“Our hospital, which is the biggest in the state by a lot, has had, obviously, a pretty intense focus on preparedness for high-consequence infections and pandemics,” he said. UNMC already had an aggressive stockpile program for N95 masks and other PPE in early 2020. But “even before the pandemic really started affecting Nebraska, we kind of looked at what was going on and said, you know, we’re all going to run out of PPE unless we do something.” A team came up with a way to reuse N95s by clipping them to clotheslines in a room with UV lightbulbs and UV-reflective walls and irradiating them for a few hours. They shared the technique with other hospitals around the state, helping them preserve their own supplies. At least at UNMC, “we never ran out of N95s.”

Elsewhere, the state was aggregating data from local health departments to identify shortages and using the National Guard as logistics support to get supplies around Nebraska — not at all a seamless process but one that, according to Jason Jackson, head of the Department of Administrative Services, benefited from not relying on the federal government. “I do think other states fell into that trap. … I don’t know what informed that confidence that the federal government was going to be able to come in and meet that need,” Jackson said. “But that never governed our response.” There’s no good data on this, but such efforts likely saved health care workers’ lives at a time when thousands were dying across the country, in part due to lack of adequate protective equipment.

UNMC was also instrumental in infection prevention and control for vulnerable corners of the state — and here again, Nebraska had a head start. The university and its associated health network, Nebraska Medicine, already had a team working on helping nursing homes improve infection control around the state before Covid hit, a job that took on new urgency in the early months of the pandemic, when some 40 percent of Covid fatalities were among nursing home residents and staff. They worked as well with other vulnerable facilities, including meat-processing plants (Nebraska is one of the top meatpacking states in the country, with nearly 27,000 workers) and prisons (it also has some of the country’s most overcrowded prisons, with more than 5,000 inmates). By June 2020, Muhammad Salman Ashraf, head of the Nebraska Infection Control Assessment and Promotion Program, had assessed that less than 1 percent of Nebraska’s nursing-home population had died from Covid, versus 10 percent in some other states (Andrew Cuomo’s government was famously accused of covering up New York’s staggering nursing-home death toll of more than 15,000 people). Lawler says this was a major contributor keeping Nebraska’s overall death toll down.

He doesn’t give high marks to the state’s Covid response overall, however.

“We did very well for the first few months of the pandemic,” he says, when many other states were caught by surprise. Ricketts moved quickly to limit gathering sizes and certain in-person businesses — gentlemen’s clubs, tattoo parlors and the like — without forcing the whole state to shut down, though he did ask people to voluntarily stay home for 21 days to help the state protect and expand hospital capacity. Lawler thinks avoiding reflexive lockdowns and instead using tailored health measures was the right way to go, but that the state got too laissez-faire too quickly, and was too eager to move on once the vaccine was available. He referenced the March 2020 article “The Hammer and the Dance,” which argued for a limited period of strict containment measures (the “hammer” of severe limits on social activity), followed by a longer-term, more flexible strategy of adjustable measures to keep the virus in check (the “dance” of continued testing and tracing, isolating infections, social distancing and masking, with the option to enforce stricter measures in case of worsening outbreaks).

“That was kind of the approach that we were advocating,” Lawler said. “The problem is, I think we never followed through on that, in terms of continuing to modulate our response based on disease activity. … We didn’t do the dance part. We just kind of took our dance card and went home.”

When I asked Ricketts if he saw a tradeoff between growth and health, he said he took a “holistic” approach to the pandemic, that public-health people are only looking at one part of the picture and that while he values their input, he’s got to weigh more factors than they do. “We focused on slowing the spread of the virus and letting people live as normal a life as possible,” he said, which to him meant, among other things, no statewide mandates.

“I think other states tried to be very heavy-handed and order people to do things, and I think that breeds resistance” — especially when governors wouldn’t even follow their own rules (see: California governor Gavin Newsom’s “French Laundry moment”). While some national news outlets swooned over Andrew Cuomo’s daily press conferences, which Variety called “the hottest property in daytime TV,” Ricketts’ own low-key, wonkish daily updates rarely even made C-SPAN.

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