Yves here. We’ve pointed out repeatedly that lockdown policies are driven primarily not by infection or death rates but Covid cases putting pressure on hospital capacity. When experts project outbreaks to be on the verge of reaching the level where either medical worker health or the ability of hospitals to provide adequate care, only then do officials start imposing restrictions. Some jurisdictions trigger earlier than others. It’s not hard to take this reasoning one step further and conclude that protecting the medical system is the paramount concern in Covid public health decisions generally. Richard North has been making the same argument about the UK’s Covid policy.
By Peter Dorman, professor of economics at The Evergreen State College. Originally published at Econospeak
Matt Yglesias has an excellent retrospective on the absurd reversals over mask usage that arose in the early stages of the pandemic. You will recall that the public health establishment, amplified by mainstream media outlets like the New York Times, told us all to ditch our masks and concentrate instead on frequent, vigorous hand-washing. This was transparently absurd at the time, since from the beginning it appeared that coronavirus transmission had something to do with airborne virus exposure.
We were told masking didn’t protect us.
We were told only N95 masks worked, and only if they were taken on and off just so, in a complex procedure us untrained mortals could never execute.
And we were told we had to save these precious masks so health care workers could protect themselves, even though that was in direct contradiction to argument #1. (Later, Anthony Fauci told us that conserving the inadequate supply of N95’s was the underlying motivation, and the rest was mostly persuasion.)
By mid-spring the story had changed, and now we were all supposed to wear masks at least some of the time, although the WHO and the CDC were reluctant to go the full distance and admit that aerosol transmission was widespread and justified routine use of masks in social settings. Today we have arrived at the point where reluctance to wear a mask is cause for shaming and shunning—as if the initial mask guidance and its repetition in the media had never happened.
But the mask fiasco was only a part of it. Yglesias also mentions the shifting and contradictory policies regarding distancing: the immediate shutdown of outdoor activities even though indoors was more dangerous and the “hygiene theater” of deep cleaning while air filtration languished. He says we should have a serious, critical examination of America’s response to the virus once the worst of the pandemic is over.
I agree, but I want to add a further observation and hypothesis. Every failure of guidance and regulation had a common theme, protection of the health care system. We should abjure masks because the health care workers needed them. We can’t base messaging or policy on aerosol transmission because that would require expensive retrofitting of health care facilities. We can’t restrict travel because medical supply chains and the movement of health care resources can’t be disrupted. The objective is to “flatten the curve”, not eradicate the virus, because the important thing is to not run out of ventilators or ICU capacity—even though flattening has no visible endgame and itself contradicts the messaging about how awful it is to get covid. Put it all together, and it’s hard to avoid the conclusion that the mission of public health had quietly morphed from protecting the health of the public to protecting the resources and operations of the health care system.
This is how it looks to me, but it’s still a hypothesis. We could benefit from scrutiny of public health schools in universities, not least their funding, and public health agencies at the state and federal levels—and also the WHO. Has public health been redefined this way in practice and even in theory? If so, what would it take to redirect it so the health status of the public and not the burden on health service providers is their guiding concern?
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> it’s hard to avoid the conclusion that the mission of public health had quietly morphed from protecting the health of the public to protecting the resources and operations of the health care system.
Well put.
Adding, another example of this (sadly) was hydrochloroquinine. IIRC, all the initital studies, and there were many, were done on already ill patients in hospitals (i.e., in profit centers). But from the earliest days, HQ, as “populist medicine,” was recommended as a prophylactic (with additional items, like zinc, also prescribed). So for months, none of the studies from so-called evidence-based medicine were useful, because they were testing for the wrong thing.
I would add that something that was missed almost completely from the very beginning is how essential would have been protecting the most vulnerable populations, and this was miserably done particularly in the first wave even if it was known early that the elder, for instance, were disproportionately affected. When most nursing homes were privately owned business accompanied by the typical cost-cutting strategies including most importantly a precarious underpaid labour force that have little opportunity to protect themselves. Nobody raised the alarm timely and the carnage in some many institutions was of concentration-camp grade, to the point of denying health care on the premise of priorities being taken in overwhelming situations not to mention denying a dignified death, and the physical company of the relatives of dying grandmas and grandpas.
For me the greatest failure so far. Outrageous!
My year-end celebration will be at home, without visitors from other households, and in my particular case I will include a Scottish smoky-arome single-malt with which I will toast for every blunder committed this year, surely getting drunk on the way. I usually don’t drink anything at all so I guess I will end with an epic binge.
Ah, ending this momentous year in a haze. An idea I fully endorse.
Do have some strong B complex vitamins ready to combat the hangover the next morning. I find this “treatment” does lessen the severity of hangover symptoms. (I suffer from bad hangover symptoms every time I indulge in “medicinal spirits.”)
Stay safe over there!
Pray for us in America. We are about to be ‘tested’ by fate.
Cheers sir!
I hope to enjoy some good spirits at the end of this year too. I hope to be able to taste them as well but I guess I’ll see when that particular symptom recedes. Otherwise there’s not much point in drinking the good stuff.
Exactly! Here’s another one, gets no play. Povidone Iodine @ 0.5%,(thats 1/2 of one percent, important) kills 100% of the virus in nasal passages. Most effective when used with a vaporizer, can be gargled with. Just try to find it…
Huh? You can buy 10% Povidone just about anywhere (online, at your local drug store) and dilute it. Studies on it for gargle and nasal spray have used up to 2.5% concentrations for 5-6 months with no ill effect. Only concern might be if you have hyperparathyroidism, since the extra iodine could increase conversion from T4 to T3 (some will wind up getting into your digestion).
I’ve been gargling with my homemade 1% 2X a day and using it as a nasal spray if I think I’ve been around too many unmaksed people It can stain your teeth, so you might have to use a tooth whitener down the road. The gargle is super foamy and the nose spray stings a little bit.
There is no substitute for having basic arithmetic competency and owning a set of basic measuring tools… ;-)
Not “protect the resources”, but “cover for the failures” of the health care system.
Hospitals are among the largest landowners in the country, and most starve their jurisdictions of property taxes. Non-profit systems, especially the big quaternary urban academic medical centers, claim their charitable mission includes a leadership role in coordinating regional public health emergency preparedness and response.
The pandemic was not only predictable, it was a mathematical certainty. When it would happen wasn’t known. That it would was predictable. With the amount of real estate owned by hospitals, the relatively low cost of warehouse construction and relatively predictable costs of ventilators and PPE, there is no excuse for shortages.
Most big hospitals could have financed purchase and storage by limiting all C-suite executives to $1 million per year in total compensation.
I think this is closer to the truth. Also, the visual images of hospitals full to overflowing, combined with the fear of the upper crust that they might need to compete with the poor for hospital resources, and the simplicity of understanding hospital capacity as a metric, along with the fact that hospitals make good coin only when they are nearly full but not overflowing, all combined to make hospital capacity THE METRIC. It never made sense. But i can say for a fact from the ground view of where i sit, it is so.
In our local hospital system, purchased from the Sisters of Mercy by Centura Health, information is withheld from the public so that our overall picture of the pandemic and our county is incomplete. And to rub salt in our wounds, hospital staff are under strict orders not to talk to the media or otherwise communicate through social media what it’s really like inside there. And we just had a major outbreak of over 130 cases in the main nursing home in the community.
And when they were testing HCQ, they did it in a way that insured it failed. The Reason Study in the UK gave people 4X the recommended max dosage and were “Stunned, Stunned I Tell You” when the predicted overdose heart anomalys emerged.
I remember Dr John Campbell going back and forth between the Reason plan and the Brit PDR being as he put is “Gobsmacked” “I mean the first thing you do when you prescribe a drug is to pull out the PDR and check the correct dosage. And they are giving 4 times the max. I just can’t understand it…..”
And when it all really hit the fan, knowing how fragile and in need the health care system was, they sent trillions to banks and gor the biggest corporations.
(Insert clown face emjoi)
In response to both you and Yves, protection of the health care system is a vital goal.
I completely agree that what is missing in this analysis is the simple fact that protecting the healthcare system is a vital goal. One assumes that would be particularly so in a pandemic. It may be a poor analogy but it is as if you are expressing surprise that, in the face of an invasion, bullets were being provided to soldiers ahead of civilians.
Hindsight is 20/20. I think everyone is forgetting the complete lack of knowledge about the virus early on and the fact that PPE supplies were certainly questionable particularly in the harder-hit cities. And yes it appears that some of the advice was spectacularly wrong. WOW. That provides nothing more than making decisions in a time of crisis with limited information invariably leads to some wrong decisions.
The fact that medical experts may err on the side of protecting the healthcare system does not seem like a bug but rather a feature. We want that system to be able to survive an unknown crisis. That does not disqualify them from directing the response. The fact that politicians may err on the side of protecting their donors is also not surprising. However, it is a very good reason to keep them away from responding in a time of a health crisis.
So I am having a difficult time understanding why this is such a “hot” take.
“medical experts may err on the side of protecting the healthcare system”
our health insurance system is not run by medical experts it’s run by insurance co. lobbyists and wall street
Everyone saw the Italians in Lombardy scrambling with overloaded hospitals in March, and identified that as the scenario to avoid. Protecting the health care system from being overwhelmed is a legit policy objective. The US isn’t alone in this. You need to try to dis-confirm your hypothesis by looking at a good spread of countries where the health care system doesn’t have the same kind of political influence.
I think this is a valid hypothesis, but I’d suggest it arose less from a deliberate policy than a sort of conceptual closed loop created by the way public health specialists (which of course covers a wide range of disciplines) are trained to think. Their narrow focus on an evidence based assessment of disease control has proven to be very limiting and downright dangerous in some cases.
I saw little or no evidence that anyone was taking a more rigorous cost/benefit or risk based assessment outside of Asia (where what seemed like an extreme over reaction by the South Koreans and Vietnamese actually worked). This isn’t hindsight, there were plenty of reasoned arguments set out back very early in the pandemic for immediate travel restrictions and universal mask use. The counter arguments I read at the time never made much sense to me.
What I find disturbing is that there appears to be a group think building up in the scientific community that the whole problem is stupid politicians and idiot rural rubes not ‘following the science’. In far too many cases, it the scientific advisors (specifically those paid to give advice to government, or those in trusted positions to give public advice) who were flat out wrong. We need to find out why.
Correction: what the Vietnamese did worked.
South Korea did not “overreact” as much as necessary and never went for elimination. They though they can control it at low levels without going into “extreme” measure. Which set them up for a lot of potential trouble in the winter.
Winter has now come and that trouble has indeed arrived — they now have more cases than ever before.
There is no controlling this thing in winter conditions without a Wuhan-style lockdown.
The summer should have been used to eradicate the virus and have in place serious preparations for stamping out any small outbreaks that might appear.
I’ve felt the really response was about protecting the healthcare workers for a long time. Public health has to be locally responsive. Asian countries already had experience with SARS viruses in mass, so they are on their 2nd or 3rd iteration of a response. The US is on its first. Plus our privatized health system goals of efficiency are at odds with public health, do number of beds, ppe, etc are hard to access from a public health view
I read the Korea link, it talked about new infections in the mid hundreds.
It’s early to call that failure when our own, thus far, is proving robust and durable.
I’ll be watching the Korea curve in the coming weeks to see what their system yields.
Vietnam is a tropical country. If it had a Korean style winter, one would expect it to travel the same path as Korea.
I believe early Humans were a tropical fruit. I do not recall seeing much, if any, snow in Africa.
Yes, which is why in theory Vietnam could have afforded not to go for elimination to a greater extent than South Korea.
Of course, then we have the examples of all the cities in the Amazon where essentially everyone got infected. But it is very clear that R_0 in winter in the temperate northern hemisphere is just too high to be fought against with anything but a properly draconian lockdown.
current Korea levels would be the envy of any place in the United States. end of story
SKorea restricted international travel early and went for mandatory 14 day quarantines of anyone who traveled. If they couldn’t properly isolate at home, they were installed in an apartment. Each entrant was required to install an app, given a really big fine if they left their space or turned off the phone, was called at least daily by a health care worker, who also provided food, cleaning supplies, and if germane, arranged delivery of meds.
“it’s hard to avoid the conclusion that the mission of public health had quietly morphed from protecting the health of the public to protecting the resources and operations of the health care system.”
**********
One person in the UK said, “It used to be that the National Health Service was there to protect you, now you are there to protect the NHS.” My conclusion is that healthcare is a business unto itself, it acts in its interests not in those of the patients who now have lost their individuality and become the Herd.
In addition the “flatten the curve” slogan was readily accepted and little examined by anyone. Sounds like a great idea but what does it actually mean?
Well we all already know that there is a drastic difference in income. It is likely, probably even proven, that there is a drastic difference also in the availability of healthcare. So, “flatten the curve” may really mean that the Elite, the influential, the rich, those at the Upper End, are worried that if Covid gets too out of control that even for them, healthcare may not be of top quality or even there. It should at least be obvious that as healthcare demand ramps up, those at the bottom will suffer the most. The more the demand the more the unavailability of healthcare moves UP into the richer layers. Not a good idea, for instance, for Senators, Governors, Generals, Billionaires, etc. and their vast Human Infrastructure.
There are many other unexplored issues regarding Covid. The most disappointing and discouraging thing to me is that we don’t have the ethical, inquiring, investigative and critically thinking minds to report on these.
so, a class analysis of pandemic response.
when it threatens Versailles, itself, the message changes.
I understand…and can even sympathise with…the Noble Lie…in this case, to protect the then limited supply of real masks.
but when the supply caught up, they should have been forthcoming about it…likely impossible, anyway, due to the chaos of trump, et alia.
instead, it was the most blatant and stupidly incompetent exercise in gaslighting ever.—“we’ve always been at war with eastasia…”
maimed fauci’s credibility, and fed into the then emerging conspiracy theorising by alex jones and them.
The only reason Fauci had any credibility going into this was that AIDS was localized, ghettoized. He has been a tool before. The wound was self inflicted.
It didn’t even work like that though.
Quite a few politicians caught it, more of them did so in the countries that handled it the worst (US, Brazil, etc.) than elsewhere, and many more will catch it in the future, some may even die.
I then look around and try to think how many of the billionaires caught it, and the answer is basically none.
And I think that tells us a lot about where “Versailles” actually is located.
“…where “Versailles” actually is located.”
amen to that.
i don’t think that question gets near enough attention.
the Real Bosses don’t generally go on tv(although this appears to be changing, somewhat)
do we have a C.Wright Mills 3.0, today?
I think G. William Domhoff is probably C.Wright Mills 2.0? Domhoff is nearing the age of retirement. I have no idea who will take up his mantle.
It wasn’t a Noble Lie. Fauci’s job is to run the org that in first instance prevents, and in second mitigate bio disasters.
Let’s look at mitigate. There weren’t enough masks. So instead of lying to preserve supply, the message should have been how to substitute with home-made. In other words, a solution.
He had the most powerful medical voice in the country. He failed to use that visibility to help people, and pandered to the politics.
Once the MBAs infect a system, whatever that system once did is repurposed to maximizing profit.
Just look at where the money is flowing and the incredible success is obvious.
Like Blankfein said, it’s God’s work, unfortunately the God is Mammon.
Thanks! The ‘noble lie’ is what filled this country and the world with distrust of science and the ‘experts’ like Fauci upon whom most of us must rely. These ‘experts’ it appears are much more concerned with preserving a rotting status quo and the power, privilege, and wealth it conveys upon them than telling it like it is. That goes in spades for politicians and establishment economists.
They could have asked us to fashion face coverings from scarves etc. Would have been better than nothing early in the pandemic. Instead the head doctor of NYC hospitals was telling us that masks were not just ineffective when used by lay people but could make things worse. If they said to make your own face coverings people would have sought N95 masks anyway, but many more people would have covered their faces with scarves at any early critical juncture.
yeah. i get how that was further cockup…but aren’t we always lamenting the bubbledwellers inability to think outside the box(or algorithm)?
i went straight to bandanas, and stayed there…because that’s what i have used for decades when doing dirty, dusty work(hay hauling, chicken house cleanout—allergies and “farmer’s lung”, etc))…there also weren’t any masks available, even way out here, by the second week of February. even the construction kind were gone from the hardware stores(which is confusing, given the lack of mask wearing throughout)
i figured a bandana was better than nothing, and i can pretty easily avoid close contact with people in stores.
took a month or more before etsy, etc was pimping homemade masks and they became a thing.
a fine example of grass roots, citizen science.
ie: i understand what they(fauci) were trying to do…even if they did it poorly, and with continuing chaos right there in their midst.
It’s hard to avoid the conclusion that the mission of public health had quietly morphed from protecting the health of the public to protecting the resources and operations of the health care system
Bit of a circular argument , I believe (Chicken and egg). One cannot have one without the other. What would break things is a repeat of 1666 plague treatment, “Bring out your dead.”
The Electoral College on Monday will elect Joe Biden as the 46th President with the Supreme Court’s approval. This is a victory of the status quo. Every action taken by US government is to prevent any change to the American healthcare system that is 20% of the GDP. The intent is to extract every penny from patients for as long as possible, not to cure them.
This article is correct. The haphazard partial lockdowns are to keep the hospital systems from being overwhelmed by COVID-19 cases, but the virus is so endemic today that collapse and forced triage in the third wave hot spots is imminent. Only vaccines can save the day. No doubt this is why emergency use was granted today for Pfizer’s for-profit vaccine and injections will start next week.
Since last March, there has been discussion of cheap antigen daily testing to determine if a person is negative before going out in public. With a functional public health system to safely isolate those who test positive, the virus could have been eradicated in two months with a proper lockdown. But, to date, paper antigen tests have not been approved by federal officials because it puts diagnosis in the hands of the patients bypassing corporate testing laboratories and clinicians.
The Plutocracy is quite clear. A public health system that eats into hospital profits is verboten. No matter, if hundreds of thousands of Americans die, because of it.
+100
It’s become abundantly clear that most organizations have as their first priority their own interest. Very Darwinian.
Not really.
Currently the way things are going, most of the population will be infected before the vaccines can be rolled out at the necessary scale.
Only a hard draconian lockdown can help between now and the summer.
There has been, but that is another distraction.
First, “cheap antigen tests” aren’t actually that cheap if they are to be taken daily.
Second, what happens when someone takes that test at home and is positive? If not going out in public means he will be homeless in a few months, would that person self-quarantine? Of course not, he will hide the result. Without a mechanism of enforcement of quarantine and of financial support for the quarantined, this is a pointless exercise.
The alternative is that people get tested at the entrance of the various places where people congregate. This is not practical though because the results are still not instantaneous so you will have massive logjams at those entry points, and that would also mean whoever is in charge of those places has to eat the cost of the testing. Which adds up to a lot when it comes to testing a lot of people every day. And this is why they have not been adopted.
But a lot of time was spent indeed talking about how that is a “solution”.
More generally if you are not testing in order to then isolate and quarantine with a goal towards elimination, all you are doing is collecting statistics, and with antigen tests often you are not even doing that.
+100
American health care has been in a death spiral for quite a while now. Obamacare was actually a HUGE bailout of the American heath care insurance companies and pharma. It has failed.
What always kept American health care any good was those people that dedicated their lives to ACTUALLY do the work. Now, the system is quite literally killing them.
Universal health care is a necessary reform to revitalize our country. It ENABLES the small business job growth we so desperately need. But, like you, I’m pretty sure the death and wealth extraction will continue.
It seems like we already have the tools to alleviate the pandemic, and they are being applied to all of the Washington politicians who are being infected, from Trump to Giulinani. Have any of these recently infected politicos been severely harmed? If not, why aren’t whatever drugs they received being distributed for all of America’s infected senior citizens?
One of my sons saw this coming and sent me my first masks in January. He also said in March he didn’t care what Fauci was saying – he wasn’t an idiot that was going to buy Fauci’s schlock, and if we were smart, we should continue to wear our masks too.
It is interesting to look at what happened early on when protecting the public was at least the goal of the states. With the lockdowns and the stimulus money, we WERE getting a hold on the virus. But in Idaho, like the rest of the country, our leaders were convinced we were protecting the wrong people – that we should be protecting businesses and their ability to make money instead – it really didn’t matter how many people were getting sick or that the number of deaths were rising – nothing more could be done without hurting the businesses – and they were far more important than the public. And now Covid is out of control, well, now we have to protect the medical system somehow, of course, without hurting the businesses. We don’t even think about the public any more.
Giving people unemployment insurance to help them through this crisis? Hah! Let them get a job at Amazon instead! In the middle of this crisis when people are suffering, our governor is bragging about the fact that Idaho made a multimillion dollar surplus this year. How did that happen?
And again, put a win in neoliberalism’s column.
“One of my sons saw this coming and sent me my first masks in January…”
it was the middle of february, for me…and it was due to all y’all, here, at NC.
we’ve been wearing masks in public ever since.
this past wednesday, 2(TWO) different church youth groups in our little town held superspreader events…at each, there was one good christian girl who was feverish, knew she was sick, and attended anyway.
so now there’s 60+ in quarantine, awaiting the (slow,glacial) tests.
and the local ISD is going full Online as of Monday.
This in a county of around 4300 people.(a full 35% of whom are over 65)
and yet, still…i go to my Facebook Duckblind and lurk among my neighbors, and the majority are still going on and on about how it ain’t real, it’s a commie hoax, etc.
of course, all this intelligence gathering is on our own, from wife’s network of chisme and just knowing everybody….the county, city and clinic websites are still showing 3 confirmed cases, and 4 tests pending, and “don’t panic”…with the unspoken subtext, ” please don’t call us and yell at us”.
I am still bewildered by the thought process involved in all this: Let’s own the libs by getting the virus?
I’ll show them!
lol.
if i just believe real hard and put on the Armor of God, it will finally Prove to the apostates and heretics that trump won and amurca is truly great!
??
I’m reluctant, but i might have to go and re-erect my duckblinds in the local churches’ fb pages…it feels, based on comments and conversations overheard, like testing whether the pandemic is real has become some kind of auto de fe…a religious test of one’s faith and godliness.
if so, that’s scary as hell…and, while it would provide much fodder for lay anthropology, does not bode well for the near and middle term future.
I can’t even go to local websites anymore without getting physically ill. They’ve all been taken over by extreme right wing religious groups and covid-hoaxers. Don’t these people have anything else to do with their lives other than spam the rest of us?
I’m having a similar issue with the New York Times’ comment section and a number of other left-leaning sites (not Naked Capitalism though).
If you bring up what a disaster the economic response has been–a lot of people are on the precipice of hunger and homelessness–you get accused of being a anti-science or an evil rich person who wants to kill grandma to make the stock market go up.
Aren’t you?
Aren’t you one of the ‘the virus is a hoax used to take away your godgiven rights’ person?
Funny, I could have sworn it was you pushing that narrative…
Are you one of those either/or types that frequents left-wing sites and doesn’t understand nuance?
The ones who think you either support declaring martial law and welding everybody’s door shut like China or you’re hoaxer who is anti-science?
If you’re the poster I think you are you were actively poo-pooing the ‘overreaction’ from medicos…and calling Covid a ‘hoax’.
This won’t stop until people get with the program, a vaccine is produced at scale or the virus mutates into something more innocuous. You are all on about the ‘economy’ which isn’t even a thing without people. The people are being terminated, mangled and financially wrung out via our wonderful ‘health care’ system.
You need a healthy population to make an economy work. Neither is the current reality.
If the government orders lock-downs, restrictions etc. they sure a shit need to support those who are affected. Period.
ps Louis: I saw that take down you suffered in the NYT comments section. It was sweet.
That’s how I caught it. A co-worker came to work sick. This person was still trying to justify their behavior even after they called to tell me their PCR test came back positive and that when I had asked them if they were sick a few days before admitted that they thought it was some other viral infection. So now I’m sick.
I keep going back to an early interview between Joe Rogan and Michael Osterholm. Dr. Osterholm said that he thought we were going to lose around 500k people to this disease in the US. He hoped we wouldn’t but thats what he thought a reasonable estimate would be. I’m saddened to think he’s going to be right. Our society has proven incapable of handling this. In my case, my employer gives us all a salary, we have a separate bank of time for sick days so it doesn’t cost us vacation to be sick, and we’re given full ability to work from home. If someone in that situation can’t stay home when they don’t feel well what kind of chance does some one without those benefits have?
hope you are doing ok
That’s crazy. So no incentive to come in because Capitalism but he still did and now you have it? What are people thinking? My best wishes for a full and speedy recovery.
Today where I went walking I noticed probably a third of the people—and not just the young ones—weren’t wearing masks.
I wish I could say something but it would be too complicated: apologies if you are a grocery store worker being forced to share indoor air with the public or starve, but if not, gee thanks for caring. You do know you’re leaving a plume everywhere you go for the rest of us to breathe in, right?
And when I get to seriously fantasizing I think about the glitter analogy and having a little bulb syringe of the stuff I could poof at miscreants. “Good luck dodging this!”
A friend lives in San Francisco and does her marketing in Chinatown and said she knew early what was coming from observing the Chinese making preparations.
The coming Eviction wave is also a looming failure of the system. Homelessness appears ready to double or triple, which will drive disease and crime, or crime and disease, to which the correct answer is the prevent the wave of evictions; not what I perceive will be the solution – draconian law enforcement, which will not succeed unless it includes (private) inhuman concentration camps for the homeless.
The richest Country on earth, and possible in history, will not house nor feed its people. It has chosen not to to house its people. The consequence will be desperate people and massive increase in “Blame The Victims.”
The richest Country on Earth would rather spend its money “making us safe” with new nuclear weapons, and the largest military on earth – one designed not to win conclusively, because conclusive wins result in a process of shrinking the military.
Anyone who thinks this refusal is limited to the right, should read the New York Times‘ comment sections on any article related to COVID-19.
There are more than a few people professing to be left-wing who either have a well-intentioned but myopic view–they’re concerned about the virus but miss the larger picture–or simply don’t care.
These people either think we can worry about the economic fallout later–never mind the fact that the longer we put it off the worse it’s going to get and the more difficult and expensive it’s going to be to deal with–or resort to “something, something retraining.”
I’m not against retraining, by any means, but if you look at the success rates they really aren’t that high. There also aren’t that many jobs you can retrain for in a short period of time–it’s more like many months to several years and the need to keep a roof over your head and put food on the table isn’t something you can magically put on hold.
I fear the coming eviction waves, foreclosures, business failures, and shutdowns of city and state governments could prove much more lethal and dangerous than the Corona pandemic. The new government forming holds little hope that disasters might be averted. I am not so sure we are the “richest Country on Earth”. What value is our wealth if the only goods and services available are so thoroughly crapified.
It’s funny how “homelessness” drives “disease and crime.”
Last I checked its extremely wealth that drives both.
The biggest, most far reaching crimes are by far those of the rich.
As are the “diseases” manufactured by the rich–like, for example, the opioid epidemic, the suicide epidemic, and the obesity crisis (heart disease is the nation’s #1 killer).
The homeless are the victims, the scapegoats. What we should really be worrying about is the extreme growth in wealth among the 1% due to COVID profiteering.
The richer they get, the sicker we get. The richer they get, the more we live in an underworld of crime, the more we will teach our children that the only way to survive is to learn their cant (aka “MBA school”).
The goal was to avoid having to pursue elimination of the virus, because elimination of the virus would have been too “disruptive” to the current economic order.
The properties of the virus are such that once it has spread past a certain point, this can only be done through a very prolonged lockdown and a total governmental control of a long list of things, and that just cannot happen under a neoliberal debt-based socioeconomic system.
So effective measures were never taken.
As a nice bonus they got to organize a massive upwards transfer of wealth, directly through the government printing untold trillions and giving them to the billionaire class, indirectly by through small businesses with ineffective inadequate lockdowns whose space is then taken over by big corporations.
How many people will die does not matter, the important part is that none of the pillars of that system are threatened in any way.
There is a constraint — people dying on the streets outside hospitals is bad PR, so some restrictions are imposed when that becomes a possibility. You see how in much of Europe they “stabilized” things at hundreds of deaths a day in each country, just below the capacity of the system, with pathetically inadequate measures that will not bring it down any lower, but they don’t seem to plan to go much further than that. The overall level of sociopathy in the US is higher so even that constraint is less of a factor.
“Flattening the curve” was part of all that.
As is the constant discussion about hospital capacity in general, framed in terms that would make you think that if the hospital capacity is not exceeded, everything is fine. When the reality is that a lot of people who end up in hospitals will not come out alive and that barely anyone who does come out of there alive will be without lifelong damage.
So how is it OK to infect millions of people as long as there is a hospital bed for them? It is not, the only sane strategy is elimination.
It is also the only sane strategy when you consider the long term — this is a coronavirus, immunity will be short lived, and people will be susceptible again within a year or two. So why do you want to saddle yourself with the burden of having to fight constant new outbreaks and with vaccinating the whole population annually?
But elimination was never an option on the table in the West.
Then there is the question of why the virus was allow to spread to a point at which total lockdown was the only option. All of this could have been easily avoided with restricting travel for a few months.
If one goes back, it becomes immediately obvious that the “public health establishment” has not only been complicit with the genocidal policies pursued after the virus got out of control, but it also did nothing to stop the initial spread out of China, in fact it even helped it by advocating against travel restrictions.
On restricting travel, today the Times has a story that claims 300k cases were traced to the Biogen conference here in Boston; plenty of international travel for that one.
When it was clear that there were infections from that conference, I knew we certainly had community spread in Boston and we were all screwed.
good post. i agree on all counts with one exception: the upwards transfer of wealth was not merely a bonus. Sadly it was clear from the get go that such talk might land you in a straight jacket in this country.
Great post bringing recent history into perspective. Thanks.
Future Pandemic preparedness and funding needs to be a high priority!
“Public health is not commonly understood as a security issue, but it should be. Pandemic disease can destabilize regions, undermine economies, and create fertile territory for social and political unrest…We need to break the cycle in which our own public health system is beholden to emergency appropriations for specific epidemics… lacking the long-term budget certainty we need to shore up our defense for long term, accelerate development of vaccines….. bolster America’s public health infrastructure to deal with the new challenges facing our communities and our families, including a new Public Health Rapid Response Fund to better respond to public health emergencies…..Hillary Clinton July 2016.
“That is why as President, I will create a Public Health Rapid Response Fund, with consistent, year-to-year budgets, to better enable the CDC, HHS, FEMA, state and local public health departments, hospital systems, and other federal agencies to quickly and aggressively respond to major public health crises and pandemics. I will also ensure that our government has strong leadership and is organized to better support and work with people on the ground facing public health challenges. Doctors and public health officials……Hilary Clinton August 24, 2016.
“….in addition we need to do more to boost our preparedness for biological threats and bioweapons; to support research for new diagnostic tests, therapeutic treatments, and vaccines for emerging diseases; to build capacity in public health departments; to train the next cadre of public health professionals and ensure that public health and environmental health practices are standard to the educations of medical students; and to provide resources for states and local governments to plan for complex, multi-faceted public health threats, like the impacts of climate change and pandemics and build more resilient communities.”….Hillary Clinton October 2016
unfortunately she’s not saying “let’s make it easier for people to get medical care” ( “work with people on the ground facing public health challenges. Doctors and public health officials” you know the important people), she’s saying she would funnel money directly from fed to boardroom (“lacking the long-term budget certainty we need to shore up our defense for long term, accelerate development of vaccines”[kaching]). Let them eat training.(“train the next cadre of public health professionals “)
War footing? Notice the absence of people, only institutions matter, and we know that “access” just means that the institutions have doors and windows
“(“Public health is not commonly understood as a security issue, but it should be. Pandemic disease can destabilize regions, undermine economies (banksters and tech undermining economies? well of course thats ok), and create fertile territory for social and political unrest…We need to break the cycle in which our own public health system is beholden to emergency appropriations for specific epidemics”)
Like the article says, we need to protect the system, not the people, and hillary is the poster child of institutional grift. She left out how her foundation was selling “access” (hey, access costs money. No money? No access.)to the institutions and banksters to get in on the free money from .gov.
At any rate, your dreams of a government guided by the hillary crowd have come true. We’ll see how that works out, you may notice I am cynical when it comes to the possibility that they will do something that doesn’t directly benefit themselves first. What is that favorite line of the well off “You can’t help anyone unless you help yourself first” or something like that. Do you have any quotes to provide as to how hillary would have dealt with obamacare? Protect the system!
After the first SARS pandemic there was a lot of concern about US readiness for a pandemic. Studies were done and old studies from before the turn of the Century were dusted off and mined for quick and dirty review studies under new covers. Homeland Security took up the theme through stirring concerns about our readiness for dealing with a terrorist pandemic biological weapon. Your Hillary excerpts trend toward and close with this Homeland Security theme with a few buzz words and phrases tossed in: “climate change”, “resilient communities”.
“Future Pandemic preparedness and funding needs to be a high priority!”
I disagree. Repair of the Neoliberally crippled Medicine, Science, and Public Health needs to be a high priority. The dismantling of the Medical Industrial Complex needs to be a high priority. Concern for the Public Good must become a priority of Government in all areas. Crafting and actualizing a new ideology for our Political Economy must become a priority.
Yes, the public health establishment scored some own goals. Too many had to serve neoliberalism (the economy! globalization! austerity!).
But… even if they didn’t score the own goals – deep seated politics, delusion, and just sociopathy… I mean just look at the pushback on masks. Collapse of the healthcare system is the only thing gets through… Too many neoliberals and “libertarians” just don’t grok the idea of public health and risk management. Taleb has been my go to guy, but he’s just being Cassandra-ed.
how much pushback on masks would there have been if Fauci did not commit the (fake) Noble Lie?
we shall never know. but if he had instead proposed “masks are helpful, but not a guarantee. here’s how to make them…”, i posit we would be in a different world with regard to that issue right now.
Sure, gave them something else to cherry-pick. But mask deniers were going to do it anyway. they were busy calling masks muzzles, and peddling crank theories about carbon dioxide saturation and lack of oxygen.
The early emphasis was on droplets, and no-one denied masks stop droplets. Yes, getting aerosols muddled didn’t help and was an own goal, but it’s not why too many people became mask refuseniks.
And, dare (or durst) I suggest, this is the point where neoliberalism’s “because markets” shows itself as the modern “lost cause”* philosophy?
Note to international readers, there’s too much US-centric history in the term “lost cause” to be easily translated internationally. For US readers, this comment is less to do with the particular 19th C history and more to do with political modern monetary power relations.
* https://en.wikipedia.org/wiki/Lost_Cause_of_the_Confederacy
There’s a lot for me to disagree with here. Making the public health system the villain seems wrongheaded when there are so many other candidates, which I would sweep I all together and just call “America”. A presidency and a huge militant faction denying the very existence of the problem would come first. Our sacred federalism and precious free enterprise system would be on the list. The various factors, including popular opinion, crippling decisive government action about anything but terrorism would be high on the list. Certainly for-profit medicine played a role, but public health isn’t often for-profit.
You can say that hospitals were “protecting themselves” by worrying about overload, but that is mean-minded. Overload means that patients , Covid or otherwise, get turned away and sometimes die . Just recently my brother had a serious medical emergency in Fargo ND and was lucky to be admitted at all.
Likewise, if there was going to be a shortage of protective equipment, it makes sense for it to be given first to medical personnel who have Covid patients coughing in their faces all day. This is one of the times where you want a command economy rather than a market economy.
There were inevitably going to be false starts and evasive communication, and this being the United States of America, there was more of it than we would have hoped. I just object to you pointing th a public health system which has been starved and sablotaged by neoliberal and neoConfederate ideologues for 40 years now.
I think you are missing the point.
There didn’t have to be a mask shortage. We had companies that were more than willing to make masks early on but their efforts were rejected. As an example: https://www.washingtonpost.com/investigations/in-the-early-days-of-the-pandemic-the-us-government-turned-down-an-offer-to-manufacture-millions-of-n95-masks-in-america/2020/05/09/f76a821e-908a-11ea-a9c0-73b93422d691_story.html
Didn’t you ever ask why? Where was Fauci then?
And don’t you think that the ‘powers that be’ knew that opening businesses was going to spread the disease. Did they care? What did they think was going to happen to their hospitals? Where was the protection for the health care workers then? As long as there were enough beds, everything was OK? And what about protecting those same health care workers now? All I hear is a lot of talk but no real action to reduce the number of cases, because, you know, businesses have to stay open.
The public health system in this country is also a product of the neoliberals. I see no reason to defend it now, especially since it has failed the public so badly.
Wait, are you saying nighttime curfews on indoor dining won’t stop the spread? I thought the virus came out only at night!
I also think it would be helpful if you separated the health care workers from the public health system we have in this country. They are not the same. The health care workers have to deal with the reality – the public health system deals with policy. And the hospitals, where the health care workers work, are businesses.
But the author of the article said:
So I addressed that issue.
Hospitals are often businesses. That is a true statement.
Much as the term “Our Democracy” leaves most of us wondering what the heck in being discussed, US capitalism really shows its true definition with Certificate-of-need laws.
“CONs have been blamed for the shortage of hospital beds during the COVID-19 pandemic in the United States.”
Certificate of need
A TB nurse who goes into a infectious patient’s house to watch them swallow their antibiotics (maybe 11 pills) is wearing a fit-tested N95 mask. I call that dealing with the reality. (Implementing the policy.)
Come on people.
John Emerson: 100% on making the medical care system out to be a villain.
I’d look to put South Dakota’s governor on a short list of people who would not be missed (thanks to Gilbert & Sullivan, “The Mikado”). Her pronouncements alone have undoubtedly sent thousands to the hospital with who knows how many to their deaths. With such people in charge of policy, due to the default position of the Trump administration on putting state administrators in charge of coronavirus policy, the digging deeper trenches phenomena in the nursing and medical practitioner circles that we’re talking about is a predictable outcome.
+100
Ravages of Public Health In the last 20yrs or so include-
-The shrink-to-fit budget strangulation
-direct meddling (Headlines anyone?)
And remember that overwhelming the hospital system sends the death rate to 10%.
(See Lombardy)
And by keeping the conversation narrow,
(Overton Window), it makes reform harder,
by setting up an attitude akin to the anti-vaxxers.
The Public Health System should be independent, stronger. It IS a command system,
specifically an Incident Command System. So we have to let it supersede HIPPA, (it did when I worked public health), and let people isolate in jail (negative air flow room), if they won’t comply with at home isolation.
but public health isn’t often for-profit
yeah right. public health is always for profit in the good ol usa
No one said that masks shouldn’t go first to medical personnel – that would be command economy. The question is whether Fauci and other medical experts should have lied to protect supply – that is a sick use of market economy. It would not have hurt to tell people to wear face coverings like scarves, and might have helped immensely.
I don’t think people here are criticizing the people working in medicine & public health and that they agree with you that the system has been ruined by neolib/neoConfederate ideologies. I hope your brother is okay.
“Making the public health system the villain seems wrongheaded when there are so many other candidates…”
I disagree in part. The public health system is a villain but not the only villain. No problem. Build more scaffolds and let the villains queue.
“…popular opinion, crippling decisive government action about anything but terrorism…” How ever did that popular opinion get started?
“federalism, ‘free’-enterprise, for profit medicine, ‘overload’ [in hospitals], shortages, false starts, starved public health system”
What a catalog of lame excuses.
The US handling of the Corona pandemic has been a colossal fail beyond anything I could have imagined. I have grown deeply concerned for how the US might handle real problems — there are plenty coming in our future. The Corona pandemic is a problem but it only became a serious problem because of how it is and has been so badly handled.
This is the core of the problem.
It isn’t even conscious a lot of the time.
One line of thinking goes like this:
“I am an “expert” in public health, those guys in the economics department are “experts” in their field, I will listen to them and will never ask myself whether they are in fact charlatans working to justify the imposition of a neofeudal social order on the population. ”
The other one is:
“Also, I went to school with them, they are nice people, they are smart, it cannot be the case that they are wrong about everything”
And then there is the fact the people at the top of the “public health establishment” are quite well-off themselves and are beneficiaries of neoliberalism.
The difficulty in speaking on public health policy is that there really is not a single guiding, trustworthy agency that is doing a credible job of espousing clear policy: that’s a huge issue. The CDC, which in a normally functioning Federal government would be the authoritative source for public policy pertaining to a pandemic, has unfortunately, been almost completely discredited due to the ill used authority of the Oval Office and attendant stooges orbiting that edifice. Putting the emphasis on protecting the healthcare system may have been an outcome arrived at informally but seemingly that’s been done by so many sources there is no where to place blame that gets us (the concerned members of the public) any leverage on dealing with the situation. The importance of knowing who’s responsible for pushing our society to where we’re at on various aspects of the pandemic is important so we can punish the responsible parties for causing so much harm. That is not a light assessment by any means.
Hopefully the CDC will soon be restored to it’s rightful place in issuing policy so we can deal with a single source instead of 50 state health officials, and numerous governors who are giving out harmful, indeed deadly, information.
In the interest of clearing up some confusion about masks, I’ll offer first a clear statement about N-95 masks: in order to be effective, the mask must be carefully fitted. Health care workers have other fellow workers in their assigned job area to assist with that task, so they can do that. Most lay people do not have that capability.
As far as surgical masks go, all that can be said is that there is a definite shortage.
I thought the article was a bit harsh in dealing with the concerns that people inside the care world have for their own lives and the lives of their fellow health care workers. Many of those workers have died due in no small part to ‘let’s party ’til the virus takes us down’ attitude on the part of a callous and ignorant public. That cavalier attitude displayed early on and still evident everywhere is no doubt what’s driving the hunkering down attitude discussed here. If so many members of the public can’t own up to their own malfeasance in all of this, what are professionals on the front line supposed to do?
But then again, we’re not supposed to shame people into doing the right thing.
I’m left wondering what can be done.
Here’s to empowering the new administration to put an end to this cruel stage of pandemonium we’re all being thrust into.
“Many of those workers have died due in no small part to ‘let’s party ’til the virus takes us down’ attitude on the part of a callous and ignorant public.”
As a member of the public I raise my middle finger in salute to you.
apologies for the crass image
Right back atcha would have served just as well.
“CDC will soon be restored to it’s rightful place in issuing policy”
Yeah , but only after you solve the regulatory capture issue there. otherwise, good luck
“As far as surgical masks go, all that can be said is that there is a definite shortage.”
I can assure you as someone who buys in bulk that there is no shortage that i can see,
The refusal of the federal government and the academic medical establishment to support research of and use of repurposed drugs and vitamins is the real scandal. There are any number of studies that support the use of zinc, vitamin C, vitamin D in preventing and treating Covid. These trials while not reaching the platonic ideal of the perfect RCT in scale , scope and study design provide more than enough evidence for everyone to be taking them.
And how many people know that ivermectin is being used around the world and is included in official recommendations in countries and areas totaling over 300 million people. There are as many as 20 trials, over half of which are RCTs showing that in most cases it is not just effective but dramatically effective in preventing covid and even treating it in early and advanced cases. It appears to reduce the risk of catching Covid by 80% or more. In one trial in South America hundreds of healthcare workers were given it prophylactically. Zero in the ivermectin group came down with Covid while several hundred in the control group did! Side effects are extremely minimal. And yet the FDA sternly warns that there is no evidence for its efficacy and should not be used and therefore most doctors will not prescribe it.
A recent Senate subcommittee hearing featured a critical care Doctor from Milwaukee has written the most authoritative summary article on the drug and who all but begged the senators to get behind its use.
https://youtu.be/YgOAaLmoa68. Here is his nine minute testimony
Only three Republicans came to the committee hearing but that was three more than the Democrats who came as the Democrats literally boycotted the hearing. I cannot think of a word to describe the extreme dysfunction and ideological rigidity of our political and medical leaders.
Thanks to the recommendations of Herb and other NC people, I am supplementing my diet with C, D, and zinc.
+1.
+100
Been using those supplements and tripling my fruit and veggies intake for months. So far it seems that has meant my reaction to the virus has been mild so far. Fingers crossed it stays that way…
He has a site with recommendations and dosages for prevention (prophylaxis) and outpatient. Its a down load pdf at
https://covid19criticalcare.com/
I just went to his site. There was (once) a video at the top of his Senate testimony on Ivermectin. The video space now has the ‘sad tv face’; when I click the play arrow this Youtube notice appears:
“This video has been removed for violating YouTube’s Terms of Service.”
How,exactly, does public Senate testimony violate UToob’s terms of service? Almost like there’s some info denial at work for some reason. ;)
I did find the video by going directly to UToob. The ranking member’s opening statement, not shown, must have been political in nature. The Doctor is worth listening to, imo. His vita is impressive. His testimony is passionate.
https://www.youtube.com/watch?v=YgOAaLmoa68
The link in Herb’s top comment works. I somehow missed that link the first time. Thanks.
After watching several early news conferences with the admin and Fauci, it looked like they were only interested in promoting a new, exclusive, patented, expensive drug still in the works, and not at all interested in examining existing, less expensive drugs. It looked like they were mostly interested in finding a new billion-dollar market instead. I still haven’t seen any official mention of zinc or vit D3 or other immune system ‘helper’ compounds, even after clinical trials have shown efficacy in general immune system improvement. Fauci takes D3. my 2 cents.
Yes, Fauci says he’s not outdoors much so he takes C and 6000IU of D/day.
If it’s good for him, how come it’s not good enough for people with dark skin, people who work indoors, people in nursing homes (all groups typically low in D)?
Or people who work night shifts? IMO, The biggest blind spot the PMC has is what it takes to support their living standards. People working graveyard shifts are a big part of why our country can work the way it does. So why are we ignoring their health?
Is ivermectin getting the Tulsi Gabbard treatment by the news media? “Nothing to see here, what you want is over there.”? No possibility of ad revenue or maybe it will help the wrong people? Would it interfere with the fear marketing?
Does ivermectin actually work in other parts of the world or is it an internet hoax?
I believe that the point of universal masking is that in our society, many who are ill with Covid19 will have no choice but to leave the house.
If those ill people wear masks, then that reduces the spread.
but… If only sick people wear masks, they will be treated like typhoid Mary, and refused admittance to places. So, they won’t wear them, but they will go out anyway.
In order to give cover for the people that really need to wear masks, we need to normalize it and get everybody to wear masks. Hey presto! “Asymptomatic Spread”.
How are you going to sell that to Joe Public in March 2020 when you are pretending there is no spread?
I think the focus on asymptomatic spreaders, instead of aerosol transmission, was another own goal. It made people think that if they caught it, they would be one of the asymptomatic carriers. So they stopped fearing the virus, and stopped mitigating it altogether.
“The public health system is also the product of the neoliberals”.
Oh, come on. We had a public health system before we had neoliberals, and they’ve been hanging in there as best they could for decades while under winger / neoliberal attack.
Fauci has 2 or 3 layers of politicos above him, with Trump at the top. Much the same is true everywhere. I call that sabotage, not failure.
What I said about overloading hospitals is true. I’ll check your link on masks.
Sorry,”John Woe” is “John Emerson
via auto fill.!Don’t ask me.
I looked at the mask story. It looks like Trump’s man Azar had a hand on it. That’s consistent with my description of the problem as sabotage.
If Azar was involved, wouldn’t that make it policy instead of sabotage? Isn’t he Secretary of HHS? So wasn’t refusing to help companies to be able to provide adequate masks more of a feature and not a bug?
In response to Plutonium King, who said:
Confusion about the thrust of scientific inquiry is quite normal during times of a paradigm shift. The shift in science resulted from the overweening desire to get answers on a vast new topic: Covid-19. Large organizations like the WHO dragged their feet on some topics but overall responded with the correct assessments.
Looking back at the history of how Western Europe’s scientific community gained an understanding of the nature of the cosmos is instructive and one that I find fascinating.
Copernicus turned the universe inside out spatially with his heliocentric theory published in 1543.
Tycho Brahe spent his entire professional life gathering precise data on the positions of the visible planets. But he insisted through out that the Earth was at the center of the solar system. The vast majority of the European intelligentsia concurred in this assessment.
Johannes Kepler, who worked with Brahe, further refined the theoretical work of Copernicus to show that the planets were being forced to move in elliptical paths although the orbits are very nearly circular. Additional information pertaining to the whole understanding were discovered first by Isaac Newton and then further work done by Albert Einstein capped off the theoretical work. The latter explained why the Newtonian system had noticeable anomalies in it particularly with the orbit of Mercury.
The point here being that all of this cumulative work relied on communications between the scientists involved across geographical and temporal distances. Einstein for example relied on the mathematical systems devised by Leonhard Euler and Bernard Riemann and would not have been able to even conceive his theories without there work.
In the short time that Covid-19 has been around, there’s been a rushed atmosphere often times and lines of communication have broken. I have confidence in the scientific work that’s being done in that it will show us the truth sooner rather than later.
I think that the paradigm shift, in this case, consisted on realising that a new Coronavirus could have a devastating pandemic impact when, so far, previous outbursts of SARS or MERS were very limited compared with SARS 2.0. IMO, Western countries were in general quite sceptic about this and though that flu, and only flu, is the only real menace, because of Spanish flu memory. So, even if there were a few, or some many voices trying to rise the alarm, the Health Care Establishment (I wouldn’t call them Sciencists but practitioners and/or managers) remained stubbornly sceptic. The minutes of meetings held in February and March of advisory committees clearly show this. In contrast with PK, I don’t consider these advisory committees as scientific as they mostly regard HC management and financing issues. Science is other thing but the authorities often like to call Science what it isn’t.
Remember the footage of the enormous pre-fab hospital China was building in Wuhan to house the epidemic? Seemed like we saw the same footage over and over again; never actually saw the finished hospital. I assume it was finished. They wasted no time expanding their capacity to take care of patients. We set up military style hospitals in field houses, etc. But it didn’t work out here – we were still swamped with patients and healthcare workers were exhausted by 24-hour shifts. Not sure how it all worked out in China. I’m sure we didn’t get much info on medicines that worked to prevent Covid from becoming severe and I’m sure there was no effort here in the US to manufacture those medicines. What preventative and palliative medicines were used in other countries besides hydroxy-chloroquin? Where is the post mortem on all of this? All I hear is crickets. If we have learned one thing it is that our hospital “system” is nothing more than a state sponsored monopoly. Do they do good work? Yes, of course they do. Do they have the capacity to handle an epidemic? Obviously not. In fact many rural hospitals are going bankrupt because their patient base is too small to meet expenses. So question: What does a medical monopoly do now? They better come up with some excuses fast while all of us are still stunned because when the accounting happens everyone is going to be disgusted. One thing that has been proven beyond a doubt is that capitalism – for-profit capitalism – is not the model we want for our healthcare.
The temporary hospitals we watched them build in China were used to isolate infected patients, even if they weren’t in critical condition, so they didn’t spread it.
We do have a governmental public health system in this country at local, state and federal levels. It’s non-profit, a relic of pre-neoliberal, pre-winger times. Between budget cuts, privatization, and top-down political interference it’s been seriously weakened for decades. Some of the jeering blanket cynicism I’ve seen in these comments does nothing good in terms of understanding what’s going on in public health.
Thank you. There is much to salvage in the old system. Then rebuild.
For instance disease surveillance, which though it may sound sinister, is about gathering lots of data, crunching, looking for trends, flagging infectious cases for follow up.
Many things cannot be monetized, like contact tracing.
After making allowance for “budget cuts, privatization, and top-down political interference” I believe the US public health system, or more accurately the remnants of what had been the public health system has failed horribly and I cannot grasp what that good is “in terms of understanding what’s going on in public health” that you believe we are missing here. Even after allowing for “budget cuts, privatization, and top-down political interference” the public health system in the US has done a wonderful job debasing its own currency.
+1. This lesson applies even more directly to the nursing home industry which has been responsible for such a large share of COVID deaths in the US.
Dr. Sara Cody, the Santa Clara County, California public health director, was an architect of California’s lockdown–the earliest in the nation. She criticized CA Gov Newsom’s decision to reopen early. If he is recalled for anything, it should be for reopening too early.
Cody: “The state modifications are being made without a real understanding of the consequences of what the last move has been, and with the possible serious effects for health and possible serious risk of an exponential growth in cases,” she said.”
“During a CNBC appearance last week, White House advisor Dr. Anthony Fauci warned that strict stay-at-home orders could cause “irreparable damage” to the economy and people’s livelihoods if imposed for much longer.”
Los Angeles County had 13, 815 new cases in 24 hours yesterday. Retail stores and malls are still open. Remaining ICU capacity is 6.2% in LA County.
In LA County, some identified hotspots are construction sites; these are minimally supervised and developers do not provide sick leave or sick pay. The pandemic is also accelerating in higher income, previously unscathed, areas of the county, so it cannot all be attributed to overcrowded housing and essential workers.
I looked up ICU capacity by county on the John Hopkins web. I was amazed by the number of ICU rooms in a county. More amazing would be the number of ICUs per population or state. To me, that would be a failure in public health for its people
I cut Fauci slack because he is a courtier who serves a Mad King.
I know! Let’s guillotine all the county public health officers! That will solve the problem! Bunch’s bastards.
Jesus Christ I’m out of here.
The notion that “Every failure of guidance and regulation had a common theme, protection of the health care system.” brings to mind my belief since the 1960s that public education has always prioritized the bureaucracy and management of students over their education.
>protection of the healthcare system
“Every failure of guidance and regulation had a common theme, protection of the health care system”
Is this claim empirically supported? Is it not the case that the failure to control the spread of Covid has economically devastated health care systems, from the start? Initially, during March-April, regular patient care was restricted, elective surgeries, etc. cancelled. Not until May were these restrictions relaxed. Now, we’re back to those maximal restrictions, at least in California. Maybe by “healthcare system,” the author means “public health systems.”
examples:
“The American Hospital Association (AHA) previously estimated that the financial impact of COVID-19 on hospitals and health systems totaled $202.6 billion in losses over a fourth-month period between March 2020 and June 2020.3 However, the slow recovery of inpatient and outpatient volumes to baseline levels, coupled with continued and increasing COVID-19 infection rates, has exacerbated these financial losses. As noted in AHA’s prior report, as patients are hospitalized for COVID-19, hospitals’ costs to treat these patients exceed expected reimbursement, which results in further financial losses…”
“Hospital financial losses mount amid COVID-19 resurgence: 5 things to know”
“1. In a 30-day period ending Nov. 7, hospital admissions, observation visits, emergency room visits and outpatient visits all declined at twice the rate of the previous 30-day period, according to the data from Strata Decision Technology.
2. In the two-week period ending Oct. 17, hospital visits declined for all 29 service lines studied, including orthopedics, which was down 14.8 percent and cancer treatment, which was down 3.9 percent, compared to the two-week period ended Oct. 10.
3. The data suggests that patients are steering clear of hospitals and medical offices to avoid being exposed to COVID-19, according to the report.
4. As more patients delay care and a growing number of hospitals postpone elective care, efforts to regain lost revenue from the first wave could be derailed, according to Bloomberg.
5. In a separate analysis, Strata found that 21 of 76 hospital systems, or 28 percent, had a negative operating margin as of September, according to Bloomberg….”
Aren’t the revenue-generating activities being curtailed? Is it not the case that Covid reimbursements do not begin to cover losses from regular operations?
Additional discussion here:
https://www.nejm.org/doi/full/10.1056/NEJMp2018846
What am I missing?
You may be right about the empirical case, but this isn’t it. Reread the OP; I don’t claim the advice was about protecting the revenues of hospitals. What I had in mind was the possibility that the chief mission of public health had become one of creating a protective ring around the health delivery system so its performance would not be degraded by a pandemic. That’s not a bad mission in itself, of course, but in the absence of a wider one of safeguarding the public it leads to perverse choices.
“the possibility that the chief mission of public health had become one of creating a protective ring around the health delivery system so its performance would not be degraded by a pandemic”
Okay. Guess it hinges on the definition of the “health delivery system.” How is that defined? If the definition involves providing patient services, then the protective ring around it is clearly eroding.
Jeremy Grimm:
I just disagree. In the present case, the public health people were doing as well as they could, considering that what they could do as defined by Donald Trump and lesser Trumps like Cuomo. Something like that has been true of all the public health workers I’ve ever known. I especially don’t see the point of joining the the wingers, know-nothings and neoliberal budgetcutters in the on public health.
I cannot agree with your suggestion that public health officials were held back by the iron grip of Trump and lesser Trumps. I believe a high level public health official has the power and obligation to contradict the Trumps when it is a matter of public health. I cannot accept that those officials told ‘noble’ lies. They just plain lied to the public.
I can understand how lower level civil servants might hold their tongues but not high level officials at the CDC, or WHO. If they cannot take flack from a Trump they have no business holding office in high position. I suspect the public health workers you have known would not include the heads of the CDC or WHO or their like and if so my criticisms do not target those public health workers. But I do condemn the Corona response of the US public health system. Are the public health workers you have known proud of the way the US public health system has handled the Corona pandemic? And is it wrong to expect even just an Indian to have some moral courage? How many of these public health workers you have known told you to ignore the CDC and wear a face mask?
I am curious how criticizing the US public health system qualifies me for joining wingers, know-nothings or neoliberal budgetcutters of public health. I very much doubt they would welcome my views.
Peter Sandman, the risk communicator of the “outrage” idea has come out of his retirement and provided a nice summary of what he thinks went on (rightly or wrongly) with the public health officials in the US, and not only. Maybe 4-5 pages that are worth to be read: https://www.psandman.com/articles/Corona31.pdf
Read and downloaded Peter Sandman’s paper. Thanks! His arguments are much more knowledgeable, convincing, and comprehensive than my own. I have trouble getting past the statements from US public health guidance about not wearing face masks and the anger those statements stirred in me.