This week, I’ll break down the latest COVID information with Dr. Megan Ranney, an emergency physician at Rhode Island Hospital. Dr. Ranney also serves as deputy dean at Brown’s School of Public Health, and she’s a strong believer in treating gun violence as a public health issue. So we’ll talk about that, the direction of healthcare in Rhode Island, and how science can compete with the spread of conspiracy theories.
Ian Donnis: Dr. Megan Ranney, welcome back to The Public's Radio.
Dr. Megan Ranney: Thank you, it's a joy to be here with you today.
Donnis: COVID cases are climbing due to a very infectious new variant how do the next few months in Rhode Island look to you?
Dr. Ranney: As has been true so often during this pandemic, it's tough to say with certainty, what we know is that this new variant, the XBB version, has grown dramatically in the state over the last two months, now responsible for almost three quarters of cases in the state. And we are seeing an overall rise in cases, our wastewater levels are similar to where they were at the height of the Omicron pandemic, part of the pandemic. But what happens next is tough to say, this variant may sputter out, it may continue to spread, or we might get a new variant. And honestly, only time will tell. The one thing that I think is serving us well here in Rhode Island is our baseline high rate of vaccinations, which are helping to protect us from severe numbers of hospitalizations, ICU stays or death.
Donnis: A lot of Americans seemingly want to move on from COVID. And they seem less concerned about it. But as long as this illness persists, more people will get repeat infections, what is known about the consequence of the long term effect of repeat infections?
Dr. Ranney: So we're slowly gathering information about those long term consequences of repeat infections, it seems almost impossible to remember, but COVID itself is only about three years old. The data suggests that each time you get infected, you do have a repeat risk of developing symptoms consistent with long COVID. Right, so things like brain fog, or loss of smell, or long term damage to your heart or your lungs. There's also though some accumulating data that suggests that long COVID may have variable length of time for different people. The short version is you don't want to get infected if you can avoid it, it certainly causes some disruptions to your immune system to the way that your body functions. And if you can stay away from COVID, it's not a bad thing to do. But those long term consequences, we are still figuring out through the science.
Donnis: Is there a connection between the low participation rate by Americans in boosters and the spread of new variants?
Dr. Ranney: We certainly see a correlation between the low participation rate in the new boosters, and hospitalizations and death, particularly for older people. age 60+. Although I always hesitate when I say age 60 is old, the older I get the younger 60 seems, but age 60 plus, or people with multiple chronic conditions, things like diabetes, cancer, severe lung disease, those people if they don't get the booster, right around the time of a surge, they are going to be at higher risk of hospitalization and death. So the lack of uptake of boosters impacts those bad outcomes. Can I say that the rise of variants or the spread of COVID among our larger community is related to booster uptake? Not necessarily, it's probably more related to us all going back to regular life. And it's all honestly discarding masks for the most part. That's what facilitates the spread of COVID. And every time COVID spreads, there's a chance of a new variant developing. So the more that it spreads, the more new variants we see.
Donnis: Let's switch gears to talk about Rhode Island's healthcare landscape. The state's two largest hospital groups Lifespan and Care New England continue to lose money. Part of the challenge is that for example, at Rhode Island Hospital, a lot of the reimbursement comes from Medicare and Medicaid and those public programs pay less than private insurers. What is the solution?
Dr. Ranney: Well, we tried one solution, which was turned down which was merging the hospital systems with Brown. That obviously was a no go for the state. We're kind of caught in a perfect storm, not just here in Rhode Island, but across the country where we are having low reimbursement rates. We are paying more for labor costs, as we experience severe nursing shortages. We appropriately are paying nurses more but that obviously cuts on the bottom line of the hospital systems. And we are not able to do the cases that would normally bump up a hospital's bottom line: those complex surgeries which honestly helped the hospitals stay in business. I think that the long term solution we we have a great opportunity in this state, given our small size to reimagine how we provide health care how we pay for health care. We have the possibility of becoming Part of things like a hospital anchor network, which exists in other similar communities, which can help both boost reimbursement but most importantly, boost health, and help keep healthcare workers on the job.
Donnis: That's a good segue for my next question. Rhode Island Attorney General Peter Neronha has been repeatedly calling for a long term strategy on the state's healthcare and hospital landscape. But he seems to be the only one in state government who's banging the drum on this is this a failure of public leadership in your view?
Dr. Ranney: I would love for us to have a permanent director of the Rhode Island Department of Health, I think that they would be a really important partner in this work. Dr. Bandy has done a terrific job taking over for a prior interim director. But without long term, permanent direction of EOHHS and RIDOH. It's going to be difficult for us to have this type of political leadership that we need to move forward.
Donnis: You are a proponent of treating gun violence as a public health issue. I think we've seen growing support for this over time. And at least in Rhode Island, the continued problem of mass shootings has ginned up political support for new restrictions against gun violence. But we know there are serious obstacles to treating gun violence as a public health issue, what are those, and do you see a strategy for overcoming them?
Dr. Ranney: So I will say that in Rhode Island, we are tremendously fortunate, we have one of the lowest gun death rates in the country. And we are one of the states that has gotten the longest, knock on wood, without a public mass shooting. And that's partly related to our policy decisions. It's also partly related to our culture within the state. And it's honestly partly also related to the number of firearms in private hands. When I talk about a public health approach to firearm injury, policy is of course, part of that. It's necessary but not sufficient. Many of the greatest advances that we have made around reducing firearm injury in this state or around reducing injury in general, are not about laws at all. They're about things like for firearm injury, the Non-Violence Institute, which has been a critical partner with Providence, Pawtucket, Central Falls Police and which has successfully decreased the number of firearm homicides over the last year and had done something similar 5, 10 years ago. When we -- when I came to this state 20 years ago, our rates of firearm deaths were an order of magnitude higher than they are here. And it was thanks to that partnership with something like the Non-Violence Institute, which is not legislatively based. Similarly, safe storage is a critical part of firearm injury prevention. Laws help with that. But the most important thing is that we have firearm owners who understand that it's important to keep their guns out of the hands of kids, or thieves, or people who want to hurt themselves or hurt someone else. A lot can help. But what you ultimately need is you need gun shops and gun ranges and gun owners who believe and agree that that's the right thing to do - to keep your gun locked up when you're not using it. And most folks in this state do agree with that. So to me, our state is in a tremendously strong position related to firearm injury prevention and related to a true public health approach, which again, I hesitate with saying it's only about laws. It's also about a lot of other stuff, too.
Donnis: I saw some tweets in your feed recently about Damar Hamlin, the Buffalo Bills player who continues to recover from a scary case of cardiac arrest. I wonder, are you a football fan? And if so, how do you reconcile being a physician with the traumatic effect that football players often experience from the sport.
Dr. Ranney: So I hail from Western New York and have been a Bills fan since I was born. Someday we will win a Super Bowl. So I am a football fan. And I was actually on vacation last Monday when that horrible event happened. My husband is also from Buffalo and we had arranged our vacation to watch the game. You know, it's something that I struggle with. But I I always say that there's nothing in life that's risk free. I think we do have an obligation to players, as well as to fans to make the sport as safe as possible. I am friendly with folks within the NFL Players Association who have been huge advocates for improving protections for players as well as improving the medical response on the field. And it is thanks to that, that Damar Hamlin survived. They had three emergency physicians on the sidelines, one of whom was a designated airway expert, who helped save his life and get him back. And so that's how I reconcile it. Now will -- my son plays flag football, would he played tackle? It's a discussion that my husband and I have. But at the same time, my view of public health is that it is about both preserving safety and promoting happiness and liberty. And I, I would struggle with saying that we're going to do something like ban football because it's it is, for better or worse part of our American culture.
Donnis: In closing, there was an echo of January 6 in Brazil last week with the assault on Congress and some other government buildings. On the other hand, we saw how Americans repudiated election deniers in the election last November. I wonder as a woman of science, who uses her social media to get out fact based information, how concerned are you about the real world consequences of conspiracy theories?
Dr. Ranney: I've been active on social media for a very long time. And there has been a dramatic rise in both disinformation, so people that are actively spreading lies with the intention of causing discord, and of coordinated attacks on individuals. Those scare me deeply, whether you are a Republican or a Democrat, or somewhere in the middle, we should all be scared by those coordinated conspiracy campaigns. I also, though, recognize that they are developing because we are often in a void of good information. And so to me, it is a call for all of us to commit to both creating and sharing trustworthy information regardless of where we lie on the on the political spectrum. But also to double checking our sources. And I think that the last couple of years, as we were, you know, a little isolated and relying on social media more as the political temperature in this country and across the globe has gotten hotter. It's easy to see something and reshare it without thinking it through. And so to me that that is the call to all of us. What happens next is up to us and up to in part, thanks to organizations like yours.
Donnis: That's all the time we have Dr. Megan Ranney, thank you so much for joining us.
Dr. Ranney: Thank you for having me on here.
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In the last week or two it became clear that Josh Saal’s tenure as Rhode Island’s housing secretary was coming to an end. Saal was under fire for the state’s response to unhoused people, the slow pace of progress on housing issues, and even the way he compiled reports. In his letter of resignation, Saal points to how the diffuse structure of Rhode Island’s housing system hinders improvement. But this siloed approach is not exactly a secret. Back in December 2021, I reported on how the state was lagging on spending millions meant to create more housing. House Speaker Joe Shekarchi told me at the time that a smorgasbord of housing agencies are -- quote -- “all doing God’s work, but they’re not coordinated with each other.” Now, with Saal’s pending exit, the task of bringing more efficiency to addressing Rhode Island’s long-running housing crisis will fall to someone else. You can read about this -- and a lot more-- in my Friday TGIF column, posting around 4 this afternoon at thepublicsradio.org and on my Twitter @IanDon.
That’s Political Roundtable for this week. Our producer is James Baumgartner.
I’m Ian Donnis, and I’ll see you on the radio.
