New Mexico is ten days into an economic shut-down ordered by our Governor, Michelle Lujan Grisham. I work in Rio Arriba County, where under normal circumstances I oversee provision of Intensive Case Management for individuals suffering from substance use disorder. But these days I am spending a lot of time overseeing ad hoc home mask-making production to supply our clinics.
We experienced our first two confirmed cases of the novel Coronavirus a few days ago and our third today. One of the individuals had neither travelled nor wittingly come into contact with anyone who does travel. This first known instance of community transmission means that people here are suddenly taking social isolation seriously.
It also means we are forced to find new ways to provide behavioral health services, to organize our community mask-making, and that the homeless are inventing new ways to survive.
Normally, the Rio Arriba Department of Health and Human Services has two case managers in the jail who work with judges to divert clients from the criminal justice system into treatment. Because of the tremendous danger posed by the pandemic to inmates (consider this cautionary tale), we have had to pull our re-entry specialists out of the jail. We can’t transport inmates to residential treatment because residential treatment centers are not accepting new clients from the outside, and social distancing does not allow us to put two case managers and a client into a small vehicle.
Since our normally overcrowded offices are tiny and can’t fit two people while still allowing six feet of separation, I’ve set a limit of two case managers in the building at a time, and instructed staff to communicate with clients through phones. We’ve asked the Department of Justice for permission to purchase cell phones for clients that are without, so we can assist them telephonically. And we’re rearranging contracts with outside agencies to focus on blanketing the streets with Narcan until the pandemic passes (when we can resume transport and other normal services), and building our tele-health capacity to prepare for a second wave.
Helpfully, just as the pandemic was reaching New Mexico, the State Police conducted a huge sweep in our community, doubling the size of our inmate population overnight. We have focused most of our case managers on jail diversion. The County has reduced its jail census from a whopping (for us) 140, to 62 in a matter of weeks.
While walking through the foothills outside of town of late, I’ve noted signs of human habitation I rarely see: a stone heart, a makeshift shrine, a canvas bag holding a blanket. I assume some of the people we’ve emptied out of the jail are seeking safety away from others by camping in the foothills outside of town.
Mask-making and distribution is equally ad hoc. Rosie the Respirators, a spontaneous, grassroots protective-gear sewing enterprise, tested several designs, currently favoring one that sews an interface filter into the face-side surface of the mask. There is some controversy about whether cotton is the best fabric. Because it absorbs moisture, it may be likely to maintain the virus and spread it to surfaces if it is set down. And while the masks are cute and fashionable, we don’t want to leave the public with the impression that having a cotton mask will keep them safe. Currently, we are giving the handmade masks to clinics for providers to place over surgical masks to prolong their usage for five to seven days. The clinics are also giving the masks to sick patients because masks are better at preventing the sick from infecting others than at keeping healthy people healthy.
Here’s how we roll: donated materials come into a central location. A coordinator determines who needs what, and sends a volunteer firefighter out to distribute supplies to home based seams-persons. Some people cut and others sew pre-approved patterns. Our volunteer firefighters then collect the finished masks and bring them to a home where they are laundered and packed into ziplocs, and then to the County’s Emergency Operations Center, where they are dispersed to health care providers.
Ironically, Covid-19 has forced us to rapidly re-localize our supply chain and has returned our economy to one based in barter and exchange of labor rather than monetization. (Okay, Rio Arriba has never ceased to rely on barter and labor exchange, so this part came easily).
There are nearly 600,000 cases of the novel CoronaVirus in the world, with one-sixth of them here in the US. This is a direct result of misguided "America Only" policies and a late-stage capitalist economy that allows a few individuals at the top to skim most of the benefits for themselves without contribution.
Horrible diseases even worse than Covid-19 arose in the Obama years. The administration sent teams of medical professionals overseas to combat them before they became pandemics. We made sure the medical community all over the US had necessary equipment. Whatever I might say about the Bushes, they were strong supporters of federally qualified health clinics.
Remember Ebola? Its mortality rate was 43%. And Swine Flu? These could potentially have made it to our shores.
Extreme selfishness is neither a religion nor a sustainable economic solution. It is nihilism.
As Passover approaches I do believe G-d has sent a plague to wake us up from our egoistic lethargy. It's time to care of our neighbors and the least among us, and to restructure our economy so it encourages respect for one another and the Eden we inherited.