Sunday, March 15, 2020

Coronavirus - Why We Might Need a Functional Government


Coronavirus pushed aside my draft columns about Biden-Sanders and the latest local guardianship hearing.
The virus has upended all our lives. As if we felt great but had been diagnosed with an aggressive cancer, everything is the same but different. We are uncertain, sluggish, a bit dazed. The garden is sunny and peaceful, yet everything feels strangely ominous. Each of us contradicting today something we said yesterday. So are most of our leaders. 
 
I don’t know how our social/medical landscape will look in May. I hope the fears and dire predictions are exaggerated. And Coronavirus isn’t Donald Trump’s fault.

But the U.S. response has been slow and underwhelming, more like Italy’s disastrous hesitation than like South Korea’s coherent approach. This incompetence in a crisis might even bring home to folks the dangers of leaving the ship of state unhelmed. 
 
We had a unit to foresee pandemics and jump-start a response. It was probably not adequate. But the Trump Administration abandoned it. Trump’s proposed budget savaged the BioShield account – set up more than ten years ago so the government could fund research on pharmaceutical responses to a pandemic or biological attack. But there’s nothing politically sexy about health preparedness.

For months, experts predicted Covid-19 would reach the U.S. Trump downplayed its significance, and misleadingly minimized the numbers. To oversee our response, he appointed Mike Pence, the failed Indiana politician he’d made Vice-President. A cartoonist should draw Trump standing smugly on a wharf, while a huge wave labeled “coronavirus” looms behind him. 
 
After one recent meeting, Trump Administration figures revealed that finally Trump had focused on the problem, rather uttering disconnected discourses on his popularity or the evil Democrats. However, he refused Republican Senators’ request to let scientist Anthony Fauci direct the government’s response. That same day, Pence contradicted scientists’ advice by bragging that he was still shaking people’s hands. That night, an NBA player who had mocked the “panic” by touching microphones and recording devices after his press conference became the league’s first Covid-19 case. Trump joked that he might be resistant to the virus because his uncle was a super-genius who taught at MIT. Officials running our national response to a pandemic oughtta be smarter than a twentyish ballplayer.

Trump’s non-response to coronavirus symptomizes his approach to government: he attacks lower-level functionaries who’ve served Democratic and Republican Presidents for decades, hollowing out whole agencies; he clamps the Presidential hand over scientists’ mouths; if he can’t make some agency further his political fortunes or burnish his image, he destroys it; and his go-to response to questions is to attack critics and ramble on and on about Trumpian greatness. His nationwide address this week blamed other countries and wrongly claimed there’s little risk for Americans.

This won’t change. For many reasons – anger about globalism, distaste for Hillary, distaste for abortion, fear of having guns confiscated, a sense that things are going downhill for the country or for white men, and concern that dealing with climate-change might curtail corporate profits – we have elected a toddler-in-chief. Whatever the justifications for electing him in 2016, we can’t we afford four more years’ of watching the weeds grow in the doorways of government.

Is it bad taste to mention pandemics and politics right now? Maybe. If we were bailing your rowboat, I wouldn’t waste energy cursing you for not having plugged the leaks; but if you were steering us into an iceberg, I might holler.
                                                                – 30 --

[The above column appeared this morning, Sunday, 15 March 2020, in the Las Cruces Sun-News, as well as on the newspaper's website the newspaper's website and on KRWG's website.  The corresponding radio commentary will air during the week on both KRWG and on KTAL-LP, 101.5 FM (www.lccommunityradio.org), and will also be available at on KRWG's site.]

[Added late:
NOTE:This just in: KTAL's "Speak Up, Las Cruces!" (8-10 a.m. Wednesdays, on 101.5 FM (or stream at the Las Cruces Community Radio site above) will focus on our current situation, with discussions with health officials, public officials, a couple of economists, and otherss -- including callers at 526-KTAL (5825), but IN ADDITION I'm almost certain we'll start Monday with a half-hour special update, and do those each Monday - Wednesday - Friday at 9 (although I guess Wednesday's will be a portion of our "Speak Up, Las Cruces!" show, repeating later in the day.  Check our website or Facebook page for details!
Click HERE for a neat graphical explanation (simulation) of how moves like quarantines, social distancing, and having a significant portion of citizens just stay home can affect the curve (how fast we get to 0 cases to millions); and the curve is important because if Las Cruces has 20,000 cases in a month, the health-care system is completely overwhelmed and more people die simply because of the crowding or the lack of doctors or ventilators -- or, as in Italy, they simply don't bother with folks over a certain age!  On the other hand, 20,000 cases over six months could be fatal to far fewer people -- although I'm not sure how the impact on the economy varies with these scenarios.
Watching these simulations, particularly the "social distancing," helps make the important point that staying at home the most you can and washing hands often, etc., may not keep you 100% safe, but by doing it you contribute to flattening the curve, keeping the most people healthy we can, and perhaps helping ensure there's a doctor or hospital bed if/when YOU need one.]

[btw, if anyone thinks it's bad taste to discuss the political implications of this crisis, please note that Donald Trump has repeatedly blamed it on Barack Obama.]
[Friday just as I opened my email program to send this column to the Sun-News, I had an email forwarding to me a Washington Post Op-Ed piece by Beth Cameron, the woman who ran the White House National Security Directorate for Global Health Security and Biodefense -- entitled, not surprisingly, The Federal Government Is Moving too Slowly, due to Lack of Leadership.  Ms. Cameron had run the office when it was established in 2014, after the Ebola epidemic.
[Ms. Cameron "was mystified when the White House dissolved the office, leaving the country less prepared for pandemics like covid-19."  She added:
"The U.S. government’s slow and inadequate response to the new coronavirus underscores the need for organized, accountable leadership to prepare for and respond to pandemic threats. 
"In a health security crisis, speed is essential. When this new coronavirus emerged, there was no clear White House-led structure to oversee our response, and we lost valuable time. . . . The specter of rapid community transmission and exponential growth is real and daunting. The job of a White House pandemics office would have been to get ahead: to accelerate the response, empower experts, anticipate failures, and act quickly and transparently to solve problems. 
". . . Our job was to be the smoke alarm — keeping watch to get ahead of emergencies, sounding a warning at the earliest sign of fire — all with the goal of avoiding a six-alarm blaze.
"My office was also tasked with preparing , . . . for the next health emergency, no matter its origin. In 2014, even before the first cases of Ebola came to light in Guinea, the Obama administration launched the Global Health Security Agenda, which now includes more than 60 countries, to accelerate epidemic preparedness. That effort, bolstered by $1 billion from the U.S. government in an emergency spending bill to fight Ebola, led to major gains in global capability to combat the Ebola outbreak and prepare for the next pandemic, which turned out to be covid-19. We began building, measuring and tracking capacities each country had, such as the strength of their national laboratory systems and their abilities to detect and report disease, stand up emergency operation centers, build an epidemiology workforce and maintain safe and secure practices. We spurred the use of transparent, measurable assessments of progress, and we leveraged our diplomacy with other countries to finance and fill gaps. At the same time, we strengthened international biosurveillance networks to help alert us to future potential pandemics."]
[A frequent correspondent replied by email to my column early this morning with this advice:

Well stated.  Sometimes I suspect we're in a toilet that was flushed several decades ago and now find ourselves in that "final spin" before we're shoved into the sewer pipe of history.

Still, my dad had (as usual) an apt proverb:  You can either play with the toys you have, or whine about the ones you don't have....do whichever is the most fun.  Turns out that it's best to play with what you have and make the best of it.  In my mind, we need to devote our strongest effort to encouraging our local citizenry, including elected officials, to  focus on actually developing an economic system based upon Maslow's hierarchy.  With that economic base we can do what we need locally to take care of most problems.  Schools, healthcare, housing, food, clothing....whatever the necessity can be dealt with locally if we set our minds and hearts to it.  We may be on our last legs as an empire, but we needn't be on our death bed as a community.

Take care.]

Common Sense advice from an expert on coronavirus.

[I am republishing here a communication from a doctor who clearly knows the subject.  Some of it has become common knowledge since I first received itOne further point, regarding services: I have heard through a nurse we know that the virus can last for 7-9 days on glass or plastic, but only for quite shorter periods on many other surfaces; and, not unexpectedly, chlorine (as in pools) kills the virus immediately.]
Dear Colleagues, as some of you may recall, when I was a professor of pathology at the University of California San Diego, I was one of the first molecular virologists in the world to work on coronaviruses (the 1970s). I was the first to demonstrate the number of genes the virus contained. Since then, I have kept up with the coronavirus field and its multiple clinical transfers into the human population (e.g., SARS, MERS), from different animal sources. The current projections for its expansion in the US are only probable, due to continued insufficient worldwide data, but it is most likely to be widespread in the US by mid to late March and April.
Here is what I have done and the precautions that I take and will take. These are the same precautions I currently use during our influenza seasons, except for the mask and gloves.:
1) NO HANDSHAKING! Use a fist bump, slight bow, elbow bump, etc.
2) Use ONLY your knuckle to touch light switches. elevator buttons, etc.. Lift the gasoline dispenser with a paper towel or use a disposable glove.
3) Open doors with your closed fist or hip - do not grasp the handle with your hand, unless there is no other way to open the door. Especially important on bathroom and post office/commercial doors.
4) Use disinfectant wipes at the stores when they are available, including wiping the handle and child seat in grocery carts.
5) Wash your hands with soap for 10-20 seconds and/or use a greater than 60% alcohol-based hand sanitizer whenever you return home from ANY activity that involves locations where other people have been.
6) Keep a bottle of sanitizer available at each of your home's entrances. AND in your car for use after getting gas or touching other contaminated objects when you can't immediately wash your hands.
7) If possible, cough or sneeze into a disposable tissue and discard. Use your elbow only if you have to. The clothing on your elbow will contain infectious virus that can be passed on for up to a week or more!
What I have stocked in preparation for the pandemic spread to the US:
1) Latex or nitrile latex disposable gloves for use when going shopping, using the gasoline pump, and all other outside activity when you come in contact with contaminated areas.
Note: This virus is spread in large droplets by coughing and sneezing. This means that the air will not infect you! BUT all the surfaces where these droplets land are infectious for about a week on average - everything that is associated with infected people will be contaminated and potentially infectious. The virus is on surfaces and you will not be infected unless your unprotected face is directly coughed or sneezed upon. This virus only has cell receptors for lung cells (it only infects your lungs) The only way for the virus to infect you is through your nose or mouth via your hands or an infected cough or sneeze onto or into your nose or mouth.
2) Stock up now with disposable surgical masks and use them to prevent you from touching your nose and/or mouth (We touch our nose/mouth 90X/day without knowing it!). This is the only way this virus can infect you - it is lung-specific. The mask will not prevent the virus in a direct sneeze from getting into your nose or mouth - it is only to keep you from touching your nose or mouth.
3) Stock up now with hand sanitizers and latex/nitrile gloves (get the appropriate sizes for your family). The hand sanitizers must be alcohol-based and greater than 60% alcohol to be effective.
4) Stock up now with zinc lozenges. These lozenges have been proven to be effective in blocking coronavirus (and most other viruses) from multiplying in your throat and nasopharynx. Use as directed several times each day when you begin to feel ANY "cold-like" symptoms beginning. It is best to lie down and let the lozenge dissolve in the back of your throat and nasopharynx. Cold-Eeze lozenges is one brand available, but there are other brands available. 
I, as many others do, hope that this pandemic will be reasonably contained, BUT I personally do not think it will be. Humans have never seen this snake-associated virus before and have no internal defense against it. Tremendous worldwide efforts are being made to understand the molecular and clinical virology of this virus. Unbelievable molecular knowledge about the genomics, structure, and virulence of this virus has already been achieved. BUT, there will be NO drugs or vaccines available this year to protect us or limit the infection within us. Only symptomatic support is available. I hope these personal thoughts will be helpful during this potentially catastrophic pandemic. You are welcome to share this email. 
Good luck to all of us!
James Robb, MD FCAP


xx

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