Concerns Over Indiana's COVID-19 Response Haven't Changed, Even After 5,000 Deaths
More than 5,000 Hoosiers have now died from COVID-19. While state officials have tried to slow the spread of the virus, some health experts say it wasn't enough.
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To put that number into perspective; takes about 5,000 people to fill about 25 Boeing 737s, or four average-sized U.S. high schools. In 2017, the student population at Butler was 5,000.
Of the more than 250,000 fatalities across the U.S., 2 percent is about 5,000 fatalities. To put the massive loss due to COVID-19 in the U.S. in Hoosier terms, that’s about the population of Fort Wayne during the last census.
Where We Started
Indiana saw its first COVID-19 case on March 6. The first confirmed death followed on March 16. Gov. Eric Holcomb then issued a two-week long Stay-At-Home order on March 23, by then, seven Hoosiers had died due to the virus. Holcomb’s order shuttered all non-essential businesses, limited gatherings to 10 people, and penalized anyone who violated the order.
The order was then extended through May 1.
On May 1, Holcomb announced the Back On Track plan, meant to help ease the state into safe levels of reopening. The plan would strategically open certain businesses as well as provide a benchmark so the state could assess what direction to move the state in, based on state data. Meanwhile the state recommended the use of face masks or coverings, but no order would exist until July 27.
“Today I can report that thanks to the discipline and actions of 6.7 million Hoosiers, we are ready to move ahead in a measured way,” Holcomb said, introducing the plan during his May 1 COVID-19 update.
Then, slowly, but surely, March restrictions began to be lifted. The state was supposed to reach Stage 5 by the Fourth of July, but instead pushed the date to Sept. 23. Stage 5 would remove most of the COVID-restrictions, but Holcomb’s mask order would remain effective, even if difficult to enforce.
“Because of the progress that we’ve made, over the last not one week, two weeks, three weeks, but going back now for a few months that steady progression has occurred, we’ll be able to move onto Stage 5 of our Back-On-Track plan,” Holcomb said.
Where We Are
It’s now been almost three months since Indiana moved to Stage 5 and reopening. Since then, the state’s broken 15 records including the number of positive cases in a single day, hospitalization rates and pretty soon, deaths.
In the early days, much of the state’s focus was on not overwhelming the hospital system and its staff. There was a push to make sure enough ICU beds were available to keep up with projected trends, as well as enough personal protective equipment and ventilators. Health care officials also called on Hoosiers to get flu shots as a way to help curb the need to visit hospital emergency rooms, or need hospitalization due to the flu.
Dr. Ram Yeleti is the chief executive physician with Community Health Network in Marion County. He was one of the first Hoosiers to deal with COVID-19 head-on. Yeleti led the team that treated Indiana's first COVID-19 patient in March, and then contracted the virus himself.
He said when COVID-19 exploded throughout the state the first time, his concerns were on inadequate staffing, PPE and ventilator shortages, and testing. Yeleti said while the state managed to get PPE, ventilators and testing sorted out, staffing remains an issue.
“The thing that I lose sleep over is that there will be no hospital beds available in the city of Indianapolis because we’re overwhelmed, because we have no staff,” he said. “The problem we’re gonna face this time is that building a field hospital won’t work because we won’t have any nurses to staff it.”
Yeleti said, to make up for the staff shortages, hospitals will have to scale back on other services they provide, which will affect the communities these hospitals serve.
Hospitals around the state are already having to reschedule some elective surgeries and are at capacity, with many having to go on diversion, and unable to accept transfers. COVID-19 is not only placing a strain on hospitals, but on communities themselves as new cases continue to surge.
While the state worked out logistical issues to get supplies where they were needed, health experts tell us it fell short with its one-size-fits-all approach to communications, contact tracing and enforcement of mandates – especially in many rural and minority communities.
Brian Dixon with the Regenstrief Institute said many of these communities were already dealing with disparities and inequities that were exacerbated by the pandemic. He said pandemic, or not, the state should have had established working relationships with community organizations and groups that know the needs of those communities to help address these problems.
“I think the state could have done a better job helping local health departments put restrictions in place when things got bad in that area,” he said. “That the state is advising them to do so, but not necessarily helping them as much with enforcement as much as they could.”
Representation matters in public health, too, according to Dixon. He said enlisting the help of health care liaisons already in those communities can streamline processes like contact tracing, and translating information to cater to the needs of communities these workers already know.
“The best medicine is prevention,” Dixon said. “I think if we could have gotten ahead of this with some of our communication, that these are the strategies that you should be using in all communities across the state, to prevent getting this disease in the first place, we wouldn’t have gotten to the point that we are right now, with rising case numbers, exponential growth, hospitals filling up, that would not be our situation if we would have tackled this through prevention early on.”
Dixon said communication was also critical in implementing, explaining and enforcing mask mandates. He said the state could have done more to communicate the strategies and importance of wearing a mask.
He said the confusion at the beginning of the pandemic over whether or not masks should be used only made things more complicated for these communities that were already hurting.
“The overall kind of lesson here is that, the more restrictive policies, people don’t seem to be able to tolerate them for very long. They seem to be willing to take a two week break from work and go back to spending time with the kids and baking, but then they get tired of that and then they don’t want to put up with that anymore,” he said.
Dixon said having not implemented a universal mask mandate with consequences early on also made way for the debates about personal freedoms and wearing masks, and made it harder to get Hoosiers on the same page.
However, he notes that some counties, like Monroe and Marion extended, and added penalties for those that did not abide by their stricter measures, and they’ve each found success with their ordinances. In the most recent action by the state to try and curb the pandemic, counties will be required to follow guidelines based on the state’s color-coded map that follows metrics by county.
As deaths from COVID-19 continue to rise, Dr. Yeleti said he dreads the next several weeks. Based on his projections, he’s waiting on the day he won’t have enough staff to deal with the rising number of hospitalizations.
“I’m not trying to say the sky is falling, but I do lose sleep over that. That’s a very real catastrophic possibility in the next few weeks. By Christmas time,” he said.