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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Saturday Soother, Covid Plateau Edition – May 2, 2020

The Daily Escape:

Spring flower bloom at Keukenhof Garden in Holland. (Hat tip to Ottho H.)

Remember when we had fifteen COVID-19 cases, and they were just going to be gone, like a miracle?

If you ask Trump, that’s where we are, plus a few orders of magnitude. All of the recent happy talk about reaching or being past the peak have omitted the detail that so far, “flattening the curve” isn’t substantially reducing the number of cases, or deaths.

The theory was that once we “flattened the curve”, we could ease up on social isolation, mask-wearing and get back to work. When we think about the downside of the curve, we think bell curves, with a sharp rise and fall from a high peak. As Wrongo said on April 20, that was unlikely to be the outcome, because it didn’t happen like that in countries that started fighting the virus long before us. And that’s how it seems to be working out. Here is where we are:

Source: Washington Post

The chart tracks a 3-day average of cases, since that smooths out some of the big day-to-day variances. As of April 29, it seemed clear that we have reached a peak, but we’re not showing any real signs of a rapid decline. This means the COVID-19 curve could remain elevated for a long time.

And we should remember that 878,839 cases are still active.

Politicians are obsessed with “the peak.” Are we at it? Are we past it? When will it come? Has it come? Now they’ve turned to communicating their plans for reopening the economy. That makes sense. Re-opening is becoming urgent, with more than 30 million Americans out of work, but it’s dismissive for politicians to say we’re past the worst of it “medically” while more people go to the ICU every day.

Massachusetts governor Charlie Baker (R), sees the plateau, and wonders when the curve will start to decline:

“Baker focused on hospitalizations and ICU admissions, saying, we’ve basically been flat for 12 days. We’re flat at a high level. But 12 days, 13 days counting today — you’re not going to find a lot of other places that just sit like this for 13 days.”

Former FDA Commissioner Scott Gottlieb MD, an advisor to Baker, tweeted:

IHME (mentioned in the tweet) is a closely watched model from the University of Washington Institute for Health Metrics and Evaluation.

What we do over the next few weeks will determine whether we get this right, or whether COVID remains a large ongoing threat. We need to understand the potential risks that come with a decision to reopen, and make plans to mitigate these risks as best we can. Some states, like Connecticut, are planning carefully.

If we look state by state, in about half of the country, the numbers of cases are still rising. In about another third of the country, there is a leveling off. Only in a minority of states are the numbers actually coming down on a daily basis. New York, Washington, Louisiana and Idaho have had reductions of more than 50% from their peaks in new infections.

According to STAT, there are several possible outcomes: Recurring small outbreaks, a monster wave of cases, or a persistent crisis. And no one knows which outcome is most likely. We should expect new infections to start rising again in states without much testing, but with large populations that opened early like Texas, Florida and Georgia.

We should also realize that in some states, cooking the books about new cases and deaths will happen. Newsweek reported data compiled by Florida medical examiners was no longer being reported by the state government. The official state data has not been updated in over a week.

Acting like we’re flattening the curve when we really don’t know if we are, is likely to create a San Andreas-sized political earthquake if cases spike again.

But let’s try to get past all this, because it’s time for another Saturday Soother, when we stop checking Twitter, and think about spring.

Here on the fields of Wrong, the pear, plum and cherry trees have flowered, while the crab apples are soon to bloom. We have bluebirds nesting in both bluebird houses. Our weather remains cold and wet, so stay indoors and brew up a hot mug of Bengal Spice tea.

Now grab a socially distant chair and have a few minutes of fun with a song parody by the Opera Guy, Matthew Ciuffitelli. Here’s his parody of “Phantom of the Opera”, called “Phantom of the Quarantine”. Wrongo promises you won’t be disappointed:

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

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Sunday Cartoon Blogging – April 26, 2020

From the WaPo: (brackets by Wrongo)

“President Trump on Friday threatened to block an emergency loan to shore up the U.S. Postal Service unless it dramatically raised shipping prices on online retailers…“The Postal Service is a joke,” Trump told reporters in the Oval Office. [In order] To obtain a $10 billion line of credit Congress approved this month, “The post office should raise the price of a package by approximately four times…”

The USPS is enshrined in the US Constitution. BTW, killing it might accomplish a few things for Trump:

  • It obstructs any Congressional effort to mandate mail-in voting.
  • It rewards private sector delivery carriers like FedEx and UPS that compete with the USPS. Many of them have donated both to Trump and Republican candidates.

The USPS is entirely self-funded. If you buy stamps, you’ve funded the Post Office. Its operations are profitable. It loses money on paper because of Congress’s unique requirement for the USPS to pre-pay all future pension liabilities, something no other American corporation or institution is required to do. That was imposed by Republicans in 2006 in the Postal Accountability and Enhancement Act.

He’s trying to make the Postal Service unprofitable. And when it’s a shell of its former self, sell it to UPS or FedEx who would be delighted to have one of their biggest competitors destroyed. On to cartoons.

Our grim future:

MAGA-ites drink the healing Kool aid:

Your lockdown inconveniences my freedumb:

Georgia takes aim at the lockdown:

Nursing homes account for 25% of US COVID-19 deaths. Remember the elderly and infirm:

The oil glut has forced the oil companies into the suburbs:

 

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Saturday Soother – April 25, 2020

The Daily Escape:

Wildflowers, Hidden Lake, Glacier NP, WY – August 2019 iPhone photo by anadoptabledog

Wrongo shopped at both Costco and at our local chain supermarket, Big Y in the past two days. Both were out of significant items, and not merely paper products.

A hallmark of American culture is the size of our supermarkets, and the dazzling variety of products available. Anyone who has shopped in foreign countries can attest to the difference, so it’s unsettling to see so many bare shelves.

What exactly is going on here? This is a downstream impact of COVID-19 and how we’re fighting the pandemic. We have a finely tuned supply chain, and the shutdown has upended it. On the demand side, commercial buyers of food, like restaurant chains, and commercial bakeries aren’t buying what they bought in pre-COVID times. While consumers are cooking at home, and buying much more than ever before.

On the supply side, there are clear disruptions: Consumer demand for meat has skyrocketed. The WSJ reports:

“US grocers are struggling to secure meat, looking for new suppliers and selling different cuts, as the coronavirus pandemic cuts into domestic production and raises fears of shortages.”

The Journal quotes Jeff Lyons, SVP at Costco:

“I have not seen beef sales and all protein behave this way since the Atkins Diet days…”

US beef production fell 24% compared with a month earlier, pork fell by 20%, and poultry was down 10%, according to estimates from CoBank, an agricultural lender. And wholesale prices are creeping up:

April’s sharp decline in beef and pork prices reflected the drop in demand after the shutdown closed restaurants, while the spike is due to increasing consumer demand when production is down.

The spread of COVID-19 among US meat plant workers has hurt meat production. Companies are trucking poultry and livestock to be processed at more distant plants that remain open. On some farms, pigs are being euthanized because slaughterhouses have closed. In Iowa, Gov. Kim Reynolds dispatched 1,000 National Guard members to help deliver COVID-19 tests to Iowa meat plants so they could get back into operation.

Egg farmers are destroying eggs. Dairy farmers have been dumping thousands of gallons of milk. Some cattle ranchers are sending their herds to early slaughter because the restaurant market is dead: No one is going out for steak & eggs, or a bacon and egg breakfast in a diner. The Hill described more lost food output:

“Some $5 billion of fresh fruits and vegetables have already gone to waste, according to the Produce Marketing Association, an industry trade group.”

We know how the virus outbreaks at food plants hurt meat production, but there are other supply chain problems.

The primary issue is supply chain mismatches caused by the lockdown. In normal times, people get a significant amount of food at restaurants, while many kids eat lunch at school. Our highly specialized supply chains can’t adapt easily or quickly to the lockdown reality.

Wholesalers who focused on restaurants do not have the facilities for packaging food in a way people are used to seeing it on shelves, and grocery stores don’t have relationships with the wholesale producers. The 50-pound bags of flour that mills sell to large bakeries or restaurants are of little use to people needing a five pound bag for a family of four.

Getting food to grocery shelves is also hampered by delivery people and grocery store workers alike who are increasingly calling out sick, either with Coronavirus, or the fear of getting it.

Finally, we’re seeing increased food insecurity. Before the pandemic began, 37 million Americans were considered food insecure. Since the start of the lockdown, about 25 million people have applied for unemployment. The bigger problem now is that so many people have no cash coming in. Meanwhile, food banks are having trouble supplying enough food to people who need it. In parts of America, that problem is far more acute that food shortages, and it’s unlikely to get better soon.

Sadly, we have millions needing food, when farmers are destroying what to them, is surplus food.

But enough of bad news, you’ve had it with a week that saw us hit 50,000 COVID-19 deaths, and Trump grabbing at straws for a Coronavirus cure. Time for our Saturday Soother, a few moments when we forget about Trump, Corona and lockdowns to focus on our breathing, and something a little different.

Today, pull up a socially distant chair and listen to Maude Maggart sing an old standard from the 1930’s, “Deep Purple”. Maggart is Fiona Apple’s sister. Pretty talented family:

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

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We’re In Uncharted Territory

The Daily Escape:

Sunset, Factory Butte, UT – photo by goat_chop56

Blog reader David K. emailed:

“Now, what do we common folk do?  Start our “victory gardens” and shelter in place?  Volunteer to help our local farmers raise food? Hoard?  Wish I had a great idea, because I agree that our leaders don’t have a clue how to respond.”

That gave Wrongo pause. What do those of us who aren’t part of the “smart money” crowd supposed to do, particularly if what we’re facing is a worldwide depression? John Pavlovitz frames the existential issues quite clearly:

What happens if the stores run out of essentials for good?
What if you run out of money to stockpile them?
What if your neighbors stop sharing with you?
What if the government won’t help you?
What might you do then?

Politicians say we’re at war, but as Kunstler says: “At least in wartime, the bars stay open. That’s how you know this is a different thing altogether from whatever else you’ve seen in your lifetime.”

We’re attacked by a novel virus that’s created a completely novel social and economic situation. By definition, we aren’t prepared for an abrupt crash of both our social fabric, and our economic well-being.

Our politicians have no answers, despite most of them having been around for the 2007-2008 Great Recession. The Fed hasn’t done us any favors since then, either.

Last Saturday, Wrongo said that we’re crossing a threshold between what we know and an unseen future. Our traditional systems are no longer capable of keeping society and the economy on an even keel. Nobody really knows how deep and how harsh this will get, but the situation presents two questions:

  • How much disorder will we have to endure?
  • What does the world look like when this thing is over?

All this is happening in an election year, when the entire government and the political parties’ power structures are vulnerable, and could change. We are facing a new reality, for which no one has any answers.

Politics being what it is, the White House and the Congress are trying to work together to come up with solutions. On Monday, Trump gave another press conference on COVID-19. During his talk, the stock market dropped nearly 3,000 points. It was the market’s worst day since Black Monday in 1987.

The smart money was behind Trump in order to get its corporate tax cuts, but now, they’ve voted with their money. And Trump’s starting to look a little bit like Herbert Hoover.

Sen. Mitt Romney (R-UT) floated Democrat Andrew Yang’s idea of giving every American $1,000. He was joined in principle by Sen. Tom Cotton (R-AK). We’ll see if this is just more Republican grandstanding, or if they actually back a real plan of support for working people.

With Trump, you can expect to see bailouts for several industries, including banks, airlines, casinos and cruise lines. Imagine: Casinos are asking for help from the guy who only knows how to bankrupt casinos.

Reuters reports that the US airline industry said that it needs $50 billion in grants and loans to survive the dramatic falloff in travel demand from the COVID-19 outbreak. This is just more socialism for America’s corporations.

Two thoughts: First, $50 billion is higher than the book value of all the airlines combined. Why should they have any of our money? Either Republicans are for free market capitalism, or they should just shut up. Most of these airlines have implemented stock buyback programs when they should have been building contingency funds instead.

Second, this $50 billion should be added to whatever Congress spends on small businesses that are forced to close due to quarantine, or on parents forced to stay home to take care of kids who aren’t going to school anymore. They’re the ones who are really hurting.

We’ve lived through a time of unprecedented affluence. We’ve told ourselves we deserved it all, that we were entitled to all that our country has provided.

But that’s most likely over, and it might not return in Wrongo’s lifetime.

We have to think about what must change if we are to have a functioning society and economy in the decades to come.

The list of all the things that we need to change is far too long to enumerate here. At a minimum, we need to reform capitalism, make health insurance universal and strengthen worker’s rights.

We have to do a better job of sharing the wealth. It we don’t do that voluntarily, our children’s children’s generation will come and fight us for what we have.

To protect our families and their future, we need to become even more active politically in order to make these and other changes happen.

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Can the Economy Endure a Two-Month Shutdown?

The Daily Escape:

Cannon Beach, OR – 2020 photo by franks28

The short answer to the question above is no, not without outright financial support for individuals by the government. That support if it comes, is likely to be too little, too late.

But the Fed tried something. On Sunday, it announced that it slashed its federal funds rate by a full percentage point, to a target range between 0% and 0.25%. In addition, they launched a new Quantitative Easing program for another $700 billion.

Investors threw up all over the Fed’s Sunday moves, because we’re looking at a “demand shock”, the state-enforced loss of consumer sales,something that can’t be stimulated away. The S&P futures immediately plunged 5% to hit its downside limit. That made for an interesting Monday, with the Dow ending down nearly 3,000 points, or another 13%. In the past month, the market has lost nearly a third of its value.

All these efforts to provide stability actually showed the market that our leaders have no idea what they’re doing. It’s the exact opposite of inspiring confidence.

Did the Fed panic? Fed Chair Jay Powell lowered rates right after Trump said he had the authority to remove Powell. That makes it seem, true or not, like the Fed is now in Trump’s pocket. No confidence-builder there.

Looking through a wider lens, Mr. Market has decided that the Fed is pushing on a string. Rates were already so low that there was little gain from the interest rate reduction, and little else that the Fed could do. Mostly, the Fed signaled that it is very frightened about the prospect of a global recession.

In addition, the market understood that the stimulus bill working its way through the House and Senate is inadequate to the task ahead. For one thing, Pelosi’s bill promises paid sick leave, but as written it only covers about 20% of all workers.

Again through that wide-angle lens, the growing COVID-19 business lockdown strategy will have an economic impact similar to a natural disaster, like a hurricane, but played out over a longer time frame. FEMA has found that 40% of businesses close in a natural disaster. And of the businesses that reopen, only 29% survive the after the following two years.

Since our economy is 70% services, many industries facing the lockdown, like tourism, casinos, restaurants, and hotels, will soon be in meltdown mode. The Fed has no answer to a massive drop in consumer spending, only the president and Congress can solve that.

We know that 40% of Americans don’t have enough cash on hand or room on a credit card to handle a $400 emergency. Many service industry workers will be hit with either cutbacks in their hours, or outright job losses. Without financial assistance, we’ll quickly see defaults on rent or mortgages, and delinquencies on credit cards and car payments.

So the Fed creates some more money. But just like in 2008, rather than distributing it to every citizen, they’re giving it to the banks. Somehow, all that money is going to people who already have plenty, while those who need it get nada.

Why is the answer always to give more to the supposed “job creators” when we get basically nothing in return? Why not just send a check to the actual people who need it?

Finally, what will this interest rate cut do for the economy?

  • Are restaurants going to start hiring workers that can’t actually come to work just because loans are cheap?
  • Are workers not collecting a paycheck going to go out and buy a new car/TV/house because interest rates dropped a bit?
  • Are banks going to lend cheap money to airlines, restaurants, and cruise lines when we have no idea how long this will last?

Every company on the planet has simultaneously realized that it is in an existential cash-flow crisis due to COVID-19. The big and smart companies already have drawn down their unused loan facilities to ride through the slowdown.

The slower and the smaller firms are staring at an economic nuclear-winter scenario where their revenue plunges for months, and they can’t pay their staff, or make their fixed payments.

The speed and comprehensiveness of the lockdowns, and their drastic impact make what’s going to happen very clear. Our leaders are in a fog of denial. They don’t see that much of what was the traditional mode of operating our system is crumbling.

During the 2008 financial crisis, we learned that events can move too quickly for anyone to intervene and limit the damage. Our business environment’s drive for highly efficient systems, from just-in-time inventory sourcing to reducing the number of hospital beds per capita, have created fragile systems that are now being stress-tested.

We may be learning, to our collective detriment, that all of these systems along with our leaders, have failed us.

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