Risky business in a post-pandemic world

In a post-pandemic world, who will shape the contours of decision-making and future economies?

By Richard Asinof, ConvergenceRI.com

Asking the right questions and including community voices as well as the elite will help Rhode Island shape a more inclusive vision of a future, post-pandemic world.

Gov. Gina Raimondo decided to move her daily news briefings to a live, in-person format beginning on Monday, May 11, to be held at the Veterans’ Memorial Auditorium, limiting them to five days a week, Monday through Friday.

The change is symbolic of the Governor’s move toward Phase 1, the gradual reopening of the economy in Rhode Island.

At her daily news briefing conducted on Saturday, May 9, the final one featuring reporters submitting questions in a virtual mode, the Governor said “We are not out of the woods yet,” warning that there was “a risk of going too fast in the new few days” as Rhode Island began to slowly reopen for business. “Let’s go slow,” she suggested.

At the last virtual news briefing, ConvergenceRI did get to ask a question of the governor, focused on the future: “The RI Innovates 2.0 strategy released in January, a report on RI’s future innovation economy, did not include strategies for investment in public health infrastructure, such as Health Equity Zones. How has the pandemic changed your assumptions about such investments to spur the future RI economy?

Here was Gov. Raimondo’s response: “It’s a fantastic question, and it is exactly what I mean when I say that we are going to come out of it stronger than when we went into it.”

She continued: “The process of standing up our economy, again, we cannot just look to do it exactly the way it was, because obviously, we need to be more resilient.”

Further, she said: “We need to be more technology enabled, we need to be more digitally literate, we need to invest in public health, we need to make sure that everybody has access to public health, we need to reduce our dependency on communal living settings for those who are sick.”

The Governor then said: “We need to train people. The very saddest part about this is that the people who are hardest hit are those who are the lowest skilled and the lowest paid. And, very sadly, I worry some of those jobs might not come back, if you think about certain sectors.”

Finally, the Governor concluded: “We need to get serious about making investments in our health care, in our infrastructure, in job training, so that: a.) We can get everybody back to work; and b.) We have a strong system on the other side of it.”
Back to the futureSo much of the news media’s attention, and perhaps rightly so, has been wrapped up in covering the immediate, urgent, crisis-driven triaging of patients, testing, and emergency care. What has been mostly absent from the conversation has been a discussion of long-term solutions to address our disrupted world, where there will be no “return to normalcy,” [which was President Warren G. Harding’s winning 1920 campaign slogan].

What will the future, post-pandemic disrupted world look like? What will be the design of the future classroom? What will the future visit to see a doctor or a nurse involve? How will the concept of “work” and “office” be re-imagined? And, who will get to participate in the decision-making about shaping such future economic directions?
The experts talk, but will we listen?
Some of the initial conversations about the future economy appear to have been organized around “listening” to the experts and elites who currently reside at the top of the state’s economic and educational totem pole.

A moderated virtual panel discussion planned by Bryant University for Monday, May 11, entitled “Pandemic Economics: What does it mean for Rhode Island?” will talk about the shape of the future world to come and “how the state can move forward toward recovery and growth for all.”

The first panel discussion is called “A time for strategic leadership,” and it will feature Neil Steinberg, president and CEO of the Rhode Island Foundation, Stefan Pryor, the Secretary of CommerceRI, Ronald Machtley, the outgoing President of Bryant University and a member of the Rhode Island Public Expenditure Board of Directors, and Ross Gittell, the incoming President at Bryant. [The discussion will be moderated by Edward Fitzpatrick, a reporter with the Boston Globe.]

What is the takeaway that the panelists for the initial discussion are white males of relative wealth and privilege?

At a time when the coronavirus pandemic has revealed the deep racial inequities around health, economic and social disparities in the U.S. economy, what is the message being sent about future strategic leadership for the Rhode Island economy?

Given that women of color represent a predominant number of workers deemed “essential” in the current Rhode Island economy, how do their voices get heard – and listened to – as part of designing a post-pandemic world, where there is greater investment for early childhood education and childcare?

The right questions at the right time
In trying to wrestle with the best way to engage in inclusive conversations around what the future post-pandemic world might look like, ConvergenceRI reached out to a number of folks to ask questions and solicit feedback about their views. Their responses took different shapes and forms, without a natural congruency or cohesiveness. This story reflects that current lack of convergence; it is a start to a much longer conversation.

One of the first to be asked was Joanna Detz, the publisher of ecoRI News, in large part because thinking about the environment and the consequences of climate change threats always appears to be an afterthought, considered an “externality” the conversations around future economic strategies.

ConvergenceRI: What does the future electric grid need to look like in a disrupted, post-pandemic world?
DETZ: Unlike natural disasters such as hurricanes and tornadoes, the pandemic has not resulted in direct damage on the electric grid, and so far, there have been no reports of widespread outages due to the coronavirus crisis.

However, in general, the grid is vulnerable to spikes in demand on peak-use days, and there is a need to update to smart-grid technology and bring battery storage online as we transition from fossil fuels to wind and solar.

ConvergenceRI: What are the investments that need to be made in public health infrastructure as a component of using the coronavirus pandemic as a road map to deal with the imminent threats to public health from climate change?
DETZ: The coronavirus has revealed many societal weaknesses. Reports show that COVID-19 is disproportionately affecting communities of color. Any plan must address racial inequities. Overall, we need to invest resources in planning and prevention so that we can quickly respond to any climate-change related public health threats.

ConvergenceRI: What is the need to re-envision and re-imagine corporate responsibility and “ownership” in a post-pandemic world?
DETZ: Corporations rely on a model of growth that is unsustainable and only serves to enrich shareholders. It is irresponsible to think that we can continue to sustain the expectations of exponential growth in our current consumerist economy. Whether it’s single-use plastics or the planned obsolescence of the newest technological gadget, companies must embrace a closed-loop system, reuse, and repair.

Editor’s Note: One story that I asked a writer to consider reporting on was on resilience in a waterfront community in Rhode Island, looking at how residents responded to the triple threat of a disrupted world because of the coronavirus pandemic, the ways in which it foreshadows the coming surge of climate change calamities, and the love/hate relationship with tourism and the flood of tourists that summers have always promised, but maybe not this year.

The assumptions about the way we have lived in the past, in an economy bolstered by consumerism and convenience, may have to adapt to radical changes in the future. Just as communities in the Middle Ages had to figure out how to survive in a brutal world where the church and the aristocracy had foundered on the rocks, so to speak, so, too, will Rhode Island’s shore communities need to adapt. The changing economies of fisheries might be a good starting point.

Wealth and philanthropy
The Rhode Island Foundation and United Way of Rhode Island have played a critical role, stepping up to the plate and raising millions in much needed emergency funding for social and human service agencies, stitching together the safety net that has been torn apart by the coronavirus pandemic.

As responsive as those two pillars of the community have been to the urgent needs of Rhode Islanders, the current economic crisis also raises important questions about whether the future wealth and philanthropy institutions can supplant the dramatic decrease in operating revenues from the state – and with unclear support from the federal government to replenish the state’s lost revenues.

ConvergenceRI reached out to Cortney Nicolato, the president and CEO of United Way of Rhode Island. Nicolato had helped to bring together two important virtual conferences last week, one on housing and another on racial inequities.

ConvergenceRI: Looking at the future pandemic world, how will the world of philanthropy and the world of corporate responsibility need to be re-imagined?
NICOLATO: With the health and socioeconomic toll that COVID-19 has presented, I think that a future pandemic world is quite a ways off. Funders and corporate supporters will pivot their attention from response support to recovery support. I do hope that this brings a new approach to supporting nonprofits, one that includes more support for operations, more innovation-based funding, and expanded technical assistance.

Women and children first
Working under severe deadlines, not everyone was able to respond in a timely fashion to ConvergenceRI’s request for their ideas about a post-pandemic future, which included questions about the future of childcare in Rhode Island, now under review by the R.I. Department of Human Services.

One potential contributor said she did not feel comfortable talking about her experiences setting up a new business in Rhode Island. Yet another potential contributor, a teacher, expressed caution about talking about what was happening in the classroom around virtual learning.

What will the future health system look like?
The coronavirus pandemic has demonstrated the current weaknesses within the health care delivery system in Rhode Island and the nation.

Previously, ConvergenceRI had interviewed Stephen Zubiago, Health Care Partner at the law firm Nixon Peabody, about what to expect in an unexpected world when it came to health care delivery. [See link below to story, “How has the COVID-19 pandemic altered the health care landscape.”]

ConvergenceRI had also detailed the work of the Providence Community Health Centers in helping to prevent the spread of the virus in vulnerable neighborhoods and communities. [See link below to story, “Connecting primary care to emergency care in a pandemic.”]

ConvergenceRI went back to Zubiago and asked him to elaborate on his views of what the post-pandemic world might look like for health care. Here is his response:

In the recent HBO show “The Last Dance,” Chicago Bulls coach Phil Jackson said: “The only thing that is constant is change.”

While Coach Jackson is a wise and winning basketball coach, I doubted that he was the first to utter that phrase. Google confirmed my suspicion and reports that such phrase should be credited to the Greek philosopher, Heraclitus, who more succinctly said “Change is the only constant in life.”

While we can’t credit Heraclitus with inventing the triangle offense or coaching one of the greatest NBA players, we can credit him with describing the present state of the health care system.

Set forth below my team has offered some thoughts on the changes that will occur in the global, national, and local health care systems in the post COVID-19 pandemic world.

Globally, the COVID-19 pandemic is impacting everyone everywhere, with The New York Times reporting that as of this weekend there are 3.8 million people have been confirmed to have the infection and more than 272,000 people are known to have died from the coronavirus.

This unprecedented impact will cause the following changes in the global health care system.

•  First, it will become indisputable that the world is interlinked on health care. No one can argue that what happens in Wuhan, China, relating to health care can not impact the entire world because it just did.

•  Second, there will be more of an impetus for spending on health care, specifically public health and preventative care. One lesson of the COVID-19 pandemic is that a health care pandemic can destroy the world economy and can cost trillions. Accordingly, health care spending must increase.

•  Third, this will be a chance for scientists and physicians, rather than politicians and financiers, to lead on a global issue. There is ample evidence that scientists and physicians are more effective at viewing issues globally and collaborating across national boundaries to solve problems and make an impact.

Nationally, as the COVID-19 pandemic rages across the country, it has brought unprecedented strain on health care systems, hospitals and clinics, nursing homes, and medical practices, from a shortage of testing materials, medical supplies, and staff to issues in access among underserved and rural populations.

The pandemic has highlighted some of these inequities, while also revealing gaps in the health care delivery system that can have lasting side effects on patients, providers, and the communities that they serve. These strains and equities will likely lead to the following:

• Further pressure to move away from fee-for-service reimbursement for health care services. Such a reimbursement system has not led to a health care system that can be responsive to public health needs, and the COVID-19 pandemic is the most recent demonstration of that.

• The use of telemedicine will become more prevalent. Medicare’s recent announcement that it will expand telehealth reimbursement coverage nationwide, enabling more senior citizens to receive care from their homes, virtually, is a strong step in this direction. Telemedicine can help make high quality, cost effective care available universally.

• Increased emphasis and spending on public health infrastructure. COVID-19 has highlighted the need to better care for those experiencing homelessness by providing adequate shelter and food. Other public health experts, meanwhile, have urged a renewed focus on conditions in nursing homes.

Locally, any discussion of Rhode Island health care system change in the post COVID-19 world must review those changes over a time continuum.

In the short term, Rhode Island health care providers will continue to respond to the immediate and gut-wrenching challenges posed on an everyday basis.

Hospitals ramped up for surge that has yet to occur, nursing homes are challenged by the realities of caring for an aged and medically challenged population, and medical practices are dormant due to stay at home orders and fears of interacting with the health care system.

Once these providers can stabilize, the next step will be preparing for a fall “second wave” of COVID-19. While doing that, a segment of those providers will have to make up on the backlog of primary care and other services, especially mental health services, which have gone largely unattended to since mid-March. Once those are accomplished, the providers will then be tasked with understanding the global and national impacts discussed above, defining how those impacts play out in Rhode Island and then making changes that will lead to better outcomes.

The COVID-19 pandemic has demonstrated that the executive branch, the R.I. Department of Health, and the hospital systems can, in the short term, be responsive to our state’s health care needs. Perhaps that can be a building block for future changes that will surely be required to confront future health care crises.

Let the conversations begin.

Here is the link to the story, in its entirety: http://newsletter.convergenceri.com/stories/risky-business,5750

Richard Asinof is the founder and editor of ConvergenceRI, an online subscription newsletter offering news and analysis at the convergence of health, science, technology and innovation in Rhode Island.