Is the U.S. Ready to Reopen? 2020-05-04
The when the worst of this is all over will begin to reopen but that process will not be cut and dried snobby versus album. Hell's it's that economics health lead to be working together. I'm Shumita Basu. In for tenzing Vega and for today on the takeaway may fourth. We're breaking down. How or if we'll be able to go back to normal after the pandemic then how leading Democrats have dismissed Tara Reid's sexual assault accusations against Joe Biden and what it means for the metoo movement. Do they actually believe any of the things they wrote? During the cabinet hearing also a look at the high cove nineteen death rate in nursing homes and long term care facilities and then how the Navajo nation is grappling with the virus with limited resources on the Navajo nation. We are looking now at a pandemic on top of epidemics that we currently have. Let's get to it across. The country states are starting to relax. Restrictions put in place due to cove nineteen even as the number of confirmed cases continues to climb and the death toll surpasses sixty seven. Thousand People. Experts say the pandemic could go on for another two years with subsequent waves of infection in the fall and winter. Still that hasn't stopped places like Georgia and Texas from allowing businesses to reopen on Friday governor. Brian Camp lifted the stay at home order. For most of Georgia's residents with an exception for people who are elderly or quote medically fragile who are required to shelter in place through June twelfth. We'll talk more about Georgia's reopening on this show in the coming days and elsewhere in the country stay at home. Orders are still going strong but in states like California and Michigan government officials are facing increasing backlash from protesters who want things to return to normal so far. The protests have been limited in size and people participating range from anti vaccination activists too far right extremists using the pandemic to push forward white supremacy still these protests and the reopening process in general raise serious questions about when and how states should resume business as usual. And what happens if we reopened too soon for more on this? We're joined by. Caitlyn rivers an epidemiologist at the Johns Hopkins Center for Health Security and Jeremy. You'd global health politics expert and dean of the College of Liberal Arts at the University of Minnesota Duluth. Thank you both for coming on the program. Caitlyn I think a lot of people here reopen and think that means go completely back to normal. So what does reopening state-by-state mean to you? That's right reopening is not going to be a light switch where one day we wake up and are able to do all of our normal activities. It's going to be a slow reincorporation of community activities back into our lives and so we might start with things that are low risk like more outdoor activities maybe some essential shopping locations the businesses that are asked to reopen. I will vary state by state but it certainly will not be all at once and then as we take that first step and start to reincorporate those activities. If things go well we can start to do more and we will proceed like that slowly. Jeremy a lot of the governors who are talking about reopening their states as quickly as possible. Keep saying that. It's an economic necessity. How fair is it to be thinking of this? As a sort of zero sum game economic health versus public health. I think if we frame it in that perspective we actually lose out on the bigger picture here. That's not about economics versus public hells. It's that economics in public. Health need to be working together and so if we think about this in terms of we have to do this for the economy. Were losing sight of the fact that if we reopen too quickly. What we're likely to do is to see another way to come slater on in the year and that wave could be as bad if not worse than what we're currently experiencing so even though there are the pains right now to go along with Having these restrictions in place it's actually better for us in the long run as opposed to opening up too quickly caitlyn. The federal government has released some guidelines on the reopening process including the criteria to consider. I've heard a lot of elected officials site new cases per day as a meaningful metric. When thinking about when to reopen is that the right way to think about it yes we do. WanNa see the start to slow before we consider reopening and keeping an eye on the number of new cases. Each day is one way to do that. Other metrics that are important. Are the number of people hospitalized both currently and new hospitalizations each day and the number of deaths and again those all us to understand whether we are in the acceleration face or whether are staying home to slow the spread has begun to break chains of transmission and slow the epidemic Caitlyn what are some of the approaches to reopening that we're seeing here in the US? And as I mentioned earlier Georgia was the first state to start doing this. So there are discussions about what industries are what segments of the economy can reopen and that does vary state by state. We've seen in Georgia that they are leisure activities. Personal services other states have chosen to focus more on businesses and so there are decisions that will vary about what will be allowed to reopen. But there's another side which is what's what is the public health approach to keep the community safe during not reopening and that site focus is really a lot on diagnostic testing and contact tracing. Those are the tools that will allow us to control transmission during that reopening process and that second public health part is pretty widely understood pretty Widely shared amongst states and again. That's diagnostic testing contact tracing. Yes so tell me where we stand on those two things right now. I know that Georgia has been saying the past. Few Days that they've pretty significantly ramped up testing But that's also from a very low number of tests earlier hauer states doing on on testing and contact tracing we have seen a pretty substantial expansion in our testing capacity last week the United States ran one point six million tests which is a great improvement over what we saw even earlier in April. But it's still not the level that many experts recommend recommendations range from about three point five million tests a week and go up from there and so there is still more room to grow and I think that's important to make sure that we're not just finding people with severe illness but really everybody with covert like symptoms and again that's to enable the second piece which is contact tracing. We have estimated along with the Association of State and territorial health officials that the US will need about one hundred thousand additional contact tracers and states have begun to make moves towards hiring those contact. Tracers again this is happening at the state level. So the the movement to hire those varies from place to place but there are efforts underway to expand our capacity to do that. What kind of skill set do you need to be a contact tracer? We recommend that contact. Tracers be familiar with the local community and they need to be comfortable with conducting interviews and collecting data. It is a skill position. But it's the kind of skill you can teach through maybe a decor or a couple day course in so. It's quite approachable. This is also a good opportunity to hire people who have not been able to work. Perhaps because they've lost their job because of the pandemic Now when we think about Vaccines and Therapeutics. And the timelines for those. How does that factor into how states can think about their plans to reopen? It's unlikely that will. We will have an effective therapeutic or vaccine in time to affect reopening plans. You probably heard in the news. Recently that any product by Gilliat is becoming an option for treatment which is exciting but that product is used late in the course of illness so when people are already quite sick in order for therapeutic to be useful to break transmission and to influence the epidemiology. We need something earlier in the course of illness. And unfortunately that's not available yet. Jeremy how much of a role is public pressure? Playing in reopening states. Like what we're seeing with some of these protests even though they're fairly small in scope. Yeah I think we can't underestimate the role that public pressure is played. And I think you hit it on the hit the nail on the head when you said that a lot of these protests that we have seen are actually other political movements that are glomming onto this but in a lot of places you are starting to see more of this public demonstration. That's taking place and governors are starting to feel pressure and I think what's actually going to be really complicated about this or puzzle of problems. Is that if we're going to do this? Sort of reopening governors have to be willing to step that back if the testing is showing that we are seeing an increase in the number of cases of the number of of hospitalizations is going up. Governors are going to have to be able to make that essentially difficult political choices. Say Okay I know. We opened up businesses. But we need to close some of those back down because we're seeing too much community spread and that's going to take a whole whole huge amount of political skill in order to be able to walk that back in the face of that potential political and public pressure Caitlyn. What do we know about the best practices around easing out of a lockdown in terms of walking back restrictions? We don't have a template because we are in a place we have never been before we have never asked everyone to stay home before. And so the exact right moves. I think are still a little bit uncertain. But we recommend that states start with low risk activities again. Those might be things that are outdoors. Things were social. Distancing is very possible. Make those first few moves and see how things go because it's much easier to pull back from low risk activities. That are unlikely to cause a great deal of transmission then to dive in with a mass gathering for example that might result in a lot of secondary cases. And then again you are in a place where you have a lot of community transmission and you have created the conditions that led us all having to stay home in the first place and so it's really about starting with low risk activties and proceeding slowly. Jeremy What lessons can we learn? From other countries that have already started the reopening process for example. I'm thinking about Singapore. And maybe you want to bring up other examples but Singapore was praised as having handled things really well from the start. They were testing extensively. There was contact tracing happening there but now the number of new cases per day is just shooting up. Their Singapore is a great example. I think of of the potential issues that can come up with this reopening because as you pointed out they received a lot of praise for their early and aggressive actions but we are seeing the second wave of cases and one of the things. I think is really interesting about the Singapore. Case is that it is is highlighting some of the existing social Cleavages that exist within Singapore so a lot of the new cases that are popping up in Singapore are happening among my workers who are oftentimes living in less than ideal conditions and so it it's reflecting some of these other sorts of social political and economic divisions that exist within society. So there are some issues there but we can look to to countries like South Korea. Which again lots of testing lots of contact tracing that has enabled these sorts of of moves to be able to to move forward and we're seeing some real potentially positive signs coming Austrailia New Zealand even the earlier today. They were talking about how they're thinking about creating a travel bubble where people who were in Australia. New Zealand would be able to travel between the two countries but they're still might be restrictions for people coming from other places but again it's that ability to do the testing to the ability to do that contact tracing and then the ability to use those data that are collected in order to inform the policy making process going to be so incredibly vital for making this Something that works. Caitlyn here on the takeaway we've been talking about the disproportionate impact of the pandemic on low income communities on people of color especially black Americans. Should we assume that reopening too soon would only further impact these populations the most? It's true that health disparities play out in so many different ways so I think one of the key pieces of missing data right now is understanding where people are getting infected even during being asked to stay home and I suspect that people who are still considered essential workers and participating in community activities are at higher risk in those will largely be under resourced communities communities of color low wage workers and so when we do reintroduce more community activities it will be still those people at risk and so. I think it's really important that we understand. How and why? New cases are arising so that we can take additional steps to protect people in those settings underlying health conditions and other factors that put people at risk for infection and for severe illness again. Disproportionately affect under resourced communities. And so I do think we will continue to see that. Show up in the epitome allergy doctor. Caitlyn rivers is an epidemiologist at the Johns Hopkins Center for Health Security and Jeremy. You'd is a global health politics expert and dean of the College of Liberal Arts at the University of Minnesota Duluth. Thank you both for joining us. Good to be with you thank you. It's been one month since tower. Read a former Senate staffer publicly accused former vice president. Joe Biden of sexually assaulting her in Nineteen ninety-three in early April. Two sources corroborated the details in her claims and last week two more sources came forward last Friday on MSNBC. Mika Brzezinski asked Joe Biden about the accusation. Would you please go on the record with the American people? Did you sexually assault Tara Reid? No it is not true. I'm saying unequivocally it never never happened. Joining us. Now is rich mccue. An investigative reporter and producer who has reported on Tara Reid's allegations for business insider rich. Thank you for being here. Thank you for having me and also with us. Is Sarah Jones Staff Writer? For New York magazine. She's written about what this case means for the feminist movement and twenty twenty. Thank you for coming on the show. Sarah thank you so much for having me rich. Walk US through. What Tower read has said publicly? And what you've learned through your reporting so far so Atari came out with an allegation Lulu every year ago. Actually her first allegation was that there was sexual harassment. That was in a small paper called the the Union in in northern California. A month ago. As YOU'VE SET UP. Tara came out on a podcast. Katie Helpers radio show and accused Joe Biden of sexual assault so now all these years later. She's come forward and basically has this is what happened. But the number of voices have come forward in in corroborating parts of her story or them as a neighbor who. I spoke with Last week who live next to Tara in nineteen ninety five and ninety six and said look. She told me of this event in one thousand nine hundred eighty five. We're right next to each. We live right next to each other and You Know I. I've found her. Her voice compelling believable because she says look I am. I'm a lifelong Democrat. I will be voting for Biden but I know Tara. She's she's a good person. You need to understand this happened. And that's the reason I'm coming forward. I WANNA come back to what that neighbor had to say to you in in a few minutes but Sarah. It's no secret that many people have seen Joe Biden as a complicated figure to say the least way long before read came forward about her alleged assault and now that he's cleared the path to the nomination. He has promised that his running mate will be a woman. Can you sort of characterizes track record on women's issues you know Biden had built up a lot of a lot of goodwill over the years Thanks to the Violence Against Women. Act which he helped right He was a notable voice addressing the subject of campus sexual assault. But he was still complicated. Figure as you know Due primarily to handling of Anita Hill testimony during Clarence Thomas. Confirmation hearings and also on abortion rates Biden supported the Hyde Amendment which bans the use of public funds for abortion Until he his most recent Campaign for president so a bit of a mixed bag there at least from a feminist perspective. Rich one question that came up during Biden's MSNBC interview on. Friday was about the complaint. That Tara Reid says she filed at the time and Biden says at this document would be in the National Archives if it exists but you actually reached out to the National Archives. What did you learn from them? So I reached out to the National Archives and they said no that that document would not exist there they have no such document. I mean according to her if she filed it was with an office called the Fair Employment Practices Office and so that was the question. We'd ask said you know if there were a complaint file that office would be in the National Archives and they said No. So that's why there's this renewed focus on the University of Delaware and senatorial papers and it is there any way to unseal those documents. They're at the University of Delaware. Or is that something that Joe Biden would have to okay himself? I believe it's the latter we've tried. We've you know I I follow the foia request and a apparently senatorial papers and congressional stuff like that is immune to request and if you were able to foil for that kind of stuff I mean what would you. What are you hoping to find their? What else are you hoping to find their well? Away to prove or disprove this happened. You know if if there was a document that she filed a complaint. What does it say does she? Does she say what she's saying happened in? If at document exists still It would answer. A lot of questions are also said. She went through the proper protocols in up to check command telling people her supervisor's she felt uncomfortable. She felt Harassment over to the certain issue Before the assault and so she said those people were taking notes So where those notes if if you know if they still exist that that would shed a light on on this whole conversation. Do you have an understanding of weather? Tar read filed a complaint about the details about this alleged sexual assault or was it about this. That's number of complaints leading up to it from my understanding. It's not about the assault from everything she said to me. It's about the the events leading up to it in her. What she was feeling at the time right. So in terms of corroborating the actual events of that day What is Tara hoping we'll be out there to to support her claims well A good question. I I don't really know the answer to it. I I only know that we're tresor reporter. I'm trying to find other people who can say you know. Yes I remember you know I. I worked in an office in. This happened or you know I work in this office in. She told just the opposite. You know or whatever But you know we're just trying to do our job in and find more people who can shed light one way or another. Which in your reporting you spoke to an old neighbor of Taras who says that she remembers hearing about this alleged incident in the mid one thousand nine hundred and she believes in telling the truth she also said that she is a Democrat. Who plans to vote for Biden Sorry Jones from New York magazine. What do you make of that? It's interesting it doesn't me all that much. I think it makes a great deal of sense to believe that Joe Biden did do this but also consider him against the person of Donald Trump. Who's been accused of sexual assault and harassment by so many women and despite everything that Biden might be the lesser of two evils rich in claimed in his interview with MSNBC last week that two major papers show that reads allegations are not credible and Stacey Abrams who is a potential vice presidential pick for Biden was asked about this on. Cnn last Thursday. Let's listen to her. I believe that women deserve to be heard and I believe that they need to be listened to but I also believe that those allegations have to be investigated by credible sources. The New York Times did a deep investigation and they found that the accusation was not credible. I believe Joe Biden that Stacey Abrams speaking there rich McHugh. What do you make of what? She's saying there about the New York Times investigation. Well I think it's it's slightly disingenuous to two point to that and say they concluded their investigation because after I came forward with my piece with two more on the record sources both the times and the Washington Post put out new stories and added their voices to the reporting. And so I you know I have to imagine that the reporters at the times and the Washington Post would would never say. They concluded their investigation. And I certainly have not Sarah. You wrote in a recent piece that Tara Reid has given public feminists and ideological test and many are failing. What do you mean by that? Do they actually believe any of the things they wrote during the Cavanaugh hearings or or before that as me to I gained public momentum and you took down figures like Harvey Weinstein Matt Lauer. Charley Rosen and liberal figures like Al Franken. It seems to me that you know some people. Viewed story of of Brad Kavanagh in particular and saw Christine Blazey for its allegations about him as though that they were principally story about the hypocrisy of Republican men or of conservative Christian men and viewed it through an Electoral Lens. When in fact what people had been saying about me too is that you know this is a story about power and how it gets abused by people who wield it and that seems to me. Something that Some public feminists are forgetting in the wake of Tara Reid's allegations about Joe Biden and Sarah. Looking forward to the presidential election later this year at risk of simplifying it. I mean. What's a feminist to do. It's a it's a terrible position. It is absolutely the purse position for feminist to be in And I don't think that there's a simple resolution to it at all. You know what I was really trying to get at at my in my piece. Is that sense of exhaustion of frustration. The idea that you are continually cleaning up after men like Joe Biden who have such complicated legacies and by the time Tara Reid came forward. She had already accused Biden of sexual harassment and she was by no means the only one who accused him of some some version of boundary. Violating Behavior This is not an ideal situation you know. I think there's some credibility to the argument that given what the alternative is Women have to vote for him anyway but I do think that there should be. You know really. A cost were reckoning with the Movement. About what we're willing to settle for from the Democrat Party. Sarah Jones is a staff writer for New York magazine and Rich macos investigative reporter and producer at business insider. Thank you both so much for joining us. Thank you you saw. This is the takeaway. I'm Shumita Basu a disproportionately high number of covert nineteen deaths in the US have been linked to long term care facilities like nursing homes and assisted living communities now a new estimate from USA. Today shows more than sixteen thousand deaths have been linked to nursing homes and long term care facilities Elaine Godfrey reporter for the Atlantic was reporting on why the death toll has been so high at long term care centers when her own grandmother died at a facility in Minnesota. Elaine thank you for being here. Thanks so much for having me and let me just say I. I'm I'm really very sorry for your loss. Can you tell us about what happened to your grandmother? Yeah Thank you for saying that. So my grandmother was ninety four years old. She lived in Minnesota at an assisted living facility and she had for several years. We didn't know that she was sick. She was dizzy and fell down one night and went to the hospital and at the hospital. They tested her for Corona virus. A few days later it turned out that she had it but otherwise she had no fever at first anyway she didn't have other respiratory symptoms really. It was really surprising to us. You know it was really fast. She died within just a few days of of her fall. Oh I'm so very sorry now. I I know that this is very personal for you but you also have done some reporting on this now and you've been talking to experts and other families is typical experience. I think it's a typical experience in the speed of it. Elderly people show different symptoms. There have been some studies that have shown that that elderly people show atypical symptom. So they don't necessarily have a fever they don't necessarily Had these respiratory symptoms that. We're seeing their symptoms. Sort of run the gamut and. I think it's important for people to know that the thing that is in common across the board is just the speed with which people become sick. Someone that I talked with in Virginia at a nursing home in Richmond Virginia told me as she was sort of working. The floors people would show signs of general illness or fatigue and then very very quickly become bedridden immediately. Lose their to move around by themselves and they'd have to be sent to the hospital So it was. It was very very common that within just a few days This this disease cold. Can you give us a sense of the real scope of this like we said at the top that at least sixteen thousand corona virus deaths have been linked to long term? Care facilities. Is that accurate? It's almost certainly an undercount Because we just. We don't have the numbers. We haven't tested everyone. We we are not sure at this point. Who's actually died of the virus that complications related to the virus In Minnesota where my grandmother lived some seventy percent of all corona virus deaths in the state have been linked to nursing homes and assisted living in six other states. Which which again. It could be more because not all states have reported their total numbers but in six other states at least half of their current virus deaths are residents and workers at these places that the scope of this is just enormous. You say it's not just about the health of that population. It also has to do with under investment in these types of facilities. Can you talk about that? And what? You've reported on a lot of the nursing homes. That are really struggling right now. They have a lot of patients. Paying through Medicaid Medicaid Reimburses these facilities at a pretty low rate compared to insurance most of the time or or private pay so these facilities aren't necessarily breaking even on the care that they're providing for people. Another part of this underinvestment. Is that many of these facilities are privately owned and sometimes the owners? You know any any money that the facility is able to make that money is used to pay shareholders. Basically this underfunding means often. These facilities are short on staff often residents have to share rooms and bathrooms which is not a great way to prevent infection spread. A lot of these facilities are struggling with a lack of P p. e. personal protective equipment. The kind of thing you have to wear when you're going room to room to room every day With these very very vulnerable people elaine. I want to turn to the question of people working in these facilities. Who are they and what are they facing? The majority of workers who make up staff at these nursing homes and assisted living facilities are certified nursing assistants. These are people who bathe patients feed them. Take care of their daily needs. There are some of the lowest paid healthcare workers in America. Most make less than fifteen dollars an hour. They're mostly women often. They're immigrants and many live in multi generational homes. They are taking care of older parents who are similarly vulnerable or young children. They are working multiple jobs. They might work at multiple nursing homes. They might have totally different jobs. But it means either way that they're being exposed to this virus at other places and potentially bringing it into the building so all of these factors sort of combined to make a really really deadly scenario for these these residents and end for staff In your piece you also raised the issue of testing and how proper testing could have dramatically reduced the spread of the virus especially in these types of facilities. And this is something that we've talked about in general a lot on this show but can you explain what you mean specifically in the context of nursing homes and long term care so we knew before this virus hit the US that the elderly were most vulnerable and that a symptomatic people could likely spread the virus so we knew those two things yet the CDC here in the US prioritized hospital patients and healthcare workers who showed symptoms to get tests over Nursing Home Residents. Who ARE SYMPTOMATIC? And over people who didn't show symptoms but might work or live in these high risk places the CDC announced that they're sort of switching up their priorities so now they include nursing home residents and workers with symptoms as high priority but either way healthcare policy experts that I spoke with said this is all wrong. It doesn't really help. They want there to be universal testing. So they're saying test. Everyone facilities. Why from the beginning did we not send tests to these facilities and require that all workers and all residents take them regardless of symptoms since they're such hotspots and since there have been so many fatalities in these places was an issue of bad prioritization from the beginning or were there not enough tests? Definitely both are big issue in this country with the response to this virus has been. We don't have enough tests. We did not ramp up testing quickly quickly enough so the CDC definitely had to make a hard choice there right. How do we prioritize what limited supply we have but experts say we knew that the quote unquote death traps would be nursing homes and assisted living facilities where people can't leave where they live in close proximity where they're already immuno-compromised or frail? So they're saying it was just a big mistake to begin with and they're saying that it emphasizes or reveals our pre existing disregard for older people in this country. That was a big point. That all of these experts Continued to me. You mentioned the recent change in prioritization for testing. Have we seen any other changes or are there any on the horizon at the state or federal level? The trump administration is doing their best to invest more money in rapid tests for residents and workers of nursing home. So we know that the governor of Maryland issued an executive order Telling all nursing homes to test everyone So so advocates are really happy about that. They say it could be too little too late. But you know if every governor said that. Let's prioritize these nursing homes. We could really stop a lot of these deaths. Elaine what do you want people to take away from your reporting and from your very personal story that you've shared here about your grandmother. I guess I'd say that we are all worried about contracting this virus our loved ones contracting this virus. I would say that we should all spare a thought for the nursing. Home residents assisted living residents and workers. Who are quite literally. You know at the epicenter of this crisis. They are really in quite a a fragile state right now if we could spare a thought for them Send SOME MEALS. Some extra extra p. p. e. their way and going forward. I think we should think about how we prioritize these vulnerable people people who are our parents and our grandparents Elaine Godfrey a reporter at the Atlantic. Elaine thank you very much. Thanks so much for having me and we've been hearing from some of you who work in long term care facilities or who have family working in one. I'm calling from New York. My name is not just an works at a long term care facility level of disrespect that they've been seeing towards not only the workers but also the patients is just atrocious. They've had times where they have had multiple debts. Five six seven eight. That's within a twenty four hour period. People have been out sick with Kobe. Symptoms no one has said anything to them and allowed them to still get sick. Ppa has not been provided to them the administrative state. Nothing they still have yet to say. Thank you to the staff or show any kind of dedication that these people are doing and the harnessing themselves into it is beyond fully. Hi this is Linda calling from West Palm Beach. I have a sister in Atlanta Georgia who works as a physical therapist and senior living facility Her patient was diagnosed with Kovac nineteen. she was alerted and had to take a test. My sister's initial test came back positive. She had to pay hundred sixty five dollars or that. Test has filed a workman's comp claim to subsequent tests proved that she is negative so three tests total and she is no longer working. Thank you nurses that long term care facilities develop close relationships with their patients and their families this gut wrenching for them to lose their patients like this when my sister was six. You repeatedly blamed herself and thought that she was a failure so far from the failure just and fighting through possible odds help as many people as she can to be healthy and safe. Everyone needs to support her and her colleagues in arms by staying home and staying healthy this virus not a joke and it should not be taken lightly. My name is Becky and calling for Morris County New Jersey. Tell us your experience working in a nursing home or assisted living facility. You can call us at eight seven seven eight. My take while densely populated states like New York New Jersey have been hit hard by cove. Nineteen the area with the third highest infection rate in the country is the largely rural Navajo nation according to NPR to date the Navajo Department of Health has reported more than twenty three hundred confirmed cases of Corona virus and more than seventy deaths out of nearly twelve thousand tests in order to understand why the Navajo nation has been hit so disproportionately. It's important to look at the broader healthcare picture for the tribe decades of federal underfunding of the Indian Health Service have resulted in understaffed and under resourced medical providers and the US Department of Agriculture considers most of the Navajo nation. A food desert due to a limited number of grocery stores and access to fresh produce on the Navajo nation. We are looking now at a pandemic on top of epidemics that we currently have. We have the highest rates of diabetes and heart related food related diseases and this is something that has been an issue pre-coded that's Denisa Livingston a tribal DNA citizen denies the name that Navajo Nation members used for their tribe. Denisa is a community health advocate with the DNA community advocacy alliance as well as the slow food international indigenous counselor of the global north. I spoke with her to get a better sense of what grassroots efforts to combat covert nineteen look like on the Navajo nation and she began by telling me about the work being done to get food and water to tribal citizens currently in need. We see donations coming in including water supplies. Ppe's and and food And that has been a very challenging ordination of breaching all of our citizens across three states as we're looking at the size of places like West Virginia and trying to channel in and also help those that are greatest need in the remote areas of the denomination and Some projects that have also continued to operate. Is the water project. It's called dig deep and one. Third of our dinette. People do not have a sink or toilet and also one third do not have every day water access and so they're hauling water and even in this case they pay about sixty seven times more for water that they hall versus pipe water. And so when we're looking at the food access and the water access. It is a critical urgency and cry out to to be able to to try to meet the needs of our people Denisa. Are you seeing efforts to build trust between health officials and Navajo nation leaders and members during this pandemic? Of course I cannot speak on behalf of the tribal government and and also the healthcare facilities as a concern tribal member in also community health advocate. It is very concerning that the narratives that we see in the stories and what we're going through and families and what they're experiencing do not match the numbers that we see. We know that there is under testing. We know that there's a lack of transparency even when we're speaking about the eastern dramatic terms So of our folks have called and messaged emailed and see what does that mean. The terminology is also not out of the public health education. That should be of course. Our tribe in community members have been creating culturally sensitive. Psa's and announcements regarding this but really understanding the depth of covert nineteen and how the symptoms operate and also held the virus mutates. And I know that folks are doing what they can but we still need to be able to engage the community at large when it comes to Public Health Education. It tell me more about the Public Health. Messaging particularly in regards to being culturally sensitive. What does the messaging look like to connect to your community members right now so some of the messages are in our language and also? Some of the messages are more geared towards protecting our elders as we know they are very precious to us and as we know that the knowledge holders and wisdom barriers and so there is that question you know. How do we you know our tech them? In a way that the community members of family members know exactly you know how to navigate that process washing hands is also a concern when it comes to the situation because washing hands is also affecting the cultural practice that we have acknowledging each other by shaking hands and finding ways that we don't show disrespect and before we were fist bumping and also elbow bumping. But now you know just allow in our community members to know that it's not out of disrespect that we can't shake hands but let's be mindful and also honor one another's presence in a way that you know that were honoring one. Another without shaking. Hands has also been something that people have been talking about but also Some of the other terms to that we're trying to bring awareness at DCA are the terms of self isolation. They we have to be mindful of what we use these terms of what self isolation myself Corinthian quarantine in remote areas as we know these are just recommendations. And this also goes you know for my grandma. Grandma lives in remote area and I spoke with her the other day and she said you know we're told to stay inside her house and she said I've just been staying inside when my grandma's act if she's outside she's normally planting she's normally taking care of the seeds and at this time doing that effort the second time I called To check on her how you doing. She said we're still staying inside so the messaging. That's coming from the top down as well needs to be in a way where yes it applies in most situations but what about when my grandma or other community members have neighbors that are not you know a few feet away or down to hallway but are you know miles even space in in a way where you know. They don't have that contact with one another so I told her. Grandma is you know it's okay to plant your seeds. It's okay to get outside and so really looking at these terms as we're looking at different cultures and and of course you know here in the US you know. There are mini cultures and many practices as we are heating. You know to the CDC's recommendations or recommendations coming from the top down. But what are those? Messages? What are those things to improve our ways and practices to be proactive rather than being reactive at this time into skill impact from the community members perspective and also in solidarity in Collaboration Partnership With One. Another about overcoming. The place that we are at right now. Denisa Livingston is a tribal deny citizen and community health advocate with the DNA community advocacy alliance Denisa. Thanks very much for being here. Thank you very much. That's all for us today. Thank you so much for joining us. We want to let you know that we'll be staying on a few stories all week long following our conversation today about long term care facilities. We'll look at the effects of extended isolation on the elderly many of whom were battling the health effects of loneliness at this moment and will keep talking about what it means to quote re open the US by zooming in on Georgia's efforts and asking what we can learn from past pandemics to plus we'll hear from you about how you think daily life will have changed when the worst of all of this is behind us. I probably won't go to the grocery store every day. I think one thing will keep is have less structure for kids weekends especially saved a lot of money to share your take on this or anything else by leaving a message at eight seven seven eight might take or by sending us a tweet at the takeaway. Thank you so much for listening. I'm should meet the best sue in for Tanzania Vega and this is the takeaway.