Good evening. I am Roberto Santamaria, your host this evening for Nantucket Pulse programming made possible by Nantucket Cottage Hospital Community Health Initiative. This is a special edition of the Nantucket Pulse program that will air weekly covering the coronavirus impacts for the island and will provide urgent updates as they unfold.

Today, I am happy to welcome friend-of-the-show Gary Shaw, CEO & President of Nantucket Cottage Hospital and special guest Dr. Josh Sharfstein. He is the Vice Dean for Public Health Practice and Community Engagement at Johns Hopkins Bloomberg School of Public Health. Previously, he has served as the Secretary of the Maryland Department of Health and Mental Hygiene, the Principal Deputy Commissioner of the U.S. Food and Drug Administration, and as the Commissioner of Health for Baltimore City. We will speak with both of them in a bit.

Now, I want to provide a reminder to our viewers about the various Emergency Health Orders issued over the weekend. Order #5 allows certain types of construction work with crews of up to 4 people on-site at a time. All such operations must submit an application to the Nantucket Building Department for approval. If a worksite only requires a single worker, then the company needs only to notify the Building Department. However, the Building Department can shut down single-person jobs if it determines the location makes it unsafe for one person to work there alone. Details are available on the Town’s website. 

Order #6 cancels many of the restrictions on commercial landscaping from the first Emergency Order. Order #6 allows up to 2 workers on-site at a time. Details are available on the town’s website. Both orders mandate that a COVID-19 officer be present at the worksites to log information like the names of everyone that visits the job site and to interface with the Town. Both orders clearly state that no employee shall report to work sick. The Town can impose fines of $300 per infraction. 

In Emergency Order #7, the Nantucket Board of Health declared a Public Health Emergency until further notice. It enacted many new protocols concerning essential services. For example,  all employees of all “essential businesses” – as defined in Governor Baker’s COVID-19 Executive Orders – shall wear a face covering over their mouth and nose when interacting with the public and within 6′ of a co-worker. The cloth face coverings recommended are not surgical masks or N-95 respirators, which should be left for medical professionals and first responders. All essential businesses shall post a sign on their main entrance doors advising consumers to wear a face covering and to limit the number allowed inside to maintain social distancing of 6’ apart. These protocols and more can be found on the official document of Order #7, available on the Town’s website.

Governor Charlie Baker canceled the school year for all public and private schools. In a letter to the families of Nantucket children, School Superintendent Michael Cozort and Deputy Superintendent of Schools Elizabeth Hallett said, 

“It is with mixed emotions that we share with you that Governor Charles Baker just informed the residents of Massachusetts that the school closure will be extended through the end of the school year.  While we believe this is the best decision for the health and safety of our students and our community, it saddens us to end our school year without the traditional closure to the year.  Rest assured, our staff and administration will be working diligently to find new ways to honor the achievements and accomplishments of our students.  This decision obviously creates many questions and concerns, and we will begin addressing these as we consider each carefully.

This decision will not significantly change what we have created as a remote learning environment.  However, we expect that we will receive guidance from the Massachusetts Department of Education as to what essential standards we should direct our focus for the remainder of this school year.   As soon as we receive this guidance we will share this  with our staff and students  and their families.”

There is good news coming from Beacon Hill for those with student loans. For several weeks, only federal student loans owned by the US Department of Education provided COVID-19 relief. Borrowers of those loans do not have to pay back anything from March 13th and September 30th nor do the loans accrue interest during that time. Now,  the Massachusetts Divisions of Banks just announced that 15 loan providers of commercially-owned Federal Family Education Program Loans and private student loans will offer relief options to those struggling to pay during the pandemic. To learn more, visit the state’s website and search “student loans”.

There has been a sharp drop in travel to the island. The Steamship Authority has noticed an 85% reduction in passenger traffic. The airport traffic is down between 85-95%, depending on the day. The ferries are running reduced schedules. Between freight and passenger ferries, the Steamship is running only 6 round trips per day at the most. The HyLine is only running 3. 

Due to this mammoth drop in passenger traffic, the Steamship is losing about a million dollars a week. They will run out of money by the end of May. To cut costs, they have been reducing service and have postponed the operation of the fast ferry Iyannough until at least May 14th. Due to legal restrictions, they cannot redirect the millions of dollars worth of bonds raised to finance the renovation of the Wood Hole Terminal to cushion this financial blow. If they run out of money, the commonwealth will cover their budget, but then will bill Nantucket and Martha’s Vineyard each 35% of the cost and then spread the rest among the port cities of Hyannis, Falmouth, and New Bedford. To avoid this huge expense falling on the Town of Nantucket, State Representative for the islands and Falmouth Dylan Fernandes and State Senator for all of Cape Cod — except for Falmouth, Bourne, & Sandwich — and the islands Julian Cyr wrote a letter to the governor and state legislature. They are asking that a portion of the billion-plus of transportation assistance the federal government sent to the commonwealth be directed to the Steamship. Currently, the Steamship is scheduled to receive $12.2 million of relief funding in the next several months. Steamship General Manager Bob Davis said this amount is “a welcome relief, but it’s a Band-aid, it’s not going to solve all our problems”. Sen. Cyr and Rep. Fernandes also sent a letter to federal lawmakers. It asks that all future federal transportation relief now have a component that goes directly to the Steamship. This way, the Steamship won’t have to ask the commonwealth for a portion of the federal relief funding it receives. This Wednesday the Select Board voted to write letters in support of these requests. 

The Federal Aviation Administration (FAA) has notified Nantucket Memorial Airport that they intend to reduce the Air Traffic Control hours of operation there from the current time of 6am to 9pm down to 8am to 4pm. The Nantucket Airport would like the FAA to reconsider this decision. Assistant Nantucket Airport Manager and Public Information Officer Noah Karberg released a statement to NCTV saying, 

We continue to work with the FAA to make a data-backed case for our concern with their current proposal. We believe the proposal does not take into account the unique circumstances on Nantucket. I would also emphasize that this proposal is a Washington DC-level effort, and regardless of proposal outcome, our local FAA Air Traffic Controller group does a great job for our community and has our support.”

Next week, the Harbor Master’s office will open again after being closed due to the pandemic. They will begin preparing the infrastructure to accommodate private boats. The process takes several weeks; they first must set up pump-outs and dinghy docks before moving on to items like the moorings, which themselves take 4-6 weeks to install. They aim to have the buoys in Madaket by Memorial Day. Please note: just because moorings are going into the water does not mean boats can use them. Rather, they are only open once the Harbor Master makes the announcement. 

The virus has also affected the number of patients that come to the hospital. The volume has fallen by at least 60%. Hospital CEO & President Gary Shaw said the decrease is “substantial” and will probably cost the hospital millions of dollars. Partly as a response, the hospital is pursuing telehealth and telemedicine at an “accelerated” pace. Mr. Shaw hopes that it can increase the volumes of patients seen in the near future by between 10-30%. Due to its membership in the Partners Health System, the hospital is getting some financial assistance from the organization to weather this storm.

The hospital strongly recommends that everyone who cannot maintain social distancing of 6’ or greater outside of their house wear a non-medical-grade face mask. These masks still slow the spread of the virus; the medical-grade ones are needed by the hospital and first responders. The hospital recommends instead of donating your non-medical grade masks to the hospital, to donate them to the community. Washing your hands and social distancing remain crucial ways to slow the spread too. 

This summer will see some stores reopen and traditions resume in a safe and responsible way. Unfortunately, the 4th of July festivities will not be one of them. The hospital warns against large social gatherings this summer like parties and meetings in close proximity. In order to monitor the spread, they stress the importance of identifying individuals that might be developing flu-like symptoms or respiratory illness so they can get tested. They predict this environment will be the new normal until a vaccine or anti-viral drug is developed. 

Please note: the cost of COVID-19 testing is covered by all insurance carriers and is free to those without insurance. The hospital recommends anyone experiencing COVID-19 symptoms or another health emergency to seek testing. Treatment costs for COVID-19 hospitalizations are also covered for those with insurance, but not for those who are uninsured. Partners hospitals can offer a 25% discount for those who must self-pay, but three-quarters of the cost is borne by the patient. Therefore, those without insurance are strongly encouraged to seek subsidized health insurance programs for low-income individuals through the Health Connector. If they are a US citizen, a Massachusetts resident, and make less than 400% of the Federal Poverty Level they can qualify for MassHealth. The Poverty Level depends on how many people in your family. Please take a look at the graphic on your screen. You can see on the left that the larger the household size, the higher an income can rise before it shifts to the right of the table, meaning the health insurance costs increase. The health insurance premium can be found in the bottom row. The state’s Children’s Health Insurance Program (CHIP) is rolled into MassHealth. Please be advised that children must be insured or else the hospital will bill the family directly. 

If you make less than 300% of the Federal Poverty Level, Health Safety Net — unlike MassHealth — is available to everyone, even if you are not a Massachusetts resident or a US citizen. Health Safety Net can act as a secondary payer for other forms of insurance as well. To learn more or for help navigating your options, feel free to call the Cottage Hospital’s public counselors at 508-825-8196.

**INTRODUCTION TO ISLAND KITCHEN PLAYOUT**

Now, let’s move onto one of the many great Acts of Kindness that Nantucketers are carrying out during this trying time. Last week I spoke with Patrick Ridge, owner and chef of Island Kitchen about the support his volunteers and food trucks are offering to families whose children are out of school now. Please note the footage was shot on April 1st, before the advisory about face masks for all essential workers took effect.

**INTRODUCTION TO DISCUSSION SEGMENT**

Now a quick programming note: Gary Shaw, Dr. Sharfstein, and I will now discuss some of the COVID-19 topics we feel are most important to Nantucket. Afterward, I will announce when we will open the floor to questions via the YouTube chat from viewers logged into their YouTube accounts. Now, I would like to introduce Dr. Josh Sharfstein to the program. Not only is he an excellent source of information about public health, but he was also my advisor in graduate school. Welcome.

**HOSPITAL STATEMENT**

Good afternoon, 

I’m Gary Shaw, President and CEO of Nantucket Cottage Hospital. 

The island has done an extraordinary job in not just flattening the curve of COVID-19 infections on Nantucket, but essentially steamrolling it. 

We’ve gone nearly three weeks without a confirmed case of COVID-19, and it’s been more than a month since our first case was diagnosed on Nantucket. 

To our year-round community, I want to say thank you for everything you’ve done to make this possible. You heard our message, and you committed to the measures that have kept our community safe. So as we begin to work with the town on a slow and measured approach to returning to work in some limited industries, we ask that you continue to commit to those things that we know have worked: physical distancing, hand-washing, wearing masks in public, limiting trips to the grocery store, and following the Town’s emergency orders. 

To our seasonal residents, as you consider a return to the island we want to give you some guidance and best practices to ensure that the summer will be as safe as possible for everyone on Nantucket. The island has the chance to emerge from the coronavirus pandemic as a public health success story, with our population safe and healthy. But despite our initial success, Nantucket remains highly vulnerable to infected persons and asymptomatic carriers of the virus coming from off the island, whether they are seasonal residents, year-round residents, workers, or day-trippers, who could prompt a major surge in new cases. 

So if you are considering a return to the island, we ask you to be part of our success story by taking the following actions to ensure the continued safety of our community: 

  • Self-quarantine for a minimum of 14 days once reaching your destination. It is best to go directly to your destination and not stop elsewhere on the island on the way.
  • Bring all necessary food and supplies with you to enable the 14-day quarantine, including prescriptions, personal health items and personal protective equipment (PPE).
  • Contact Nantucket Cottage Hospital by calling 508-825-1000 if you are exhibiting flu-like symptoms or experiencing respiratory illness during or after quarantine to receive instructions on accessing appropriate care.
  • Comply with all local, state, and federal directives and recommendations regarding physical distancing and other measures to limit the spread of the virus. 
  • Wear face masks in public places when physical distancing is difficult.
  • Refrain from hosting or attending private home parties or large gatherings.  Instead, order take-out food or have it delivered from local restaurants.  
  • Be diligent with hand-washing and disinfecting much-used surfaces. 
  • Limit trips to the grocery store. 

This guidance will continue to evolve over the spring and summer, so please check the Town of Nantucket and Nantucket Cottage Hospital websites frequently for updates. 

We know this summer will be unlike any that came before it, and it will take some time for all of us to adjust to the new normal. This is not going to be the summer for parties or large gatherings. We want to ensure that the measures which have so far kept our community safe are embraced and practiced by all those coming to Nantucket.

And now I’d like to give you an update on coronavirus testing at NCH. 

Nantucket Cottage Hospital established one of the first drive-through testing sites in the state of Massachusetts on March 16 we have tested 250 patients for COVID-19, and 240 of those tests have been negative. As you know, we have had 10 confirmed cases of COVID-19, and seven of those patients are considered recovered, with two still in isolation, and sadly, one death as a result of complications of the disease. 

We are actively working to expand our PCR testing capacity, and the criteria for testing patients at our drive-through and those coming into the hospital continue to evolve on a daily basis. We are now testing all patients admitted to the hospital, including those admitted to the labor and delivery unit and their spouse, along with patients who are considered high-risk into the ER. We have some capacity to process COVID tests internally with the Cepheid analyzer in our lab. We have kept those tests available for admitted patients and for situations in which time is of the essence to enhance patient care, to both preserve personal protective equipment, and to allow frontline works to return to work faster.

Simultaneously, we are also pursuing a serology study that would test a significant portion of the island population for antibodies and show whether those people have been exposed to the virus. We are working day and night to make this happen for the island and collaborating with our partners at Mass General and the MIT Broad Institute, as well as Dr. Jeff Drazen, who is a member of our NCH Board of Trustees and a physician at Brigham and Women’s hospital. We still have some hurdles to get through, including funding and approval for the study through the IRB process, but we are optimistic this can happen. So stay tuned for that. 

Finally, we want the community to know we are here for you, and open for care. Please know that it is safe for you to come to the hospital for any care that you need. We have taken every precaution to protect our patients and our staff, and so we want you to know that it’s important to never delay coming in for care. If you have an emergency or an urgent issue or a health matter that is not urgent but needs attention, please come in or call us.  We are set up to care for you here safely, as well as through virtual visits by video and phone. Again, please do not delay the care you need. The hospital is safe and ready to care for you. Thank you. 

**OUTRO**

We will continue to provide you with updates on the Coronavirus and impacts for Nantucket.  This week, Nantucket Pulse debuted a wellness segment series hosted by Natalie Ciminero with our local health PROFESSIONALS ON CHANNEL 18 AND NCTV18.ORG. Please share this with friends and family, ITS DESIGNED TO CONNECT OUR VIEWERS WITH LOCAL HEALTH PROFESSIONALS THAT CAN HELP US  TAKE CARE OF OURSELVES AND OTHERS AROUND US. It’s important that communications remain in place as events continue to unfold and we all remain connected.  It’s crucial to get the facts from your local news sources such as the Inquirer and Mirror, 97.7 ACK FM radio, and NCTV Channel 18. Please stay tuned to see a special message to our essential workers from the community.