"76 Days" w/Epidemiologist Eileen White, Part 1
Epidemiologist Eileen White
An epidemiologist and nurse with a background in acute care, Eileen White worked as Chief Nurse Consultant and Epidemiologist at the Indiana State Department of Health in Genomics and Newborn screening. She managed the stroke and cardiac systems of care at the Minnesota Department of Health, working in policy and program management and clinical program development. She now works as a freelancer in public health, and manages a Facebook page called "Public Health is Your Job, Too," reviewing COVID-related public health and clinical information and research, and educating the public on valid and non-valid forms of data and evidence in support of an informed public. She believes in making decisions based on data, not politics.
Eileen is a former epidemiologist with the Fishers (Indiana) Health Department. She tendered her resignation after being asked to make a political decision that contradicted what the data suggested.
In addition, Eileen survived a bout with COVID in April 2020.
Joe and Eileen watched the documentary "76 Days," and discussed it and its impact afterward. Covering the first days of the COVID-19 outbreak in Wuhan, China, the film goes inside a front-line hospital that struggles to handle the outbreak of the disease. "76 Days" is screening at Heartland Film Festival Friday, Oct. 9 at 9:15 at Tibbs Drive-In (480 S. Tibbs Ave., Indianapolis). Read our review of "76 Days" here, and buy Heartland Film Festival tickets here.
In Part 1 of this discussion, Joe and Eileen discuss "76 Days," its impact, and how the response differs from the US.
Joe: The first thing that really hit me hard with this documentary is the moment we learn where the COVID patients are being kept. We see the nurses in these full-on hazmat suits go to a set of double doors, and we see there is essentially a holding pen where there are MANY people, who are all begging and pleading to get inside, and the nurses can only let in a couple at a time. This for me really hammered home the true nature of this disease, as people talk about how "only" a small percentage of people die from the disease, is how quickly the disease overran this hospital.
Eileen: I agree, it’s incredibly jarring to see that, as a nurse who is used to hospitals and normal flow of patients. The fear and panic in the voices of patients was striking, but even more so for me was the terror I could hear in the voices of doctors and nurses. It is rare, even in ICUs, to have panic. It’s usually controlled chaos, and so you really have a pretty well oiled machine. This was scary and the fear was palpable. Also, the PPE was striking. They are so well sealed up. That level of taping and hazmat suits isn’t something most hospitals have taken. I’ll be interested to see what our data shows looking back on how many healthcare workers were sickened and died in places that approached it with the full coverage, vs the approaches we had here, with reusing materials like N95s for weeks and our shortages requiring folks to be much less protected in a lot of hospitals. There is so much about this scene and the following communications from their government that show what government taking this seriously (once they finally acknowledged it, because it took far too long for them to take it seriously as well) can do. The level of protection and contact precautions was just not something we ever accomplished here, and it is indicative of a vacuum of leadership that we still have no federal governmental response and coordination for PPE and capacity.
Joe: It was terrifying too to see them threaten to not treat anyone if people didn't calm down. That feels more like a cultural difference; I can't imagine our nurses saying something like that to even a large group of patients. That whole scene felt like something out of a zombie movie--just a panicked mass of people, and healthcare workers who had to be brutal with honesty. But it certainly was reality.
Eileen: That’s very true. There was a lot of the healthcare worker struggle in this. My husband and I were both nodding and simultaneously kind of stunned at some of the stuff that was going on. Those comments are incredibly different than we are used to hearing but it is a reflection of their own frustration and fear too. The constant reassurance throughout even in the face of awful circumstances was different too. We normally are pretty honest about the state of things to family but they had a lot of optimism that isn’t typical here and that was more than I’ve seen. I understand it likely came from wanting to provide comfort. We also saw some things that are similar even during a pandemic. Grumpy older folks who can’t remember things or wander and need constant redirection are incredibly familiar in healthcare, especially to nurses on the floors. So there were moments of normalcy amongst the starkness of these hospitals in this pandemic. And some of those same common themes of healthcare workers needing each other to make it through, needing to lean on each other, even when it became clear some of them were from other cities and had come to help and didn’t even know each other.
Joe: You bring up another good point that resonated throughout: the elderly people who were really unaware of even why they were in the hospital, people who missed their families, and that heartbreaking opening scene where the young woman is told her father has passed, but she isn't allowed to even see his body. It again underscores how unpredictable and vile this virus is.
Eileen: These were things that I think have been lost here, these stories. That families were torn apart, that some of them didn't know for months what happened to their loved ones. That many of the elderly had no idea what was happening, and often there were problems with translation between dialects, and communication about previous healthcare issues like dementia is nearly impossible when the families are separated as they were. China quickly separated anyone who was positive from the rest of the family, and put them in hospitals. This meant those elderly folks who relied on their children for literacy, for healthcare, for information, were on their own. It was a cost we haven't heard much about here. We haven't seen these kinds of stories come out in such a powerful way, and I suspect its because there are still so many who don't "believe." This is our country's biggest hurdle.
As they first show Wuhan outside of the hospital environment, as the lockdown was being instituted, you hear the loudspeakers coming on, advising everyone on what to do, and what not to do. They say very clearly "do not believe in, engage in, or spread rumors". They were clear about what this was going to take in order to stop this virus. There is a lot you can say about how slow they were to respond in China, and how many cries for help were being raised by physicians in Wuhan and ignored, but once it became obvious, the leadership took over. What is clearly inherent in shutting down the livelihoods of millions and millions of people is that there has to be a clear, dominant message. And it has to come from the government. And people have to listen. China has a very different government and not everything is good. There are very different processes there, and very different culturally acceptable norms. People were amenable to listening there. And they have experience with outbreaks that we have not. They are used to wearing masks during periods of high transmission, they are not new to the idea of individual sacrifice for a greater good.
This is the foundation of public health: the sacrifice of individual freedoms for the good of the collective health. This only succeeds when government takes the reins, and takes it seriously and acts to support the collective health. That leadership would have made a huge difference in our country. We could have learned from China, and from other countries. A clear message of purpose, and one that praised individual sacrifice for collective benefit, and one that prioritized health over all, would have resulted in a national, much stricter shutdown than we had. We likely could have saved thousands and thousand of lives if we'd done the right thing, the hard thing, early. But we still haven't. And instead of starting this fall with at least some semblance of control, we are nationally largely out of control from an outbreak standpoint, and still have no national effort for emergency planning, coordination of transfer of materials, development of public health infrastructure, or investment in testing.