening that I noticed my reaction as muscle aches spread from that left arm across my upper chest. Then the chills set in, and I pulled the covers over me in bed. I repeatedly felt my forehead, testing for a fever. Nothing happening. The next day, the muscle aches diminished, but the chills persisted, and I sat in a leather chair with a blanket pulled over me, doing little but reading a newspaper and then falling asleep. I had slept all night, but it mattered not; the fatigue overpowered me. Late that afternoon, I struggled through two online meetings, and my energy again failed me. I spent the next day feeling slightly more energetic until about 3 p.m., when I fell into a deep sleep, again with blankets covering me as I accomplished nothing. My wife says I turned white, but I wouldn’t know. I lacked the energy to look into the mirror.

By Friday, I at least posed a question to my primary physician on the patient portal: Is this normal? He wrote back to say that about 20 to 25 percent of people getting the shingles virus experience such a reaction, which mostly proved that the vaccine was beneficial. My immune system was relearning how to fight the shingles virus. That was vaguely reassuring, and I knew he knew whereof he spoke, but it took one last development to convince me.

Late that Friday afternoon, with the better part of a week lost to malaise, I suddenly felt the fog lift and the fever break, though it was not really a fever. All within an hour. It just stopped. My immune system had learned what it needed to know, and it ceased fighting what was not there. And I was fine. That’s part of how vaccines work, but I could not recall ever experiencing such a reaction to any previous vaccine.

 

Our backyard after the Presidents Day blizzard.

Amid this experience, however, the snow piled up in Chicago. First came a snowstorm that covered our yards and streets in blinding whiteness. Often, in Chicago winters, these snows come, sit around for a few days until the sun comes out, and they melt away as the temperatures rise.

But not this time. Until February in this season, we had seen little more than timid flurries of pixie dust that barely covered the ground, with green shoots of grass still poking out from below. Now it came to stay, as temperatures soon plunged to zero and slightly below, solidifying the growing accumulation of snow even as we struggled daily to clear a path down our gangway and along the sidewalk in front of our home. I shoveled in front of a neighbor’s home as well, knowing he had recently had hernia surgery. And the very next day, we had to do it again.

Jean wanted her turn at shoveling as a way to get some exercise. She got her wish.

The three weeks of persistent snow culminated in a 17-inch overnight debauchery on Presidents Day that left us staggering and feeling quarantined by virtue of a simple inability to move a car down the alley, or the challenge of climbing over hip-high snow piles at intersections. During those three weeks, our cumulative snowfall mounted to 40 inches.

Our somewhat metaphorical confinement by way of extensive pandemic restrictions now took on major physical dimensions, leaving us feeling imprisoned. Not only was there nowhere to go because the restaurants were closed, but there was no way to get out, either. In place of my brief fatigue in reaction to a shingles virus, I now felt a very real spiritual and emotional fatigue at the mere thought of needing boots and a heavy coat just to step outside. Staying at home felt more like incarceration than refuge. Even the mail, which provides some tangible connection to the outside world, was no longer arriving. The carrier on our route, and probably on many others, was not braving the snow piles and frigid weather, and the mail piled up at the post office until, one day, I simply walked the mile to get it, standing in line for more than half an hour for a pile of paper surrounded by a rubber band, partly containing bills to pay. The process took long enough that, by the time it was over, I needed to use a bathroom and home was too far away. I opted for the nearby Cozy Corner diner, and showed my gratitude by staying for lunch. It’s a very decent eatery, actually, and I enjoyed my California melt with fries. And then I walked home again, through the very snow piles that had impeded its delivery. Watch where you walk when you cross the street.

After weeks of erratic service, the mail came all at once, and not again so far.

By the following Sunday, temperatures rose and stayed above freezing. The snow began to melt, removing the impediments to delivery. Nonetheless, in the past week, delivery occurred only on Tuesday, when the mailbox was suddenly full, but it was an aberration rather than real change. No mail arrived for the rest of the week. This has been an ongoing problem across Chicago, for systemic rather than purely weather-driven reasons, and even more so in some South Side ZIP codes than ours, which is itself bad enough. The Chicago Tribune ran an article about the Trumpian mess in which U.S. Rep. Bobby Rush expressed his impatience on behalf of his constituents about the staffing excuses, saying there were plenty of unemployed people in the city, so “if you have a job, do it.”

The as yet uncollected recyclables in a bin filled to the brim.

That comment formed an interesting backdrop to the other event the same day all mail arrived. The city recycling pickup occurs on our block on alternate Tuesdays, and our bins were full, if somewhat piled around with snow. The trucks seemed to be very selective, leaving our stuff uncollected, so that we are now storing recyclables in paper bags in the garage. I complained to the city Streets and Sanitation Department in an online forum that left little room for comment, then forwarded the complaint and further explanation to our 1st Ward alderman, Daniel La Spata. I noted that the previous week, the regular garbage pickup occurred without a problem under worse circumstances. He informed me that a private company had been hired for the recycling, similar problems had emerged elsewhere, and added, “Honestly, that’s the difference between public employees and privatized ones, and why we’re pushing back on the latter.” Some might question that comparison in light of the post office problems, but I would suggest that the U.S. Postal Service, to a significant degree, has been the target of efforts to undermine it as a means of justifying privatization and subverting the integrity of mail ballots. In any case, I still want them to empty those blue recycling bins.

During all this, I nonetheless wanted to access the COVID vaccine so that I could move beyond the sense of limitation that nearly a year of closed stores and restaurants, and mask wearing and social distancing, has instilled in all of us. For compulsive extroverts like me, the compounded effect of long-term pandemic restrictions followed by a month of being buried in frozen precipitation is producing a profound restlessness. Put simply, I want out.

I have not yet mentioned that five grandchildren have been studying remotely in our home since September. We are guardians for one, and the others are here as their mother engineers a major change in her life, and besides, my wife is a retired public schools teacher who can mentor them. Throughout February, the Chicago Teachers Union engaged in a vociferous public debate with the Chicago Public Schools and Mayor Lori Lightfoot about reopening schools, arguing over the adequacy of the preparations for protecting teachers and staff from coronavirus exposure. This took place against the backdrop of the larger national debate over online versus in-person education, but I know what I see. The kids are noticeably glazing over and tuning out, and listening to a teacher on a screen is getting old. Students, particularly students of color (most of our grandchildren) and those with working parents, are falling behind, and the schools will have a major challenge in coming years of reversing the impacts of online education. Students in the early grades need human contact to remain fully engaged. None of this is to deny the necessity that drove the schools to close, but the national failure to manage the pandemic has greatly exacerbated the consequences.

We need to get our national act together, and moving millions of doses of vaccines to sites where people can get some sense of relief is the most important step right now. Instead, I’ve found myself checking online daily, sometimes multiple times daily, only to find no availability for vaccine appointments. But my wife finally got her call for March 2, so I remain hopeful. I have no other choice.

That expression of patience is at the heart of our dilemma. I could live with the snow, however impatiently and with some humor, because I knew that warmer days lay ahead, and snow cannot outlast St. Patrick’s Day in Chicago. Unlike Texas, our infrastructure is designed to handle winter. A slow, steady rise in temperature would allow snow to turn to water at a steady pace without triggering floods. We will be fine.

What has been less certain has been the ability of our national public health infrastructure, as disheveled as political neglect has allowed it to become, to respond to the pandemic. But I can also feel a steady warming trend since January 20, however halting it has seemed at times. The big snowstorm, which jostled its way through Kentucky and Tennessee and Arkansas all the way down to Texas and Louisiana, slowed distribution of vaccines, but maybe for a week. My wife learned that she got her appointment because PrimeCare, a local health care provider, had just received a big shipment.

Snow recedes to a manageable level as the weather has warmed.

My turn will come, and so will yours if you’re smart enough to get vaccinated. My outlook will change with the warm breezes of spring, and I will start to think about where I can go and what I can do. We will end this year-long cabin fever that has been induced by a tiny virus with protein spikes that latch onto receptor target cells in a microbiological process most of us do not understand.

But it may be a long time before we stop talking about it. Our collective COVID cabin fever does that. Let’s all talk about what we as a nation can do better next time. Do it over beer or coffee or tea, but make it a productive, meaningful conversation. I’m tired of gripes. I prefer solutions.

Jim Schwab

Plotting Post-Pandemic Recovery

Posted on by
Reply

Photo by Carolyn Torma

In recent years, the development of local or regional recovery plans following major natural disasters has become increasingly common. The Federal Emergency Management Agency has long encouraged such planning, and I led the production of two major FEMA-funded reports from the American Planning Association on the topic—Planning for Post-Disaster Recovery and Reconstruction (PAS 483/484, 1998) and Planning for Post-Disaster Recovery: Next Generation (PAS 576, 2014). I’ve spoken repeatedly on the topic, trained planners, and valued the collective knowledge of the two teams we assembled to make those projects happen. The underlying idea is to help a community assess its losses, reassess its goals, and find the silver lining in the dark cloud of the disaster that will allow it to rebuild better and stronger than before. This is the central concept of community resilience: the capacity to learn from such events, adapt to the changes they require, and move forward.

The idea of natural disasters has generally encompassed those caused primarily by meteorological and geological disturbances, such as storms and earthquakes, though it includes impacts exacerbated by human mistakes in building and planning. Disasters necessarily involve the collision of natural forces with the human and built environment, which has caused some people to question the very use of the word “natural” in connection with disasters. Personally, I am comfortable with the term “natural disaster” so long as we understand that no disaster exists without this interaction.

But there are those disasters where damage to the built environment is a secondary consideration, and the loss of lives is primary. Drought is somewhere in the middle. Damage to structures can occur, but only as the result of the slow, nagging loss of moisture in the air and soil. Heat waves can take hundreds of lives without affecting a single structure, though they can put enormous stress on energy and transportation infrastructure.

Pandemics, however, fall into another category entirely as biological disasters. They occur when bacteria or viruses emerge in the environment and attack humans before we have developed any effective immunity or vaccines. The current COVID-19 crisis fits this mold precisely. It can be far more devastating than a natural disaster simply because it can roam far more freely across the planet, as did the 1918 influenza pandemic, striking down hundreds of thousands if not millions of people. Before the era of modern medicine, pandemics like the bubonic plague in the Middle Ages could kill half of the affected population. Even without vaccines, we at least have the huge advantage of understanding how such microbial threats spread. Our disadvantage in the U.S. has been national leadership, starting with the President, that has been psychologically allergic to scientific advice. The result has been needless loss of life on a colossal scale.

It was a matter of time before some community, even without such federal leadership, applied many of the principles of recovery planning to the coronavirus pandemic. One critical question related to recovery is identifying the point at which the crisis is over, or at least waning. In natural disasters, drought being again the exception, this point becomes clear within a matter of days, or even hours in the case of tornadoes, as the storm passes. However, weather systems such as that which produced the 1993 Midwest floods, can last for weeks or even an entire summer. But at some point, it becomes clear that the emergency is over, and planning for long-term recovery can begin. In the absence of a vaccine, however, it is less clear when we can use the “all clear” signal for a pandemic. Right now, in the U.S., it is painfully clear that the rush to reopen is producing unconscionable and shocking consequences across the South and Southwest, and in a few other locations as well. It is incredibly hard, perhaps even impossible, to plan meaningfully for recovery when you are still stoking the fire by facilitating the spread of the virus.

Nonetheless, some states, notably including New York, much of New England, and Illinois, have fought hard against the odds to bring down infection rates, which are now a fraction of what they were in April or May. Their victory remains tenuous, considering the larger national crisis that remains a growing threat to public health, but Chicago under Mayor Lori Lightfoot has announced a list of states whose residents must quarantine for 14 days upon arrival, notably including Florida, Arizona, and Texas. Later, Iowa was added. By July 17, the Cook County Department of Public Health expanded that quarantine area to include all of suburban Cook County except a handful of suburbs that maintain their own health departments, and 17 states are on the list with new case rates exceeding 15 per 100,000 people per day. While it is nearly impossible to monitor all arrivals, the message is clear: We don’t want to re-create the problems we so recently overcame.

That is the context in which a large Recovery Task Force the city assembled released a recent report, Forward Together: Building a Stronger Chicago, which examines how Chicago could build a vibrant recovery from the coronavirus experience. Because such reports, especially those involving dozens of contributors and participants, are never crafted overnight, it is worth noting that the effort was launched on April 23, at a time when the outcome was far from clear. Neither the city nor the state could be certain then how long the problem would last or whether the stay-at-home orders and other measures would succeed at all in the near term. As of July 18, Illinois had dramatically increased its testing rate and brought its positivity rate for coronavirus tests down to 2.9 percent, well below most rates elsewhere, although it remains higher in Chicago at 5.4 percent.

So far, the strict measures announced in March have produced measured success, and the task force used that time to look farther down the road to the kind of city that might emerge from this ordeal. Forward Together is, to be clear, not a true recovery plan; it is billed as an “advisory report.” But it is the closest thing to a recovery plan that I have seen so far, and merits scrutiny and consideration for what it offers. (New York Mayor Bill de Blasio promised his own “road map to recovery” on April 26.)

The task force itself was broadly based. Lightfoot co-chaired it with Samuel Skinner, a businessman, lawyer, and political operative who served as both Secretary of Transportation and White House Chief of Staff under President George H.W. Bush. He has a long track record in public affairs. Committee chairs and members included elected officials, among them Cook County Board President Toni Preckwinkle, who was Lightfoot’s run-off opponent in the 2019 mayor election, labor and community representatives, business leaders, academicians, and civic leaders, including some prominent activists. The task force was broadly inclusive, which bodes well for public buy-in on the resulting recommendations. Moreover, the report shows significant evidence of wide community outreach, including a youth forum that tapped the ideas of teens and young adults.

Like all big cities, Chicago has witnessed significant disparities in impacts of the pandemic on specific disadvantaged groups, including the elderly, but also Blacks and Latinx residents. While these two groups each comprise 28 percent of Chicago’s population, they respectively comprise 30 and 48 percent of the cases of coronavirus and 44 and 32 percent of the resulting deaths. This is an important backdrop to the discussion of goals in the report.

The report discusses four specific initiatives to move the city forward and address many of the inequities and vulnerabilities exposed by the coronavirus. Invest South/West aims to bring public and private investment to those neighborhoods in the city that have suffered historic disinvestment, and where COVID-19 rates have generally been highest. Racial and ethnic inequities in coronavirus impact have been notably more severe among both Blacks and Latinx residents, in large part because of lower levels of insurance coverage but also because of differences in job exposures, poverty levels, and living conditions. Solutions Toward Ending Poverty (STEP) is a new program, announced in February by Lightfoot, that is attempting to identify evidence-based metrics that can plot a road map toward reducing urban poverty in Chicago. We Will Chicago—Citywide Plan aims over three years to develop what amounts to a comprehensive plan, something lacking in Chicago until now. The report says We Will Chicago “will encompass all elements of citywide planning.” Finally, Chicago Connected will aim to shrink the digital gap between more affluent and poorer neighborhoods by making broadband more readily available, a need whose urgency has clearly been exposed by the closing of schools and the challenges of assisting children from poorer households with remote learning.

A significant part of the report focuses on the economic development opportunities that Chicago can pursue to restore prosperity as the pandemic recedes. It is clear that certain categories of jobs—food service, retail, administrative, and manufacturing, but also arts and entertainment and personal services—have suffered the brunt of economic displacement from the pandemic. The report notes the opportunity for Chicago, as a result of some economic changes wrought by the pandemic, including shifts to online retail, to focus on transportation, distribution, and logistics (TDL) segments of the economy. These would take advantage of a longstanding Chicago advantage as a transportation hub.

TDL, however, faces its own challenges of inequitable opportunity. Food insecurity represents a serious challenge in “food desert” neighborhoods. Resolving those inequities is the intended purpose of the four initiatives, but it is hardly a challenge that will be resolved overnight. It has taken years of unequal opportunity, to say nothing of deliberate discrimination, to create the current dilemma. Failure to address these problems will slow down or even stagnate Chicago’s recovery from the current crisis.

The report makes what strikes me as an honest effort to address social services gaps that, if anything, grew under the previous administration of Mayor Rahm Emanuel, who closed some mental health centers in a bid to reduce budget deficits. The problem is that such reduced access to services only exacerbates problems among those needing such help and may increase other costs as a result. For example, a significant proportion of the inmates at the Cook County Jail (and many others around the nation) suffers from mental illness.

There is an urgent need to restore those services, but more importantly, the report shows that mental health services are far more prevalent on a per-person basis in more affluent, whiter neighborhoods than in poorer areas. For instance, 48 percent of whites with mental illness were receiving services in 2015, but just 31 percent of both Blacks and Latinx with mental illness were doing so. A map toward the end of the report shows differences shows a variation in presence of mental health providers ranging from zero or well below 0.25 per thousand residents in certain poorer areas of the city to well over 2 in predominantly white, middle-class areas and hundreds per thousand in downtown Chicago, a district well-nigh inaccessible to many South Side residents.

This may reflect, among other things, a disproportionate presence of white professionals in mental health and a need to bring more minority psychiatrists and psychologists to those neighborhoods. Reopening clinics in the neediest areas of the city would be a major step forward. As for the connection to coronavirus, the stress induced by greatly increased unemployment, to say nothing of job pressures within health care, can contribute to mental health challenges. Perhaps the most noteworthy proposal in this section of the plan is the recommendation to create a dedicated 211 line whereby residents can access a wide range of social services. It strikes me as essential, also, to reduce pressure on police to respond to personal mental health crises by instead responding to such incidents, to the extent possible, with mental health professionals and social workers.

As I noted, this is framed as an “advisory report.” I strongly suspect, however, given the tenor of the moment, that its recommendations will find widespread support among Chicagoans. What remains to be seen is how well voters and aldermen hold the administration’s feet to the fire to make it all happen. It is not enough to have confidence in a mayor who seems determined to make it happen. Implementation will require broad-based commitment to achieving the goals the report lays out. That includes embedding those goals in the comprehensive planning process that We Will Chicago envisions, and enacting measures to move them forward.

What is important about this effort for the rest of the country is the very idea of mounting such a broad-based effort to produce a forward-looking analysis of how our cities can recover from the coronavirus pandemic. Many may first have to learn how mayors and governors can exert the leadership, and evince the humility to consider the science, necessary to get the virus under control, as many other countries in Europe and Asia have done. These leaders must also be open to hearing from a widely representative cross-section of their citizens in preparing similar reports. Pandemic recovery planning is for all of us an experiment that can build on the foundations of other kinds of recovery plans while recognizing and thoroughly exploring the unique features of this monumental public health challenge. It is no small matter, and should not be treated as such, politics notwithstanding.

Jim Schwab

 

Community Planning and Pandemics Podcast

Posted on by
Reply

Periodically, I have linked blog readers directly to a new podcast in the Resilience Roundtable series, produced by the American Planning Association and hosted by the APA Hazard Mitigation and Disaster Recovery Planning Division. Last fall, I became the moderator of this series, and the last, pre-pandemic podcast interviewed Florida planning consultant Julie Dennis about her experiences in recovery planning for Hurricanes Irma and Michael.

Earlier this month, however, we shifted gears, and I interviewed Dr. Monica Schoch-Spana, a medical anthropologist and research fellow at the Johns Hopkins University Center for Health Security. Our topic was community planning and pandemics, and she shared numerous insights into the public health and community planning aspects of dealing with a pandemic like COVID-19. Most readers already know that I have written repeatedly about some aspects of the pandemic since March, but Monica in this interview sheds light on several other features of our current situation that I had not yet illuminated, in part because I lack her specific technical background.

Therefore, I am happy to provide this link to the new 40-minute podcast.

Jim Schwab

Weak Links in the Chain

Posted on by
Reply

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

America’s Public Health Disaster

Posted on by
Reply

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