Point of View

Letter to Editor: Let’s Get COVID-19 Testing Right

March 30, 2020 by Letter to Editor Leave a Comment

COVID-19 “testing” is a word with a variety of meanings. We have to get it right.

We seem to encounter constant confusion or overly simplified descriptions of our evaluation strategies for COVID-19 as just “testing”… as if all and any tests are the same. But they are not. Similarly, we have not, on a per capita basis, tested more people than China, or South Korea or Italy. Hopefully this will change soon.

Some of our tests are gold standard and have been in short supply, high demand, and requiring days and weeks to obtain results. Others are rapid (hours or a few days) and even more recently, point-of-care with results known in minutes.

But all of these tests so far are genome tests sensing for viral DNA or RNA using a version of rt-PCR (reverse transcriptase, polymerase chain reaction). It identifies the presence of an antigen—in this case a specific infectious virus. PCR is a type of lab test that typically requires a high-level laboratory, highly trained technicians, known and validated probes and primers, good controls and elapsed time and precision to perform correctly.

At first, only CDC was allowed to conduct these tests with collected samples sent only to one of their sites, then other labs were certified, and now high-level university labs in most states with help from highly trained graduate students as extra technicians are racing to perform as many as possible because they have long been considered gold standard methods. The basic premise is that a sample of collected material via a nasal and/or pharyngeal swab will provide viral particles of a sort and amount which can be amplified and therefore detected if you have current COVID-19 infection.

However, swabs may not be collected correctly, nor enough material on each, and newer rapid diagnostic tests for COVID-19, like “quick flu” and “quick strep” have real and persistent issues of low sensitivity (false negatives) while typically being designed for higher specificity (true positives).

Estimates from China’s testing during the initial Wuhan crisis indicate swabs for their various rt-PCR tests were only 30-50% accurate. Even more alarmingly, only last week China released data indicating that even initially positive and hospitalized patients who seemed to recover symptomatically and had negative re-tests have tested later as positive. Positive, negative, negative, negative, positive! Theories abound on how this might be possible if there is no re-infection. This is shocking to consider. The last positive result suggests that many former patients deemed recovered, and presumably allowed to travel and congregate in large groups, are still shedding virus and possibly infecting others.

Was this because of an inaccurate set of prior tests or because new tests only detected non-infectious remaining viral particles? This is still not known. But another recently defined issue is that the China case count definitions are not what we might think either. We were told last week that there were no new cases in a certain region of China, but now we know that they do not include in overall daily counts for total and for new cases, any patients re-testing as positive after being released from the hospital or other medical care. These counts also do not include asymptomatic cases (but known positive) in the case counts we have been hearing. That is a very big issue, of course. Case definitions and test result definitions must be standardized if the world is to value and make decisions based upon them. “I have no idea why the authorities chose not to count [asymptomatic] cases in the official case count. I am baffled”, said one of the Wuhan doctors who had a second positive test after recovering. (NPR)

False negative rates will also be an issue with the latest rapid COVID test Abbott is running on the ID NOW platform and approved under EUA (emergency use authorization) by the FDA. But if we all eventually have access to this test under loosened inclusion protocols, I will try to get it.

It will be an important addition for quickly finding more active current infection, aka cases, albeit that experts agree false negative rates may run as high as 15% for COVID-19. This means that if you receive a negative result, you must continue to act and react as if you are still able to transmit the disease. THIS IS CRUCIAL TO UNDERSTAND! The faster test with results provided on-site will allow us to quickly know more about disease and transmission patterns, but still not all we need. It is likely that this consideration became clear to President Trump before he made his latest request for social distancing to continue through all of April. Observing just the strange pattern of negative to positive results in China would be enough…

But there may also have been a bit of good news in a recent Presidential briefing. With his administration finally agreeing to purchase test kits used so successfully by South Korea’s identification and containment efforts, we may soon also be able to include another very simple immune status test here in the US. “Soon” might still be a month away, but test kits have been purchased and submitted for FDA certification by at least one company. These types of tests are qualitative serology (blood) tests measuring antibody (not antigen) responses…IgM indicates current active infection, in this case with COVID-19, to which a person has mounted an antibody response. If such a person later is re-tested and shows IgG antibodies, it means they convalesced from the infection and are clear and immune for some unknown period; this also means they will no longer transmit the current viral strain. An initial IgG result implies similarly that you were at some point (likely relatively asymptomatically) infected and now recovered. Again, you would not infect or transmit the disease.

Of course there are finer points to antibody type, affinity, and sufficiency, but for what is known and needed at this time, showing an IgM vs convalescent IgG signal, or none of either (not as yet infected) would be of enormous interest for not only each person’s peace of mind, but also for national modeling efforts that could drive other decision-making for resources, care and interventions, as well as social and economic goals to follow..

So, antigen vs antibody testing? Longer PCR lead time vs rapid PCR? Nasal/pharyngeal swab vs finger stick/venous blood? My choice will be to get one of these when inclusion protocols begin to allow testing for less symptomatic people when more tests become available. Meanwhile we should stay sequestered for a while longer. You do not want to become seriously ill in the first wave of reduced resource availability.

I think we have a fortunate trajectory in our region, with fewer and later cases, lower modeled deficiencies forecast for beds and ICU interventions, and have been made safer earlier by swift mitigation efforts of our State leadership. We have a way to go; we are not China, but neither are we NY. So far, we are simply lucky.

Pamela Getson is a PhD biostatistician with a BS in physiology. She was Director of the Statistical Core Group of Children’s Hospital while on Faculty at the George Washington University School of Medicine/Pediatrics. She now lives in St. Michaels. In addition to teaching and research, she designed and evaluated clinical trials, and later served as a senior math/biostat reviewer of data submitted in support of new vaccines at the FDA/CBER. She consults to industry and academia, but now living on the shore permanently in retirement, primarily assists with her husband’s new interest in oyster gardening and resumption of their love of sailing and nature.

Op-Ed: The Pandemic Deniers Could Kill Us by J.E. Dean

March 30, 2020 by J.E. Dean Leave a Comment

One would think that the small army of pandemic deniers would start thinning as the number of cases and deaths rise. It’s not happening. Some of us, including here on the Eastern Shore, see the problem as a combination of overreaction and disastrous policy decisions. Covid-19 is not terribly different than a bad year of the “regular flu,” they say. And, had misguided politicians not shut down the economy, life would be continuing largely as it did before, especially in places like Talbot and Kent counties, where the number of coronavirus cases has been relatively small.

Much to my horror, both as a senior and as someone with an impaired immunity system, some are purposely ignoring directives on social distancing and other steps intended to stop the spread of contagion. It is likely that if restaurants were open, pandemic deniers would be eating out, partying, and otherwise socializing as they did before the crisis. And if some of these deniers get a cold, it’s likely that they won’t take special efforts to avoid infecting others.

Such behavior, in the current environment, is criminal, or at least it should be. Ignoring proven means of preventing the spread of the virus is the same thing as purposely passing it on to others. Depending on your demographic, that could mean creating a risk as high as 1 in 10 of killing someone.

Fortunately, political leaders are taking steps to enforce the behaviors that should have been enthusiastically embraced by all of us. One hopes that it won’t be necessary to arrest or jail anyone, but most likely it will be. Unfortunately, the number of violators stopped by enforcement will likely be dwarfed by the number who ignore the directives and are not caught. It’s inconceivable that all “banned” birthday parties, social distancing violations, unwashed hands, and other “violations” will be stopped.

So, what to do? First, in addition to supporting efforts to contain, treat, and stop the pandemic, learn what the “rules” are and follow them. The Spy, CDC, and dozens of other media outlets provide easy access to details. Second, when a neighbor or friend violates the “rules,” say something. For example, earlier this week, I ran into neighbors while walking my dog. The neighbors, suffering from the same cabin-fever afflicting many of us, immediately walked very close to me. The husband stuck out his hand to shake mine, smiling while he did it. “Good to see you, John,” he said, “How are you holding up?” I instinctively started to extend my hand but immediately thought better of it and took a quick three steps back. “I’m social distancing,” I said, forcing a smile. “I’m trying to get used to the new world.”

Fortunately, my neighbors were not offended. They both politely laughed. The wife even said, “You can’t be too safe.” I smiled back and commented, “I’m looking for all this to be behind us.” The friends nodded and we both went our separate ways.

My statement, that I’m looking forward to the end of the crisis, is obviously true. Unfortunately, I believe we are on the front-end of the crisis. I expect worldwide cases of infection to top one million in the immediate future and three million by the end of April. I also expect the death toll to continue to rise, not only in cities, but also in rural areas. I understand that when the virus hits poorer parts of the world, the rates of death will skyrocket proportionately to the lack of available medical care.

I hope not to personally become one of the statistics, but it’s not really in my control. Governor Hogan, on March 29th commented, “I think that in two weeks, around Easter, we’re going to be looking at lot more like New York.” Dr. Anthony Fauci, the same day, suggested that the U.S. could see as many as 200,000 deaths. My hope is that the pandemic deniers wake up.

If I am surrounded by even a few reckless, thoughtless, selfish, misguided, stupid people, my odds of infection increase. That is why I am angry at the deniers. You should be too. And, if you examine your behavior and see that you are part of the problem, please act now. You’re putting countless others at risk.

J.E. Dean of Oxford is a retired attorney and public affairs consultant. He is a former counsel to the House Committee on Education and Labor. For more than 30 years, he advised clients on federal education and social service policy.

Snapshots of Daily Life: Reminiscing by George Merrill

March 29, 2020 by George R. Merrill 1 Comment

For a diversion, lately, I’ve been rummaging through closets. Ever notice how their contents multiply over time and fill with surprises?

During a foray into one closet, I rediscovered an old file box labeled 1946. It contains random papers that my mother kept. I found vintage World War II memorabilia. My father was at war in Europe, my mother on the home front on Staten Island raising three children. She volunteered as a nurse’s aide at Halloran Hospital where wounded soldiers returning from the war were treated. There’s a snapshot of her in uniform. How young she looks, I think. In the box, I found some V-mails, censored and copied by the military for national security –– letters my father sent from the front. I found pictures of relatives, all of whom are long gone, uniformed Navy and Army officers. I found a few ration stamps issued during that period, a copy of the military journal, Stars and Stripes, announcing the Bulge offensive and a copy of Up Front, Bill Mauldin’s classic documentary depicting soldiers’ lives during WWII.

Of the national crises during my lifetime, I recollect two vividly: WWII and 9/1.

WWII thrilled me. I was nine. Traveling the Staten Island Ferry regularly I saw the energy of America at war –– uniformed military personnel arriving and leaving, troop ships in the harbor, the region pulsing with vitality. America’s relative safety –– bordered by two oceans –– and my boyish sense of omnipotence combined to leave me with many fond memories of what to me was a glorious adventure, not the tragic conflict it was. As an adult, I was horrified at the carnage of 9/11 but also shaken by what had never occurred to me before: that America wasn’t invincible as I’d always believed and it had become as vulnerable as the rest of the world. I went from years of feeling omnipotent and safe to being frightened and vulnerable, just as my country had.

It’s odd how our minds’ recall some of life’s signature moments by peripheral, even absurd details associated with them.

The morning of 9/11, I’d gone to the supermarket for eggs and milk. On the news rack, I saw one of the tabloids that print sensational rubbish. There was picture on the front page of a large frog lying next to a woman in a hospital bed with the headline: “Woman Gives Birth to Frog.” Too good to pass up. So, I bought a copy thinking I’d write some kind of goofy article about it. I arrived home and, with tongue in cheek, started writing a piece about this poor woman’s discovery. My wife came to my studio, looking frightened, and told me a plane had just flown into one of the twin towers. I’ve never forgotten either the silly frog or my wife’s terrifying disclosure.

One day in August of 1945, my father returned from the war. I sat on the curb, my back leaning on a sycamore tree. I couldn’t wait to see him. It was hot and the macadam on the street had risen in small bubbles, as if boiling. I stepped on them, making them snap like gunfire. The war was over. My father finally arrived in the car and he hugged me. I remember how the stubble of his beard felt like sandpaper against my cheek, the mottled bark of the sycamore at my back and the macadam bubbles under my feet that rose in the summer heat.

Thomas Aquinas once considered our perceptions of reality in this way: there was an ‘essence’ of things and then their ‘accidents,’ incidental characteristics that are peripheral to their essence. I think when we’re not sure of the essence of something, just what the very heart of the matter is, we often get to it by following the path of its ‘accidents,’ like playing Charades or like the free association that leads us to the essence of a dream. Strange how a sycamore’s mottled bark and heat bubbles in a macadam street could become the icons of one of my life’s most exhilarating moments; and how a mindless frog became symbolic to me of the first foreign invasion of America’s homeland since the war of 1812.

My father would periodically send packages from Europe. Receiving them was exciting. I remember one containing a German officer’s tunic, a helmet, bayonet, cartridge belt and a host of medals Nazi soldiers earned. The package also contained several K-Rations small wax covered boxes, containing basics (then) like canned chopped ham, malted milk tablets, fruit bars, sugar, instant coffee, chewing gum, cigarettes, water purifier, and packets of toilet tissue.
Toilet tissue, then, was more available on the roiling battlefields of WWII, than in today’s supermarkets.

Of the many civilian privations resulting from WWII, the consolation of touch was not one of them. Touching, recently, has been a volatile social issue. Because of sexual abuse, touching earned a bad rap. Now that abuses are being exposed, and perpetrators prosecuted, touch is returning to its venerable place in the connective tissue of human relationships. And no sooner has touching been given social clearance, and it’s been assigned sinister connotations again at a time when we desperately long to touch each other. A friend of ours who lives alone reports that, during this time of social distancing, the high point of her day is not any calls she gets, but the warmth she feels as her dog jumps on the sofa and snuggles next to her. And now we do what we can; make calls instead; it’s our ‘wartime” way of remaining in ‘touch.’

The coronavirus pandemic has been characterized as a war, indeed, a world war. Our enemy is invisible. This is a war like no other. Our enemy has no army, no tanks, no planes and not even a gun. Our enemy claims no national identity or moral purpose and is tiny like an atom; infinitesimal in size but terrifying in potency. The problem is not that our enemy hates us; the problem is that it needs us. It needs us to get a life. We see the virus as an adversary, while it sees us as rescuers. Without us, the coronavirus is lost, depending only on animals for its survival. In a strange way, it seeks the life force that vivifies you and me. It’s that life force that offers the virus a more prolific, if not necessarily, better existence.

Join me in praying that the coronavirus finds more benign ways to get a life and that we’ll all be touching soon.

Columnist George Merrill is an Episcopal Church priest and pastoral psychotherapist. A writer and photographer, he’s authored two books on spirituality: Reflections: Psychological and Spiritual Images of the Heart and The Bay of the Mother of God: A Yankee Discovers the Chesapeake Bay. He is a native New Yorker, previously directing counseling services in Hartford, Connecticut, and in Baltimore. George’s essays, some award winning, have appeared in regional magazines and are broadcast twice monthly on Delmarva Public Radio.

Letter to the Editor: CASA of the Mid-Shore information

March 29, 2020 by Spy Desk Leave a Comment

Dear Friends,

During this unprecedented time, CASA of the Mid-Shore continues our commitment to the vulnerable children in our caseload who are under court protection because of abuse, neglect, abandonment, or their parents’ inability to safely care for them. This is a frightening time for all of us, and we remain mindful of the additional burden the novel Coronavirus is placing on some of society’s most vulnerable citizens.

Our staff and Court Appointed Special Advocates (CASAs) are following federal and state guidelines, to include social distancing. Our office is closed to the public. We have temporarily suspended all in-person visits and are maintaining contact with our children via safe and creative methods, such as texting, phone calls, video chats, as well as staying in contact with their caregivers. I have asked each CASA volunteer to keep us informed of any needs the children have so that our advocacy for them can continue in this crisis. We are in the process of sending a small gift (such as stuffed animals, art kits, and even grocery store gift cards for our older youth) to every child to let him or her know they are in our thoughts.

Our major fundraising event, the Galaxy Gala on May 16th, has been canceled out of an abundance of caution and to keep everyone as safe as possible. As many of you know, our Spring fundraiser is a significant source of funds that go far in sustaining CASA’s programmatic needs. Event proceeds were expected to cover 40% of our operating budget. If you have already agreed to support this event, we thank you for your generosity and will be in touch to discuss this. We hope all of our friends will consider making a donation to CASA to support our unique and important work with our community’s children. Please consider supporting us by mailing a check to the office at 1 S. Washington Street, Suite 2, Easton MD 21601, or by visiting www.casamidshore.org to donate online.

On behalf of everyone of CASA of the Mid-Shore, I thank you for your compassion and consideration. I wish you and your families good health and look forward to seeing you once we are on the other side of this crisis.

Be well,

Robin Davenport

Executive Director

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Op-Ed: Increase Physical Distance without Increasing Social Distance by David Foster

March 27, 2020 by Spy Desk 1 Comment

Don’t get me wrong. I fully understand the importance of maintaining a physical distance of 6 feet or more from anyone outside our household. My quarrel is with the term Social Distance. The term social normally refers to the organization and interactions within a society, including verbal, telephonic, email, text, etc. and this is hardly the time when we want to decrease that kind of interaction much less increase social isolation within our communities.

Long before we heard of Covid-19, there was already an epidemic of loneliness in our country, particularly among the elderly. Loneliness has a well-documented physical as well as psychological dimension. Did you know that loneliness has an equivalent impact on morbidity and mortality of 15 cigarettes per day?

We need to recognize that Cabin Fever, prolonged isolation inside, also has real physical and psychological consequences. Last week we asked our county public health officer if there was anything wrong with people in Chestertown going outside for walks or bike rides. The answer was unequivocal: as long as they maintain a physical separation of 6 feet or more, he actually encouraged people to get outside.

The next few weeks and months are going to be tough. If we want to get through this with minimal adverse impacts, please listen to the health experts: wash your hands, maintain a physical separation of 6 feet or more, exercise outside, and call or write someone who needs to hear from you.

David Foster is the Ward One councilman for the Town of Chestertown

The 1918 Flu Epidemic on the Eastern Shore by Angela Rieck

March 26, 2020 by Angela Rieck 2 Comments

The 1918 “Spanish” influenza (ironically most scientists believe it started in the United States) is the most famous pandemic in America. While we are living through our own pandemic, it is interesting to learn how our predecessors fared in the 1918 and 1919 influenza outbreak.

The 1918 virus differed from the current virus COVID 19. The 1918 virus was an influenza and was especially lethal for those between the ages of 10 and 30. Death from the 1918 flu came rapidly, usually within a week, some victims died the same day. Within three days, pneumonia often followed and without antibiotics and ventilators, it proved fatal in 25% of the cases. Those exposed to the spring 1918 influenza were immune to the deadly fall influenza.

Scientists still do not understand why the 1918 disproportionately impacted the young since most flu viruses’ prey on the very young and very old. There are two theories. One is that the flu produced a dangerously strong immune response called cytokine storm causing a lethal overreaction. Other scientists believe that the older generation had been exposed to other flus, thus building antibodies. Conversely, the COVID 19 virus is fatal to those with weakened immune systems and those over 60.

To learn how the 1918 pandemic impacted the Eastern Shore I researched newspaper articles, thesis papers, Public Health Statistics, the Internet and books on the 1918 Flu Epidemic. While I was fortunate enough to find local papers from 1918 and 1919 stored in the Library of Congress, none were from Talbot or Kent county. (The Star Democrat is missing digitized versions from those years.) However, there are similarities among the counties.

Overall, I was struck by how little was reported. There were few news stories; most not on the front page. Articles were devoted to the war effort, shortages, crime and local news.

The first onslaught of this flu in the Spring of 1918 was virtually ignored, and for good reason, there were no influenza deaths in that Spring in either Kent or Talbot Counties, and only 5 reported cases. There were two minor stories about a soldier’s flu, both on page 2.

“If your friend or your relative or your best beloved has a runny cold, don’t kiss him or don’t kiss her and don’t kiss them. They may have the “Spanish Flu.” Bacteriological investigation of the cases which have gotten into this country seem to indicate that there is nothing new or mysterious about this malady. Some of the cases are of what we would call grippe, some of common colds. The only serious thing about it, according to the New York Commissioner of Health, is its tendency to a resultant complication of pneumonia.” Evening capital and Maryland gazette, Annapolis, August 30, 1918.

Our predecessors could not have known what was coming. Scientists now believe that over the summer the virus mutated into a deadly strain.

Everything changed in late September and early October when the first reports about this deadly influenza came out of Camp Meade in late September. Eventually 25% of the 14,000 soldiers were infected and 800 died. Of those who contracted pneumonia, the death rate climbed to 27%. On September 27th the draft was halted.

From September 24th to October 5th, the disease spread rapidly on the Eastern Shore. By October 5th the Surgeon General proposed shutting down schools and all social gatherings. Movie Theaters and shows followed several days later. Factories remained open to support the war effort. By October there were 871 cases of the flu and corresponding pneumonia in Talbot County and 73 deaths. In Kent County there were 371 cases and 61 deaths.

INFLUENZA HAS THE COUNTRY IN ITS GRIP! MANY HUNDREDS DIE OF PNEUMONIA CAUSED BY THE DISEASE Schools, Churches, Theatres And Other Crowd-Drawing Places Closed. Spanish Influenza, or the old fashioned “grip,” is raging ail over the country and many deaths are occurring daily as a result of pneumonia developments. Influenza has been brought to the Eastern Shore from Baltimore. Philadelphia, and Wilmington by our people visiting in those cities. In some of the towns on the Shore, a number of deaths; have occurred and in other towns hundreds of the people are seriously ill. Schools, moving picture shows, churches, and all places where the public gathers in any very considerable number have been closed to prevent the spread of the disease. In Worcester County there are a great many people ill and every precaution should be taken to prevent an epidemic. Every caution against the spread of influenza must he observed by the public. The Health officers warn because of the importance in this wartime effort to keep all our industrials up to the fullest capacity of their productiveness for the national interest. Snow Hill Democratic Messenger, October 5, 1918.

The surgeon general distributed guidelines. Precautions included isolating the sick, cleaning their utensils in boiling hot water and soap, hand washing, wearing masks, and gargling.

HEALTH BOARD TELLS HOW TO HALT EPIDEMIC. Stop the spread of influenza and pneumonia by obeying these ten new rules issued yesterday by the Board of Health. I—Cough and sneeze in your handkerchief only. Spitting is dangerous and unlawful. 2 —Glass and eating utensils must be sterilized by washing in boiling water. Your lips must not touch the mouthpiece of a public telephone. 3—Waiters should not touch your bread, the edge of your glass, cup, plate, knife, bowl or spoon 4 Wash your hands and face several times a day. Don’t shake hands. 5. —Pneumonia and influenza germs come from mouth and nose. Wash your face. 6 —Do not kiss your child on the lips. 7 —Do not visit one who has the “flu” or pneumonia. 8 — Do not go to school or to work if you have a cold. 9 Avoid over-work, over-eating, worry, fatigue, lack of sleep. Keep your windows open, rain or shine. 10—Get a competent doctor the minute you feel sick. Report quickly all cases of either disease to the Department of Health. The Daily Banner, Cambridge MD (October 1918 & January 1919).

Imagine how it must have felt to suddenly hear about a previously unknown flu that in 10 days was killing our strongest population. While the front page was filled with obituaries about those dying from the flu, news about the influenza was relegated to inside pages. Unlike our 24-hour media cycle, there was little speculation, no summaries of deaths and frequent assurances that this was no different from other flus. Even though in some cases, entire families were afflicted.

The worst was yet to come, 25% of all deaths on the Eastern Shore were attributed to the 1918 flu, and these deaths occurred from October through December.

Conflicting messages were widespread, for example on October 11th, the Cambridge Daily Banner reported that the Philadelphia Public Health director, Dr. Krusen, pronounced that the worst was over, the cold weather would kill the virus. (He also gave permission for a large parade to sell war bonds on September 28th.) However, on page 3, The Daily Banner also announced closings for the flu.

WORST IS PAST IN “FLU” EPIDEMIC Clear Cold Weather Will Greatly Aid In Fighting Disease. Philadelphia, Oct. S. —Clear, cold weather, which Director Krusen says is the best destroyer of influenza germs, gave the city and state authorities unmeasured assistance in Philadelphia’s fight against the grip epidemic. “I feel we’ve reached pretty nearly the top now,” said Director Krusen. “Our organization is being amplified and perfected. Aid is coming from all sources and we soon will be able to be optimistic.” The Daily Banner, Cambridge, MD, October 08, 1918

That same day, another paper, The Midland Journal (Rising Sun) reported 20,000 new cases in the past 48 hours.

Obituaries of dozens of citizens who died from the flu were printed on the front page. Children, soldiers, health care workers, politicians, even Woodrow Wilson (whose stroke was believed to be caused by the influenza), succumbed to this disease.

By October 12th, the consensus was that the flu was waning, and by October 25th most schools and social gatherings had reopened. But that optimism was short-lived.

Despite the optimistic predictions, the death toll continued for the rest of 1918, by the end of 1918, there were 118 deaths in Kent County and 133 in Talbot County. All told, 9% of the population got the flu in 1918 Talbot County and 6% in Kent County.

By December 13th, a third wave appeared, and it became apparent that the reduction in cases had been due to the quarantine, not the cold weather. Reopening schools and meeting halls gave the influenza access to more victims. Schools, theaters and meeting places were closed again and did not reopen until the end of January 1919. By January, coal was scarce because coal miners had been decimated by the virus. Deaths continued to mount until February and by March, it was gone.

INFLUENZA EPIDEMIC. It seems we cannot get rid of influenza in Worcester County. Alas the disease has broken out again in several sections of the county. This is not only true in Worcester, but in many other sections of the State and the nation. Democratic Messenger, Snow Hill, December 14, 1918.

Health Notice Owing to the apparent increase in influenza among school children and teachers, I deem it best to close the schools for the present week. The moving picture theatre will also be closed for the same period of time. While there is not as great danger attendant upon children collecting in crowds in the open air, I feel that it is my duty to urge parents to prohibit their children from going in crowds to skate. If we find that crowds collect anywhere, we may be compelled to take some steps to prevent it. During this period, as well as at all times, people should be very careful when coughing or sneezing, and hold something in front of their mouth when compelled to cough or sneeze. It is in this manner that, diseases, especially influenza, is spread. Visiting should not be practiced at this time, especially where any one is sick, unless you go to offer your assistance, then in cases of influenza, a mask should be worn, when working about the patients. E. E. WOLFF, M. D. City Health Physician. The Daily Banner., January 14, 1919, Cambridge.

Of course, where there was uncertainty, there were conspiracy theories. It was rumored that the Germans deliberately brought this disease to America.

Is This Mysterious Infection a New Kind of German Offensive? Is this new disease which has already killed hundreds and stricken thousands of our soldiers and civilians a new German war offensive? If not, how did it happen that this epidemic appeared so suddenly and extensively in such widely scattered cities and army camps throughout the country? Smitten as from a bolt from a clear sky thousands of Americans have been suddenly prostrated in many widely separated parts of the country, during the past ten days, by a disease which is called, apparently for want of a better name, “Spanish Influenza.” Naturally, under all circumstances, there is much speculation regarding the matter. Perhaps because there seems to be a rather natural disposition to ascribe about everything that is perfidious in the world today to Germany, some have ventured the guess that the disease may have been introduced and spread by German agents.

This theory, however, is generally considered as being hot only entirely groundless but really absurd, for it seems hardly conceivable that, if Germany undertook an offensive of this kind, she would choose such a mild and humane sort of disease. A much more plausible explanation would seem to be the simple fact that the recent cold snap caught the country entirely unprepared for such severe weather and, as a result of our unheated dwellings and other buildings and the inadequate clothing that was being worn, large numbers of people in different sections of the country contracted colds, which developed in many cases into pneumonia and resulted in an unusual number of deaths. Almost always at this season of the year colds are frequent and they often result fatally, and it may well be that, but for the high tension of these strenuous war times, this epidemic would not have attracted unusual attention. In any event there seems to be no occasion for special alarm or panic about the matter, for the disease is evidently one which the American medical profession is perfectly able to handle, and, moreover, effective measures are being taken, wherever it appears, to check it and destroy its power. The Midland Journal, Rising Sun, October 4th.

Prayer, quarantines, and hope were NOT the only alternatives available to residents of the Eastern Shore. There were advertisements for patent medicines to cure the flu. Most remedies involved a laxative. Quinine (used for malaria) was tested and found ineffective.

Spanish Influenza or Grip by Dr. Lee H. Smith. An old enemy is with us again, and whether we fight a German or a germ, we must put up a good fight, and not be afraid. The influenza runs a very brief course when the patient is careful, and if we keep the system in good condition and throw off the poisons which tend to accumulate within our bodies, we can escape the disease. Remember these three C’s—a clean mouth, a clean skin, and clean bowels, to carry off poisons from the system and keep the bowels loose, daily doses of a pleasant laxative should be taken. Such a one is made of May-apple, leaves of aloe, root of jalap, and called Dr. Pierce’s Pleasant Pellets. Hot lemonade should be used freely if attacked by a cold, and the patient should be put to bed after a hot mustard footbath. The Prince George’s Enquirer and Southern Maryland Advertiser. (Upper Marlborough, Md.) November 22, 1918

Some doctors continued to recommend whiskey.

Is Whisky Good For “Flu?” Dr. A. A. Cairns, Chief Medical Inspector of the Bureau of Health, of Philadelphia, flatly differs with Coroner William B. Knight on the statement that whisky is an essential in fighting the influenza epidemic. Giving his personal opinion of whisky as an influenza Remedy, Dr. Cairns said: “There are many physicians who do not use whisky at all in the treatment of influenza cases. In fact, whisky has been taken from the American Pharmacopeia as a medicine. Whisky is an old- time remedy that has gone out of practice.” The Midland Journal, Rising Sun, October 25th.

In hindsight it was a serious mistake to lift the quarantines so quickly. However, given that the medical treatment at the time, which lacked antibiotics for pneumonia, ventilators and oxygen; there may have been very little that could have changed the course of the disease. It was a vicious virus, and doctors, to this day, do not understand the reason for its power. People died, not for the lack of facilities, but for the lack of medical knowledge (viruses were not discovered until the 30’s). Vaccines were tried, but failed.

During this pandemic, residents were distracted by World War I. Newspapers reported on bond rallies, rationing and supporting the war effort. There was little time to ruminate on the deadly virus. Eastern Shore residents were lucky in their isolation, without the 24-hour news cycle, they were able to live their lives and pray that the deadly virus would not descend upon them.

How many people on the Eastern Shore died from the 1918 flu? The virus attacked so rapidly that some deaths were misclassified. Worldwide estimates range from 50 to 100 million people…that is a very wide range. It is estimated that over a half million Americans died. The most deaths occurred in second wave in the fall. The third and final wave from December through February was less deadly because scientists believe that the virus mutated to a less virulent form.

Ultimately the flu was devastating, in Talbot County 13% of the population and in Kent County almost 10% of the population had been infected. (This may be an underestimation, since does not include the higher incidences of Tuberculous that have been attributed to the influenza.)

Lessons for us, are fewer. We are lucky that COV19 is not as deadly as the 1918 influenza. Public health experts are advocating isolation to “flatten the curve” and hope that the COVID 19 mutates benignly. Some experts are questioning that approach because of the impact on the economy and the small population who is seriously impacted. Vaccines and treatments are being vigorously studied, but treatments are months or years away.

All that we can do is wait and hope and pray as generations did before us. While medicine has changed, humans have not.

Angela Rieck, a Caroline County native, received her PhD in Mathematical Psychology from the University of Maryland and worked as a scientist at Bell Labs, and other high-tech companies in New Jersey before retiring as a corporate executive. Angela and her dogs divide their time between St Michaels and Key West Florida. Her daughter lives and works in New York City.

To Bruce, With Love by Al Sikes

March 26, 2020 by Al Sikes Leave a Comment

The article headline in the New York Times was: “How Do Christians Fit Into the Two Party System? They Don’t.” The author, Tim Keller is the founder of Redeemer Presbyterian Church in New York.

I spent dozens of mornings with Tim in a small study group while living in New York City. His voice is deeply informed and telling. Tim’s essay in the Times, noted above, stated that the reason for separating faith and politics is to not create the impression that “those considering the Christian faith…need not only to believe in Jesus, but also to become members of the (fill in the blank) Party.”

Bruce Sundberg

Good Friday and Easter, indeed the Lenten season, are intended to replenish the soul. And, this moment in our history is for many, soul-wrenching. While our bodies need care, so do our souls – the physical needs the spiritual. Human distinctiveness is in many ways our soulful presence.

Most persons can, if pressed, provide a skeletal summary of Jesus’s life. Few, indeed a diminishing number, are students of his life—most of us are busy leading the only life we know for sure.

I will offer, however, a countervailing thought.

Early in my career life, I met Bruce Sundberg, who at the time had a Midwestern portfolio of Young Life organizations. He lived in St. Louis and was the staff hub of Young Life in Missouri and close-by States. Young Life is a Christian organization that, and I quote, “provides fun, adventurous life-changing and skill-building experiences.”

Bruce became not just a close friend, but also a spiritual presence in my life. His words were encouraging, but his presence was profound. As it is said, “he walked the talk.” His friendship guided me toward attempting to subordinate the challenges of my career to a faithful presence. I should add, “at least I tried.”

Bruce’s health is now in decline. My wife and I stay in touch through his loving wife, Beth. At an early point in their marriage they lived with their two daughters in the Philippines as they opened up Southeast Asia for Young Life.

Circling back to Tim Keller’s admonition about faith and politics, I can say for certain the former is a gift and the latter is too often an expression of our flaws. It would be perverse indeed if people thought the gateway to faith was somehow through political affiliation.

The divinity of Jesus, and that is my belief, is in part reflected in the extraordinary actions of His most devoted followers. Mother Teresa, for example, was informed by the transformational condition of belief, love. And when crisis, or simply hurt, confronts humanity, you find the Red Cross and so many caring organizations that were founded and continue to be led by the devout.

The world, before and after Jesus Christ, has a deep need for love. The events leading up to Good Friday and culminating with Easter are enduring gifts of God’s love. And to Bruce Sundberg, who has been a transcendent treasure in my life – Thank you.

Al Sikes is the former Chair of the Federal Communications Commission under George H.W. Bush. Al recently published Culture Leads Leaders Follow published by Koehler Books.

Report from Annapolis 2020 Final Report by Laura Price

March 26, 2020 by Laura Price Leave a Comment

What happened during the final few rushed days in Annapolis? Amidst the Coronavirus crisis that we are experiencing and shut downs all around us, the Legislature’s 2020 session came to an abrupt end three weeks early. There was an urgency to pass bills that were deemed priorities, despite the economic catastrophe that is taking place. It didn’t seem to matter what impact financially some of these bills would have on the public. Pass tax increases, they did, and pass the expensive education bill, they did.

While the sweeping sales tax bill that would have added sales tax to nearly all services was defeated, a “luxury” sales tax bill did pass. As did the “Google” digital advertising tax, the digital download tax and the tobacco tax. These were all identified as ways to pay for a small portion of the most expensive legislation of all, the Kirwan Blueprint Education bill.

However, the use for some of these taxes has already been changed. The first year of the “download” tax will be used to deal with the Covid 19 response. The tax revenue from the tobacco tax will now be used to settle a lawsuit with the historically black colleges. And the digital tax will be likely be challenged in court because it conflicts with the U.S. Constitution’s commerce clause and the International Tax Freedom Act.

Point being, we have known all session long, that these new taxes would never come close to paying for the State share of Kirwan and we counties have definitely known that it didn’t pay for ANY of the local share.

Last minute amendments were added to the Kirwan bill to supposedly make lawmakers more “comfortable” with its passage. Spreadsheets were updated and numbers kept changing during the past several weeks, somewhat reducing the local share. There were two that I previously discussed that unfortunately ended up being merged onto one sheet of paper. One was the “local relief” to give counties such as Prince George’s and Baltimore City, along with jurisdictions like Caroline, Dorchester and Somerset additional State aid. The other was to fix a double counting of the “floor formulas,” which means that no matter the supposed wealth of your county, 15% of the base and 40% of an “at promise” student is funded by the State. This amendment corrected a mathematical error when the bill was written. Included counties were Anne Arundel, Kent, Talbot, Worcester and a few others .

As I wrote before, the two amendments got merged and was titled “Local Relief.” As the Senate was going into its final voting passage on Monday, one more set of figures came out for the Local and State shares. The final numbers ended up being higher for the County share. Part of this must be due to other amendments pushing implementation dates for certain aspects of the bill sooner than the original phase in. But there is an oddity that I can’t figure out yet. Most of the seven counties whose technical fix was being corrected, changed dramatically. I cannot yet explain what caused the changes but will be inquiring, as it just doesn’t seem logical since it has no “wealth formula” attached to it.

The other major amendment was the “trigger” provision offered on the floor by Senate majority leader, Nancy King. It reads:
Beginning December 1, 2020, and each December 1 thereafter, if the December General Fund estimate in the December Board of Revenue Estimates report is more than 7.5% below the March General Fund estimate in the March Board of Revenue Estimates report of that year, per pupil increases in major education aid required under this Act shall be limited to the rate of inflation, as defined in § 5–201(h) of the Education Article as enacted by this Act”.

The Board of Revenue Estimates consists of the Comptroller, the Treasurer and the Secretary of Budget and Tax. They update their revenue projection in March. This amendment states that if on December 1, the revenues are down by more than 7.5%, education increases will be limited to the rate of inflation. With current revenue estimates about $18 billion, the revenues would have to drop by $1.4 billion. That is an enormous number, bigger than even what is considered a recession. On the surface, this appears to be a safety net, but the likelihood of this occurring more than once is pretty slim.

Here’s why. Let’s say you project $100 in March. In December, revenues are $92.50 or less, the trigger provision kicks in. The following year in March, one would assume that a responsible budget projection should be similar to your actual number. For an example, the estimate comes in at $90. That means that the following December, actual revenues would have to project to be $83 or less. The reality is, that this trigger may only happen once. Even though it would be evaluated each December, it is unlikely to happen in successive years. Meaning the full force of Kirwan implementation and massive spending increases would occur even without a recovery in our economy. Many of the legislators took comfort in this provision, however I do not.

At the end of the day, the passing of this and other legislation that costs our citizens dearly, in the face of this unprecedented health and economic crisis is irresponsible.

Laura Price is 2nd Vice President on the Executive Board of Directors of MACo, Chair of Budget and Tax, Talbot’s legislative liaison and member of the Talbot County Council.

Op-Ed: Our Community and Covid-19 by Dr. Michael Fisher

March 25, 2020 by Spy Desk 1 Comment

“Ask not what your country can do for you, ask what you can do for your country.” John F. Kennedy

As our region and our country endure the dangerous COVID-19 outbreak, we must accept radical changes. Americans do not like to be told what to do, but we must now accept measures that are outside of normal times. Historically, health care systems are challenged in terms of personnel, equipment, costs and space; our local health care system is no diﬀerent. We are anxious, even frightened for our personal health and that of our loved ones. People are dying, and we are wondering when it will hit closer to home. But there are things you can do to help and we all have a role to play.

Our nation’s top doctors have developed guidelines to limit spread, and we must follow them. Every contact has the potential to spread the virus because it is diﬃcult to identify those infected when so many are without symptoms. Forwarded emails and re-tweets show how quickly one submission can be sent to 10 people, who each share it with 10 more, and so on. It’s called “going viral” — and that is what is happening with COVID-19. The spread becomes exponential very quickly.

Stay home. Keep your distance, except to help a neighbor, attend a blood drive, shop for food or go to the pharmacy. In those cases, keep your distance. Wash your hands frequently. Soap and water are better than hand sanitizer so if you can, wash.

Our hospitals and health departments have mobilized task forces and are anticipating needs in the event of a surge in cases. Our Governor has imposed serious emergency measures statewide. COVID-19 is highly contagious, so families may not be able to be at the bedside as we are accustomed to, in normal times, when loved ones are hospitalized. Now, visitors put others at risk and also use up gowns, gloves and masks needed for the protection of our doctors, nurses and other staff providing patient care.

As I write this, 10 percent of Italy’s COVID-19 patients are health care workers. We cannot afford to lose so many from the ranks of our own health care providers, who are dealing with fear and anxiety but also exhaustion. Please exercise patience in your interactions with our local health care system.

Hospitals need to conserve precious resources such as ventilators and other vital equipment, and despite our medical advances in the U.S., we lack adequate stockpiles. It is too late to assign blame; however, we all need to anticipate what happens if we or one of our family becomes very ill.

Now is the time for family discussion and for making and documenting decisions regarding end-of-life choices. This is true for all, but especially for anyone with serious underlying chronic medical conditions, advanced age or intractable disease. Don’t wait until a medical event forces a trip to the Emergency Room under high-stress and emotional circumstances that will make clear, rational thinking difficult; you can find the “Maryland Orders for Life Sustaining Treatment” form online at marylandmolst.org.

Protocols exist to make tough decisions who receives advanced intensive care and who receive supportive, palliative care; we pray we will not need them. These are rapid and grave circumstances for some, despite the fact that many will recover. Yes, COVID-19 is more likely to overwhelm the elderly and frail, but anyone of any age can get it, can infect others, and also become dangerously ill.

Pandemics have happened before and history shows that many may succumb. Nonetheless, here on the Shore, we have an incredibly generous and connected population, and together we can pull through. This will end, and we will see the development of treatments and vaccines. We will mobilize for future pandemics based on our experience with COVID-19. Be strong and grateful for the blessings around us, and pray for mercy in this horrible time. And please, be part of the solution rather than part of the massive problem we face in the days ahead.

Michael J. Fisher is a retired physician who practiced for over 30 years in Easton and the Mid-Shore.

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