Category: Analysis & Comment

Opinion | Andrew Cuomo, Stop a Coronavirus Disaster: Release People From Prison

This is a public health crisis that threatens to become a humanitarian disaster.

By Mary Bassett, Eric Gonzalez and Darren Walker

Dr. Bassett was the New York City health commissioner. Mr. Gonzalez is the district attorney of Brooklyn. Mr. Walker is the president of the Ford Foundation.

Gov. Andrew Cuomo has been an exemplar of leadership in this time of crisis, someone to whom other state and local officials are looking for guidance. On Friday, the governor took the crucial step of ordering the release of 1,100 people from New York’s jails and prisons. But he must do more. If we don’t act fast, we jeopardize the lives of many. Worse yet, we risk creating a uniquely deadly incubator for the virus.

America incarcerates more people than any other nation on earth — some 2.3 million people, nearly 80,000 of whom are locked up in various New York correctional facilities for young people and adults. No other country in the world faces the kind of threat gathering in our jails and prisons.

Given the conditions in which incarcerated people live — limited access to soap and water; shared bathrooms, mess halls and living quarters — this population is especially vulnerable to the virus, and largely unable to prevent its spread. In New York, we’ve already begun to see the effects. Dozens of residents and correctional staff members have tested positive. More will follow.

The consequences will be devastating, for people both inside and outside prison walls. When officers and staff members who work in prisons get infected, they will bring the virus home to their families. As happened in Italy, mounting tensions inside prisons, where anxious residents no longer have access to family visits or the proper supplies to protect themselves, create security risks that will be compounded by short staffing when correctional officers fall sick.

And because of inadequate medical care in most of these facilities, people in prison who become infected will die unnecessarily, while others will be transferred to local hospitals in rural communities upstate, where most of New York’s prisons are. These hospitals are woefully unprepared for the influx of patients, adding to growing strain on our state’s health care system. Dr. Ross MacDonald, the chief physician for the Rikers Island jail complex, was not being hyperbolic when he wrote on Twitter recently: “A storm is coming.”

We have little time to curb the spread of the virus within our state’s jails and prisons, and, by extension, across our state. This is not only an issue about the health of people in prisons, but also a public health crisis that threatens to become a humanitarian disaster.

For this reason, we and a number of public health experts call on Mr. Cuomo to release as many people as possible from New York’s correctional facilities, and to ensure they have the medical and re-entry help they need when they return home.

Here are several actions Mr. Cuomo must take, in addition to ending money bail for most people charged with crimes:

First, the governor should grant compassionate release to elderly inmates, as well as those with health conditions that put them at higher risk, including people with chronic and co-morbid conditions such as asthma and chronic obstructive pulmonary disease, and those who are pregnant or have with immune deficiencies. We know that older incarcerated people are both more vulnerable to the disease and present the lowest risk of reoffending.

Second, Mr. Cuomo should release the thousands of people currently incarcerated on noncriminal technical violations of their parole, like missing an appointment with a parole officer — except in the very few cases in which a technical violation involves a risk to public safety. There are some 4,000 people incarcerated in New York prisons for such non-crimes. Only the governor has the power to release these people — and 50 current and former parole commissioners around the country already have recommended he do so.

Third, he should grant early parole to people who are up to 180 days away from completing their sentences. After all, they’re coming home in weeks or months.

And, finally, the governor should direct prison and jail administrators to furlough low-risk inmates and use his own emergency powers to extend those furloughs through the end of the crisis.

Mr. Cuomo has often noted that our state does not need public policies that only “sound good,” but rather ones that are “good and sound.”

There is no good reason to keep putting residents, as well as police and correctional officers, at risk — or to turn a parole violation into a death sentence. Why needlessly strain our state’s systems or incubate the virus inside correctional facilities for future spread? There is no sound reason that elderly and vulnerable people, who pose no threat to the public, should be sentenced to die in prison.

We must protect public safety. But, today, there is no greater threat to public safety than the coronavirus. There are hundreds, if not thousands, of incarcerated people in New York who can safely be released to their families and communities.

Mr. Cuomo alone holds the power to save the lives of people trapped in New York’s prisons and jails. We call on him to build on the important step he has already taken and do the good and sound thing for human dignity, public health and a more humane justice system.

Mary Bassett (@DrMaryTBassett) is the director of the François-Xavier Bagnoud Center for Health and Human Rights at Harvard. Eric Gonzalez (@BrooklynDA) is the district attorney of Brooklyn. Darren Walker (@DarrenWalker) is the president of the Ford Foundation.

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Opinion | The Psychological Trauma That Awaits Our Doctors and Nurses

Don’t underestimate the moral anguish of deciding who gets a ventilator.

By Jennifer Senior

Opinion columnist

This is the moment to pray for the psychological welfare of our health care professionals. In the months ahead, many will witness unimaginable scenes of suffering and death, modern Pietàs without Marys, in which victims are escorted into hospitals by their loved ones and left to die alone.

I fear these doctors and nurses and other first responders will burn out. I fear they will suffer from post-traumatic stress. And with the prospect of triage on the horizon, I fear they will soon be handed a devil’s kit of choices no healer should ever have to make. It’s a recipe for moral injury.

Succinctly put, moral injury is the trauma of violating your own conscience. It is an experience known to many combat veterans — the term was in fact popularized by Jonathan Shay, a longtime psychiatrist at a Department of Veterans Affairs outpatient clinic in Boston, in his book “Achilles in Vietnam.”

That this violation may be in the service of a larger, more defensible objective doesn’t matter — or rather, it does little to mitigate the guilt, self-reproach or spiritual crisis activated by making choices that feel so very wrong.

Moral injury is now a looming reality for our front-line medical professionals, should they be forced to ration ventilators or other lifesaving resources. This is not why most of them went to medical and nursing school. “It’s something none of us have been trained for, except perhaps military physicians,” Dr. R. Sean Morrison, chair of geriatrics and palliative medicine at the Icahn School of Medicine at Mount Sinai in New York, told me. “There’s a tremendous amount of worry about what it’ll feel like in the moment.”

An article published on March 23 in The New England Journal of Medicine estimates that the number of American patients who will require ventilation for the coronavirus could be as high as 31 per machine. A New York hospital, according to The Washington Post, is already putting two patients at a time on ventilators designed for one.

Triage, in other words, is probably inevitable.

Twenty-first century doctors in wealthy countries have no scripts for this. But there are resources emerging. Morrison pointed me to an astonishing website run by VitalTalk, an organization that under ordinary circumstances specializes in helping doctors communicate clearly and compassionately about serious illness.

It has a brand-new set of talking points for the coronavirus, including rationing. Morrison said it’s what the health care professionals at Mount Sinai will be referring to, should things get dire. And they’re utterly surreal.

Patient family: You’re playing God. You can’t do that.

Clinician response: I am sorry. I did not mean to give you that feeling. Across the city, every hospital is working together to try to use resources in a way that is fair for everyone. I realize that we don’t have enough. I wish we had more. Please understand that we are all working as hard as possible.

Patient family: Can’t you get 15 more ventilators from somewhere else?

Clinician response: Right now the hospital is operating over capacity. It is not possible for us to increase our capacity like that overnight. And I realize that must be disappointing to hear.

Patient family: How can you just take them off a ventilator when their life depends on it?

Clinician response: I’m so sorry that her condition has gotten worse, even though we are doing everything. Because we are in an extraordinary time, we are following special guidelines that apply to everyone here. We cannot continue to provide critical care to patients who are not getting better. This means that we need to accept that she will die, and that we need to take her off the ventilator. I wish things were different.

New York State does, in fact, have guidelines for ventilator allocation, written in 2015. They recommend that hospitals appoint triage officers or committees — made up of experts who do not have clinical responsibilities for the patients at issue — to make the difficult calls, thus easing the moral burden on the men and women on the ground. Who does and doesn’t get a ventilator, and for how long, will depend on a range of criteria, from the overall health of the patient to how well the patient is doing at that particular moment.

I’ve spoken to a number of doctors who said they’re comforted by these guidelines. There are clear rules to follow.

But Stephen Xenakis, a psychiatrist and retired brigadier general who has spent decades treating veterans, says that rules aren’t sufficient to inoculate first responders from psychological suffering.

“We have rules too, in the military,” he told me. “Rules of engagement. And you may follow the rules of engagement, and everyone around you may say that you followed the rules of engagement. But after the incident occurs, you ask yourself, ‘Did I make the right decision?’ Because the outcome was not acceptable, was not digestible.”

Or it’ll be something even more nuanced than that. The outcome may be acceptable — that is, reconcilable — in the moment. But not later on.

Xenakis gave an example of a doctor who removes a 70-year-old patient from a ventilator. The man’s children are pleading. But the if-then of the algorithm requires it. A decade later, that doctor’s own father is 70. And it hits her, hard: Did she really make that decision?

“The angst that clinicians may experience when asked to withdraw ventilators for reasons not related to the welfare of their patients should not be underestimated,” warns the authors of the article in The New England Journal of Medicine. “It may lead to debilitating and disabling distress.”

We look at veterans and thank them for their service, never being able to fully comprehend what they’ve been through. The same may soon be true of some of our health care professionals. We may think we know. But we don’t.

The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips. And here’s our email: [email protected].

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Alan Cross: A look at art and music created in times of pandemic

The spectre of disease, pandemic, and death have been with us since life emerged on this rock. And once we got around to discovering music, homo sapiens (and perhaps Neanderthals, whose numbers were probably drastically culled by disease), began reacting to these periods of widespread sickness with stories, art, and song.

The first recorded pandemic hit the people of Athens between 429 and 426 BC. No one knew why, other than the gods must have been displeased with mankind.

We still don’t know what caused the death of up to 100,000 — Typhus? Typhoid Fever? Some sort of viral hemorrhagic disease? — but it left an unusual mark on the city. Those were the peak years of Greek tragedy, a form of theatre that had tremendous influence on both ancient Rome in a few centuries and the Renaissance more than a thousand years in the future. From disease came great art.

Speaking of the Renaissance, scholars point to the city of Florence as its birthplace around 1350. The Black Death killed much of the population in 1348 (and maybe as much as 60 per cent of all of Europe between 1331 and 1353) yet Florence rallied, becoming a flashpoint of intellectual and artistic evolution that was felt for centuries.

Meanwhile, the hot musical genre was “pestilential music,” a series of compositions inspired by rampant illness. Some believed that music could be medicine while others were sure that it was a moral poison that made it easier for disease to take hold. God apparently didn’t like popular songs, so anyone singing such ditties could expect to be struck down.

But not everyone felt this way. In the 1500s, an Italian physician named Niccolo Massa prescribed music therapy to prevent getting sick: “It is especially advantageous to listen to songs and lovely instrumental music, and to play now and then, and to sing with a quiet voice.” In other words, stay positive by chilling out with some music.

London, England, was plagued with, er, plagues through much of the 16th century (Henry VIII was forced to self-isolate during the Sweating Sickness of 1529, much in the way we are today) and saw a spike in fatalities in the early 1600s. But as England slowly recovered, Shakespeare was somehow inspired to write King Lear, Macbeth, and Antony and Cleopatra, all in 1606. At exactly the same time, composers began to experiment with new musical modalities, resulting in the rise of Baroque music and stars just as Bach, Vivaldi, and Handel.

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Fast-forward to the late 1800s to New Orleans, a city that not only served the riverboat traffic from the Mississippi, but also ships coming in from the Gulf of Mexico, the Caribbean, and beyond. It was a thriving port, but also one of the most unhealthy. Thanks to the heat, humidity, the swamp, poor hygiene, and the constant turnover of the population, it was a terrible place to live if you were an African-American. On average, a Black man could hope to live to 36 before he was taken by cholera, yellow fever, typhus or influenza. Yet in spite of this, New Orleans was the birthplace of ragtime, which later evolved into jazz, the most important music genre of the first half of the 20th century.

Not all pandemics left behind such magnificent albeit unintended artistic consequences. Some were more subtle.

For example, who doesn’t know the playground song Ring Around the Rosie? Some folklore scholars trace its origins to the Great Plague of 1665 describing a rosy red rash (a plague symptom) and a necklace of herbs designed to ward off disease. But that didn’t help because in the end “we all fall down” and died. (Quick point of clarification: Other historians dispute this interpretation, saying it only appeared after WWII.)

Another rhyme with deadly origins appeared during a worldwide influenza pandemic in 1889-1890. Certain the disease could be stopped by sealing up the home from the poisoned air outside, this safety tip emerged in schools:

There was a little girl, and she had a little bird

And she called it by the pretty name of Enza; 

But one day it flew away, but it didn’t go to stay

For when she raised the window, in-flu-Enza

Not exactly Shakespearean, but that little poem endured for decades, especially after the 1918 H1N1 pandemic that killed as many as 100 million people around the world over just 24 months.

When tuberculosis once again became a major problem in the 1920s and 1930s, sickness songs spread like, well, a contagion throughout blues and country performers. Same when polio hit in the late 1940s and early ’50s. And after the Hong Kong flu epidemic of 1968-69 (death toll: one million), certain things became ingrained in our psyche. We certainly otherwise wouldn’t have had a cartoon character like this.

And let’s consider HIV/AIDS for a moment. No other disease of the last several centuries inspired more art, from music and musicals (e.g. Rent) and plays (e.g. Angels in America) to books (The Band Played On) and movies (Philadelphia).

And here we are again facing the worst pandemic since the end of the Great War. We’re all shut-ins as we try to flatten the curve of infections. That includes plenty of musicians who do what musicians do best: explain to the rest of us how we’re feeling.

The last time I checked, there were nearly 500 coronavirus-related songs on Spotify (call it “pandemic pop,”) all of which have been written in the last couple of months. One might become the anthem of our times. Or maybe we’ll have to wait for this enforced isolation to give us a new storyteller.

We will get through this. And who knows what great art COVID-19 will leave behind?

Meanwhile, enjoy this playlist as you give humanity a wide birth.

—

Alan Cross is a broadcaster with Q107 and 102.1 the Edge and a commentator for Global News.

Subscribe to Alan’s Ongoing History of New Music Podcast now on Apple Podcast or Google Play

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Prudential considers other options besides minority IPO for U.S. business

(Reuters) – Prudential (PRU.L) said on Tuesday it was actively evaluating other options in relation to its U.S. business Jackson along with preparations for a minority public offering, due to continued market turmoil on the coronavirus outbreak.

“Our business continues to be financially resilient,” Prudential said in a statement as businesses and organizations globally suffer disruptions as governments move to stymie the spread of coronavirus.

Prudential, Britain’s largest insurer, had announced plans earlier this month to float a minority stake in Jackson amid demands from rebel investor Third Point for a full break-up.

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