The problem of inclusion and fairness

I began writing this post last March. And then a pandemic happened and circumstances changed and I abandoned it. But I think the discussion is just as relevant now, if not more so. So I’m going to attempt to dust it off and finish writing it. Here’s how I began…

There is a fairly well-known image that is used in discussions about equality. The picture shows 3 children of different heights trying to watch a baseball game over a fence. In the first frame, each child has a crate to stand on, but only the two tallest children can see over the fence. This frame is labelled “Equality.” In the second frame, the tallest child has given his crate to the shortest child. Now all the children can see. The image is labeled “Equity.”

Over the years the image has circulated, the quality of the graphics, the labels on the message, the symbols have been debated, and the interpretations have been varied. Below is a common one used in education and discussions. The 3rd frame is often labeled “inclusion” and represents the systemic barriers being removed.

Equity-Equality-Graphic-blog

It seems that I have been having a LOT of conversations lately about how to include Patrick. Since the start of the (2019-2020) year, we’ve had a lot of new transitions. And that means we’re trying to figure out how to fit into a lot of new settings.

The biggest one has been over the subject of P.E.

Here’s what happened. One of my best friends at Patrick’s school was also working part-time as the elementary school P.E. paraprofessional. (a.k.a non-credentialed teacher.)

One day, she called me up FUMING about what was going on at the school. Apparently, they were having trouble with some students choosing not to participate during P.E. and other “specials” classes. The principal had told the teachers that they needed to give a grade for the class, and since it was a pass/fail class, they were looking at giving failing grades to students who refused to participate.

Enter Patrick. Patrick has a combination of disabilities that prevent him from participating fully in a regular P.E. class. He has cerebral palsy that makes it difficult to control the muscles, particularly those in his legs, especially when running. He has visual tracking problems from his brain injury that make it very difficult for him to follow a ball. He has trouble with motor planning, meaning the ability to think through the steps of a motor process that, for others, wouldn’t be consciously broken down. He has serious ADHD that make it hard for him to focus in a chaotic environment. He has working memory impairments, or in other words, problems with his short term memory that mean he can suddenly forget what he is supposed to be doing. And, to top it off, his transplant puts him at exceptional risk of injury from a fall or a blow to the abdomen and he is required to be excluded from contact sports. (Dodgeball, anyone?)

Patrick’s IEP provides for “adaptive P.E. services,” meaning that instead of being required to pass a regular P.E. class, he gets to work with a special P.E. teacher who adapts P.E. to his abilities and works on specific goals.

The problem is this.. Patrick is in a mainstream classroom. And the schedule of that classroom includes the class going to P.E. while the teacher used that time as prep time in the class. And, even though I knew he couldn’t really play, I didn’t see much harm in allowing him to go to P.E. because that’s what his classmates were doing.

But apparently, what was happening was that Patrick, unable to do what the rest of his class was doing, would try to visit with the adults. His para would tell him he needed to go play, and because he couldn’t, he wouldn’t. He’d just sit on the side and patiently watch.

So, when they started talking about who should receive a failing grade for not participating, Patrick’s name made the list.

My friend was furious because she knew this was wrong. Let’s be honest. No one would have been talking about failing a kid in a wheelchair for not doing P.E. We’d had multiple conversations about what he should and should not be doing as she’d made her lesson plans. So she went to an administrator, who pulled the IEP, marched it into the principal’s office, and demanded that he intervene.

Patrick didn’t fail P.E. But it made some of the staff who work with him angry about how “unfair” that was to the other students who saw him not playing.

But it made me aware that I had not done enough in setting clear expectations for P.E. with the school. Enter advocate mom. I called for a special IEP meeting to get clear adaptations written.

Now, Patrick attends an exceptional school. So when I went into the meeting saying that I needed them to make a plan specifically to allow Patrick to be excluded from the P.E. requirement, they insisted instead that they needed to write a plan for him to be included instead.

Plan A. that they wrote didn’t work. Plan A was to require the paras to lead alternative activity for the students (yes, multiple) who could not do the regular P.E. activity and were sitting out. The argued that they kids who were choosing not to participate would choose the easier activity instead. (In hindsight, I disagree with this opinion. Why not allow mainstream students to sometimes do adapted activities? That’s inclusive, right?)

On to Plan B. My friend, because she knew us personally and cared enough to see the individual, started go over her lesson plans with me at our weekly breakfasts. We’d decide what Patrick could do that was related to her plan. Sometimes, that was giving him a special role in a game. (Basket holder, line judge, etc.) Other times that was giving him a simplified version of the activity. (While the other kids shoot hoops, Patrick will practice passing with the help of an adult.) I dropped in on class unannounced and helped to model what this would be like for the staff that was there.

Plan B is what worked.

And it got me thinking a lot more about inclusion.

In children’s Sunday School, we run through scenarios regularly about how to Choose the Right. And a common example is “There’s a new kid” or “There’s a kid others don’t like” or “There’s a kid who isn’t good at a game” … anyway.. there’s a kid, and the other kids don’t want to let them play or let them eat lunch with them or whatever. What do you do?

The answer is, you let them play anyway. Right?

But is it inclusion if it stops there? Is it enough to “let them” attend? Was it enough that Patrick was sitting in P.E. on the stage alone? He didn’t mind. He didn’t want to play. If you asked him to get up and do what the other kids were doing, he’d give a polite “nah.” He was fine, right? He was welcome.

But is that inclusion?

Look again at the picture at the top of the page. The short kid is invited to watch the baseball game. He’s even given a box. It’s totally fair.

Or is it? Is it more fair to give him the box the tall kid is standing on? That way at least he can see. But the tall kid doesn’t get a box that way. Isn’t it more fair for every kid to get a box?

The thing is, adaptation isn’t fair. But it’s at least a start.

One of the things I love about distance learning is that I’m in charge of the school day, so Patrick actually gets all of his accommodations. We use a Kindle with OpenDyslexic font for reading. He can use special manipulatives or a calculator or Google Home to help with math. And he’s getting very good at using Google Read and Write and other adaptive technology.

Adaptations level the playing field so that physical limitations don’t get in the way of him reaching his potential. In P.E., adaptations were changes to game rules, simplified activities, or special equipment. Patrick’s school spends a lot of time teaching him to advocate for his accommodations. One way we as a society can be more inclusive would be to not push back against allowing these when they are justified.

But inclusion CAN be more than that. Because true inclusion sometimes means being willing to change the rules for everyone.

Think, for example, of food allergies. If someone has a life-threatening food allergy, adaptation would say that you allow that person to bring their own food to lunch, instead of eating what everyone else is eating. But if others at the table are eating the allergen, inviting and allowing differences is still not enough. Allergens can be spread by touch, and so we have nut-free classrooms and even nut-free schools. That’s the only way, literally, than a child can safely come to the table.

If done right, inclusion benefits more than just the person with the most apparent need. But it takes some creativity.

Here’s an example. I taught a Sunday school class for 3 year olds. We had one student who every week hid under the table. We had another student who always wanted to remove her shoes. Yes, we could have said that the rules required that everyone sit on their chairs and wear their shoes. And everyone would have learned the rules. But a couple would have spent so much energy on that lesson that there’d have been no time to talk about Christ. So what did we do? We put away the chairs and we sat on the floor. Everyone was allowed to have their shoes off if they wanted. And kids under the table could see the pictures. The only rule was that they had to allow other kids to have a turn under the table, too. Because ALL 3 year olds are sensory creatures and the adaptation that one needed benefited them all.

But inclusion also means being willing to let go of traditional ways of doing things sometimes. And I think that’s the hardest part.

Sometimes, when I get to speak to a group of Patrick’s peers about inclusion, I read them the book “Can I play too?” by “Mo Willems.” Here’s a read along if you don’t know the story:

I like this story because it really captures in a lot of ways what it’s like to try to play when you have a disability or other difference.
1) We don’t always know how to make it work when we start trying to play.
2) A lot of times, what we try fails.
3) After enough failures, the person with the difference will decide they are causing too much trouble and withdraw.
4) Some of the best solutions are the ones people might never have considered.

This is why I love adaptive sports. Because they remove the primary obstacle to inclusion: winning. They also toss out several rules. I remember attending one adaptive baseball game where a player wanted a hit. So they threw him 27 pitches. 27 misses, and then he knocked it out of the park!! And the crowd went wild as he ran his home run.

This is the picture where the wooden fence has been replaced by a chain link. Where there isn’t an obstacle that gives some an advantage over others. This is what people are referring to when they talk about systemic problems.

For Patrick, being graded on participation a typical P.E. class was a systemic problem.

2020 made us acutely aware of so many other systemic problems. The inequalities revealed in our healthcare system, in our justice system, and so many more all came to the surface in violent and devastating ways. And I think a lot of us feel absolutely helpless in the face of systems that we don’t have any idea how to change.

Because, let’s be honest. Inclusion isn’t always possible. Not all sports can be adaptive. Not all diets can be nut-free. You can’t just say you want a system with more social programs when those programs don’t yet exist. We need to be challenged by school or sports to grow, and that means pushing people to their limits.

You also can’t force inclusion. Another thing that 2020 has shown us is that mandates are met with opposition. That opposition comes because broad mandates create new systemic problems that make people feel overlooked.

The thing is that MOST of us really are trying our best. Most of us do care about doing what is right. And what most of us crave most deeply is to feel seen and valued. Especially for our best efforts, even when they are inadequate.

Columnist David Brooks put it this way:

“Many of our society’s great problems flow from people not feeling seen and known.”

David Brooks, “Finding the Road to Character,” October 2019

He went on to say that a trait we all have to get better at is “the trait of seeing each other deeply and being deeply seen.”

Inclusion doesn’t happen by pulling one group out of the shadows and pushing another into it. This is one of the great risks of today’s cancel culture.

It may be an unpopular idea, but I’m not sure that systems CAN be fixed from the top down. Instead, I think that if we want to see our society change in a significant way, it’s going to need to be something that happens on a much more intimate level.

Here’s another great quote:

I believe the change we seek in ourselves and in he groups we belong to will come less by activism and more by actively trying every day to understand one another.

Sharon Eubank, “By Union of Feeling We Obtain Power with God”, October 2020

To be honest, when large-scale changes have been made to try to include Patrick, the result has almost always been awkwardness that made us ALL pull back. Plan A where they ran a whole separate P.E. section for him would have made everyone feel uncomfortable.

But Plan B worked precisely because it was personal, thoughtful, and simple.

We simply need to start seeing each other.

I think we also need to extend each other more grace. If mortality is a school, then we are all going to make mistakes as we learn. We will all sometimes be on the giving side of some hurts. We would benefit from being as quick to grant forgiveness as we are eager to receive it.

On Valentine’s Day this year, I knew that traditional Valentine’s parties were going to leave out every student who was learning from home. As PTO president, I had some power to try to make things better. So, in addition to providing usual support for valentine’s parties, I spent several hours creating virtual valentine’s exchanges, online games and other activities that could be played with the students both in class and those connecting digitally from home.

Patrick’s sweet teacher went out of her way to buy craft supplies so that the class could make each other valentines. And she instructed the class to remember the kids at home and make them for them, too.

But that left home learners entirely on the outside. they were remembered, but not included. And, I’ll admit, after all my effort, I was hurt to still be literally on the outside looking in.

Some attempts at inclusion are a BIG miss.

But that doesn’t change the fact that he has a teacher who very truly cares about him. Who stays late sometimes just to visit with him after the other students have gone. Carrying that hurt would only hurt me. The slight wasn’t intentional.

Where am I going with all this? I’m not sure I exactly know.

I do hope, though, that if I make our experience seen that it will help as we all try to do better at seeing each other. We have too much anonymity in our society. It’s easy to get caught up in “us” and “them” when you speak generally.

But the more you get to know people as individuals, the more natural it is to try to love and take care of each other. What is that quote? “people are hard to hate close up. Move in.”

In other words, we do start with that sunday school answer. We notice the people sitting on the sidelines and we invite them. But it goes a bit deeper than just inviting. We get to know them.

And then we consider each other’s needs. And we make ourselves open to different ways of doing things. We try. If we fail, we forgive and we try again.

Make me no promises

How do the lyrics go? “Make me no promises. Tell me no lies.”

Photo by Nataliya Vaitkevich on Pexels.com

There’s a problem with the messaging being published right now about vaccines. Every day I see a new headline with the title “I’m Vaccinated, Now What Can I Do?” or “Can You Hug Your Grandkids After Getting a COVID Vaccine?” “COVID-19 Vaccine Doesn’t Mean You Can Party Like Its 1999.”

They all carry the same message. Getting a vaccine doesn’t mean you can let you guard down. Nothing is 100%.

The problem is, it’s way underselling the effectiveness off the vaccine.

I saw a viral Facebook post yesterday that, basically, said that if vaccinated people still have to wear masks, still have to distance, can’t hug their grandparents, etc. then vaccines don’t work and they aren’t worth the risk.

THIS MESSAGE IS WRONG.

So how did we get here?

Well, to start, science knows its limitations. Research studies, especially medical research studies, publish a summary not just of the successes, but of the failures. Therefore, there is no 100%.

Then, there’s the problem of medical malpractice and informed consent. If you’ve spent any time in the medical world, you’ve probably observed that doctors tell you every risk, every worst case outcome. It’s part of their job that you know exactly what might go wrong. No one wants a devastating, unforeseen outcome. Especially since, when one happens, malpractice suits often follow.

Doctors are trained not to promise outcomes that cannot be guaranteed. This is why our introduction to Patrick was “life expectancy of 1-2 years.” Before his adoption, the GI who was treating him sat me down and spelled out in great detail how very difficult his life would be. For an hour. Most NICU parents can recount a similar experience where they were told about poor quality of life and low risk of survival and were left convinced there was no hope. This is why the term “defy the odds” is used so commonly in our circles.

The problem with this approach is that it often misrepresents the odds. Skews them towards the negative. Even when prognosis is good.

I’ll be honest, years of being told “the odds” related to Patrick’s transplant had me so terrified that I considered turning down the offer when it came. I cried the entire flight from Utah to Nebraska. Did he defy the odds? Or are the possible wonderful outcomes the exact reason why we take medical risks?

The truth is that, in most cases, the odds being emphasized about are the long odds. The long shots. The off chances.

So if you’ll humor me, I’d like to share some of the answers I wish were being emphasized in response to the questions in the headlines. I’ll follow by explaining what this information means for our family and vaccines.

The questions here come from the social media post my friend shared yesterday.

“If I get vaccinated can I stop wearing a mask(s)?”
At first, no. This partly because we do not know much about the risks of spreading the disease and because of variants. But I suspect there’s a behavioral motive, too. Early experience taught us that some health rules are better universally adopted. It’s easier to encourage everyone to wear masks than to try to split hairs about who should wear them and who shouldn’t. Mask mandates will lift when case counts decrease to safe levels.

A personal aside: Given that mask-wearing, distancing and quarantining when sick have essentially eliminated the influenza that has been a public health crisis for years, I hope we never fully abandon mask wearing.

If I get vaccinated will the restaurants, bars, schools, fitness clubs, hair salons, etc. reopen and will people be able to get back to work like normal?”
Accomplishing this goal will require many people to be vaccinated. In order to resume normal business, we’ll need to reach a certain level of herd immunity. That’s defined as somewhere between 60-90%1 of the population having immunity. We can accomplish this the slow destructive way, by just letting the virus run until 60-90% of the population has caught the virus, keeping precautions in place so our hospital system doesn’t collapse. Or we can do it the faster, safer way, with vaccines. Experts hope that herd immunity will be acheived by summer or at least fall, when most people have had the chance to receive the vaccine. A lot of that depends on our choices. Herd immunity is the point at which business will return to normal, or something like it.
1. https://www.nytimes.com/interactive/2021/02/20/us/us-herd-immunity-covid.html

“If I get vaccinated will I be resistant to Covid?”
Yes. Don’t dwell on the odd outliers. No medical treatment comes with a 100% guarantee. But with the current vaccines, we get pretty darn close to it. In studies, the Moderna and Pfizer vaccines showed 90% effectiveness in preventing moderate to severe illness for those who received both shots. However, the 10% who still experienced mild disease were.. well, mild. In other words, these two vaccines have nearly 100% efficacy in preventing or reducing your risk of severe illness, hospitalization and death.2 Data in the general population is following the same pattern. Johnson and Johnson’s vaccine shows 72% efficacy in studies. (66% overall). However, it was 85% effective in preventing hospitalization and death.3,4
2.https://www.sciencemag.org/news/2020/11/absolutely-remarkable-no-one-who-got-modernas-vaccine-trial-developed-severe-covid-19?campaign_id=9&emc=edit_nn_20210118&instance_id=26125&nl=the-morning&regi_id=94133618&segment_id=49584&te=1&user_id=b1e0880472a5057b2471cc3672dea780&fbclid=IwAR2yregj5DNSXDv9XbidrmP7lhCVlnIqpj6dti58ar2S9E3cvY4T3u3WYHI
3. https://www.nytimes.com/2021/01/29/health/Covid-vaccine-explainer.html?campaign_id=9&emc=edit_nn_20210201&instance_id=26625&nl=the-morning&regi_id=94133618&segment_id=50744&te=1&user_id=b1e0880472a5057b2471cc3672dea780&fbclid=IwAR2dLw3v_WpX2Cr9XuLd-nBI4scgcoD8ldGe1ZMR6EPiO85Q7Iwqz-Y-D6U
4. https://www.jnj.com/johnson-johnson-announces-single-shot-janssen-covid-19-vaccine-candidate-met-primary-endpoints-in-interim-analysis-of-its-phase-3-ensemble-trial

“If I get vaccinated, at least I won’t be contagious to others – right?”
We hope so. However, there are some vaccines, such as the one for polio, that still allow carrier transmission of the virus. And no studies have been done to see if the vaccine provides mucosal (as in in the mucus of your nose) immunity. That would require swabbing a whole bunch of vaccinated people and no one has done that yet. We are still early enough in this disease to be working in hypotheticals. And it’s better to err on the side of caution. So, they recommend that you assume you may still be able to be a silent carrier of the disease.

That said, studies have shown the AstraZeneca vaccine does reduce contagion.5 The Pfizer vaccine showed significant protection from spread in animal trials.6 In general, vaccinated people, even when infected, carry less of a virus than an unvaccinated ill person.6 Reducing the number of infected people is likely to reduce spread. So while we don’t know and caution is still warranted, there are early signs that vaccines reduce spread.

And if there is still a chance of spread by vaccinated carriers? That’s an even stronger argument for more people to be vaccinated.
5.https://www.nytimes.com/live/2021/02/03/world/covid-19-coronavirus?fbclid=IwAR1tjCFBfNX5ykwhaKaBCx2crCjOPmeorZM2GElbVvPJqhwZR71zci1NHOE#astrazeneca-coronavirus-vaccine
6. https://www.bbc.com/future/article/20210203-why-vaccinated-people-may-still-be-able-to-spread-covid-19

“If I get vaccinated, how long will the vaccine last?”
This question is tricky, because we don’t have data yet. The vaccines themselves are less than a year old. Experts predict at least month and possibly years.7 This comes from an understanding that contracting the actual illness provides at least 3 months’ protection, but a recognition that there are cases of reinfection. Different people will have different immune responses. Also, Covid like other viruses can mutate. It’s possible that an annual shot, like a flu shot, might be necessary to keep up with mutations. Only time will tell. However, don’t mistake a lack of information with a lack of effectiveness. The vaccines do protect you from the virus and continue to do so in study participants.
7. https://www.kgw.com/article/news/health/coronavirus/vaccine/verify-how-long-will-immunity-from-the-covid-19-vaccine-last-no-one-knows-for-sure/531-86718292-cef8-4e81-9c54-4333aafbae65

“If I get vaccinated, can I stop social distancing?
It’s hard to make recommendations with less than a year’s data. So the safest recommendation is to continue distancing. As a society, we need to keep social distancing until 1) We establish a certain level of herd immunity, 2) We know more about the effectiveness of the vaccine on current mutations. Remember the behavioral element of this recommendation. It’s easier to tell everyone to distance than to try to distinguish who can safely do so and who can’t.

However, because the vaccines greatly reduce risk, it may be relatively safe for vaccinated people to gather in small groups. Remember that vaccines are only effective 2 weeks after the second dose. And for contact tracing purposes, it’s still best to keep these gathering small and make sure there is no contact with unvaccinated people.8
8. https://www.radio.com/kcbsradio/news/can-vaccinated-people-socialize-safely-with-each-other

“If my parents, grandparents and myself all get vaccinated can we hug each other again?”
People with weakened immune systems may have a weaker immune response to a vaccine than a younger, healthier patient. So there is a possibility that you could pose a risk to an immunized grandparent, especially if you haven’t yet been vaccinated.. If you want to 100% safe, experts say you shouldn’t hug. But they also recommend common sense.

Lucy McBride, a primary care doctor, gave this advice,”If we want to 100% avoid COVID risk, the answer is no. If we want to consider emotional and physical risk and reward in tandem, for our family, the answer is yes because the emotional benefits of hugging an immunized grandparent greatly outweigh the very small risk of sickening or endangering anyone involved.”9 Hugging is safest if everyone is fully vaccinated and at least 2 weeks after their second shot.

I love these other words from Dr. McBride. “We can and should allow ourselves the pleasure of looking forward to the days when we and our loved ones are vaccinated, because our risks of being together will be so very low and the benefit to our mental health high.”9
9. https://www.webmd.com/vaccines/covid-19-vaccine/news/20210203/covid-faq-i-got-the-vaccine-is-life-normal-again?fbclid=IwAR3x4XjLQfPe0t82WdKvXKhNytQQwEdocDACshhLmi43xOaDX_dVIarcO5o
10. https://www.theatlantic.com/ideas/archive/2021/01/giving-people-more-freedom-whole-point-vaccines/617829/

“So what’s the benefit of getting vaccinated?”
If there’s so much we don’t know and the vaccine isn’t the golden ticket, is it really worth the risk? After all, a fast developed, limited study vaccine sounds risky, right?

One thing is abundantly clear from all the data. All of the currently approved and soon to be approved vaccines will reduce your chances of contracting COVID, reduce the severity of your illness if you do, and make you less contagious. Also, it is the fastest way to quickly and safely reach herd immunity.

“Are you sure the vaccine won’t injure or kill me?”
Doctors never say they are sure. However, clinical trials show the vaccines to be remarkably safe. And the rapid vaccination effort in the country provides extra assurance as we have data from 22 million currently vaccinated people. There is a risk of anaphylaxis in those with a history of allergy. That risk is treatable. A few incidents of reported death do not seem to be directly linked to the vaccine, but are being studied. Only 1,000 adverse event reports would be considered serious. Compared to 22 million, that number is very low. Meanwhile, these vaccines themselves are being highly and very publicly scrutinized. As for Bell’s Palsy, which has received some viral internet attention, in studies, there were actually many more cases in the control group than in the vaccinated group. Incidents of other events such as heart attack, stroke and embolism in the vaccinated group were the same as would be expected in the normal population. Some of these events will happen in any group of people.11

Overall, the risk of severe illness and death from COVID-19 is much, much higher than the risk of death or injury from the vaccine.
11. https://www.usatoday.com/story/news/health/2021/01/28/covid-19-vaccines-cdc-safety-data-pfizer-moderna-coronavirus/4281434001/?fbclid=IwAR0yVbrFJgmh0JCA5QXcq17qyD-8Y6YAdCqpJER_zKowouGDq9CIdquaDl0
12. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/adverse-events.html?fbclid=IwAR3zADlbswgiETfRL6uN_yZJE9UY2jc_erVQZWEvFe3ZKs22Sn74e1D3qVM

“If statistically the virus won’t kill me, why should I get vaccinated?”
Vaccination protects you, your family, and society at large. True, COVID has a 99% survival rate. But in a country with a population of 328 million, that’s still 3.2 million people who could die. 10-15% of COVID cases progress to “severe disease.” 13 For every person who dies of covid, at least 4 others were hospitalized. The financial impact alone of that many hospitalizations, many lasting months, is significant on businesses, healthcare systems, and especially individuals. 76% of hospitalized have long-term symptoms of the disease.14 20% of reportedly healthy 18-34 year old patients report long-term effects of the disease. 13 And when hospital ICUs are above 80% capacity, the risk of death from other factors such as car crashes, heart attacks and strokes increase as well.15
13. https://www.who.int/docs/default-source/coronaviruse/risk-comms-updates/update-36-long-term-symptoms.pdf?sfvrsn=5d3789a6_2&fbclid=IwAR0tZTv8uWRfP3QAXwE56sPCNiYMWQiV1_bH3SfBkRsCCc3ObKpGCNGureQ#:~:text=Approximately%2010%2D15%25%20of%20cases,about%205%25%20become%20critically%20ill.&text=For%20some%20people%2C%20some%20symptoms,to%20others%20during%20this%20time
14. https://www.healthline.com/health-news/over-75-percent-of-people-hospitalized-with-covid-19-have-symptoms-months-later?fbclid=IwAR0GfQp_Q1pUgPT7d6vd1sfEnMOMgjaucJHXmgJs0AedCAf0lWyD6PcJRUA#Long-term-symptoms-are-common
15. https://www.deseret.com/utah/2020/11/12/21562579/coronavirus-covid-19-pandemic-real-stories-impacts-hospitalization-long-term-effect-salt-lake-county

“If I experience a severe adverse reaction, long term effects (still unknown) or die from the vaccine will I (or my family) be compensated from the vaccine manufacture or the Government?”
True. They are shielded from litigation. Vaccine manufacturers take a considerable risk, especially in rapid production of a virus. The probability of adverse reaction is small, though never none. As of February 14, the rate of death among vaccine recipients was 0.0018%.16 Rate of anaphylaxis (which is the most severe effect reported thus far) is 2-5 people per million.16 Compare this to a 1% chance of death and approximately 20% chance of lasting adverse effects from the disease itself. You will not be compensated for this risk, either.
16. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/adverse-events.html?fbclid=IwAR3zADlbswgiETfRL6uN_yZJE9UY2jc_erVQZWEvFe3ZKs22Sn74e1D3qVM

I was worried that the trials had been rushed, too. However, I’ve seen multiple statements, including from doctors whom I trust and who have reviewed the research, that assert the trials were complete and safe. A pandemic creates a unique circumstance where 1)there are many eager trial participants, 2) there is ample opportunity to expose those participants to the disease and 3)the government was willing to remove the red tape that usually slows studies. When they say they expedited trials, what it really means is that they didn’t let them sit on someone’s desk for months between steps.

Also, these vaccines use technology that was already in use. For example, Moderna and Pfizer use mRNA technology that was being used for cancer research. (Remember how we fundraise to support cancer research?) Johnson & Johnson and AstraZeneca use technology developed when working on vaccines for Ebola and Zika. They customized existing technology to this specific virus.

And in case you’re wondering, even using nanotechnology, they couldn’t hide microchips in the vaccines without them being detected. Vaccines are reconstituted from powder to make a clear liquid. Even the best microchip using current nanotechnology would appear as a small floating contaminant in the vial. Feel free to ask to inspect your dose. Also, multi-dose vials would make it impossible to hide and equally distribute multiple doses of microchips in a reconstituted solution. (I know you probably don’t believe this, but if you know someone who does.. well, this may not change their mind. But knowledge is power.)

In summary
In my opinion, doctors and journalists need to trust the public a little bit more. We ARE capable of balancing hope and caution. However, when the message of caution is over-emphasized, there is a tendency to give up hope.

As a society, we have prayed, fasted, sacrificed, researched, hoped and waited for an end to this pandemic. Those prayers were answered with the rapid production of not just one but several highly effective vaccines.

This. Is. A. Miracle.

We need to be careful that we don’t let skepticism, caution, politics, or worry lead us to reject this gift. This answer to our prayers. Turning down the vaccines because you may have to wear masks and distance a little while longer is like turning down a new sports car because you’ll still have to follow the speed limit.

The road back to normal is through these vaccines.

So, what about us?
Utah will open up vaccines to the high risk medical group on March 1st. And there are a few questions I am asked regularly.

Will Patrick qualify for the vaccine?
Patrick meets 4 of the criteria on Utah’s high-risk list. Solid organ transplant, asplenia, immunosuppression and cerebral palsy. However, vaccines are not yet approved for pediatric patients. Trials are underway in this patient population. They are taking longer than adults because children are less at risk, parents are more hesitant, and teens are less compliant with study regimens. Still, we hope by late summer or early fall that a vaccine will be available to him. And we have been instructed to get him vaccinated as soon as possible.

What about you and Brian?
I am also in the high risk group because of my immunosuppression for Rheumatoid Arthritis and because of my weight. We have been strictly quarantining for my sake as well as Patrick’s. I’m the only one who has his entire medical picture in my head and he needs me to be here and healthy.

I plan to stalk the health county website on March 1 until I have an appointment. I’ll go off my R.A. meds to improve my immune response. It should be miserable. And totally worth it.

Brian will probably have to wait until the end of the line, unless we can get someone with decision making power to include caregivers of high-risk children in the higher priority groups.

When can we hang out with you again?
Did you notice above that the safest groups were those where everyone was vaccinated? We hope that you, with us, will choose to be vaccinated so that we can get back to spending time together as soon as possible.

Patrick and I both are in that group who may not have as “robust” of an immune response to the virus. So we don’t know how much protection we’ll have. But if we are vaccinated and you are vaccinated, we have much better chances of being safe.

Our initial interactions will be limited to small groups of vaccinated family and close friends. We’ll slowly come back into society like we did after transplant. Large group activities will wait till all of us are vaccinated. But time (and better data) will tell.

If you want to see us before the U.S. reaches herd immunity, get your shot.

Will Patrick be back in school in the fall?
Honestly, I don’t know. I have every intention of sending him back to school when his team says it’s safe. Patrick needs people.

Since we expect it to take longest for children to be vaccinated, it will for sure need to wait until he at least has the protection of immunization.

This could happen in fall. It might be later. And honestly, given how much better math has been with me teaching, the schedule may be part-time. At least to start.

Here’s a header so you know we’re at the end
There’s a lot we still don’t know. There is a lot that can’t be promised. But despite uncertainties, the future is very, very promising.

Hebrews 11 is one of my favorite books of scripture. Verse 1 read:

“Now faith is the substance of things hoped for, the evidence of things not seen.”

And verse 11 tells us that Sarah conceived when she was past age “because she judged him faithful who had promised.”

God hears our prayers and keeps his promises. He still sends angels. He still works miracles. And we are watching one unfold in this moment.

Let’s not be too afraid to accept that gift.

Trying to change the world (SeaWorld that is)

IMG_1955This is not a transplant update. But it is a blog post that needed following up on for a while.

As you know, we went on our Make-a-Wish trip in September. You may or may not have noticed that we kind of glossed over writing about our visit to SeaWorld. The honest truth is that, other than the awesome dolphin encounter experience we had there, our trip to SeaWorld was not a good one.

Patrick was on a roller-coaster high after a week in theme parks and so he asked to ride more rides while we waited for the dolphin and whale shows. However, as we started to ride rides, we came across a funny thing.. the park staff seemed pretty uncertain about allowing Patrick’s TPN backpack on rides. They have a safety policy against “loose articles” on rides. We got a few ride operators to let him ride.. But when we got to the ride Patrick wanted most, the kiddie roller coaster, they wouldn’t let him on. Not unless he could leave his backpack behind.

This seems logical, right? Just take it off, ride, put it back on. Except that the risk of infection shutting off TPN is pretty significant. And suddenly shutting off TPN can cause hypoglycemic shock.

We asked for a supervisor. They supervisor also turned us away. We were pretty mad. I convinced Brian we could work it out. We went to guest services.. they were too busy for us. I saw a supervisor leaving Guest Services and chased him down. He also didn’t have a ready solution for us. He said he’d need to call for someone. So we told him we were going to go catch a dolphin show and come back.

During the dolphin show, a lightning storm rolled in and essentially shut down the park. We gave up. We left. (Now I’ll never see Shamu.)

But it didn’t sit right. Earlier this year, the Oley Foundation (a non-profit devoted to tube feeding) held their annual conference blocks from SeaWorld and I knew that many families had turned that into a mini vacation. So I asked if others had run into similar problems. Unfortunately, the answer was yes. Many had been turned away from the kid rides with because of their TPN and other medical equipment.

So I wrote to SeaWorld. And I wrote to them again. And I sent them messages through Facebook. And eventually, a few weeks later, a manager wrote back and fairly generic and non-promissory reply, expressing regret that I was frustrated my visit hadn’t gone as expected. He also invited me to visit him on my next visit to the park to discuss accommodations.

That evoked a kind of lengthy reply from me. Of course I wasn’t going back to SeaWorld in person to discuss the problem. But the delay in reply made me even more certain that something needed to be fixed.

So I wrote a nice long e-mail. I explained tube feeding and its unique challenges, quoted the American Disabilities Act, and appealed for a conversation about how to improve the park’s policies towards patients who have to carry medical backpacks. I made an appeal to help make a better experience for others, not to make things right for our family, but for those who come after us.

I wasn’t getting far with e-mails. I wanted the conversation in writing. They didn’t. They gave me a phone number to call and I kept putting it off, then things got busy. And I didn’t have time to call him back. Until today. Today I had a good talk with the manager of Shamu’s Happy Harbor at SeaWorld Orlando. I wish I could say that they had revoked their no loose articles policy for medical backpacks. That didn’t happen. They did, however, say that my e-mails had prompted some conversations about improving park accommodations for tube-fed patients and using some common sense on a case-by-case and ride-by-ride basis to determine where it is and is not safe to ride with tube feeds running.

So, for those perhaps considering a trip to SeaWorld Orlando with TPN, enteral feeds or other medical equipment, here are some of the things you probably want to know.

1) You should stop in first thing at Guest Services and ask for a ride accommodation pass. This may take some time. But they’ll go through ride by ride and help you figure out what you can ride and give you a pass identifying you as a safe rider.

2) If you encounter a ride operator who says you can’t ride when you feel it would be safe to do so, you should ask for a manager. Please note, a manager, NOT a supervisor. Only a manager has the authority to override park policies.

3) Be ready with a plan of how you can secure your backpack during the ride.

4) Know that training in this area of medical need has not been a standard thing for ride operators. We talked about that a little today and I was promised they would improve training.

5) Know that this isn’t going to get you on all the rides. So, if you really aren’t devoted to the rides, plan to enjoy the animal shows and other experiences so you won’t be disappointed.

This wasn’t the big policy change I hoped it would be. I think a lawsuit probably would have been the only way to really force that and, to be honest, that is not my style. I prefer the “let’s talk together and work this out” approach. I was pleased, however, to find that my efforts at education and advocacy weren’t completely wasted. The manager I spoke to told me that just that week he’d bent park rules to allow a wheelchair with oxygen attached onto a carousel where previously they would have been forbidden by the letter-of-the-law. So one heart at least was perhaps touched, and that will affect conversations and training.. and maybe with time and some patient teaching from future visitors will make a difference.

I’ll share what I learned with Give Kids the World and in the groups that I participate in. Maybe if we all work together with the positive expectation that SeaWorld will live up to these promises, they will get more used to offering accommodations and fewer people with have the kind of disappointing experience we had.