Sunny Days Cast Shadows

Another week has passed as we anticipate “the surge.” The words of Nathaniel Hawthorne seem written for our time: “Time flows over us, but leaves its shadow behind.

As cities and counties across Georgia took the lead to enact their own Stay-at-Home ordinances, pressure mounted on Governor Kemp to do what the majority of Governor’s across the nation had already done — order people to stay home to slow the spread of the virus.

Last weekend, prior to the Governor’s Order, I shared photos with the Governor’s office of large raft-up boat parties on Lake Sinclair, pleading with him to order a shelter-in-place. My Facebook post with these pictures had gone viral and clearly people were alarmed by the callousness of the boaters.  By the end of the weekend, the Governor signed an Order requiring the Department of Natural Resources to break up large gatherings on and around lakes throughout the state.

After issuing his Stay-at-Home Order, I received calls from a number of city leaders in the district. Governor Kemp’s Order nullified their more strict ordinances, leaving them confused about how the Order affected their communities, and whether their local police had the authority to enforce the new order.

Again, I communicated these concerns with the Governor’s office, and again, the Governor released another “clarifying” Order.

Beyond the Shadow of a Doubt: After clarifying his intent, there is no doubt that reopening beaches, which had been ordered closed by local governments, was a purposeful preemption of local control. Churches, golf courses, and businesses (specifically including gun stores), remain open as long as they follow certain CDC guidelines, including keeping six feet of distance between people. Businesses such as  gyms, salons, entertainment venues, and bars/nightclubs were ordered closed. Restaurants are limited to carry-out only. Citizens must stay in their homes except for essential activities such as grocery shopping, medical care, exercise, and taking care of family members.

Dark Before the Dawn

Is Georgia ready for the “surge”? The US national average for hospital beds per capita (per 1000) is 2.8. Georgia is below the national average at 2.5.  Contrast this to Japan at 13.1; Germany 8.0; and Italy 3.2.

Most of us want to know if Georgia has enough ventilators and hospital beds to meet the need. I have been trying to get this data, but it is difficult, if not impossible, to obtain. According to the COVID Tracking Project, only 15 states are collecting data specific to ICU admissions and of those, only seven are tracking ventilator use. Rough averages of this data indicate that 32% of all hospital admissions require intensive care, and 28% require ventilators. To date in Georgia, 1332 COVID-19 patients have been hospitalized.

The following is information obtained from a conference call with the Georgia Hospital Association:

Available Bed Space: Georgia has 26,578 hospital beds. 2200 of those are ICU beds (8%). Certificate of Need (CON) has been waived so that other types of beds can be used for ICU.

New Bed Space: More bed space will be needed as the surge approaches. The State is working with the Georgia Hospital Association to identify hospitals that have extra, old, or empty space that can be brought on-line ASAP.  Opening up this space is VERY costly — the state has allocated 72 million dollars to expand space for 300 extra beds (including ICU space). Many hospitals simply cannot afford to do this. In addition, this extra space must be staffed. Georgia is already facing a severe nursing shortage right now.

Previously closed hospital space is being re-opened in Albany & Snellville to provide an additional 208 beds.

Four mobile medical units will be deployed. Twenty bed units will be sent to Rome & Albany. A 24 bed unit will stay in Atlanta, and a second 24 bed unit will be on stand-by.

Licensing rules are being suspended in order to hire nurses whose licenses have lapsed five years or less, and some scope of practice is being opened up.

Most of Georgia’s ambulatory surgery centers have been closed because elective surgeries have been cancelled. These centers can offer additional bedspace, laid off employees for hiring, and use of idle equipment. We need healthcare workers to stay in Georgia! Unfortunately, NY is offering nurses $10,000/week for temporary work.

Ventilators: Data from the National Hospital Questionnaire says we have 3387 ventilators in Georgia. 1200 more have been requested from the national stockpile and those are being shipped in week by week. Cpap and anesthesia machines can be repurposed to substitute for ventilators. Inquiries are being made with private vendors about ventilator loans. IV pumps and portable negative pressure rooms are also needed.

Personal Protective Equipment (PPE): There is still a huge need for masks, gloves, gowns, and face shields. The mask shortage in particular has caused the most concern. The State of Georgia has received some help from the national stockpile. According to protocols, each patient contact burns through one set of PPE, but nurses are now wearing masks for longer periods of time instead of with every patient.

The State of the Hospital Community: Scientists are predicting that the surge of Georgia’s coronavirus outbreak will occur sometime around April 23rd. That gives Georgia less than three weeks to build out extra bed space, recruit healthcare staff, and purchase needed equipment and supplies.

Atlanta hospitals are very busy. Albany, GA is the #4 hotspot in the world, measured by infected per capita (behind Wuhan, Italy, NY)

Healthcare Worker Morale: Many businesses are helping healthcare workers, such as restaurants and dry-cleaners. Any support you can give is appreciated. Please help if you can. Be creative. Even just supportive social media posts help.

The Governor Sheds Some Light

Once a week, members of the legislature join a 30-minute conference call with the Governor.  Questions are submitted by the House & Senate caucuses. To a large extent, the quality of the information we receive depends on the quality of the questions. If you have a question, please let me know by responding to this email.

Is Georgia considering shutting down at the state borders?:
No. Not at this time. No state has shut down its borders. Florida is doing some screening at its borders.

Can we add data to Public Health daily reports? 1) hospital bed capacity 2) number of nursing home cases 3) number of recovered cases 4) number of cases in correctional facilities?
Tracking of hospital bed capacities is being developed. The number of cases along with locations in Long Term Care facilities has been released. There are not enough resources at this point to track recoveries. Number of cases in correctional facilities is available at:

Will there be change in election dates?
The Governor’s office says that election dates can only be changed by the General Assembly and the Secretary of State’s office. The Governor’s Emergency Order does not grant this authority to the Governor.

Is Public Health still using a contact tracing plan?
Yes, contact tracing has been in place since the beginning. Contact tracing will continue to be used in areas where the numbers are still small. Also, in areas where clear community transmission is happening, contact tracing will be used to notify potentially exposed people.

What is the rate of testing: What is our lag compared to other states?
The state didn’t get good test kits from the CDC until the last batch was sent to the states. Testing has really ramped up with the establishment of partnerships — universities and public/private. A new rapid test (results in 30 minutes) drive thru site has been set up at Georgia Tech for those who have been pre-screened, through a partnership with CVS.

Georgia Emergency Management (GEMA) Update:

Medical supplies are being routed through the Dept. of Public Health warehouse, utilizing the same team across various agencies who have managed distribution during hurricanes.

Getting supplies is still a struggle but less so now. The supplies are being pushed out to hospitals, Long Term Care facilities, and first responders.

Can we get protective supplies out to retail employees? PPE must be used for the highest need and right now that is for Long Term Care, hospital workers, and first responders.

GA National Guard Update

Newly formed Infection Control Teams are helping with Assisted Living, Nursing Homes and Long Term Care. Local Emergency Management agencies, legislators, and concerned citizens request help. Also, Public Health’s epidemiological team provides reports with numbers of cases so high need facilities can be targeted.

The Infection Control Teams are brand new. The GA National Guard has subject matter experts and has trained hundreds of soldiers within the last week. Adjutant General Tom Carden says, “We are learning as they go. We are adjusting protocols. We are building a plane while flying it.”

The GA National Guard has set up military triages in the state’s hotspots. They have 14 medical support teams that are new.  They recruited nurses, and other healthcare workers who weren’t already working and built teams. They trained, tailored and deployed. They have two teams in Albany. Carden says, “We will not tie ourselves to what we have on our books. We will build what is needed. We have hundreds of soldiers working.”

Between Stimulus and Response, There is a Space

Slowing the spread of the virus and “flattening the curve” is being implemented at a great cost to workers and businesses throughout the state. The Georgia Department of Labor has been hard at work rolling out the CARES (Coronavirus Aid, Relief, and Economic Security) ACT and responding to a record volume of Unemployment Insurance applications. The economic impact of the pandemic is devastating.

Too many people are having to live paycheck-to-paycheck, and stimulus efforts to put cash into these people’s hands have been slow to roll out. Community Food banks, short on volunteers and money, are responding to record numbers of people needing assistance. Their inventory is down by as much as a third because retail grocery store donations, which they typically depend on, are down. If you are able to donate cash to your local food bank, now is the time to do so. Many families are running out of food and cash.

Small Business Loans (SBA): Small businesses (under 500 employees including non-profits, sole proprietors, independent contractors, Tribal businesses and Veterans organizations) can obtain forgivable loans through the Paycheck Protection Program if they maintain payroll through the crisis. Low-interest loans can be obtained through Economic Injury Disaster Loans, including cash advance emergency grants of $10,000.

If you have applied for any of these SBA assistance options, please let me know how the process went. There have been reports of problems.

Unemployment Insurance: Chances are, someone you know has applied for Unemployment Insurance. Last week, the Georgia Department of Labor processed ten times the normal number of applications. As a result of Federal legislation, recipients will receive an additional 13 weeks of benefits, for a total of 39 weeks, and $600 extra per week. Recipients can earn up to $300 per week in wages without it impacting benefits. When laid off, the employer should apply for benefits through a “partial claim.” Applications can be submitted by individuals, but it will take much longer. Part-time workers qualify for Unemployment Insurance. Contractors, self-employed and gig workers also qualify, but this new part of Unemployment Insurance has not been rolled out yet.

The Light at the End of the Tunnel

This photo of a pink-sorrel, by photographer Marc Merlin of Atlanta, captures the play of light and shadow I am feeling in my own life right now. Marc is posting his wildflower photography on his Facebook page each day, so when I scroll through my feed, his artwork brightens my mood.
Between stimulus and response, there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.
–Viktor Frankl