One of my secondary areas of research is how information flows during a crisis. As noted previously, how people act is based on their perception of reality, not the actual state of things, and so for modeling purposes you have to model what people think is going on – as well as what is actually going on – in order to anticipate their actions. The situation in Savannah, GA, where I am based, is a snapshot of what is going on in communities across the nation – and world for that matter. Unfortunately, the lack of trust in institutions, especially government and the news media, has become reminiscent of the former Soviet Union and rumors are often taken as fact. And here in Savannah, there are some pretty toxic rumors floating around, some originating in the health care community. Please read this post to the end; it’s important!
For a variety of reasons people started confiding in me regarding potential problems in the local health care system. It reached the point where over the last couple of weeks I have asked for confidential reports from practitioners as to their impressions on how their institutions were performing to clarify these unsolicited reports. While that information has proven quite valuable, it has also placed Enki, as an entity concerned with the distribution of reliable, actionable information, in a difficult position.
There has been a lot of curiosity about these reports. I really don’t want to get in the middle of public disputes between the hospitals and their employees. Yet, for the community, the state of preparedness of the hospitals is of vital interest. For Memorial the comments have been mostly supportive: while pointing out flaws and concerns also pointing out the right things they were doing. I was somewhat surprised by that, given the recent purchase of the facility by HCA and subsequent changes. With Saint Josephs/Candler (SJC), the tone was fairly uniformly negative from the initial two dozen or so responses. This surprised me a lot. In their last few years of life (in the early 2000’s), my parents were frequent patients, and the quality of compassionate care was excellent. One of my aunts was a nurse and later took vows to become a Carmelite (most of my father’s side of the family is Catholic; my wife and I are Eastern Orthodox) so I have a fondness for the Catholic health care system, and our personal physicians are part of that network. So not only do I not have a bias, I’m in general favorably disposed towards SJC. That said, a number of very specific concerns were raised, including the allocation and use policies for Personal Protective Equipment (PPE). At this point I won’t repeat them or other issues raised, as SJC has vehemently denied them, and some more recent reports indicate an improved situation. But it is clear to me that a number of SJC staff were worried about the subject, as these concerns are coming from sources who do not appear to know one another.
It’s hard to sort things like this out – legitimate concerns, misunderstandings, or simply grousing from the dissatisfied? Obviously these are in one sense anecdotal, but these are concerns that are circulating in the community and are influencing perceptions and therefore actions. Obviously the truth matters, but from my research perspective, the fact that there is a dichotomy between what institutions are saying and what their employees are saying is the “fact.”
After collecting some information to help inform my work, I deleted the posts on the subject and moved on. However, over the last two days a disturbing new allegation was received regarding PPE at SJC, involving the status of N95 type masks from China. As some of you might know, on April 3rd the FDA approved the use of Chinese KN-95 masks as a substitute for the US certified N-95 masks. According to SJC, they have begun distributing and using KN95 masks. To be clear, that is perfectly acceptable under current guidelines and if properly certified not a problem at all. Unfortunately, there are also a huge number of counterfeit KN95 masks floating around (this link goes to CDC/NIOSH for how to identify good vs bogus masks), and many practitioners are nervous about using them. Again, SJC categorically states that they while they are having to go outside their usual supply channels, all of their masks are properly certified.
So we have two competing narratives for a serious situation, an allegation from someone who wishes to remain anonymous, indirect verification from another source who also does not want to be on the record for fear of their job, and a forceful on the record denial by an SJC spokesperson. Which is true? At this point I don’t see evidence that anyone is lying. I can’t imagine that SJC is not being careful with their supplies; the last thing they need operationally, much less from a liability standpoint, are staff falling ill. But I can also well imagine that a practitioner sees an unfamiliar Chinese manufactured mask and knowing of the controversy rightfully gets worried. And of course there is always the potential for bad masks to get into the supply chain despite best efforts, especially given the supply shortages nationwide. I also understand the concerns (as in this Bloomberg link) regarding job security, even with raising the issue internally. The problem comes in when those concerns “go wild” and cause stress and uncertainty in the community before they are properly vetted.
This is not to criticize the potential whistleblowers, or defend their institutions, but to try to provide a perspective and path. If you have a serious concern involving a dangerous situation, much less misconduct, please carefully document it and go through channels to make sure your concern is not a misunderstanding. If your institution is unresponsive or you are afraid of them, please present it to the appropriate regulatory authorities (which can usually be done anonymously) and if that fails, only then go public through the media/journalists, and be prepared to provide your documentation. Anonymity is one thing, and can be protected, but to publish serious accusations any outlet needs to see the proof. I know that’s a big ask, as you might risk retaliation from your employer, but you have a professional obligation to do it that way. Otherwise, you also have a professional obligation to not make a bad situation worse by spreading information that, no matter how true, is “unactionable” and causes uncertainty, stress, and concern in the community. In ordinary times you can feel free to grouse about employers as much as you like. I know I do. However, in times like these if there is a serous problem you have to be decisive. As Yoda says, do or do not; there is no try (via the rumor mill).
The issue for me is that while I am involved in the journalistic enterprise by providing supporting data and analysis to various news outlets (and this blog is technically a news outlet in and of itself), Enki does not have the resources to conduct serious investigative journalism that issues like this deserve and require to get a definitive answer. So I plan to keep out of this from here on out.