A survey is only as good as the controls it sets

Lunches have been packed, sleep routines reset, and spelling words called out since students returned to classrooms across Georgia. Now parents, teachers, and students are reviewing progress reports and sizing up what happens during the next half of the grading period.

This point in the school year also gives school leaders an opportunity to review what is working and what might need to be adjusted. During a pandemic, the ability for schools to pivot on a pinhead may be the difference between lives saved and lost.

On the afternoon of Thursday, September 9, 2021, Washington County Public Schools sent out a survey using a Google platform tool asking for feedback from the school community. The survey tool is one I have used as both an executive director and board president of nonprofits.

The school system’s email with the link to the survey was sent to me by parents in the community. The form didn’t ask for any identifying information: no name, email, address, phone number. It did ask if the person responding is a school employee. It could be filled out by anyone anywhere  who had the link. I filled it out and submitted it. Twice.

Friday morning when I returned to the link it said I had already submitted my answer. Fair enough. After poking around with it some during the second of many cups of coffee, I got this:

Washington County Public Schools survey
September 10, 2021

The survey showed my email address, but Google’s software told me it wasn’t collecting anything from my account.

This isn’t the first time the schools have sent out a survey without parameters set on who could fill out the survey, or requiring any identifying information, in order to submit the survey. Last school year I picked up the phone and ended up talking with Dr. Rickey Edmond, who assured me that they were able to collect identifying data even though none was require to submit answers. I told him having seen the backside of these surveys via my Google business account, I’d sure like to know how they were managing that, because it might help me in the future. All I got was, “We can.”

With the broad questions asked in last week’s survey, what can Dr. Edmond  the Board of Education, and school principals really take away beyond how smooth car pick up and drop off are, and general satisfaction with instruction? Is a blind survey the only way for school leaders to know how parents and employees gauge the school year to date? How confident can school leaders, parents, teachers, and students be that the survey sent out on Thursday has the controls and parameters to collect accurate information?

It will be interesting to see what Dr. Edmond and the Board of Education members share with the community. Based on recent inquiries by myself and others concerned about the system’s Covid-19 record-keeping and reporting, my confidence in the quality of information collected and shared by the school system is low. Will the results of a survey available to anyone with email be used to guide judgement impacting not only the education of every student, but the health of the entire Washington County community?

I love a good Open Records Act request

With the return to classrooms across Georgia, I have been following the Covid-19 numbers in public schools in our state. Dismissing the recommended guidelines of the CDC, and the Georgia chapter of the American Academy of Pediatrics, many superintendents and school boards are playing doctor with the health of their own communities. The outcome, with Georgia’s schools back in session for about a month, has resulted in schools opting to be online only, delaying the start of school, pausing all instruction after beginning the school year, and students, teachers, bus drivers, and bus monitors, dying of Covid-19.

Concerned families, school communities, medical providers, and epidemiologists wait on a weekly Friday report from the Georgia Department of Public Health (DPH) for Covid-19 cases and trends in their county. Friday afternoon is also when most school systems release their Covid-19 information to their community. Some school leaders choose full transparency and share all the data they send to DPH for its weekly report. Their communities know the number of confirmed cases, how many people are quarantined, and clusters in each school.* Other schools provide a scant report that often leaves community members in the dark while confirmed cases continue to break records in Georgia.

This data is supposed to help school leaders decide how safe, and effective, it is to keep students in classrooms. Some schools have opted for virtual and printed materials for entire grades, entire schools, or the whole system as a result of data and historic trends.

On Thursday, August 27th, during what Washington County’s school superintendent described as a “fireside chat,” Dr. Rickey Edmond told almost 100 people attending the online event that only confirmed cases matter. He dismissed the number of students and staff quarantined as”fluid.” I agree that number could be considered fluid, because it can change every day. The number of confirmed Covid-19 cases can also change every day. DPH has already elevated Washington County schools to “substantial spread” and “increasing” in its weekly report.

Washington County, GA (map source Wikipedia)

With the state ratcheting up the level of concern for everyone in Washington County’s public schools, and having looked at reports posted by other systems across Georgia, I wondered exactly what DPH requires for its weekly school report. Seeing the reporting form was the best way to know.

A friend once told me, “I love a good Open Records Act request.” Like them,  I also love a good Georgia Open Records Act (GORA) request. On Monday, August 30th, I sent one to the Dr. Edmond, copying the Washington County Board of Education members. My request was, “The information I am requesting is for the information used for the Covid-19 information released to the public on August 13, 20, 27, 2021. I am requesting the Covid-19 reports and/or data Washington County public schools sent to the Georgia Department of Public Health for its weekly school report.” That’s a pretty straightforward request because DPH requires it, the school is supposed to compile and send it, so releasing all of it doesn’t require extra work.

What I got back from Edmond was,  “Reasonable access provided with good faith:
1. In response to your request: Covid-19 information released to the public on August 13, 20, 27, 2021 is attached in a PDF Table.
2. We can’t provide you with “COVID-19 Reports and/or data sent to Georgia Department of Public Health because that information is submitted via electronic portal and the medical form used falls under 50-18-72(a). As a school entity, we must uphold HIPPA, FERPA, and privacy requirements.
3. We have provided you with additional information complied by DPH for your reference.”

Covid-19 data from Dr. Rickey Edmond, Superintendent, Washington County Public Schools, Sept 2, 2021, in response to GORA request

A complete and thorough GORA response should always be done “in good faith,” to use Dr. Edmond’s choice of words. The information sent to me isn’t what I asked for, and doesn’t comply with the GORA request. Dr. Edmond insisted that what they send has lots of confidential information in it. I asked that he redact any sensitive information and send me the form so I could see what the state requires for its weekly report on schools in our state. Additionally, saying that the form is completed online and cannot be released otherwise just doesn’t hold water in a school system with an IT department and virtual teaching capacity. Do they not save a copy of what they submit?

At this point, I was even more concerned about what the school system didn’t want to freely provide to the community. Case numbers matter, but so do the number of students and staff out for quarantine, and the number of clusters occurring in school settings. It is possible a school could have a low case load but a very high number of absences due to quarantine, resulting in dwindling classroom numbers.

What are they reporting that they aren’t telling us, and why is it so important to keep that information from us? As North Central Health District Director Michael Hokanson told me on the afternoon of August 27th, the reporting from schools relies on a good faith effort on the schools’ part.

If schools are sloppy with the parameters for collecting data, the data can’t, and shouldn’t, be trusted. If a school system isn’t carefully tracking why students are absent, for example a dental appointment, strep throat, or a death in the family, what you get at the end of the day is a number that tells you nothing about why those students were out of school. Kids and staff out due to quarantine are going to miss a significant number of consecutive school days. That impacts how they are learning, how teachers must adjust, demand for substitutes, and ultimately, if a system should use online resources to keep students up to speed, and everyone healthy.

Edmond told me to contact DPH to get the form that I ask for in my GORA request. Trying to find the right person at DPH, and actually reach them, is a circle of Hell Dante didn’t know about centuries ago. The staffers I did reach are frustrated and exhausted with how their agency is combatting Covid-19. One told me, “the right hand doesn’t know what the left hand is doing.”

I left messages at schools, emailed schools, and filled out GORA requests via forms school boards provided on their web sites. One school superintendent called me back eager to share blank copies of the weekly form schools send to DPH  and volunteered to send the detailed form required for the district health office. I got the form from more than one system to verify I had the right one.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

What the report requires is the result of counting cases, quarantining of students and staff, and clusters.* This shouldn’t be a difficult thing to record on a daily basis and add up at the end of the week. The Georgia Department of Education created a video to guide school administrators on how to easily complete the form, using “Careful Recordkeeper” as the name of the school staffer filling it out. There is no sensitive or confidential data about anyone at the school required to complete this weekly report.

Dr. Nancy Kreiger at the Harvard School of Public Health recently said, “The answer to having not-good-enough data is to make it really public that it’s not good enough and to figure out, how do you make it better?” Kreiger went on to say about data, “You need good data to do proper planning, to understand what the risk is, how the risk is changing. And you need that to be real data that are publicly available and accessible.”

If a school isn’t committed to collecting accurate data, none of what they report can and should be trusted with full confidence by the state, or the people concerned about the health of every person in that school.

The responsibility of collecting good data falls on the Board of Education requiring it, and the schools led by Dr. Edmond following through.  Thousands of families in Washington County are making life and death decisions for their children and themselves during this pandemic.  For the Board of Education, Dr. Edmond, and school leaders to be satisfied with a refusal to collect good data and share it with families is not only a disservice to Washington County families. It shows a huge distain for the exhausted healthcare providers and DPH staffers working in the county and across our state.

*From GA DPH, “Laboratory-confirmed COVID-19 in two or more people [students or staff] with symptom onset/collection dates within a 14 day period who are epidemiologically linked, do not share a household, and were not identified as close contacts of each other in another setting during standard case investigation or contact tracing”).

A suggestion for Atlantans frustrated about access to vaccinations

Governor Brian Kemp’s administration has excelled at how to not handle this year-long pandemic. The roll-out of vaccinations has not been an exception to their poor performance in the past year.

That a vaccine is available is a surprise to no one, but the state’s preparation for access to shots has put us last in the country for success. Citizens are frustrated, and rightly so.

Kemp chose to base scheduling on a website and understaffed phone lines. People without internet or computer access have been limited to spending hours on the phone trying fruitlessly to get an appointment. Kemp  announced expanded eligibility for vaccines but the state’s website wasn’t updated to reflect that, which resulted in phone bank staffers turning away people trying to begin their vaccinations. What a colossal waste of taxpayer dollars and time.

Access to vaccine locations has been equally frustrating. The majority of vaccines have only been available in urban areas, leaving rural residents without reasonable access. Five state sites outside the perimeter of Atlanta, capable of serving thousands of people a day, will open today. Scheduling problems migrated to those sites as well.

Now that Kemp has opened up eligibility to more people, people in Atlanta are complaining that they can’t get vaccinated near their homes. Kemp is urging those people to drive to south Georgia for shots.

There are all kinds of reasons this isn’t helpful, particularly for rural Georgia.

With libraries closed, which often serve as the only point of access to the internet and computers for many small community residents, vaccine appointments remain a hurdle they cannot scale. Kemp should have ramped up phone capacity for appointments along with the addition of these new locations.

Most rural Georgia communities lack public transportation. Counties aren’t equipped to get people who lack transportation to vaccination sites. Shots in arms is critical to reducing case load, saving lives, and energizing our state economy, especially as the weather warms up and people think about vacations.

With newly expanded eligibility for vaccination, metro Atlanta residents are complaining about not being able to get their shot a few miles from home. Kemp ‘s best solution is to drive out of town for vaccines. Rightly so, people who don’t get paid time off from the one, two, or maybe three jobs they need to house, feed, and clothe their families, have every reason to be angry. But they aren’t the only ones complaining.

Covid-19 vaccination site, Sandersville, GA

This is my suggestion to people who do have reliable transportation, and can afford to, but don’t want to, take sick or vacation time and miss two days of work to get their shots-quit bitching. Your privilege is offensive to every rural resident who has gone without medical care because they didn’t have the technology available in their home for telehealth, the means to drive a considerable distance to see a specialist, get prenatal care, or visit someone they love who was out of town for care.

Rural Georgians have done without the medical care urban residents have since urban areas developed across our state. Small town Georgians have watched our hospitals close, medical services shrink, and doctors choose urban over rural for decades.

That rural communities have managed to feed themselves for a year  without the ease of Instacart or Door Dash is a testament to their abilities. There hasn’t been same day, or even next day, Amazon delivery for school and household supplies. Streaming anything on the web for entertainment, education, or work hasn’t been an option for too many families.

After all that we have managed to survive, having to drive out of town for a vaccine that will protect you, your family, neighbors, and coworkers, should be the last thing you complain about right now. Make an appointment, put gas in the car, choose some podcasts or audio books to listen to, and drive yourself to a place where people just as eager, but less privileged, have waited just as long as you have to get a vaccine.

Pulling the bandaids off in rural America

What rural communities lack in infrastructure is becoming very clear to elected leaders at all levels. The question that must be answered is whether those needs will be addressed and when.

The lack of fast affordable internet service in rural communities is now holding back teachers, students, and parents. Teachers don’t have access to broadband in order to log on and hold sessions with students. Students often don’t have internet access or a computer.

If you are looking for some good stocks to consider, this might be a good time to invest in the paper industry. Schools are making printed packets of work for families because online education in rural America isn’t an option.

Rural communities don’t have the luxury of Instacart and similar shopping and delivery services. There is no option to have groceries delivered to your front door. If driving to a store is the only option for rural households, the urge to stock up beyond a week’s worth of groceries is understandable when frequently used items are on store shelves.

Businesses trying to shift to online work face the same challenges as schools. A technology company I have relied on emailed customers two weeks ago offering not only online platforms for remote work, but refurbished laptops for employees to use while they work from home. The question remains whether there is internet access at the employee’s home.

While social media and news outlets fill space with ideas for streaming movies and television programs, rural America remains on the sidelines. There is no streaming of entertainment options without high speed internet. Libraries are closed and ball fields are vacant. Choices are so limited now.

The bandaids offered to rural America have been pulled off. Lessons are being taught about how we can better serve rural communities across our country. If the lack of resources in rural America are not addressed when we are able to paddle less frantically, the failure of elected leaders to respond nimbly and effectively should direct every voter’s choices.

The coming tsunami from a healthcare provider’s perspective

Earlier this week I contacted a friend who is a healthcare provider in an urban Northeastern city. They offered to share their personal experiences and perspective on the pandemic as time and energy allow. I am grateful for their insights and commitment to serving the public. I promised that they would not be identified.

March 19, 2020
Let me preface these reflections by stating that I am not truly on the “front lines” at this moment, but I do work with both inpatients and outpatients at a large hospital in the Northeast.  My job brings me into direct contact with people who have infectious diseases, some of which may be undiagnosed, on a regular basis.  In the past, I worked in EMS through the HIV/AIDs crisis, the Swine flu, SARS, H1N1 and was never as apprehensive as I am right now.

The anxiety and fear here are palpable.  It’s like waiting for a predicted tsunami, but a tsunami scenario from which there is almost nowhere to escape.  Most of my social circle (which includes medical and non-medical people) are experiencing this same feeling.  If you aren’t concerned you should be.  Those of us providing healthcare at any level have an increasing sense of dread and worry about what is happening. We wonder about tomorrow, next week, next month and what we will be doing – fear of the unknown.  We hear the cries of our colleagues in Italy and other countries who have more sick patients than they can handle, making heart wrenching decisions over who can be saved, trying to allocate scarce equipment resources appropriately, and daily having to choose who will get the chance to live and who will be left to die.  It’s a situation that medical providers face in any disaster, but this pandemic may last months.  The weight of all of this is already taking a physiological and emotional toll.

As we reduce and eventually eliminate outpatient services and move towards telemedicine provider visits, it means that healthcare providers will most likely transition to other areas of the hospital to supplement staff.  Imagine being told that instead of your marketing job, tomorrow you will be doing engineering. You know the product and its capabilities, but you don’t know its design or how to troubleshoot problems when it breaks down.  Yes, some skills and knowledge can be carried over to another role, but there is a big learning curve…and in this case lives are at stake.  This is a scary situation for care providers because we pride ourselves on providing safe, competent, efficient, and compassionate care.  But as patient numbers increase and providers become sick, this situation is inevitable.  Angst. Worry. The feeling of impending doom.

While much of the public is shielded from hourly updates on COVID-19, we are not.  Our protocols, procedures, staffing, equipment, and communication with coworkers have all changed and continue to update throughout each workday.  As the daily stress levels mount for us, we stare in disbelief and horror at the news watching thousands of people on the beach in Florida, or out in Spring Break mobs in bars, carelessly crowding each other and spreading this virus.  We have difficult conversations with friends and loved ones who still may be amongst the “non-believers”.  We know it is real.  This is not the flu.  This is not hysteria or the fault of the media.  Get your head out of the sand before you infect your elderly parents or grandparents, your neighbor, your friends.

Some may not survive this.  Some of my coworkers may not survive this.  I don’t want to see your loved one die alone – yes, ALONE. Think on that for a bit.  That thought terrifies me and it should terrify you.  We have the benefit of learning from the experiences of China, South Korea, and Italy.  They have told us to listen to their lessons, their mistakes.  Let me tell you that I wept listening to health care providers talk about their dire situation.  It’s the recipe for career ending post-traumatic stress disorder.  I have already experienced enough sadness in the healthcare field in my prior role as a street EMS provider.  I don’t need to take on more.  But that is what the healthcare providers need to do, and what we are expected to do.  I am willing to do my part, to go where I am needed, to do anything I can to help you or your loved ones in this pandemic.  Please do your part and stay home.  My life may depend on important action.

A test of faith

Last Friday Governor Brian Kemp took the unprecedented step of declaring a statewide public health emergency as the number of Covid-19 (coronavirus) cases began to increase on national and state levels. The Georgia General Assembly suspended its calendar last Thursday and returned for on Monday for a special session called by the Governor to approve his actions.  Yesterday the Georgia Department of Public Health (DPH) confirmed  197 cases of Covid-19 and three deaths.  The number of reported cases are updated daily at noon.

Whether the changes we are adopting come from business, civic, or elected leaders, the chorus in this choir is to avoid being closer than six feet from other people. I prefer the phrase physical distancing instead of social distancing. We need our social connections now more than ever, just not the close physical ones.

Last weekend I was supposed to be with about 12 other Life Is A Verb Campers for a house party filled with making art, cooking Pi Day themed meals, walking, yoga, and sharing stories. Instead of being together physically, we gathered at 11:00 in the morning via Zoom for coffee and everyone’s choice of pie. I made a roasted mushroom and asparagus quiche. It wasn’t the same as being in a room together, but it was good to see much-loved faces and talk.

Having done that on Saturday, the next morning I did a quick FaceBook search of five large churches in rural Washington County to see how they were adapting to the six foot wingspan way of living now. All five opened their doors to congregation members. One of the five churches was St James Christian Fellowship. This congregation is led by Georgia State House Representative Mack Jackson. He did not reply to my email with questions about opening the church last week.

Last Thursday Jackson worked with other state representatives to suspend their work and return home out of an abundance of caution due to Covid-19. On Friday some members stood closer than six feet to Kemp while he announce the public health emergency. Despite the cautions taken by the state, Jackson and other faith leaders invited people to gather together, perhaps more than once, last Sunday.

Everyone in those churches knows that the local hospital, like those in other rural counties, is not equipped to handle a large number of Covid-19 patients. The capacity just isn’t there, no matter how caring and well=trained the health providers are. With all of the free and easy-to-use technology available for streaming a service, why any church leaders thought that unlocking the doors last Sunday was a good idea, is enough to test one’s faith.

 

Forecast for Covid-19 in the United States

Covid-19 forecast from University of Massachusetts Amherst,
March 11, 2020

Real data and solid research matter. Read it. Share it. Use it. The information below is taken directly from the link in this post.

Results from Survey 4 (administered March 9-10, 2020)

  1. Experts predict a four-fold rise in reported cases in the US over the next week. They predict 1819 total cases (80% uncertainty interval: 823-6204 cases) of COVID-19 will be reported by the CDC on Monday March 16th, more than 4 times the CDC reported number of cases as of Monday, March 9th.
  2. The majority of experts (20/21, 95%) expect COVID-19 will reach community-level spread in the US

  3. Experts expect that community-level spread will occur in the US within 3 weeks (80% uncertainty interval: 0-10 weeks).

  4. Experts anticipate 44 US states will report cases of COVID-19 within one week (80% uncertainty interval: 39-48 states).

  5. Experts believe that only 13% (80% uncertainty interval: 4-30%) of all COVID-19 infections (symptomatic and asymptomatic) in the US were reported to the CDC as of Monday, March 9th.

This implies that as of the beginning of this week there were between 1410 and 10575 undiagnosed infections with COVID-19 in the US. 6. Experts believe that nationwide hospitalizations for COVID-19 will peak in May. 7.

The above results include answers from 21 experts.

What I’m reading about last night

What I’m reading about last night (link to the address is below from the New York Times):

WAPo: “In describing his bleak vision of a ruined United States exploited by foreigners, Mr. Trump wrote a series of checks he almost certainly cannot cash.”

The ugliest moment in the 60-minute address came when Mr. Trump announced the formation of an office on “Victims of Immigration Crime Engagement,” and then introduced families of people allegedly murdered by illegal immigrants. It was an appeal to raw prejudice and fear that will do nothing to promote the national unity he claims to be seeking. (emphasis added)

WAPO: Fact checking demonstrates that Trump continues to take credit for things he didn’t do, including the sourcing for DAPL pipeline materials

WaPo: Why any glow from last night won’t last very long

WaPo: The word you didn’t hear last night

NYT: Video of the address to Congress and NYT Washington correspondents comments and analysis during the speech and the Democratic response

NYT: Did Bannon and Miller talk Trump away from a pivot on immigration during lunch yesterday?

NYT: Five takeaways from last night’s speech

Jay Bookman at the Atlanta Journal Constitution on pouring money into the military,
“In short, this is not a carefully thought-out strategy from the Trump administration, based on consultation with the experts and our allies. Instead, the man who took five draft deferments to avoid fighting in Vietnam, the man who says that he knows better than the generals how to defeat ISIS and who claims he understands the military because he attended a military-themed boarding school, is offering a military strategy fueled largely by his own deep personal insecurities.”