Category: Health Care

Monday Wake Up Call – September 20, 2021

The Daily (no) Escape:

More than 660,000 white flags have been put on display at the National Mall in Washington DC in memory of Covid victims. The display is called “In America: Remember”, organized by artist Suzanne Brennan Firstenberg.

“Reality is that which, when you stop believing it, doesn’t go away”  ̶  Philip K. Dick

And a corollary: Delusion requires passionate and unyielding belief to keep pesky facts from intruding. This is why for some people, cults are a viable form of social organization.

The Covid vaccines save lives. America has an abundant supply. The shot is free. But many Americans remain unvaccinated. Some don’t have access, but it appears the vast majority of the unvaccinated are making a decision that appears to be driven in part, by their politics.

The WaPo reports that:

“Since May of this year, more than half of the deaths from the coronavirus have been in states that voted for Donald Trump. There have been 239 deaths per million among red-state residents, compared with 150 per million in blue states.”

And for vaccinations, states that voted for Trump in 2020 have lower vaccination rates. Here’s a chart:

Are Republicans following a political strategy with vaccines? Brian Beutler thinks so:

“To grasp that Republicans encouraged COVID spread to harm Biden, you don’t have to believe, in a conspiracy-addled way, that they convened in secret and built a playbook for maximizing infections. You simply need to observe that a critical mass of conservative elites view undercutting Biden and Democrats as a political lodestar, and make immensely consequential governing and broadcast decisions on that basis alone.”

According to the NYT, that thinking has led to 16,200 preventable deaths since July 1 nationwide. And it’s important to realize that most deaths occurring now are preventable in a way that was absolutely not the case at the start of the pandemic.

Following on Phillip Dick’s quote above, a reality is that Covid is now a preventable disease.

Ignoring reality, Red State governors are actively discouraging vaccination and masking. They are actively encouraging a preventable but deadly illness to spread. They are putting the entire nation at risk of a vaccine resistant variant. They’re threats to our national security.

Polls show that Biden’s approval rate has slipped, in part due to the Covid surge. Covid may be hurting Biden politically, but it’s hurting Red State Republican constituents literally (and seriously). The Red State Covid fatality rate isn’t high enough to really hurt their vote totals except in marginal districts. The Republican bet is that the intensity/turnout advantage they get from anti-Vaxx deniers will pay off in the 2022 mid-terms.

They seem to have internalized that a pandemic combined with pandemic denialism helps them. In 2020, the Republican ground game benefited from the fact that Covid denialists were more willing to go out in public. They used the fact that their voters were more likely to vote in person to push Trump’s Big Lie election-fraud theories.

But here we are. They’re living in a world where the virus is fake, and thousands of people are dying from taking the vaccine. They’re taking Ivermectin and anti-malarial drugs because the fake virus is a little threatening, but not bad enough to take the vaccine. It can be deadly, but “it isn’t for me” because it’s a liberal conspiracy.

But the “reality” is that excess deaths from all causes since February, 2020 according to the CDC is 830,400. Last year, the age-adjusted all-cause mortality rate in the USA rose by 15.9%. This is by far the biggest one-year rise in that rate in the 120 years that official records have been kept for this basic measure of overall public health.

Time to wake up Red Staters! Many of the GOP higher ups (and their media lackeys) think that you’re not masking or taking the vaccine, will hurt Biden and the Democrats. Maybe you should be thinking about the greater harm that following their lead may bring to you and your family.

To help you wake up on this last Monday of summer, listen to the Foo Fighters, who are going through a “disco discovery” stage wherein they call themselves the Dee Gees, cover the Bee Gees’ “You Should Be Dancing”:

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Americans Die Earlier Than Europeans

The Daily Escape:

The Barber Pole, Vermillion Cliffs National Monument, AZ – May 2021 photo by Dave Coppedge

Derek Thompson in The Atlantic says that America has a death problem:

“According to a new working paper released by the National Bureau of Economic Research, Americans now die earlier than their European counterparts, no matter what age you’re looking at.”

Covid deaths are excluded from the study.

Before the 1990s, average life expectancy in the US was not much different than it was in Germany, the United Kingdom, or France. But since the 1990s, American life spans leveled off, and then fell behind those in similarly wealthy European countries.

We started hearing about America’s declining longevity when Anne Case’s and Angus Deaton’s 2015 study showed that White mortality in the US was rising. They called the new trend “deaths of despair”, caused by increased deaths by suicide, drug overdose and liver disease associated with alcohol.

Now, the bad trend has spread to all Americans:

“Compared with Europeans, American babies are more likely to die before they turn 5, American teens are more likely to die before they turn 20, and American adults are more likely to die before they turn 65. At every age, living in the United States carries a higher risk of mortality.”

The study collected data on American life spans by ethnicity and by income at the county level, and compared the data to those of European countries, locality by locality, allowing for direct comparisons. It explodes the myth about America having the best medical outcomes.

More from Thompson:

“Americans are more likely to kill one another with guns, in large part because Americans have more guns than residents of other countries do. Americans die more from car accidents, not because our fatality rate per mile driven is unusually high but because we simply drive so much more than people in other countries.”

Americans also have higher rates of death from infectious disease and pregnancy complications. And all of this is over and above our terrible Covid death rate.

One reason for the differences in mortality is that unlike Europe, America doesn’t have a robust public health system. These systems are at their core, a multidisciplinary delivery of services in our towns and cities that work to solve health problems before they require hospitalizations.

The US public health system has significant gaps in capability and delivery. It is both fragmented, and weak politically. The politicization of public health in the Covid crisis has caused some local public health officials to quit or retire. Some have been physically threatened just for doing their jobs. Approximately 1 in 6 public health officials have left their jobs in the past 18 months.

By contrast, our European peers have robust public health service delivery in most locations.

The researchers found some significant findings. First, Europe’s mortality rates do not vary much between rich and poor communities. Residents of the poorest parts of France live about as long as people in the rich areas around Paris. From the study:

“Health improvements among infants, children, and youth have been disseminated within European countries in a way that includes even the poorest areas…”

Second, White Americans living in the richest 5% of counties still die earlier than Europeans in low-poverty areas:

“It says something negative about the overall health system of the US that even after we grouped counties by poverty and looked at the richest 10th percentile, and even the richest fifth percentile, we still saw this longevity gap between Americans and Europeans…”

The study also shows that Europeans in impoverished areas seem to live longer than Black or White Americans in the richest 10% of counties.

Third, America has a surprising US longevity success story: In the three decades before Covid, average life spans for Black Americans surged, in rich and poor areas, and across all ages. As a result, the Black-White life-expectancy gap decreased by almost half, from seven years to 3.6 years.

The study credits the Medicaid expansion in the 1990s, which covered pregnant women and children and likely improved Black Americans’ access to medical treatments. The expansion of the earned-income tax credit and other financial assistance have gradually reduced poverty. Air pollution reduction is also a factor. Black Americans have been more likely than White Americans to live in more-polluted areas, but air pollution has declined more than 70% percent since the 1970s, according to the EPA.

Let’s give the last word to Derek Thompson: (emphasis by Wrongo)

“For decades, US politicians on the right have resisted calls for income redistribution and universal insurance under the theory that inequality was a fair price to pay for freedom. But now we know that the price of inequality is paid in early death—for Americans of all races, ages, and income levels. With or without a pandemic, when it comes to keeping Americans alive, we really are all in this together.”

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Sunday Cartoon Blogging – August 8, 2021

The Commonwealth Fund’s August 4 report says that the US health care system ranked dead last among 11 wealthy countries, despite spending the highest percentage of GDP (17%) on health care.

The report considered 71 performance measures in five categories: access to care, the care process, administrative efficiency, health care equity and health care outcomes. The countries analyzed in the report include Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the US.

America ranked last on access to care, administrative efficiency, equity, and health care outcomes. We performed well in rates of mammography screening and influenza vaccination for older Americans, as well as the percentage of adults who talked with their physician about nutrition, smoking and alcohol use. But we had the highest infant mortality rate and lowest life expectancy at age 60, compared with all the other countries.

Eric Schneider, the lead author and senior vice president for policy and research at the Commonwealth Fund:

“The US has two health care systems. For Americans with the means and insurance to have a regular doctor…reported experiences with their day-to-day care are relatively good, but for those who lack access, the consequences are stark.”

Our poor performance is nothing new. The US has been in last place in all seven of these studies that the Commonwealth Fund has released since 2004. This is another failure of our political system. Our politicians talk but never act.

On to cartoons. There were lots of Cuomo cartoons, little on Covid, the Olympics or infrastructure this week.

Someone should tell Cuomo the “I Grope Everybody” defense is a terrible defense. A good rule in life is not to touch people you’re not supposed to be touching. Keep your hands to yourself:

Gov. DeSantis explains Florida man’s definition of how to end Covid hesitancy:

The GOP also predicted Sharia law in America, the end of Christmas and death panels:

Remember when Obama wore a tan suit and Republicans went nuts? This week, Biden wore a tan suit to announce the big jobs increase. It was also Obama’s birthday week. It’s an obvious attempt to troll conservatives:

The summer of our discontent:

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Our COVID Data Is Inaccurate, And It’s Going to be Spun

The Daily Escape:

Sand Harbor State Park, Lake Tahoe, CA – 2020 photo by debarnec

Happy belated tax day! Two disturbing articles about both the accuracy and reliability of COVID-19 data were in the NYT yesterday.

First, the collection and reporting of data is increasingly reliant on outdated technology to deliver test results:

“Health departments track the virus’s spread with a distinctly American patchwork: a reporting system in which some test results arrive via smooth data feeds but others come by phone, email, physical mail or fax, a technology retained because it complies with digital privacy standards for health information.”

The problems are compounded by human error:

“These reports often come in duplicate, go to the wrong health department, or are missing crucial information such as a patient’s phone number or address.”

Before the pandemic, nearly 90% of laboratory test results for diseases tracked by public health departments were transmitted digitally. But the need for substantially greater Coronavirus testing has brought many more players into the public health arena, including companies that usually run employment screening tests, and small clinics that usually test for diseases like the flu and strep throat.

This has increased the share of lab tests coming to public health departments via fax and phone.

The result is unreliable information. The Times quotes Janet Hamilton, executive director of the Council of State and Territorial Epidemiologists: (emphasis by Wrongo)

“Nationally, about 80% percent of coronavirus test results are missing demographic information, and half do not have addresses…”

Hard to trace an infected person without an address. America’s health system is a jumble of old and new technology that make it difficult to track what’s really going on with the COVID pandemic.

Also, the Trump administration’s guidelines on demographic data haven’t taken effect yet. In June, they required laboratories to report a patients’ age, race and ethnicity, so public health officials could better understand the demographics of the Coronavirus pandemic. But, those rules won’t take effect until August, and they only state that laboratories “should” provide patients’ addresses and phone numbers. They do not mandate it.

Dr. Frieden, former CDC director says:

 “You’ve got hundreds of laboratories and thousands of tests. Nothing is interoperable because they haven’t been mandated to do that.”

Other countries have a unique number identifier for each patient, something that Congress refuses to provide in the US. Instead, data often come to public health authorities using only the information that laboratories need to track the record, not the details that public health officials need to help manage the disease.

Anyone who has healthcare knows that patients routinely fill out the same information on multiple forms in multiple offices. The need for doctors and testing services to use fax machines betrays the fundamental lack of modern technology in some health care settings.

And remember, it’s not for lack of money: There’s plenty of money in the US health care system.

The second item regarding COVID data is more troubling. The NYT reports that: (emphasis by Wrongo)

“The Trump administration has ordered hospitals to bypass the Centers for Disease Control and Prevention and, beginning on Wednesday, send all coronavirus patient information to a central database in Washington — a move that has alarmed public health experts who fear the data will be distorted for political gain.”

From now on, HHS, and not the CDC, will collect daily reports about the patients that each hospital is treating, how many beds and ventilators are available, and other information vital to tracking the pandemic.

This is seen as an inherently political move by outside public health experts. The NYT quotes Nicole Lurie, who served as assistant secretary for preparedness and response under former President Obama:

“Centralizing control of all data under the umbrella of an inherently political apparatus is dangerous and breeds distrust….It appears to cut off the ability of agencies like C.D.C. to do its basic job.”

This is more disturbing than finding out that the data are terrible. Alex Azar, who runs HHS, is a Trump crony and has clearly used his position to be helpful to Trump’s re-election campaign.

If there ever was any hope for a dispassionate, reasoned, and scientific FEDERAL response from Trump, it is certain that these two problems, one with the quality of the data, and the second with how it will be spun as it is reported, show we’re doomed.

How many health care workers will have to die? How many people living in states run by Trump’s personal bootlickers will get the treatment that they need?

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Can America Avoid Becoming a Failed State?

The Daily Escape:

Fall sunset, Shenandoah NP, VA – photo by juliend73

Sorry, but this column is going to be a downer.

We’ve been talking for the past few days about how hard it is to get politicians to focus on fixing what’s wrong in America. Wrongo originally started down this path in 2009. His plan was to lay out the problems, and to suggest ways in which America might fix them.

But 11 years later, little of what has been suggested here has occurred. Explaining what’s wrong has made very little difference.

Our really big problems now seem to be locked in: Climate change will happen. We can’t (or won’t) deal with the burgeoning disinformation platforms that threaten civil society. It’s difficult to see what will change our growing income inequality. As always, politicians are itching for a fight with some country. Today, the villain is China. Globalization has won, our supply chains now hold us hostage, and our economic future is increasingly controlled by Asia.

America is fast becoming a failed state: Our president tells people to drink bleach. There are more than 100,000 dead in the pandemic, and a significant percentage of them probably were needless deaths.

We have the ability to deal with the crises,but we’re choosing not to. Trump and McConnell, along with Biden, Pelosi and Schumer, all have access to the same, or more likely better information than we do.

They are choosing to ignore that the country is going to hell. Instead, they use each individual crisis for their own political benefit, and for their patrons’ financial benefit. They choose to ignore the near-certainty of a second wave of infections in the fall of 2020, bringing with it the possibility of a second economic collapse, along with more deaths.

We no longer provide the basics for our citizens. We live in a nation where income, savings, happiness, trust in government, and social cohesion are all in free-fall.

This is a recipe for social collapse.

In America most infrastructure is decrepit, from airports, to schools, to roads, because there hasn’t been much public investment. That’s because Americans don’t want to pay higher taxes like the Europeans do. Politicians on both sides still believe the evidence-free ideology of neoliberalism: We’ll all be rich if we invest in nothing, and wait for Mr. Market to correctly allocate resources.

No one cares about anyone else. Nobody will support any group’s pursuit of any goal unless it is also their goal. American life is becoming purely individualistic, adversarial, and acquisitive.

We haven’t invested in the systems that provide healthcare, education, retirement, and childcare. As a result, the average American family now goes without many of these things, since they’re priced out unless they have high paying jobs.

We pay absurd prices for health care. Having a child? That’ll be $50K. An operation? It will cost about what you would pay for a starter home. If she didn’t have health insurance, Wrongo’s daughter’s medication would cost $10,250/month. These basics of life are affordable in the rest of the rich world, but in America, they cost more than the average person can pay.

The average American now dies with $62k in debt. Life has become a sequence of unrepayable loans. Student debt becomes credit card debt and a mortgage, which leads to medical debt. These forms of debt define life in America. The average American is now a poor person, in the sense that they barely make enough to pay for the basics of life. Today, 80% of Americans live paycheck to paycheck, struggle to pay their basic bills, and 63% can’t raise $500 for an emergency.

These are the statistics of a nation that is descending into poverty.

Can it be fixed? Sure, but who’s going to pay for it? If taxes can’t be raised, if deficits can’t grow, what will happen? Nothing.

Except that we will move closer to a collapse. Our leaders say it’s because there isn’t an alternative. They say that we don’t have the money to pay for the changes we want. 70% of Americans say they want decent healthcare, retirement, and education, but they never vote for it.

Not even when it is offered during the primaries.

And it’s never offered in the general election, because nobody will vote for higher taxes to fund a functioning society. The idea simply isn’t acceptable to either of our political parties.

Wrongo’s decade of writing about what’s wrong hasn’t changed anything. Change requires a commitment to taking political risks, and massive voter turnout.

Otherwise, same old, same old is the path to our society’s destruction.

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Monday Wake Up Call – Get Back to Work Edition, May 11, 2020

The Daily Escape:

Pileated Woodpecker chicks – photo by JH Cleary

Americans are starting to peek out of their nests again. Governors have decided, and 30 of them are re-opening their states. Those states are not exclusively Republican; there are a few Democratic states too. The logic behind reopening is that of risk assessment and risk management. Somewhere between prudence and overreaction lies today’s American toxic politics.

We judge risk versus gain for everything, including for other causes of death. We try to model healthy behaviors. Most of us wear seatbelts, most watch our diets, and have stopped smoking years ago.

We also have to judge the risks associated with whether to end, or continue the lockdown. That means deciding which steps to take that will minimize both the spread of the virus, along with minimizing the crushing economic hardship being experienced by many Americans.

Ignore that the government isn’t currently taking care of healthcare and housing if you are unemployed.

The lockdown could go on for much longer if the federal government was willing to underwrite living costs for those who are out of work, until such time as it was safe to go back to work. But they have no intention of doing that.

So, from the Trump perspective, the choice is clear: Businesses need to open and their workers need to go back to work, despite the risks. Their argument is that living with COVID-19 isn’t as risky as it seems. Twenty-two states have had fewer than 100 deaths. So far, only 15 of 50 states have had total deaths for the crisis that are higher than NYC’s current rate of 500 a day. 

The original goal of lockdowns was to keep the health care system from being overwhelmed, and in the largest cities, that risk seems to be behind us. Whether that will be true in rural America where few hospitals operate, remains to be seen. Derek Thompson said in the Atlantic:

“This crisis represents an existential threat to America’s small businesses. Almost half of all job losses in April occurred in leisure and hospitality, where small businesses are overrepresented in companies like restaurants and stores. The decimation of small business would have long-lasting implications. It would destroy jobs that would be unlikely to return quickly, while creating a crisis of long-term unemployment.”

And all of those restaurants, cafés, theaters, community centers, and specialty shops that are part of the local fabric of our towns and villages could be wiped off Main Street. Losing many of them would be an economic tragedy. More from Thompson: (emphasis by Wrongo)

“The virus is real, the hospitalizations are real, the deaths are real, the need for masks and social distancing is real, the threat to millions of restaurants and shops is real, and the incomparable levels of unemployment are real, too. The White House plan to reverse this cavalcade of horrors is to “reopen” the economy. But 20 million Americans just lost their jobs in the past few weeks, not because the government shut down the economy, but because a pandemic scared millions of Americans into staying at home. There is plenty to be wisely afraid of, but Washington thinking that a pandemic economy is like a garage door that it can reopen by pressing a button might be the scariest thing of all.”

No one knows what will happen between now and Election Day. It’s not just a matter of businesses opening up. For people to go back to work, schools must be open, day care must be open, public transportation must be safe, and customers must show up.

Are you up for all of that?

In the Great Depression, we learned that unemployment at today’s scale required massive government intervention to address: Jobs programs, infrastructure investment, and a robust social safety net.

It required an FDR to galvanize the country. Needless to say, neither Trump nor the Republican Party have the desire to provide that leadership. They will be every bit as uncaring and incompetent at rebuilding our economy as they have been at stopping the pandemic.

Time to wake up America! The economy has been opened, and you need to protect yourself whether you’re back to work, or trying to find a new gig. And you know that Trump isn’t going to help you protect yourself and your family, and he’s certainly not going to help you find a new job.

To help you wake up, listen to Guns ‘n Roses cover Paul McCartney’s “Live and Let Die” which played during Trump’s visit to an N95 mask manufacturing plant in Phoenix:

Remember all of this in November.

Those who read the Wrongologist in email can view the video here.

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Sunday Cartoon Blogging – May 10, 2020

The National Bureau of Economic Research (NBER) has an interesting new report showing that New York City’s subway system was a major disseminator of COVID-19 during the coronavirus’ initial infection of the city during March 2020.

They show that subway ridership correlates directly with new cases, particularly in Queens. The near-shutdown of subway ridership in Manhattan (down by 90%) at the end of March correlates strongly with the reduction in the rate of increase in new cases in Queens thereafter.

They superimposed maps of subway station turnstile entries with zip code-level maps of reported coronavirus incidence. That showed Coronavirus propagation followed a process strongly consistent with subway riding. Moreover, local trains appeared to have a higher propensity to transmit infection than express trains, perhaps because people spent longer on those trains. Bus hubs served as secondary transmission routes out to the periphery of the city.

The subway was shut down because of staffing issues on March 25, not because the mayor or governor thought it was an important disease vector. Since then, at least 98 transit workers have died from coronavirus. On to cartoons.

Jogging in Georgia requires evasive tactics:

Trump did it again:

It never ends. On Fox and Friends, Trump said there is “no question” the video of the Ahmaud Arbery shooting is troubling. But, he hinted that further evidence might emerge that could possibly exculpate the shooters:

 “You know, it could be something that we didn’t see on tape. There could be a lot of — you know, if you saw things went off tape and then back on tape”

BTW, the NY Daily News reported that no burglaries had been reported for seven weeks before the shooting.

Small man sits near a great man:

America grows smaller as the president tries to make himself bigger, all the while failing at the actual mission of leading the Republic.

Pro-life doesn’t get in the way of reopening:

The only animal Trump wants at the White House:

Dropping charges against Flynn looks partisan:

Another reason to stay indoors:

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Saturday Soother – May 8, 2020

The Daily Escape:

The Second Wave, Coyote Buttes North, AZ, bu\ it’s easiest to reach from Kanab, UT – March 2020 photo by thatstheguy

“You know, that might be the answer – to act boastfully about something we ought to be ashamed of. That’s a trick that never seems to fail.” – Joseph Heller

Happy Saturday, fellow disease vectors! That’s quintessential Trump. He’s doing with the Coronavirus what was patented by Richard Nixon in Vietnam: “Declare Victory and Get Out”.

Trump had no intention of using the agencies of the US government as a positive force to deal with the pandemic, and now he’s backing out of any role helping the country to recover. From Eric Boehlert:

“Trump has no plan to “reopen” the country and he has no plan to manage this pandemic moving forward. The way I see it, the press dutifully starts each day assuming today is the day Trump gets serious and finally provides serious leadership. It’s not going to happen, though.  We’re on our own, yet the press stubbornly pretends otherwise because presidents are supposed to provide leadership in times of crisis.”

Boehlert refers us to Jay Rosen, an NYU journalism professor, who writes:

“The plan is to have no plan, to let daily deaths between one and three thousand become a normal thing, and then to create massive confusion about who is responsible— by telling the governors they’re in charge without doing what only the federal government can do, by fighting with the press when it shows up to be briefed, by fixing blame for the virus on China or some other foreign element, and by “flooding the zone with shit,” Steve Bannon’s phrase for overwhelming the system with disinformation, distraction, and denial, which boosts what economists call “search costs” for reliable intelligence.”

Trump’s playbook is to have his re-election ride on manufactured confusion. There won’t be a plot for us to expose, it’s happening right before our eyes. We all know that Trump has no intention of leading. That he has no desire to get involved in helping to solve the greatest American crisis since 9/11. And the disconnect is, that a president acting like this would have been inconceivable before Donald Trump.

It isn’t debatable: Trump has washed his hands of the pandemic, and plans to blame the governors when things go wrong, while taking credit for anything that goes right. He isn’t even trying to hide that anymore.

We heard this week that Trump buried the CDC’s detailed advice about reopening. The administration doesn’t want the public to know what the scientists are recommending. That means people won’t be in a position to hold their employers, or their local governments, to a standard that they either can’t, or don’t want to meet.

At this point, all we can do is grit our teeth, and try to protect ourselves and our loved ones as best we can.

It seems likely that Trump, because of opting out of what a president is supposed to do in a crisis, will be the proximate cause of the deaths of thousands. All as a cover for his callous ineptitude.

And there’s little that we can do about it, except hunker down and be careful as we try to get through it.

We need a break from all of this negativity.

We need to settle back in a comfy chair at a socially distant spot, and de-stress from another difficult week. It’s time for another Saturday Soother, those few moments when we move to a different and better emotional plane. This weekend includes Mother’s Day, so it’s also a time to think about family and how we got to where we are.

To help with that, take a few minutes and listen to some of the world’s biggest current musical artists who collaborated on a BBC Radio 1 cover of the Foo Fighters’ “Times Like These”. Each performing from their own homes, as has become the standard these days. The group was dubbed the “Live Lounge Allstars” and included the Foo Fighters’ Dave Grohl:

Wrongo knows very few of these artists, perhaps showing his age. But this also shows that they should make more music outside of their usual genre. Those who read the Wrongologist in email can watch the video here.

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World’s Most Expensive Health Care System Can’t Provide Minimum PPE

The Daily Escape:

Tim Hunter, BSN, in Brooklyn, NY – April 2020 photo by Tim Hunter

Tim Hunter, an acquaintance from the world of show dogs, is a nurse living in Buffalo, NY. In early April, he accepted a traveling nurse assignment at Kingsbrook Jewish Memorial’s ICU in Brooklyn, NY to help out on the front lines of the COVID-19 fight. Tim posts on his experiences, and he graciously agreed to share this dispatch from earlier this week:

“Wednesday May 6th starts Nurse’s Week 2020

The last time we worked, we were informed that we will, moving forward, only be getting our body suits and can no longer get a disposable gown to put over the suit. Big freaking deal right? Wrong. What does this mean? This means we will enter rooms “protected” but after leaving a room we will be tracking COVID all over the unit. Nurses are buying spray alcohol to try and kill whatever lands on the suit so we don’t risk getting each other sick. Or do you take off the suit in between care? Absolutely not. What if you need to intervene right away? There’s no time to get it on.

People who have no relevant education or experience are protesting having to sit at home, while we watch people who have been intubated for weeks struggle, while we’re standing in patient’s rooms and intervening we’re looking at posters of patient’s family, of these people who are dancing at their daughter’s wedding and giving their grandson a piggy back ride. People that were once fine and people that should be able to still be doing those things.

We drive to work in dead silence because we have no idea what we’re in for. Maybe it will be a super typical hospital shift, or maybe it will be the worst night you’ve ever worked.

We’re watching people get tracheostomies after weeks of intubation in hopes that MAYBE someday they’ll be okay enough to have their life back. We’re drying patient’s tears when they wake up from their sedation and they’re terrified!

We’re watching people who we were once hopeful would maybe get off of the vent sustain lung injuries from not being able to handle the pressures of mechanical ventilation any longer.
We listen to family members cry because they don’t know if they will ever see their loved one again, and they mourn that they’re going through this alone.

We see patients grabbing our hands begging us not to leave rooms because they’re lonely, and scared.

We walk past tractor trailer trucks full of dead bodies on our way in and out of work every night. Because there is no way to manage, no morgue can keep up with the amount of people dying. Even now with the “down swing”.

And the end of a shift we feel like our head is in a vice grip, and literally crave a breath of actual fresh air after rebreathing CO2 all night.

We wake up in the middle of the night with a panic because of a headache or any symptom and literally fret over that one time we did compressions or were a part of an intubation, because of how high risk those events are.

You know what nurses want for nurses week?
To know they’re safe, to know that in AMERICA that we can be afforded a shitty disposable gown to help protect ourselves from sitting in a virus. To not become so neurotic that our hands are completely raw from washing them so much. We want you to have enough respect for human life to not make stupid decisions. We want you to pay attention to science and not stupid conspiracy theories.

We don’t want to be called heroes, we don’t want shitty pizza, or signs. We want to be safe, well-staffed, and to not feel like every day we’re risking our own well-being.

Returning to the bedside has been the most amazing thing I’ve ever done, but after this I will go back to my job with an insurance company. While people that actually deserve your accolades keep fighting this.

So think this status is for attention, likes, call it fear mongering or whatever. But really it’s just so maybe for a second you’ll take this seriously. I have 33 days left in my contract to keep fighting with these people, and I honestly hope that things are headed back towards normal when I drive home. But with all of the small gatherings that pop up on social media that you’ve convinced yourself are fine, masses of people standing outside of a damn Dairy Queen, and seeing all the people in streets ignoring social distancing measures, it’s honestly unlikely.

Happy Nurses Week though…”

#EndRant

This is the state of American health care in 2020. Tim, thanks for your bravery and insight.

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Who Should Fight America’s Pandemics?

The Daily Escape:

Lightning strikes with rainbow, Dickinson, ND – photo by Lightcrafterartistry

COVID-19? Nobody thought anything like this would ever happen. Wrong. Lots of people did. From VOX:

“Per capita, the United States is currently seeing about twice as many confirmed coronavirus cases as Canada and about 30 percent more deaths.”

The key difference between the US and Canada says David Fisman an epidemiologist at the University of Toronto:

“We have a federal government that is supporting provinces’ responses….You have a chief executive who is directly undermining the public health response.”

Politics and politicians by definition, are always in the loop in a national emergency. Yesterday, we talked about how civic-minded politicians stand aside, letting the experts decide strategy. Then they help the experts by making the government work to support the strategy. And they then help with communicating priorities to citizens.

Our national response to the pandemic has been mostly incompetent. The wealthiest, most scientifically advanced country in history has been brought to its knees by a virus it knew was coming. As late as 2016, we had a coordinated national strategy to combat pandemics.

What can we do to insure we do a better job in the future?

This has been a hot topic in pundit land for the past few weeks. There are two threads of discussion: First, make the US military the leader in fighting pandemics. Alternatively, an “empowered” civilian agency or possibly, an empowered public-private partnership should direct the fight.

Let’s start by talking about how civilian government agencies might do a better job, if they were “empowered” and also funded. In 2005, GW Bush said: (emphasis by Wrongo)

“If we wait for a pandemic to appear, it will be too late to prepare….we need medical personnel and adequate supplies of equipment…In a pandemic, everything from syringes to hospital beds, respirators masks and protective equipment would be in short supply….If a pandemic strikes, our country must have a surge capacity in place that will allow us to bring a new vaccine on line quickly and manufacture enough to immunize every American against the pandemic strain…”

Bush thought it would take $7 billion to build out his plan, plus annual appropriations thereafter. But that wasn’t supported by Congress. Obama built on Bush’s plan, but his efforts also were not sustained by a Tea Party Congress. Trump’s FY 2021 budget proposal reduces CDC funding by 16%. It was submitted just 11 days after the WHO declared the Coronavirus a public health emergency.

What should we be doing? First, we need to invest in ourselves, to break our reliance on offshore sources of PPE and pharmaceuticals. We saw that China stopped exporting PPE to the US, husbanding it for their own needs, and subsequently, showing a preference for shipping these goods to nations they perceived as friendlier.

Second, we need to empower an elite governmental team to combat a pandemic. The 2014 Ebola outbreak told us we needed a health security infrastructure. By 2016, America had coordinated an “all-government response” to the next pandemic. Laurie Garrett, a science journalist summed up the infrastructure created by Obama as a:

 “…special elite corps inside of the National Security Council, the Department of Homeland Security, Health and Human Services and CDC…an emergency capacity for surge drug approval at FDA
 a lot of co-ordination with the states
 a division that was doing nothing but training hospitals in infection control and appropriate epidemic responses
 and…Study on how to surge hospital beds, how to surge physicians out of retirement…”

Sounds great, no? It needs to be rebuilt if we are to have effective control of our pandemic response.

The story of using the military also begins with Garrett. In September 2014, she briefed the Joint Chiefs of Staff on how the US military could help the countries affected by Ebola. She says that this was:

“…unprecedented in US history; we’d never mobilized US military for a medical response like that before”.

But today, the military wants the job. From Roll Call:

“To many lawmakers, the Defense Department is an attractive place to fund medical programs, partly because the defense budget is so large and enjoys support from both political parties, especially Republicans.”

Congress not only funds the NIH, it also provides $1 billion a year for DOD research labs looking into cures and treatments for cancers and other diseases.

Going forward, the military would like to see an increased focus on health as a part of national security. The debate is not a matter of either health security, or military security, it has to be both.

With a new administration, we need to think beyond stimulus packages, to fundamentally rethink what national security means. In the next pandemic, we can’t be scrambling for enough face masks to protect our medical professionals and hoping that the military can save us.

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