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Saturday, August 7, 2021

NYC Cops Still Handling Most 911 Mental Health Calls

 A pilot program aimed at reducing potentially volatile police interactions with people in mental health crises got off to a bumpy start, with cops still responding to the vast majority of 911 calls, THE CITY has learned.

The program, part of Mayor de Blasio’s much-criticized $1 billion ThriveNYC program, started June 6 in three Harlem precincts. Teams consisting of two emergency medical technicians (EMTs) and one Department of Health social worker are supposed to tackle mental health-related 911 calls when appropriate.

But in the first month, the EMT/social worker teams wound up handling only about 20% of the 532 mental health calls — 107 cases in all. The other 80% — representing 425 calls — were addressed the usual way: by teams of cops and EMTs, according to data the Mayor’s Office plans to release Thursday.

That’s because in most cases, 911 dispatchers decided the person in crisis was either a threat to themselves or others. The EMT/social worker teams are supposed to be assigned only to calls where no such apparent threat exists.

And the four teams — which cover 16-hour shifts seven days a week — weren’t always available to respond to all the calls to which they were routed, the data shows.

In 31 instances, the NYPD wound up handling calls designated for EMTs and social workers because the teams were already out on other cases.

The pilot program emerged in response to a series of incidents over the last five years in which 18 people experiencing mental health emergencies were killed by police in New York City.

Ellen Trawick and her son, Kawaski Trawick, at his college graduation in 2013.
Ellen Trawick and her son, Kawaski Trawick, who was later killed by police in his Bronx apartment.
 Courtesy of Trawick Family

The NYPD most recently came under fire for the fatal 2019 shooting of 32-year-old Kawaski Trawick by cops responding to a 911 call about an “emotionally disturbed person.” Trawick was gunned down inside his Bronx apartment in a building operated by a city-sponsored supportive housing organization.

‘It’s an Outrage’

Figures showing that 80% of mental health calls were handled by police in the Harlem precincts run contrary to pre-pilot program projections by Susan Herman, director of the Mayor’s Office of Community Mental Health, the new name for ThriveNYC.

In a November private call with members of Correct Crisis Intervention Today (CCIT), a coalition of 80 advocacy groups pushing for the reform, Herman estimated that cops would wind up handling only 30% to 40% of such calls.

At a City Council hearing in February, Herman said that ultimately deploying EMT/social worker teams would be “the new primary response to mental health emergencies.”

ThriveNYC Director Susan Herman talks about the agency’s revised budget.
ThriveNYC Director Susan Herman talks about the agency’s revised budget, Feb. 28, 2020.
 Ben Fractenberg/THE CITY

CCIT steering committee member Ruth Lowenkron, director of the Disability Rights Program at New York Lawyers for the Public Interest, said the new data shows the promises and estimates of the de Blasio team were hot air.

“It’s an outrage. This is not what was represented,” Lowenkron told THE CITY Wednesday. “The bottom line is there is so much sleight of hand in terms of what they say they’re doing and what they’re actually doing.”

Lownkron said the data indicates “there is absolutely no attempt to adhere to the promise” the administration has made about the program.

‘We’re on Track’

In June, Police Commissioner Dermot Shea hinted that three months into the pilot program, 85% of the mental health calls in the targeted precincts continued to be handled by the cops. In an interview on 1010 WINS, Shea stated, “They are still having police respond because there is a weapon or violence involved.”

In response to THE CITY’s questions about this, a spokesperson for the Office of Community Mental Health wrote in an email that Herman’s estimate in November “is consistent with what we’re planning for now, but requires some clarification.”

The spokesperson explained that since November, the administration decided that EMT/social worker teams would not be dispatched to any mental health 911 call if the individual was experiencing “urgent medical need.” Ambulances will be sent instead.

The office now concedes that eventually, only 50% of all 911 mental health calls will likely be handled by EMT/social worker teams.

In an interview with THE CITY Wednesday, Herman defended the initial results of the program, stating, “It’s clear from what we’re seeing that this pilot has had a promising first month of operation. We’re on track to meet our goals.”

EMTs respond to a person in distress on 125th Street in Harlem, July 20, 2021.
EMTs respond to a person in distress on 125th Street in Harlem on Tuesday. 
Ben Fractenberg/THE CITY

A key problem with cops handling these calls was that the subjects wound up under arrest and taken to jail or dropped at hospital ERs — two locales not suited to addressing the needs of individuals experiencing a mental health crisis.

Herman said in the first month of the program, 50% of the individuals helped by the EMT/social worker teams wound up in hospital ERs, while 20% were transported to community-based care centers. Another 25% were assisted at the scene and referred to the city’s NYC Well program, which assists people with mental health issues.

“What we’re doing with this new approach is shifting the way an entire system is operating,” Herman said. “We’re bringing mental health care to people as quickly as possible in these scary moments.”

‘Situations are Fluid’

The complexity of dealing with these types of calls is also evident in how first responders reached out for help: In 14 cases, cops wound up calling in the EMT/social worker teams, while in seven instances the EMT/social workers had to call in the cops.

Lowenkron praised the cops who made such calls, but questioned why 911 dispatchers would send police in the first place.

“These situations are fluid,” the Office of Community Mental Health spokesperson noted, adding that in some cases, cops arriving on the scene determined the EMT/social worker teams could help de-escalate the situation.

“Upon NYPD arrival, the [police] may see that the situation has stabilized, or the officers may have helped stabilize it,” the spokesperson said. “Or there may have been reason to suspect a weapon or the possibility of imminent violence. When they arrive and see that isn’t the case, they now can call on [EMT/social worker] teams to provide the appropriate health-centered response.”

As for the situations in which the EMT/social worker teams wound up requesting NYPD assistance, the spokesperson cited a couple of examples:

“Upon arrival, teams see that a call that came in as suicidal ideation may have escalated towards imminent action. In other cases, a person’s agitation may increase to the point where the team feels the situation has become more volatile, and NYPD can offer assistance to keep everybody safe.”

City officials have said the NYPD would continue to respond to mental health 911 calls “involving a weapon or imminent risk of harm” to the individual or others.

After Mayor Bill de Blasio announced in April that he planned to spend $112 million to expand the pilot program citywide, Oren Barzilay, president of FDNY EMS Local 2507the union representing EMTs, expressed concerns that members would wind up facing dangerous situations without police backup.

He told THE CITY that few members volunteered for the program “because of the danger…. There’s a fear that without having police on the scene, who is going to mitigate?”

Barzilay did not immediately respond Wednesday to THE CITY’s inquiries about the release of the statistics on the program’s first month.

https://www.thecity.nyc/2021/7/22/22587983/nypd-cops-still-responding-to-most-911-mental-health-calls

NYC's New COVID Vaccine Passport Simply 'Glorified Photo Storage App': Critics

 

NYC's COVID Safe app confirmed these photos of a plastic bunny, a cat in a box and a bottle of lotion as vaccination cards.
NYC's COVID Safe app confirmed these photos of a plastic bunny, a cat in a box and a bottle of lotion as vaccination cards. INTREPID GOTHAMIST REPORTERS


Pictures of cats, Mickey Mouse, even a takeout menu from a BBQ restaurant: Users of New York City’s COVID SAFE app have discovered they can upload just about any photo into the new vaccine verification software.

Though the app only debuted this week, its vulnerabilities have come under scrutiny as the city announced a new policy to require proof of at least one dose of a COVID-19 vaccine for entry to indoor dining, gyms and entertainment performances.

“The New York City app is nothing more than a glorified photo storage app,” said Brian Linder of cybersecurity research company Check Point. He added, “When someone shows a picture of a card in this app, it's believed that it's real, but there's absolutely no verification of it whatsoever.”


City officials said it’s up to the staff at restaurants, gyms and event spaces to verify the authenticity of the pictures in the app--no different than bouncers checking drivers’ licenses at bars.

“The NYC COVID Safe App was designed with privacy at the top of mind, and allows someone to digitally store their CDC card and identification,” Laura Feyer, spokesperson for Mayor Bill de Blasio, said in an emailed statement. “Someone checking vaccination cards at the door to a restaurant or venue would see that those examples are not proper vaccine cards and act accordingly.”

Other acceptable proof of vaccination status under the city’s policy include the paper cards issued by the Centers for Disease Control or the state-run Excelsior Pass, which taps into a database built on blockchain technology. That’s the same platform used to secure transactions of cryptocurrencies like Bitcoin. Those vaccinated outside of New York can show the relevant state or country’s proof of vaccination, de Blasio said earlier this week.

But the COVID SAFE app creates an opening for a black market based on fake vaccine cards. While a bill criminalizing the falsification of vaccine records under state law is now awaiting Governor Andrew Cuomo’s signature, the opportunity for fraud is rampant on many levels.

“It’s never been more urgent that we protect this process from fraud, so that the health and safety of the public isn’t compromised by bad actors using fraudulent vaccination cards or passports,” said State Senator Anna Kaplan (D.-Long Island), who introduced the bill in her chamber earlier this year. “The ‘Truth in Vaccination’ bill that I wrote will serve as a strong deterrent to prevent people from lying about their vaccination status, and it needs to be signed into law without delay.”

For example, the COVID Safe app’s dependence on photo evidence relies on users submitting clear pictures of their cards. Friends who want to bypass the system could simply share a valid card among each other and hope that a bouncer doesn’t notice.

“I think it's...very hard to read, especially if you're taking a picture and it could be blurry,” said Saoud Khalifah, chief executive officer of Fakespot which tracks online retail scammers. “It's just not a scalable solution.”

Fake vaccine cards thrived on the dark web, Etsy and other online forums early in the nation’s vaccine rollout.

“We saw this quite dramatically in the beginning where these cards were for sale — you could pay anywhere from a couple bucks to more to buy an actual real looking card, physical card on a place called the dark web,” Linder said. “Now today, again, you could use Photoshop to create one and load it in the [COVID SAFE] app.”

But the security of the personal information may also be vulnerable on the apps themselves, Linder added, even with the Excelsior Pass built using IBM’s blockchain technology.

“Now you have personally identifiable information and an app that is completely unvetted and auditable, but creates a false sense of security, maybe for a restaurant owner or even somebody at the airport or train station or wherever,” Linder said.

Some would-be users of the Excelsior Pass have also reported problems verifying their vaccination status, especially if they received their doses from private doctors or pharmacies that may not have uploaded the right information to the state’s network.

Khalifah said the Excelsior Pass’s blockchain technology also isn’t as transparent as it could be.

“So usually, blockchains are public. And they provide a place where you can get consensus between different computers all around the world, and an open kind of platform,” he said. “In this case, this is closed, and it's private. And we don't really know what's happening behind the scenes.”

A request for comment from the state Department of Health was not immediately returned Friday.

The additional hurdles for using the Excelsior Pass may drive people to use the city’s less-reliable app instead, Linder added.

“If people are unable to do that, or if they didn't actually get vaccinated, they simply use the New York City app, which is literally so easy to fake,” he said. “Why would anyone bother with a digitally fair, digitally verifiable app, when I can simply upload a picture of what looks like my fake vaccine card into the New York City app that they're using?”


https://gothamist.com/news/nycs-new-covid-vaccine-passport-simply-glorified-photo-storage-app-critics-say

Antibodies Can Last for More Than 1 Year After SARS-CoV-2 Infection

 Kaihu Xiao1,2Haiyan Yang1,3Bin Liu1Xiaohua Pang2Jianlin Du1Mengqi Liu4Yajie Liu1Xiaodong Jing1Jing Chen2Songbai Deng1Zheng Zhou5Jun Du1Li Yin2Yuling Yan1Huaming Mou2 and Qiang She1*


DOI:  https://doi.org/10.3389/fmed.2021.684864

Background: COVID-19 is a global pandemic. The prevention of SARS-CoV-2 infection and the rehabilitation of survivors are currently the most urgent tasks. However, after patients with COVID-19 are discharged from the hospital, how long the antibodies persist, whether the lung lesions can be completely absorbed, and whether cardiopulmonary abnormalities exist remain unclear.

Methods: A total of 56 COVID-19 survivors were followed up for 12 months, with examinations including serum virus-specific antibodies, chest CT, and cardiopulmonary exercise testing.

Results: The IgG titer of the COVID-19 survivors decreased gradually, especially in the first 6 months after discharge. At 6 and 12 months after discharge, the IgG titer decreased by 68.9 and 86.0%, respectively. The IgG titer in patients with severe disease was higher than that in patients with non-severe disease at each time point, but the difference did not reach statistical significance. Among the patients, 11.8% were IgG negative up to 12 months after discharge. Chest CT scans showed that at 3 and 10 months after discharge, the lung opacity had decreased by 91.9 and 95.5%, respectively, as compared with that at admission. 10 months after discharge, 12.5% of the patients had an opacity percentage >1%, and 18.8% of patients had pulmonary fibrosis (38.5% in the severe group and 5.3% in the non-severe group, P < 0.001). Cardiopulmonary exercise testing showed that 22.9% of patients had FEV1/FVC%Pred <92%, 17.1% of patients had FEV1%Pred <80%, 20.0% of patients had a VO2 AT <14 mlO2/kg/min, and 22.9% of patients had a VE/VCO2 slope >30%.

Conclusions: IgG antibodies in most patients with COVID-19 can last for at least 12 months after discharge. The IgG titers decreased significantly in the first 6 months and remained stable in the following 6 months. The lung lesions of most patients with COVID-19 can be absorbed without sequelae, and a few patients in severe condition are more likely to develop pulmonary fibrosis. Approximately one-fifth of the patients had cardiopulmonary dysfunction 6 months after discharge.

https://www.frontiersin.org/articles/10.3389/fmed.2021.684864/full

SARS-CoV-2 Variants in Patients with Immunosuppression

 

  • Lawrence Corey, M.D., 
  • Chris Beyrer, M.D., M.P.H., 
  • Myron S. Cohen, M.D., 
  • Nelson L. Michael, M.D., Ph.D., 
  • Trevor Bedford, Ph.D., 
  • and Morgane Rolland, Ph.D.

  • DOI: 10.1056/NEJMsb2104756

  • PDF: 
  • https://www.nejm.org/doi/pdf/10.1056/NEJMsb2104756?articleTools=true

  • Patients with immunosuppression are at risk for prolonged infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In several case reports, investigators have indicated that multimutational SARS-CoV-2 variants can arise during the course of such persistent cases of coronavirus disease 2019 (Covid-19).1-4 These highly mutated variants are indicative of a form of rapid, multistage evolutionary jumps (saltational evolution; see Glossary), which could preferentially occur in the milieu of partial immune control.2,3 The presence of a large number of mutations is also a hallmark of the variants of concern — including B.1.1.7 (alpha), B.1.351 (beta), P.1 (gamma), and B.1.617.2 (delta)5 — which suggests that viral evolution in immunocompromised patients may be an important factor in the emergence of such variants. Since a large number of persons globally are living with innate or acquired immunosuppression, the association between immunosuppression and the generation of highly transmissible or more pathogenic SARS-CoV-2 variants requires further delineation and mitigation strategies.

    Rapid viral evolution has been described in immunosuppressed patients with persistent SARS-CoV-2 infection. Choi et al. described an immunosuppressed patient with antiphospholipid syndrome who was hospitalized in August 2020 and treated with anticoagulants, glucocorticoids, cyclophosphamide, intermittent rituximab, and eculizumab.2 During 152 days of persistent SARS-CoV-2 infection in this patient, the investigators identified 31 substitutions and three deletions in genome sequences. Twelve spike mutations were found, including seven in a segment of the receptor-binding domain consisting of 24 amino acids, some at sites linked to immune evasion (478, 484, and 493).6,7 The patient eventually died of severe Covid-19–related pneumonia. In another immunocompromised patient, Kemp and colleagues analyzed SARS-CoV-2 sequences at 23 time points over 101 days.4 Viral diversification was limited during the first 2 months but subsequently increased after the patient received an infusion of convalescent plasma on days 63 and 65, leading to rapid shifts in the frequency of the different variants. As such, sequences that were sampled on days 89, 93, and 102 showed distinct combinations of spike mutations. Truong et al. recently described the cases of three patients with B-cell acute lymphoblastic leukemia (including one with B-cell aplasia) after the receipt of chimeric antigen receptor (CAR) T cells. These patients were found to have multiple escape variants over the course of persistent Covid-19 infection.3 Some case reports have not identified highly divergent variants but have documented variants with mutations (e.g., V483A1-4 and E484K8) that alter antibody recognition.

  • https://www.nejm.org/doi/full/10.1056/NEJMsb2104756

  • 7-month kinetics of SARS-CoV-2 antibodies and role of pre-existing antibodies to human coronaviruses

     

  • […]

  • PDF: https://www.nature.com/articles/s41467-021-24979-9.pdf

    Abstract

    Unraveling the long-term kinetics of antibodies to SARS-CoV-2 and the individual characteristics influencing it, including the impact of pre-existing antibodies to human coronaviruses causing common cold (HCoVs), is essential to understand protective immunity to COVID-19 and devise effective surveillance strategies. IgM, IgA and IgG levels against six SARS-CoV-2 antigens and the nucleocapsid antigen of the four HCoV (229E, NL63, OC43 and HKU1) were quantified by Luminex, and antibody neutralization capacity was assessed by flow cytometry, in a cohort of health care workers followed up to 7 months (N = 578). Seroprevalence increases over time from 13.5% (month 0) and 15.6% (month 1) to 16.4% (month 6). Levels of antibodies, including those with neutralizing capacity, are stable over time, except IgG to nucleocapsid antigen and IgM levels that wane. After the peak response, anti-spike antibody levels increase from ~150 days post-symptom onset in all individuals (73% for IgG), in the absence of any evidence of re-exposure. IgG and IgA to HCoV are significantly higher in asymptomatic than symptomatic seropositive individuals. Thus, pre-existing cross-reactive HCoVs antibodies could have a protective effect against SARS-CoV-2 infection and COVID-19 disease.

    https://www.nature.com/articles/s41467-021-24979-9