Vaccine Phase 2 First Look

How to define eligibility for priority groups in Phase 2 of the state COVID-19 vaccination program was the subject of the regular weekly meeting of the Vaccine Sub-Committee at the RI Department of Health (DoH) on Friday, January 22. The goal is to have this clearly settled by the time Phase 2 is expected to begin in late March or early April.

RI COVID-19 vaccine Phase 1 progress
(Source: RI DoH)

The supply of vaccine, currently about 14,000 doses per week, is not expected to increase for the foreseeable future, Alysia Mihalakos of DoH told the sub-committee. Phase 1 began in December with the most high-risk groups, frontline health care providers and nursing home residents and staff in Phase 1.1, moved on to frontline professionals in critical infrastructure such as firefighters and law enforcement in Phase 1.3, and will conclude with all persons 75 years of age or older in Phase 1.5.

RI COVID-19 vaccine Phase 2 proposal
(Source: RI DoH)

The main challenge, according to meeting facilitator Mckenzie Morton, is to specify eligibility criteria that can be “operationalized,” meaning that the state can readily deploy resources in accordance to match and verify eligibility. As a result, the principal criterion proposed is age, which is known to correspond to risk of hospitalization and death, so that Phase 2 would begin with all persons age 65 or older. After that, all adults with medical conditions that put them at high risk would become immediately eligible, and other adults without such medical conditions become sequentially eligible by age strata 60-64, 50-59, 40-49, and finally 16-39.

COVID-19 hospitalization and death by age
(Source: US CDC)

No vaccine is yet approved by the US Food and Drug Administration (FDA) for persons younger than 16 because clinical trials are still in progress, so there is as yet no data on safety and efficacy. As of last week, a national trial had recruited 800 of a needed 3,000 volunteer test subjects ages 12 to 17.

Social Vulnerability Index (SVI) by census tract, more vulnerable is darker, centered on Central Falls
(Source: US CDC)

Although age can be checked with commonly available identity documents, geography is also known to correlate with greater risk of infection, and the proposal is to prioritize in part using the Social Vulnerability Index (SVI) published by the US Centers for Disease Control and Prevention (CDC) that measures “potential negative effects on communities caused by external stresses on human health” with census tract granularity. Exactly how “geography” would be defined for vaccination was not discussed, leaving open such questions as, for example, how a teacher who works in Central Falls and lives in Exeter would be classified.

US CDC risk factors for hospitalization
(Source: RI DoH)

Although the CDC lists medical conditions known to be associated with increased risk of hospitalization and death from COVID-19, several sub-committee members pointed out problems with the CDC list. Relatively rare conditions, such as amyotrophic lateral sclerosis (ALS), which is commonly called Lou Gehrig’s disease, and Ehlers–Danlos syndrome, probably did not make the list only because of their rarity. It was observed that other conditions on the CDC list may be secondary in risk, such as Down syndrome that is often correlated with heart disease that is also on the CDC list. It was also suggested that substance abuse disorders can result in severe alcohol disease such as cirrhosis, which would put a patient at high risk, but this is not on the CDC list although a history of smoking is on the list. Mental health disorders can result in patients being unable to access reliable physical health care, putting them at higher risk from COVID-19 and also presenting difficulties in making sure they receive a required second dose of vaccine after the first.

RI COVID-19 risk factors for hospitalization
(Source: RI DoH)

Some conditions listed as high-risk by the CDC are so common that they provide little help in prioritizing vaccination, such as high blood pressure, high cholesterol, and obesity that each affect over 30% of the entire population of RI. Nor are such conditions grossly disproportionately reflected in hospital admissions: obesity is present in 25% of hospital admissions for COVID-19 in RI, less than its 30% prevalence. As a result, the proposal focuses on four specific conditions of known prevalence that account for a disproportionate number of hospital admissions in RI at least triple their prevalence: renal disease (22% of admissions, 2%/20,000 prevalence), cardiac disease (30% of admissions, 4%/34,000 prevalence), lung disease (19% of admissions, 7%/59,000 prevalence), and diabetes (30% of admissions, 10%/89,000 prevalence). The proposal also includes those who are immuno-compromised, either because of another medical condition such as HIV positivity or because they are on suppressive drugs as would be the case for organ transplant recipients, accounting for 9% of admissions but of unknown prevalence. (Some patients have more than one condition.)

While there was some concern about people claiming to have high-risk conditions due to anxiety to be vaccinated, DoH Director Nicole Alexander-Scott said that her preference was to follow a “self-attestation” model, essentially putting people on the honor system, especially because the eventual goal is to vaccinate everybody. If there are too many barriers requiring proof of eligibility, the concern is not only would this discourage people in legitimate medical need, but would likely disproportionately discourage the most vulnerable who may not even have a primary care practitioner (PCP).

RI COVID-19 vaccine Phase 2 principles
(Source: RI DoH)

Consistent with the frequently emphasized goal of equity, several members of the sub-committee raised the concern that COVID-19 has radically disparate effects by race and ethnicity, citing as an example a study that showed infected Black patients in their 50s have a risk of death comparable to those in their 70s among the general population. Rather than take race into account explicitly, the proposal intends the combination of geography and medical conditions to subsume race, as these factors are believed to be significant likely causes of racial disparity in health outcomes.

The proposal avoids distinguishing by occupation in Phase 2, which would be operationally difficult as well as requiring selections among, for example, teachers and grocery store workers, effectively putting different occupations in competition with each other for vaccine. Alexander-Scott said that more than half of teachers would qualify based upon age and medical condition alone, even before taking geography into account, reducing the need to prioritize teachers specifically. Jonathan Brice, a school superintendent representing educational interests, said that he would prioritize teachers who work with students unable practice mask wearing and physical distancing, either because they are very young, in his example kindergarten through second grade, or because they have special needs. It is possible that the federal government may make additional vaccine supply available and earmark it for specific groups such as teachers, Mihalakos said, but at this point there is nothing definite.

One of the main advantages to the proposed structure for Phase 2 is that it would allow communicating to the public approximately when any given adult could expect to be vaccinated, based upon the known supply of doses, one of the most frequently asked questions to DoH, Mihalakos said. If the supply increased, as is expected from additional vaccines being authorized by the FDA and greater production of vaccines already approved, it would be simple to recalculate the improved time estimate.

RI COVID-19 vaccine Phases 1 to 3 overview
(Source: RI DoH)

The final Phase 3 would cover children younger than 16 and all others not previously vaccinated.




Bills That Address the Pandemic Passed Out of Committee: Health and Human Services holds first 2021 meeting

Josh Miller, Health and Human Services committee chair

The Rhode Island Senate Committee on Health and Human Services passed three bills out of committee on Thursday night in its first meeting of the year. The bills would extend coverage of telemedicine and provide coverage for it under RI Medicaid and enshrine certain ACA consumer protections and varying health insurance premium rates based on gender.

“Our priority will have bills that are important to address the COVID-19 pandemic,” said Sen. Josh Miller (District 28 – Cranston), committee chair. He continued, “Future meetings will therefore address issues such as nursing home visitation, overdose prevention and access to healthcare in the hardest hit communities.”

While most of the bills passed unanimously, many among the public testifying last night were concerned over language in the Sub A of Senate Bill 4. The bill would extend coverage of telemedicine under Rhode Island Medicaid. Some industry groups from different outpatient specialties were concerned that their own field was left out, as only primary care and behavioral health are specified in the bill. Sen. Miller noted that the reason is that the provider networks for insurers were historically inadequate (pre-COVID) for primary care and behavioral healthcare, and that the reimbursement rates were much lower for the providers than other specialties.

“Already we have the data, both anecdotal and scientifically, on how access to behavioral health and primary care was improved based on telemedicine during the pandemic.” said Miller. He said not having that parity language for the two fields would be a big step back, especially if reimbursement rates for telemedicine were lower than for in person. The bill was introduced by Miller, and cosponsored by Sens. Gayle Goldin (District 3 – Providence), Bridget Valverde (District 35 – EG, NK, SK, and Narragansett), and Maryelln Goodwin (District 1 – Providence).

Senate Bill 5 protects consumer protections as they exist under the Affordable Care Act, laying out a list of essential services that all health insurance must cover if they wish to sell health insurance in Rhode Island. The bill was (again) introduced by Miller himself, with Sens. Ryan Pearson (District 19 -,Cumberland/Lincoln) Valerie Lawson (District 14 – East Providence), Meghan Kallman (District 15 – North Providence/Pawtucket) and Frank Lombardo (District 25 –  Johnston) cosponsoring. The list of essential services includes but is not limited to hospitalization, emergency services, prescription drugs, maternity and newborn care, lab services, preventative services, and more. The law is written so if the ACA was to be overturned and no longer be the law of the land, health insurance companies would still be bound by these standards in the Ocean State.

Cori Chandler of the American Cancer Society Cancer Action Network presented concerns in telephonic testimony that the current bill is missing elements they consider critical. She emphasized the importance of prohibition on life and annual limits. Prior to the ACA, insurance companies could limit the number of visits to services that would be covered under insurance plans, or just impose a $2,000 limit on coverage every year. 

Senate Bill 3 would prohibit insurance companies from charging different rates for premiums based on gender. The bill has been introduced in the past by Sen. Susan Sosnowski (District 37 – New Shoreham, South Kingstown), and as many testifers noted was a source of gender discrimination. Other cosponsors on the bill include Michael McCaffrey (District 29 – Warwick), Goodwin, Hanna Gallo (District 27 – Cranston/West Warwick), and Walter Felag (District 10 – Bristol, Tiverton, Warren). Laurie-Marie Pisciotta executive director of the RI Mental Health Association noted that males were more at risk for schizophrenia, develop it earlier and live with it longer than their female counterparts but the insurance premium rates remain the same.

HHS is the first committee to meet since the start of the term and the first to meet in a digital format. Only Miller and staff were present in the committee room. Other senators on the committee, including new appointees Sam Bell (District 5 – Providence), Alana DiMario (District 36, – Narragansett and North Kingstown) and Jeanine Calkin (District 30 – Warwick), attended using televisual software and broadcast on Capitol TV. Members of the public who wished to testify could either submit written testimony (of which there were 70 letters), or call into the meeting, giving the usual staid senate committee meeting a talk radio show vibe.

While the bills easily sailed out of committee, the work is far from done. Sen. Miller acknowledged the state Senate was now meeting once a week, down from its usual three times a week in the Great COVID Before Time. He acknowledged the testimony and concerns from the public, and proposed sending the bills out of committee onto the floor, and working out amendments as a committee to be presented when the bills are presented. Currently, according to Miller, the earliest the bills could be passed by a floor vote is a week from Tuesday.

“I would give us like a 91 on both technical and conduct,” said Miller, rating how the new format of the meeting went under the circumstances. “Calls were much better than I imagined they might. “




Opened and Closed

Opened

Five Guys: 63 Airport Rd, Warwick. fiveguys.com This greasy (tremendously unhealthy) burger chain opened a new location on Airport Road in Warwick, with a mobile pick up window that already has car lines going out into the street. 

Pizza Marvin: 468 Wickenden St, PVD. pizzamarvin.com This new pizzeria over in Fox Point boosts “New Haven-style inspired” pies, whatever that means.

Foodlove Market: 1037 Aquidneck Ave, Middletown. Opening this summer, they sell pre-made to-go meals made with local ingredients, from pizza to rotisserie chicken to groceries, sushi, poke bowls and more.

Air and Anchor: airandanchor.com An online jewelry and accessory shop started by a couple in Cranston. 

Zurner Oceanic: 40 Franklin St, Newport. zurneroceanic.com Opened during the pandemic, this nautical-themed shop sells … well, oceanic-themed goods. 

Charter Books: 8 Broadway, Newport. charterbookstore.com Taking its name from the 1663 doc that founded our state, this new bookstore aims to push more than just pulp, airport thrillers. 

Graze on Main: 58 Main St, East Greenwich. grazeonmaineg.com Across the street from the Greenwich Odeum (and hidden in the back) this biz curates cured meat and cheeses in specialty charcuterie platters.

Rejects Beer Company: 124 Aquidneck Ave, Middletown. fb.com/Rejects-Beer-Co-102299191680951/. The newest brewer in the East Bay. See story page XX.

Times Are Tough Gallery: Located literally in the breezeway of someone’s Middletown home, this gallery store sells prints, cards, jewelry. And can we get a big ol’ “No shit!” about the name? Visit fb.com/timesaretoughgallery to arrange a visit.

Closed
Eli’s Kitchen in Warren: This Warren restaurant, run by chef Eli Dunn, closed at the end of 2020. Dunn announced he and a couple of his partner chefs would open a new space at a new location sometime in 2021.




Gee, You’re Swell: Groundswell Cafe + Bakery pours the perfect cup for the new year

Resolutions are great, especially when they involve shaking off your 2020 coffee-run routines and reaching for a new cup o’ joe as we embrace a new year. In a push to get myself out of my caffeine rut, I ventured off-island (gasp!), and stumbled upon Groundswell Cafe + Bakery, an idyllic oasis nestled in Tiverton’s historic Four Corners neighborhood. The gorgeous cafe is built inside a gingerbread-trimmed house that looks like something out of a well-funded community theater’s production of Hello, Dolly!. I’m all for channeling my inner Minnie Faye (Hey, Rhode Island theaters! Cast me when it’s safe again!), so even before I stepped inside, I felt at home. Although the decor is decidedly vintage-inspired, the menu is thrillingly modern, with house made artisanal coffee and millennial-friendly nitro cold brew, plus a dizzying array of made-to-order sandwiches, pastries, salads and more. 

Of course the true mark of a great coffeehouse is their java, and Groundswell has some of the best I’ve tried in Rhode Island! The dark roast has some intense chocolate and caramel notes, and it’s the perfect antidote to a cold January afternoon, especially with some foamed oat milk poured in for good measure.

Of course, you can’t just drink a coffee without nibbling on one of their tasty pastries, and if you only get one thing, get a coconut macaroon. It’s a pint-sized patisserie that packs a punch of strong coconutty flavor, plus a deliciously soft texture that melts in your mouth. Bet you can’t eat just one (for the record, I had four)! Not into coconut? The strawberry crostata is equally masterful, with layers of flaky pastry giving way to the succulent berry filling beneath. I can’t wait to see what other seasonal specialties the Groundswell crew will think up as we saunter into the springtime and beyond.

Groundswell also serves up breakfast and lunch all day long, with an impressive array of offerings. I was particularly impressed with the egg white wrap, served on pillowy lavash bread, and the Instagram-ready pain bagnat, the cafe’s take on a French classic, chock full of rich and flavorful niçoise salad, ripe heirloom tomatoes and herbs de provence. There’s also a kids’ menu for the littlest caffeine-addicts-in-training, featuring a wholesome PB&J on homemade farmhouse bread, and an ooey-gooey grilled cheese that I may just have to ask them to make in an adult size when I return. Groundswell Cafe may not yet be open to indoor seating (new year, same pandemic), but the idea of curling up around their outdoor fire pit with a handcrafted mocha latte and a couple of Paris-perfect noshes makes for the coziest new hidden gem of the year. Santé! 

Groundswell Cafe + Bakery, 3883 Main Rd, Tiverton; groundswellcafegarden.com




New Year, New Providence: A roundup from ecoRI News

Providence’s 2021 Climate Resolutions

The Office of Sustainability and the Environmental Sustainability Task Force are launching major environmental initiatives for the new year.

Compost. The city is making another push for residential compost collection. A pilot program launched in 2013 had mixed results. The neighborhood drop-off service was funded by the city’s share of sales from recyclable items sold through the state’s central recycling facility in Johnston. But the program ended when the global free fall in prices for recyclable goods wiped out Rhode Island’s municipal profit-sharing. 

This time, the Office of Sustainability aims to tap into a portion of the $3.9 million the city spends annually on waste and recycling services to pay for a new program to manage food scrap.

Even if the City Council approves a composting resolution, it’s not clear if Providence will look to curbside food-scrap collection, neighborhood drop-off sites or something else.

Green purchasing. Health and environmental advocates are working with council member John Goncalves and the Office of Sustainability to create an environmentally preferable purchasing policy.

The resolution stems from a plan to ban single-use plastics at city buildings and schools. It grew to include increased use of renewable energy and purchases of non-toxic cleaning products. If approved, the city and schools would buy paper products with high-recycled content. Other purchases would be recyclable or made of recycled or reused material. The Office of Sustainability would work with city and school purchasing departments, including food service companies, to identify and eliminate items that pose health and environmental risks and contribute to greenhouse-gas emissions.

Climate justice. City Plan Commission meetings will address adding elements of the Climate Justice Plan into the city’s comprehensive plan. The changes include strategies to address environmental and climate justice, environmental health, renewable energy, transportation and mobility, housing and buildings, and a less wasteful economy.

Amendments to the comprehensive plan must be approved by the City Council. They are used to shape zoning revisions, land use, transportation planning and housing decisions.

So far, suggested changes to the comprehensive plan include creating “green justice zones” in neighborhoods suffering from pollution and economic inequality. The amendments make way for creating microgrids powered by local renewable energy and supported by battery-storage systems. Weatherization, jobs and job training are offered to improve quality of life and make frontline communities healthier and prepared to withstand climate-crisis impacts such as flooding and heat waves.

Getting the Gas Out of a Portsmouth Neighborhood

The Energy Facility Siting Board (EFSB) made quick work of denying a request by National Grid to exempt its liquefied natural gas (LNG) facility in Portsmouth from operating as a major energy source.

EFSB chair Ronald Gerwatowski said the storage and vaporization equipment being operated on Old Mill Lane was an energy facility and, as such, requires a license and adherence to energy-facility laws.

“There’s no ambiguity about it,” said Gerwatowski, during a December 18 meeting. National Grid “didn’t do a very good job of convincing me that it was temporary in any sense. The argument that it is temporary just doesn’t hold.”

He noted that the Old Mill Lane site was approved as a temporary LNG storage and fuel pumping center to alleviate the natural-gas outage on Aquidneck Island in January 2019. “But now it’s here as a multiyear solution for an uncertain number of years,” he said.

National Grid was given until June 1 to submit an application for an energy facility license. It could face fines if the deadline isn’t met.

She’s Making Cycling Better for Black Women

Allyson McCalla says you don’t need a spandex jersey and fancy shoes to ride a bike.

“If you have a bike and you have a helmet, we can make it work,” she said. “You can ride in jeans, you can ride in shorts, swishy pants, sweatsuits, spandex … you can ride in anything.”

The director of community outreach for the Newport-based nonprofit Bike Newport is on a mission to make bicycling accessible for everyone, but particularly for women of color.

“Since I’ve been biking — and I was biking probably about 15 to 20 miles a day — I didn’t see any people of color at all, let alone women of color,” McCalla said. “We’re really underrepresented.”

To change that, and to create a strong community of Black and Brown women cyclists, McCalla is starting a Newport chapter of the international organization Black Girls Do Bike.

Although many people of color do bike, bicycling activism and infrastructure is often targeted to a largely white demographic. A Rutgers University survey found that more than half of the people of color surveyed didn’t have confidence that their governments would add safe cycling infrastructure to their communities if they requested it.

For detail on these stories, and to get more of the latest environmental news, visit ecoRI.org. Subscribe to ecoRI News’ free weekly e-newsletter at www.ecoRI.org/subscribe.




Power Up with Plants

Sandra Musial, MD, is passionate about food, its impact on health and sharing that knowledge with others. So she, along with two other doctors who share her passion, started a group called Plant Docs. In pre-pandemic days, the Plant Docs ran five-week workshops in the basement of vegan food hall Plant City that taught people how to embrace a whole food, plant-based diet. “Pairing medical intervention with a restaurant is a cool concept,” said Musial. “It’s about health, but it’s also about enjoying food.” I recently spoke with Dr. Musial about the health-transforming power of plants.

Emily Olson (Motif): When it comes to their diet, what do Americans get wrong?

Sandra Musial: The traditional western American fare is leading to crazy levels of obesity, hypertension, diabetes, cancer. All of these are diseases of the western world. Countries that are still eating from the land have lower rates of all of these diseases. Instead of eating whole foods — fruits and vegetables, whole grains and legumes — people are eating highly processed foods with lots of added sugars, oils and refined flours. I work at a pediatric obesity clinic and there are kids who in an entire day will never eat a fruit or vegetable.

EO: School-provided lunches must drive you mad.

SM: I think if we improved school lunches, it would have a mass effect on the whole US population. And children would bring that education home. A few years ago, WIC [the nutritional program for women, infants and children] improved the quality of their food package by limiting juice and decreasing refined flours and flour products. The national rates of obesity in that 3- to 5-year-old range went down, and they think it’s attributed to this mass improvement in the federal WIC package.  

EO: What impact can a whole food diet have on health?

SM: You can reverse many of the diseases of the western world. Obesity, Type II Diabetes can be reversed, you can open some of the plaque in the coronary arteries. Studies have shown that end-stage cardiac patients, when put on a strict healthy diet, can add years to their life.

EO: Then why do we turn to medicine to correct these problems?

SM:  I don’t know that people are being told it’s an option. But if every doc said, “You can go on this pill that you can take for the rest of your life and have surgery and die early, or you can have a lifestyle change,” people still might not want to make changes.

EO: Is it an economic issue?

SM: There is some truth to that. Broccoli is more expensive than soda, but on the same budget, if you buy dried beans and that’s your protein, that’s the most economic and nutritious protein there is. It’s more complicated than that, of course. People who live in the inner city don’t always have access to fresh whole foods. And it’s a multigenerational thing. If that [style of eating] is all you’ve ever known, it’s hard to get away from it.

EO: So what’s the answer?

SM: I think we have to have a multi-pronged approach to education, and I think it has to start with one-on-one at the doctor’s office. Medical schools have to do a better job teaching future doctors about nutrition. And there needs to be more community and government involvement to reverse what has happened [in food policy] over the last 30 years.

EO: Tell me about the Plant Docs classes.

SM: We limited each class to 20 people who want to learn the importance of eating plant based. Each participant would meet one-on-one with a doctor at the beginning and the end of the series, and we’d send them to a lab for blood work during the first and last weeks. Participants come from all walks of life. We’ve had vegetarians who want to give up dairy and want more ideas for vegan cooking, and we’ve had people who are scared after a heart attack. If there were enough people, I’d love to do a series with special interest groups.

EO: Any final thoughts?

SM: [Holistic health practitioner] Ann Wigmore said, “Food can be the most powerful form of medicine or the slowest form of poison.” I love that. Our cells become what we feed them. If you feed them whole foods, they become healthy, boost your immunity and fight disease. Or you can slowly kill yourself. You really are what you eat.

The Plant Docs will resume classes when it is safe to do so. Email sandy@plantdocspvd.com to get on a mailing list. For more information, go to fb.com/plantdocspvd or plantdocspvd.com. Scholarships for classes are available.




Chaska: Garden City hot spot achieves perfection

I have been a staunch advocate and number one fan of East Greenwich’s Rasa, the most southern member of the Rasoi/Kabab & Curry restaurant group. Chaska, the newest member of that group has recently stolen my heart … with soup.   

Chaska opened up in Garden City a little over a year ago.  I went with some fellow Rasa-groupies opening week and we were all duly impressed the moment we walked in. Chaska is a feast for all the senses, as the décor is unmatched. Everything is imported and meticulously selected so your eyes don’t quite know where to look next. From the art work and light fixtures to the bowls and glasses, everything is gorgeous, unique and adds to the Chaska experience. It is truly something you need to see for yourself. The stellar service, food and drink also did not disappoint and we all vowed to go back to try more menu items, as everything sounded spectacular. Then COVID hit and, like all good plans, my plan to return to Chaska went by the wayside.

Fast forward to November 2020. Christmas shopping brought me, along with a few friends, to Garden City right before the pause. It was that gorgeous Saturday right after Thanksgiving, with a slight chill in the air, but nice enough to make outdoor dining sound exciting. We could not resist the siren call of the glistening igloos on Chaska’s patio and were lucky to score one as they were quickly filling up.

The igloo was perfectly cozy for our group of four, especially with the space heater going. Our friendly server quickly took our drink orders and we settled in with the menu, overwhelmed by choice and excitement.   

My eyes darted immediately to the house made coriander tomato soup. I cannot resist tomato soup, ever, but certainly didn’t want to waste my choice on something I can get at Panera at the expense of dishes like burrata tomato butter chicken and bagara baingan — eggplant simmering in a tangy peanut coconut sauce. But it was lunch, and the air felt chilly so I decided to give it a go. 

The soup arrived in a gorgeous hand-crafted bowl and the smell of tomato and warm spices filled our igloo. I put my spoon into the soup and got a bit nervous as it first appeared thin. But as I filled the spoon with soup and lifted it to my lips, my conception of tomato soup changed forever. 

It is not without irony that Chaska is hindi for “personal obsession” as this is the perfect description of my reaction to this soup. Chili and ginger added the perfect amount of heat to this soup, as the warmth lingered on my tongue and filled my chest. The combination of tomatoes and Indian spices like coriander and cumin, perfectly pureed together, made each bite a burst of flavor. The silky texture of the soup went beautifully with the garlic cilantro naan. Each bite filled me with warmth, spice and happiness.   Despite the germ factor, each of my friends tried the soup and agreed it was the best they’ve ever had. As I neared my last bite, I wanted to weep.  How could it be over already?  

I moved to my main course: a warm roasted vegetable salad with fresh greens and a roasted spice blend. Yes it was amazing and healthy and filling and I loved every bite, as I sipped my tamarind margarita. But my palette yearned for one more spoonful of the world’s most heavenly tomato soup.   I vowed to return soon, despite the impending pause and dropping temperatures.  

Sadly that has yet to happen, but soon I will don a hat and heavy blanket and make my way to that friendly, delightful patio in Garden City. In the meantime, my soul remains warm and fulfilled by a beautiful restaurant meal with wonderful friends; something for which – after 2020 – I will never again take for granted.  

If you plan to dine in an igloo, I recommend making a reservation. The igloos fit four comfortably and are available for lunch and dinner, weather permitting.  Home – Chaska (chaska-usa.com)




Granting Immunity: COVID vaccine roll-out stymied by lack of supply

“We’ve crossed the 30,000 doses mark… as of 9am,” said Dr. Philip Chan of the RI Department of Health (DoH) in a press briefing late in the afternoon on Friday, January 8. “This morning, 31,541 doses have been administered and 1,798 people were fully immunized, meaning they received their second and final dose of the COVID-19 vaccine.”

Vaccine Phase 1 eligible groups
(Source: RI DoH)

Currently, RI is in Phase 1 of its vaccination plan, having begun the first three of five sub-phases. New sub-phases begin before the prior sub-phase has completed, so for example Phase 1.1 that includes nursing home staff and residents is still in progress although Phase 1.3 that includes firefighters, police officers, and hardest-hit communities has started. Phase 1.4 that includes dentists, dialysis center staff, and funeral home workers, is expected to start the week of January 25. Phase 1.5, otherwise healthy people at least 75 years old, is expected to start in February or March. The limiting factor is vaccine supply.

Vaccination progress as of Jan 5
(Source: RI DoH)

“We wish there was more vaccine available to people in Rhode Island right now, where we’re efficiently distributing what’s been given to us by the federal government and we’re limited by the doses that we’re getting nationally,” Chan said. “Currently, though, we are getting enough vaccine to vaccinate roughly 1.5% of the entire population of Rhode Island a week. It’s not a lot, but it’s definitely some and we’re getting there. We are hopeful that the supply will open up soon, and there’s some evidence that this may happen in the near future.”

Vaccination timeline Phases 1-2
(Source: RI DoH)

Both of the two vaccines currently authorized, from Pfizer and Moderna, require two doses administered 3 to 4 weeks apart for full immunity. The Trump administration has been holding back half of the vaccine supply to make sure there are sufficient second doses, but the incoming Biden administration has been discussing a change in policy to ship out all vaccine as quickly as possible in hopes that production will increase in time to meet demand for second doses. The Strategic Advisory Group of Experts (SAGE) within the World Heath Organization (WHO) last week strongly cautioned against skipping second doses, a suggestion that has been made by some as a means of extending the supply, citing the absence of clinical data for extending the time between doses beyond six weeks. (There is no maximum interval, and if an individual misses the six-week window then they should still get the second dose as soon as possible.) The UK has contemplated making a 12-week interval standard, but there is no clinical data to support this.

Criteria for vaccine priority
(Source: RI DoH)

RI has not yet specified eligibility for Phase 2. With the current supply of slightly fewer than 14,000 doses per week, it will take more than 21 weeks to fully vaccinate with two doses the estimated 150,000 people in Phase 1, implying a timeline extending into May or June without a substantial increase in supply. The RI DoH Vaccine Sub-Committee at the regular meeting on the morning of Friday, January 8, discussed the principles by which Phase 2 priorities could be allocated, taking into account age, occupation and geography. A number of members pointed out that the Social Vulnerability Index (SVI) is already calculated by the CDC by census tract, and would provide direct socio-economic risk data rather than using geography as a proxy for it.

Social Vulnerability Index (SVI) by census tract, more vulnerable is darker, centered on Central Falls
(Source: US CDC)

RI stands in 13th place among the states in percentage of vaccine first doses administered out of those received, 30,264 of 72,175 (41.9%), as of Thursday, January 8, according to data from the US Centers for Disease Control and Prevention (CDC). RI is also in 13th place for number of vaccinations administered per capita, 2,857 per 100,000 population. While RI is well ahead of the nation as a whole, which has administered 6,688,231 of 22,137,350 first doses (30.2%), the state lags most of its New England neighbors in per capita first doses per 100,000 population, behind Vermont (4th, 3,579), Connecticut (7th, 3,261), Maine (8th, 3,082), and New Hampshire (9th, 3,079), but ahead of Massachusetts (22nd, 2,197). By contrast, states in the Deep South (Georgia, Mississippi, Alabama, South Carolina, Arkansas) at the bottom of the list have both utilization rates of their supplied doses and per capita vaccination rates less than half that of RI.

A major concern throughout RI DoH is the need to get accurate and authoritative information out to the public. “We’re starting to get reports and have been getting reports from across the country, including here in Rhode Island, of simply inaccurate and false information related to vaccines and other aspects of COVID-19… I do want to, again, encourage people to seek out information from reliable sources, like your primary care provider, and not from social media or other sources that can really be questionable,” Chan said. “I want to again reiterate to people that myself along with my other physician colleagues, nurse practitioners, health care professionals, have taken an oath to keep people healthy. Literally our job is your health, and we base our actions and advice on science and evidence.”




New Treatment Available: Monoclonal antibody treatments for all eligible RI patients

A new treatment for COVID-19 patients is available in RI to anyone who tests positive and is age 65 or older, or has an underlying health condition: a one-shot infusion of monoclonal antibodies. It is most effective when administered as soon as possible after testing positive, and it is hoped that it can reduce severity of sickness and prevent hospitalization.

Monoclonal antibodies are one of the then-experimental treatments given to Donald Trump when he contracted the virus and was hospitalized several months ago, as we reported (“Trump has COVID-19 and it’s not ‘karma’ at all”, by Michael Bilow, Oct 2, 2020): “The AP also reported he received an ‘experimental antibody cocktail’ which The New York Times reported contains Regeneron, an experimental bio-engineered drug made by Eli Lilly, which is in a class of ‘monoclonal antibodies’ that can be designed against a wide range of specific targets, including viruses, cancers and autoimmune diseases.”

At the Department of Health (DoH) press briefing on Friday, January 8, Director Nicole Alexander-Scott said, “Rhode Island now has a doctor-recommended treatment for COVID-19 that is extremely effective at preventing people from developing severe disease and from being hospitalized because of COVID-19. The key, though, is starting early: The earlier you start treatment after testing positive, the better and more effective this can be. After completing a simple infusion, intravenously, of this treatment, many people with COVID-19 start feeling better as early as the next day. The treatment does not require hospitalization, and it’s intended to help prevent people from actually having to be hospitalized.”

Dr. Alexander-Scott has repeatedly emphasized her strategic priority of reducing hospitalizations to protect health care services from being overwhelmed, and this is a major reason the state is pushing the new monoclonal antibody treatment as a matter of policy in addition to its significant benefit to individual patients. Treatment for infection is the third major prong of the state’s pandemic response, along with testing and vaccination.

The goal is to give this monoclonal antibody infusion to as many eligible patients as possible by making the eligibility criteria automatic. Dr. Alexander-Scott said, “If you test positive for COVID-19 and are 65 years of age and older, or you have an underlying health condition, immediately call a health care provider and ask about treatments for COVID-19 you should start with your health care provider.” Patients who do not have a health care provider can access TeleCARE at Brown Emergency Medicine – brownemtelecare.org – to get this treatment, she said, and general information about treatments is available from the DoH website – covid.ri.gov/treatment – directly. “So remember, as we’re expanding testing and you’re getting tested, if you test positive and you qualify, access the treatment that’s available. It makes a difference.”

Dr. Alexander-Scott strongly encouraged the use of the new treatment. “It’s available right away now for everyone who is positive and who qualifies. It has to be ordered by a provider, so your provider has the information. We’ve worked closely with our providers to make sure they know where the resources are, where the infusion sites are, how to get their patient connected, and then we also have the Brown Emergency Medicine TeleCARE option that was described so that you could call and speak to a provider online: That provider can order it for you, get you connected immediately with an infusion site.”

Eventually, the plan is to have infusion sites co-located with larger testing sites, so that eligible patients can get the new treatment immediately after testing positive by a rapid test. “We’re working to build out as many different infusion sites as possible, particularly at places where there is a lot of testing already occurring, so that you can just go to the next room if you’re at one of our testing sites that’s able to accommodate this and get access to the treatment. We want to get at every element,” Dr. Alexander-Scott said. “Thank you to some of our local clinical sites also that are partnering with us to make sure that this treatment can be available in all of the different environments that would work well.”




Dog Dance Parties, K9 Civil Disobedience, and Dog Island: An interview with the Peaceful Pack

Photo credit: Peaceful Pack

The Peaceful Pack is an animal boarding service located in Johnston that advertises itself as more of a home than a kennel. It is owned and operated by Ashly and Sheila Rose, and they recently invited me into their pack to talk about owning a business, working with your spouse and bringing pups to protests.

Erica Laros: How did the Peaceful Pack start?

Peaceful Pack: We met in 2012. We met and fell in love and we never left each other’s side since the first time we really hung out. That was 2012 and we got married in 2014. Bought the house and started the business in 2015 and six years later … with Max [their Australian Shepard]. We started off with Coco and Max. We had two dogs. We didn’t want to leave them behind and we didn’t want to miss anything. We didn’t want to miss the little footsteps of Max when he was a baby and Coco as an older dog mixing in with him and seeing their connection together. We didn’t want to miss any of that. She [Shay] was working corporate and I [Ash] was home here and we just kind of fell into it almost. 

We saw that there was a need and saw there was so much value and appreciation. You know when you do something and it’s different when you have an abstract thought about an idea and then you see the reality of it. Then you see when people have tears in their eyes. You can see that we’re really doing something. That makes a difference for one person and it multiplies. 

Even today we saw some dogs and we watched from afar and of course we were interested. We watched for a couple minutes. We saw the owner and hopped out of the car and said hi. We introduced ourselves really quickly and she was like, “This [meeting you] is heaven sent. You just don’t understand.” For us that is big. It makes our whole purpose worth it really.

Photo credit: Peaceful Pack

EL: So were you both dog lovers when you met?

PP: I [Ash] always have been in love with all animals. I’ve been working with horses since I was younger and I was always into animals. And I know Shay had dogs when she was younger as well… 

We are both pretty compassionate and sensitive souls. So those topics already– I [Shay] literally cry all the time. I am always involved in something creative or something that touches your soul a little bit deeper.  So that is already natural to me to be able to care on that level.

So it’s right in alignment with how we really are essentially and how we like to love. And what we learn from the dogs.

And how we like to live, too.

Because it’s a lifestyle.

We are definitely dog aunties and dog moms all the way. 

EL: Tell me a little about how you got the nuts and bolts of the business together. Did you consult a lawyer or friend for help or do it all yourself?

PP: We did everything from the ground up.

Literally learning as you go. Every single day. Even when you feel you have it down you are literally still learning something new.

Everything from talking to other dog boarders to getting a little deeper into that community and learning from them. Exchanging stories and contacts and really piecing things together that work for the way we want to run the business. We want it to feel more homey than a kennel. We don’t want 25 dogs just running in and out. We’re not in it for the money. We’re in it for the connection with the dogs and really serving them and making sure they get the mental exercise and the physical exercise and all the adoration and love they deserve. Because we don’t have long with them. So we have to get it in while we can. [laughs] We want to love them to the fullest. For us that’s an absolute privilege.

Even the fact that we also get to have our own dog [Max] with us makes it that much more fulfilling for us.

The Roses; photo credit: Desiree Boranian

EL: Max has so many friends.

PP: Yes! He loves it! And he knows them all by name. Literally you would be so shocked. Every single one, we will name specifically the dog and he [Max] will grab the dog and come back. He has such great talent.

…It’s wonderful.

EL: And you’ve taken the dogs to political protests. So they are getting their political action in there.

PP: [Laughs] Yes we have. Protests to Pride events to personal Pride events at clients’ homes where they’ve invited us to parties, and we’ve done some weddings. They’re pretty much with us wherever we are. And we are pretty much nowhere without them. [laughs].

EL: So some dogs got to attend to their first protest.

PP: [Laughs] Yes and they loved it. They learn to relax in the car and manage their state while there is a bunch of hectic things going on outside. 

That’s a big deal.

And for them all to be calm and watch everything around them. They’re in on it, and it’s kind of cool to see. We’ve taken them to events and parades and the dogs love it…

They are usually on their best behavior… like sprinkling [magic] dust on them [laughs].

EL: But you do some meditation with the dogs? And sprinkling the magic dust on them? Tell me is there some secret method you use when you have multiple dogs in the house and you want to ‘zen’ them? What’s your secret?

PP: It’s your own inner zen. They feel you as the pack leader — they feel your energy. So if you’re irritated or frustrated and you think it’s in your head and that you can keep it in, they feel all of that. So it’s important to get yourself to a state where you’re like let me relax first, sit down with them, usually it’s being with them present but your inner zen is there. As soon as you are calm, they can feel and it totally resonates with them.

We do have special little tricks though [laughs].

EL: I knew it.

PP: We do a lot of rotating. So meaning that our schedule varies their activities and we keep them busy all day long so when we take a break and sit down they understand the fact that it’s time to relax…We change the atmosphere. 

The music changes a little bit. It comes down to music like this [classical] where everyone is learning to relax and be quiet. The lights will come down. We actually did a little experiment the other day to prove our point where we played this type of music [classical] and everything was quiet-quiet-quiet. We had about seven of them that day. They were nice and quiet. Then we flipped it to some of our hip-hop music where we love to jam out and dance and have a fun time and the dogs love it, too. They party. 

…We love music therapy with the dogs. We do a little crystal healing. We do mini reiki sessions with the dogs. And we do meditations where we sit together as a pack. That could be anything [like] howling with the dogs– which our neighbors must love [laughs]. So we’ll howl with the dogs and they love it and they’re all riled up and then we’ll rotate into resting and sitting with them and loving on them for a little while. Then they’ll run around outside for a little while and we’ll take them on a little road trip. The varying activities are keeping their minds going, their little souls going…They love the varied activities. They love socializing and seeing other dogs. Six feet away obviously.

EL: Of course. Because dogs totally understand social distancing. 

PP: Yes they get it! [laughs].

EL: That’s amazing. What do you find as the biggest challenge of being a business owner?

PP: Trying to meet everyone’s expectations and trying to be available. We’re still just two people even though we want to serve the entire community. You’ll still come across time conflicts. Twelve o’clock is a big, big time everybody wants. 

EL: You also live and work in the same place. Do you have to create boundaries for personal space?

PP: We do create some time boundaries where we are open for appointment only.

That’s the best way.

EL: Who does the photography?

PP: We both do pretty much everything. We both work with and handle the dogs throughout the day. She does most of the driving. I’ll do invoices while she drives. We both do everything pretty much together. Any time we try to do anything separate we just come back to the point that we’re a pack and it’s easier for us and it flows better when we’re all together. Even with the dogs. Everything is with them and for them really. So if we’re not all together it doesn’t feel as in sync. So I think we share all of the responsibilities really equally.

EL: What would be your ideal space if money, land and number of dogs were no object?

PP: … [a] place called Rose Island…near Newport…the first idea that popped into my head is a big island with a whole bunch of dogs and us with G wagons. I just see so many dogs in a big field. I don’t know how that’s going to work. [laughs] [We] would need a boat to pick up and drop off the dogs.

EL: Maybe they could make it Dog Island?

PP: Definitely think a farm would be good for us…Little furnished human quality cabins that we would stay in on a big piece of property with big fields to run in and agility courses.  

EL: Any parting advice to pet owners?

PP: Listen to your dogs. Learn to understand what they want and what they need. When you make that deep connection with the dogs, you’re able to provide a better life for them. And that’s really what we’re here for as pet owners and pet moms and aunties. As caregivers we’re just here to provide for the dogs. A safe place to play. A place to be happy. [It’s important] to really listen to the dog and connect with the dog’s soul. Not just have a dog. It’s wonderful to have an animal, but it’s incredible to connect with that animal on a deeper level where it’s soul to soul.