I have been working from home the last two days and while you might think that means I have been able to just do whatever or not actually work, nothing could be less true. I have been working on procedures, pages, getting things up and running, answering questions, basically a bunch of work to get ready for when we shut everything down. And the COVID19 shutdown is coming.
I believe the data I have seen which argues that a shutdown – or “flattening of the curve” – will stem the tide of a outbreak and is one of the logical responses that we all should be doing, globally or wherever there is a hotspot. But it feels like the response to this virus has been anything but smooth and orderly here in the States. In fact, it feels very jaggedy.
Interesting then that the UK seems to be having the same problem. They have known for a while that the correct response is quarantine but have been reluctant to call it. Maybe culturally the two countries have that in common: we don’t trust the government. We seem to have elected officials whose official position is that the government sucks. But not surprisingly I haven’t seen big business jumping in here to help out.
This is exactly what governments are for – they provide services and structures that businesses wouldn’t be able to profit from. They are here to protect citizens from pandemics. To help us recover from natural disasters. To help citizens recover when their health and well-being are randomly ripped away from you by “bad luck”.
Our institutions don’t seem like they are here for that anymore. The Trump administration’s response to the COVID19 outbreak is to propose subsidies for.. shale oil drilling companies. And to close “loopholes” which would allow hospitals to buy ventilators. Make the rich richer while the average person sucks on fumes.
In Washington State (USA), one of the few left with even a modicum of understanding about the role of government, the governor has canceled all gatherings of more than a few people. And yet England planned to just go forward with the weekend’s Premier League matches. Putting literally the entire population at risk because they were afraid of hurting the bottom line for these multinational corporations.
It wasn’t until Mikel Arteta tested positive for the coronavirus that the League canceled this weekend’s games. And technically they haven’t even done that yet. They are going to do something very Premier League – they announced that they will have a fucking meeting to decide the course of action. I’m sure that they will come to the correct conclusion but this is a bit late.
If Arteta got the virus from the match against Olympiakos, then Arteta’s already made contact with a number of players and staff from the match against West Ham. Plus his own players and his own members of his staff. I’m not at all suggesting that Mikel Arteta would endanger anyone. He’s not an horrific cunt like Diego Costa who went through the press room coughing on everyone “as a joke” or the moronic NBA player who touched all of the mics at the press conference. There is plenty of evidence that people are contagious well before they show symptoms. My point isn’t to call out Arteta, it’s that the League should have acted sooner. All of the leagues should have acted sooner.
The League Mike Deaned this call: letting things get out of hand before they pulled out a red card. Now they will probably strut off and look soulfully into the cameras to show how much they “really care”.
It’s infuriating but I see this playing out at the micro level as well. Lots of places are staying open, pretending that this isn’t happening.
It’s happening. The only response is to shut it down.
But just shutting things down isn’t enough. We also need to let folks claim unemployment if their wages are cut because they are an hourly employee. We need to mobilize testing stations and clinics to get people treatment as soon as possible. We need to relax laws that will allow us to buy ventilators and other medical supplies. And emergency measures should also be taken to shift money from the national defense budget into a national health corps – opening military hospitals (active duty) to the public, mobilizing military forces to build infrastructure like hospitals where needed.
Most people will escape this virus with a bad cold. Some will escape with almost no symptoms. And yet others will be put through hellish suffering before they die when their lungs fill up with mucus or their organs collapse.
The president is worried about the stock market and maybe he should be. Because if the USA struggles to deal with this crisis many folks will lose faith in our institutions. And once confidence is gone, it’s hard to get back. As Arsene Wenger once said, confidence goes up by the stairs, and down by a lift.
Completely with you on all of this. I would not at all be surprised if we end up mobilizing some military to help deal with sick folks.
And we do need to do something to help out hourly workers not working. Screw the payroll tax cut. And while there’s some logic that helping out small business owners is a good idea, that still doesn’t inherently help the workers.
1. Open all military hospitals to civilians
2. Mobilize all military health care services
3. Allow people to claim unemployment during quarantine
Interesting you mention military hospitals. One of the best examples government neglecting an institution-rather than deliberately hamstringing like this administration seems wont to to-is the criminal mismanagement of the VA hospital system. I live less than a mile from a VA hospital that was forced to stop all non-emergency procedures because they were struggling to sanitize instruments. In a palliative care unit in the same hospital a veteran suffered thousands of ant bites. No one checked on him. A family member who works in healthcare attributes these failings to VA system attracting a certain kind of provider who enjoys the security from collecting a government check and doesn’t care as much as patient care. I don’t know though. Seems like a long series of failures in management. Who’s going to check on the system?
Are you familiar with the “Iron Law of Institutions”?
The version I like says there are two groups within each institution, those who care most about the goals of the institution and those who care about the institution itself. Inevitably the institution focused group gains power because they do a better job of looking out for their fellow members of the institution. Eventually, the goal focused group is marginalized and the institution’s unspoken priority becomes looking out for #1.
I rotated through the VA during training and it was horrific. I removed a lung cancer from a patient 120 days after diagnosis. Why did it take so long? Because of ten or twenty tiny delays as each step proceeded at a pace that was convenient for the part of the machinery that had to perform it. I watched an attending surgeon literally start banging her head against the table in the meeting when she was told that from now on we couldn’t book people for surgery until after all the preoperative work up was done because clock on surgical delays started once the case was booked. Washington wanted to make sure our numbers looked good, even though doing it the new way meant it would almost always take several weeks to a month longer to get someone’s colon cancer out. Once I literally had to beg interventional radiology to drain a deep intramuscular leg abscess (which would be less morbid for the patient than open surgery) because it was already after 3pm. Another time I had a patient whose nurse documented normal vitals signs for 12 hours even though he had been dead long enough to develop rigor mortis. I still have nightmares about the night I was told by GI that ‘sorry they don’t come in at night’ even though my patient was hypotensive and bleeding from a gastric ulcer in the ICU and had antibodies so I couldn’t get blood transfuse him. They abdicated responsibility by suggesting that I transfer him to the University even though everyone knew that would take at least six hours. My personal favorite was the patient with severe peripheral vascular disease who’d already had one leg amputated earlier in the year, when he needed his other leg amputated hee couldn’t get a wheel chair because he’d already used his ‘mobility assist device’ allocation for the year on crutches.
Those are just the horror stories I remember. The true killer was that the bureaucracy always won. You could never change anything because the uncooperative person was always just the tip of the iceberg and they were supported by an underwater mountain of inertia of work rules and government regulations. Eventually, I, like everyone else, just accepted that things were the way they were and that trying to change them was hopeless. The best advice I ever got came from another resident, he said, “Oh, you’re on the VA next month? Start stockpiling alcohol now.”
To be fair there were individuals who cared deeply about the vets, and there were times when they could find a way to make the system work for someone in extremis, but it always required ‘calling in a chit’, i.e., getting someone who owed them a favor to bend the rules this one time. The system itself was deeply apathetic the needs of its patients.
There are certainly problems in all practice models, but the nice thing about private practice is that the system is less tightly integrated so that it is inherently more flexible, less about the needs of the institution and much more sensitive to the individual physician. Obviously this can work both ways, there’s a nearby chain of hospitals with captured medical groups that specializes in milking the system, but my hospital is a community institution. In private practice you can set up self reinforcing networks of physicians who are patient focused. As a surgeon I get referrals because my primary doctors know that I will take good care of their patients. In turn I call GI doctors, cardiologists, ID docs and intensivists who I know are smart, hardworking and will do what is right for my patients. I get walk-ins (self referrals) because all my patient reviews talk about how much I care about them. And when someone can’t pay their bill I can and do tell them I will never send them to collections as long as they send me something each month, I don’t really care what it is.
What a useful set of concrete examples, thank you.
My father is dealing with cancer in a private hospital, and I have to totally disagree with you on the dichotomy you set up between government and private. There is also in your own comment useful stuff about the iron law of institutions. You must be able to see that profit as a motive is problematic for public goods like Healthcare and education, and if you think the logic of profit and managerialism (that I see at play as a professor in a public university in the USA) does not permeate every institution including government in the USA, there is a conversation we can have about it sometime. Now I have to rush to hospital though.
I specifically mentioned the active duty military hospitals and not the VA hospitals. I have had experience with both and the active duty hospitals are much better. The government would serve the vets batter by giving them all medicare for life.
Agree
Payments to people for virus sickness has just been introduced in the UK, along with other benefits for employers who have to shut down etc.
So Arsenal/ City game got postponed because the owner of Olympiakos who apparently interacted with some Arsenal players tested positive for the virus………..yet the EL went ahead with the Oly/ Wolves match anyway?
Does this make any sense whatsoever?
I’m in South Africa and we currently have 16 confirmed cases. As of 3 days ago. That number has been the same for the past 3 days thus far.
None are local transference cases. Yet.
Everything is carrying on as normal in every sense of the word.
But the data from everywhere else, (thanks to every one who has shared links to articles here) paints a bleak, if not terrifying picture.
Personally I have a small business summit to attend tomorrow. Expected crowd is approx 500/600 people. But I’ll also have to travel via plane between 2 international airports and im not really sure I want to do that especially after reading the data sets.
As for the government response here thus far, it seems to be decent but the entire population is aware how inept anything handled by the government is in this country. And that includes public healthcare. 4fs, we’re currently experiencing rolling scheduled blackouts.
Praying for all of you and the entire world at this point
I’ve been wondering if in six months or so when this is all over there will be some sort of retribution. Will there be any actions against China for first allowing it to happen and then attempting a massive cover up and not alerting the WHO of the severity of the virus. Happens so often yet the world continues to connect with them as if ‘oh well, it’s to be expected, after all it’s China’.
WHO has been very appreciative of the response by China.
Money talks. The Premier League is probably one of the most “talkative” of organisations. The correct thing to do would be to close it down right away. It will obviously have to at some point, so why not bite the bullet and do it now? It’s not just the grounds that are high risk, it’s being crammed into trains to get to and from the ground. Madness.
Regarding the response of the US administration, this article pretty much sums up what I think most of us already know.
https://www.theguardian.com/world/2020/mar/12/donald-trump-coronavirus-crisis
Thankfully the Premier League have made the right decision.
A couple of thoughts on your post Tim. Even though there are similarities between the US and UK’s approach the key difference is that Johnson isn’t stupid enough to go it alone. The UK government are being led by the Chief Medical Officer. Decisions such as keeping schools open at present make sense when a large percentage of those working in healthcare need to be as available as possible. Whatever your personal opinions at times like these there needs to be leadership and trust.
Which brings me to the next observation which is just how much your current leader has undermined your faith and trust in government, the judiciary, media, institutions, the lot. I think the rest of the world increasingly looks at the US as damaged goods. Back when Bush was in the White House he was generally dismissed as a fool. But Trump is dangerous because he’s smart. He’s divided and conquered and built animosity with pretty much every nation except Russia and. North Korea. As a nation you need to get that sense of trust back and I’d imagine it’s an even steeper climb than the confidence stairway.
Finally the article I think Mark shared made a very good point as to how the US is geared up to work well in the good times but struggles in the bad times. There are some key societal decisions this virus will present. How do you cope without universal healthcare? What’s an acceptable safety net for those who cannot pay? Because the challenges this virus will present are deeper than tactical reallocation of resources. A longer term societal response will be required if casualties run into the thousands and the continuation runs through the Summer and into the following Autumn and Winter.
Interesting times ahead.
But Trump is dangerous because he’s smart.
Is he though?
I think he’s fully aware of what he is doing. And correct me if I’m wrong but isn’t his supporter base as solid as ever?
I suppose you could argue the case that he is “smart”, but that adjective also has negative connotations. If someone sells you a car that breaks down the very next day, people might describe that as being “smart”. That being the case, “smartness” isn’t really what you want from a leader, is it? The ability to be cute and pull a fast one? Mostly, his “cleverness” is almost childlike. You can see right through it.
I’d have thought “wise” would be a far better attribute. The ability to listen to other people and gain an understanding. On that score, he is worse than useless.
With no real leadership at federal level, it seems to me that for each individual state, it’s going to be every man for himself. At local level also. Expect a mass of civil disobedience, where people look after number one. Bear in mind also that almost 50% of the population own a gun.
If that isn’t a recipe for disaster, then I don’t know what is.
Is it right that he has put a block on Medicaid funding testing?
Does anyone actually believe the story about the virus starting out in animals and transferred to humans eating those animals?
The Chinese have been eating all sorts of animals for centuries, so why now?
Might it make more sense that they were experimenting with a virus for military purposes and it got out?
These coronaviruses (and flu) have been jumping from animals to humans for centuries. Swine flu, bird flu, SARS, MERS, and now this. Of course anything is possible, the USA could have developed the virus and brought it to China for example, but this kind of speculation is possibly incredibly harmful and best left to 4Chan.
Agreed. It’s so annoying listening to people talk about conspiracy theories with confirmed reliable they-who-cannot-be-named sources. Wild speculation at the very least.
The Covid-19 pandemic is a powerful reminder of the adage about human beings being social animals. So much of our economies and social systems depend on social gatherings. Literally all education from kindergarten to post-secondary, all spectator sport, the mass transportation, travel, retail, entertainment and hospitality industries.
At least the internet age has somewhat mitigated this constant mix and flux of intermingling society. But unless Amazon has a hidden, secret drones to deliver your toilet paper, someone still has to handle and bring the package to your door.
Back to the Premiership for a bit. UEFA are postponing the Euro’s for a year so Leagues in different countries can complete.
But If the League doesn’t restart until sometime in May there are what 10 games left, can it run into June because a lot of the players are out of contract on June 1 so surely the whole lot will have to be scrapped.