Category Archives: Health

If States Were Countries

Originally posted on July 8, 2020

The New York Times published an interesting chart that pretended that U.S. states were countries and then compared their new per capita corona virus cases to actual countries. There were a total of 25 “countries” in the chart, of which 10 were real countries and the remaining 15 “countries” were really states. None of the 10 countries was in Europe, and none are considered advanced. It seems that a large part of the U.S. is right on up there when considering shithole countries. Here’s the chart:

Corona April 2020

Originally posted on June 20, 2020

April 2. Kushner says that the federal national strategic stockpile is “supposed to be our stockpile; it’s not supposed to be state stockpiles that they then use.” I have to wonder, exactly who the “our” is? Does he intend to use it for his own personal interests? It turns out that Operation Airbridge, run by Kushner, lends credence to my suspicions.

April 3. Trump offers rapid coronavirus tests to oil executives meeting with him. Trump: “Listen: They gave us millions of jobs. If anybody wants to be tested, we’ll test them.” So much for the rest of us.

Corona Mar 2020

Originally posted on June 20, 2020

March 2. Trump presses pharmaceutical CEOs to say a vaccine will be ready in a matter of months. They demur. Regardless, at yet another rally, he says that drug companies are “going to have vaccines I think relatively soon. And they’re going to have something that makes you better, and that’s going to actually take place we think even sooner.” And: “The U. S. is right now ranked by far number one in the world for preparedness.” And: “A lot of things are happening, a lot of very exciting things are happening and they’re happening very rapidly.”

March 4. On Hannity: “A lot of people will have this, and it’s very mild. They will get better very rapidly. So, if we have thousands or hundreds of thousands of people that get better just by, you know, sitting around and even going to work – some of them go to work, but they get better. It’s not that severe.”

March 5. Trump: “I NEVER said people that are feeling sick should go to work. That is just more Fake News and disinformation put out by the Democrats.” Meanwhile, Pence says: “We don’t have enough tests today to meet what we anticipate will be the demand going forward.” But, but I thought on February 26 he said everybody who needed a test could get one.

March 6. Regardless of what Pence said on the 5th, Trump: “Anybody that needs a test gets a test. They’re there. They have the tests. And the tests are beautiful.” He also says he would like to keep the Grand Princess, with its 700 cases, off the California coast so the official case count doesn’t rise. “I like the numbers where they are. I don’t need to have the numbers double because of one ship that wasn’t our fault.” There’s apparently no thought at all of the people on the ship. And bizarrely: “I like this stuff. I really get it. People are surprised that I understand it. Every one of these doctors said, ‘How do you know so much about this?’ Maybe I have a natural ability. Maybe I should have done that instead of running for president.”

March 8. Golfing at Trump International. Saying: “We have a perfectly coordinated and fine tuned plan at the White House for our attack on Coronavirus.”

March 9. Tweets: “So last year 37,000 Americans died from the common Flu. It averages between 27,000 and 70,000 per year. Nothing is shut down, life & the economy go on. At this moment there are 546 confirmed cases of CoronaVirus, with 22 deaths. Think about that!” And: “The Fake News Media & their partner, the Democrat Party, is doing everything within its semi-considerable power to inflame the Coronavirus situation.” Dow drops 2000 points.

March 10. Says: “We’re prepared, and we’re doing a great job with it. And it will go away. Just stay calm. It will go away.”

March 11. The WHO declares a pandemic. The NBA suspends its season. Trump announces he will suspend travel from Europe, except the UK and U.S. citizens.

March 12. Trump claims that travelers to the U.S. are being tested. This is not true. Dow drops 2300 points.

March 13. The U.S. declares a national emergency. asked if he takes responsibility for the testing delays, he responds: “Yeah, no, I don’t take responsibility at all.” When asked why he disbanded the White House pandemic office in 2018: “I just think it’s a nasty question…And when you say ‘me’ I didn’t do it.

March 15. Trump: “This is a very contagious virus. It’s incredible. But it’s something we have tremendous control over.” He also tweets: “The individual Governors of States, and local officials, must step up their efforts on drive up testing and testing sights [sites]…” Apparently he is preparing to blame someone, anyone else for his failures.

March 16. Dow drops nearly 3000 points. Trump announces new social distancing recommendations. Epidemiologists estimate that tens of thousands of lives might have been saved if he had acted sooner, by a little as a week. Asked how he thought he was doing: “I think we’ve done a great job.” One can only wonder just what a bad job would look like.

March 17. Trump: “I felt it was a pandemic long before it was called a pandemic…I’ve always viewed it as very serious.” One can only wonder just how he would view something not very seriously.

March 18. Trump: “I’ve always treated the Chinese Virus very seriously, and have done a very good job from the beginning.” Could it be that, as the consequences of his own failures become more evident, he instinctively starts looking around for someone else to blame, in spite of his previous praise of the Chinese?

March 19. Trump passes responsibility to the governors to obtain whatever supplies and equipment they need, saying: “We’re not a shipping clerk.” This looks like a continuation of blaming everyone else. He also introduces hydroxychloroquine as a potential covid-19 cure, incorrectly stating that the FDA has approved it for such.

March 21. Tweets: “HYDROXYCHLOROQUINE & AZITHROMYCIN, taken together, have a real chance to be one of the biggest game changers in the history of medicine.” This is not only unproven, it is even dangerous.

March 23. An Arizona man dies after trying to follow Trump’s medical advice.

March 24. Trump: “I would love to have the country opened up and just raring to go by Easter.” I’m sure he would, regardless of the price paid by his constituents.

March 26. The U.S. now has more reported cases than any other country. Trump: “We’ve now established great testing…We’ve tested now more than anybody.” And: “This is something that nobody has ever thought could happen to this country.” Both of these, like a lot of what Trump says, are untrue.

March 27. Trump signs the CARES act, a $2T stimulus package. He promises 100,000 ventilators after invoking the defense Protection Act, when the adults in the room say maybe 30,000 by June. In echos of the Ukraine mess he says governors: “should be appreciative” of him and has told Pence not to call those who: “don’t treat you right.”

March 29. Trump says that if the death toll is between 100,000 and 200,000 then he has done a good job.

March 30. On a call with the governors, Trump: “I haven’t heard about testing being a problem.” Are his underlings so afraid of bringing him bad news? Everybody else in the country was aware of this problem.

March 31. Deaths in NJ and NY double in 3 days. Trump: “I don’t think I would have done any better had I not been impeached, okay? And I think that’s a great tribute to something, maybe it’s a tribute to me…”

Corona Feb 2020

Originally posted on June 19, 2020

After January’s lack of anything the pace picks up in February.

February 1. Trump golfs at West Palm Beach.

February 2. Trump restricts travel from China, allowing only Americans to fly into the U.S. He says: “We pretty much shut it down coming in from China. It’s going to be fine.” It turns out that 40,000 Americans return and few of them are tested, let alone quarantined. Pictures of the airport lobbies show a perfect environment for the virus transmission. As it turns out, a large portion of the cases in the U.S. entered from Europe, not China. So the travel ban from China probably did nothing of significance.

February 7. Asked if he thought China was covering up the virus, Trump says: “No. China is working very hard…We’re working together.”

February 8. The CDC test kits are widely reported to be not working properly.

February 10. At another rally Trump says: “Looks like by April, you know, in theory, when it gets a little warmer, it miraculously goes away.” Really? The Australians might dispute this.

February 11. Another rally, no mention of the virus.

February 13. Tells Rivera: “it’s a problem in China. Has not been spreading very much. In our country, we only have, basically, 12 cases and most of those people are recovering…so it’s actually less.”

February 15. Trump golfs at Trump International.

February 18. The Diamond Princess cruise ship, docked and quarantined in Japan, has more than 700 cases.

February 19. Trump repeats the nonsense about warmer weather and has a rally in Phoenix, not mentioning the virus.

February 21. Yet another rally, Las Vegas, no mention of the virus.

February 24, Trump asks Congress for $1.25B in emergency funds. The Association of Public Health Laboratories: “We are now many weeks into the response with still no diagnostic or surveillance test available outside of the CDC…” Trump: “The Coronavirus is very much under control in the USA. We are in contact with everyone and all relevant countries. CDC and WHO have been working hard and very smart. Stock market starting to look very good to me.”

February 25. Stock market dips. Trump: “CDC and my administration are doing a GREAT job of handling Coronavirus.” And “I think that’s a problem that’s going to go away. They have studied it. They know very much. In fact, we’re very close to a vaccine.”

February 26. Trump replaces Azar with Pence. Trump: “We’re testing everybody that we need to test. And we’re finding very little problem. We’re going very substantially down, not up. It’s a little like the regular flu that we have flu shots for. And we’ll essentially have a flu shot for this in a fairly quick manner. ” The number of cases “within a couple of days is going to be down to close to zero, that’s a pretty good job we’ve done.” Meanwhile, back on planet Earth, the CDC confirms the first instance of community spread of the virus in the U.S.

February 27. Trump: “It’s going to disappear. One day – it’s like a miracle – it will disappear.”

February 28. At a rally, after noting that there have been no reported deaths in the U.S., Trump: “You wonder if the press in in hysteria mode. Now the Democrats are politicizing the coronavirus . You know that, right? Coronavirus. They’re politicizing it…and this is their new hoax.” And: “We’re ordering a lot of supplies. We’re ordering a lot of, uh, elements that frankly we wouldn’t be ordering unless it was something like this. Bu we’re ordering a lot of different elements of medical.”

February 29. The first death in the U.S. is reported. It later turns out that there were previous deaths perhaps as early as February 6 in California.

Corona Jan 2020

Originally posted on June 18, 2020

After China told the world about the new virus in December 2019 many governments started to take actions that would help prevent illness and deaths. Unfortunately, the U.S. wasn’t one of them. The one constant theme through this entire situation is that Trump’s main concern was his re-election in November, not the welfare of the citizens. Here’s a timeline for January.

Early January. The emergence of the coronavirus starts to get mentioned in Trump’s daily briefing. By some reports, at least on 12 separate occasions.

January 18. While golfing at Mar-a-Lago Trump is given his first detailed briefing about the virus.

January 20. The CDC confirms the first case of the virus in the U.S.

January 22. Trump’s first public mention of the virus. Asked if he was concerned he replied: “No, we’re not at all. And we have it totally under control. It’s one person coming in from China.”

January 23. China locks down Wuhan.

January 24. Trump tweets: “China has been working very hard to contain the Coronavirus.” The CDC announces it has developed a test, different from the one published b the WHO.

January 28. Trump holds a rally in New Jersey, not mentioning the virus.

January 29. Trump announces the coronavirus task force. A memo from trade advisor Navarro warns that immediate action is needed to prevent a pandemic that could kill between 1 and 2 million U.S. citizens.

January 30. The WHO declares the virus is a “public health emergency of international concern”. The word “pandemic” is not used.

January 31. Fauci says there’s no doubt that asymptomatic transmission is occurring.

By this time any competent and caring leader would have at least started not just planning – that should have started years ago – but getting policies and procurements in place to make sure we were as prepared as we could be. At this point Trump shows no sign that he cares one bit about the virus.

Failures at the C.D.C.

Originally posted on June 3, 2020

There was an article today (June 3, 2020) in the NYT that detailed some of the failings of the CDC. The gist of the article was that the CDC, which had previously been widely considered as the premier health agency in the world, had largely bungled its response to the coronavirus pandemic. The failures surrounding our ability to accurately test for the virus were truly catastrophic. As I read the article two aspects relate pretty directly to Trump and his incompetence.

The first of these is the leadership that Trump put in place. Trump is so difficult to work with that he has trouble hiring and then keeping truly competent and non-corrupt people. The CDC is currently directed by Dr. Robert Redfield. He had NO experience leading a government agency and was somewhat controversial. The CDC’s earlier director, Dr. Brenda Fitzgerald, resigned over conflicts of interest. Their current boss, the secretary of Health and Human Services, Alex Azar, was also a recent replacement. Azar did have previous experience as a government manager, but most recently had worked for Eli Lilly – the fox is now guarding the henhouse, eh? In turn, Azar had replaced Tom Price, who resigned after the HHS IG discovered he had been traveling on government money. This constant turnover no doubt affected the CDC’s ability to better control the pandemic.

But even if the CDC had been run competently the director, whoever he/she was, would have had to contend with Trump. From the NYT article:

Even as the virus tested the C.D.C.’s capacity to respond, the agency and its director, Dr. Robert R. Redfield, faced unprecedented challenges from President Trump, who repeatedly wished away the pandemic. His efforts to seize the spotlight from the public health agency reflected the broader patterns of his erratic presidency: public condemnations on Twitter, a tendency to dismiss findings from scientists, inconsistent policy or decision-making and a suspicion that the “deep state” inside the government is working to force him out of office.

Corona Virus – Pre 2020

Originally posted on May 31, 2020

The threat of a truly dangerous new virus arising out of China or Africa has been well-recognized by any number of people, including Obama way back in 2014 (and even back in 2005). Trump has tried to claim nobody could have foreseen this, but that is just another feeble attempt to justify his own incompetence. Later, he tried to shift the blame for the U.S.’s poor response to others (of course including Obama). As of this writing, the U.S. has far more deaths than any other country, and Trump’s laser-like focus on his re-election is the primary reason for this.

Any reasonably competent leader would have known that pandemics are a significant threat and would have done something to prepare. Why did Trump fail so miserably? Doesn’t read? Doesn’t think? Doesn’t listen? Doesn’t care? All of the above? Regardless of why, this crises shows just how incompetent he really is. Below is a brief timeline.

From 2017 to 2020, Trump proposes cutting the CDC’s annual budgets for emerging and zoonotic infectious diseases by anywhere from $61m to $114m. Luckily Congress didn’t go along, and Trump does sign the increased spending.

Jan 15, 2017: Trump’s incoming administration is given a briefing on the threat of an emerging pandemic. As part of this they are given a 69-page “Pandemic Playbook” prepared by the outgoing Obama administration. Due to the chaotic nature of Trump’s administration most of the attendees are no longer in government service.

Feb.1, 2018: A story appears in WaPo about the CDC cutting its budget to prevent a global disease outbreak by 80%, including cutting our eyes in China. This was quite the change from 2014 when Obama announced our assistance in fighting West Africa’s Ebola outbreak.

May, 2018. The “Pandemic Team” was part of the National Security Council, headed by John Bolton at that time. During a re-org of the NSC that team was disbanded, with a number of its members leaving government service.

Dec. 31: China confirms existence of a new virus.

Health Care

I’m really cautious about wading into this one; I don’t have any good answers. Maybe there are no good answers, just less bad ones. I do think we have to do something to fix the health care system in this country. Aside from those who make some serious profits from the industry (like lawyers, insurers and drug companies), no group is happy with it. Doctors dislike the oversight from the insurers, the patients dislike the impersonal nature of the business, and employers dislike the rising costs. From a strictly efficiency standpoint, Americans in aggregate get less health care (measured in medical results, not in medical procedures) per dollar spent than just about any other industrialized country, even those with socialized systems. As a small example, just wander the often empty halls of most hospitals and look at machines lying idle.

If one has money or good insurance, the U.S. system can be the best in the world. We have developed amazing new (and often expensive) technologies that can more or less fix a wide range of ills. That’s good, because the American lifestyle produces a lot of ills. It is probable that much of this new technology would not have been developed under a socialized system, as it takes large amounts of money to do new development and a socialized system doesn’t have much incentive to develop it.

Everyone has heard about the large numbers of uninsured Americans, now at roughly 20% of the population. And many others have pretty scrimpy insurance. There are any number of stories about how uninsureds don’t get early and relatively cheap treatment, until their condition requires a very expensive trip to the emergency room. Many evenings, the hospitals in my area play a revolving “shut down the emergency room” game due to the high number of walk-ins who have no other place to go.

The hard-hearted conservatives would say that’s tough luck, they should work at getting a better job, and besides it’s God’s will. The jelly-minded liberals would say that everyone is entitled to the same medical care, no matter how dissolute a life they’ve led. Hillary tried to fix the whole thing in one motion, which was way over-reaching, and got shot down. There were really two basic things that needed to get fixed. First, somehow provide some medical services to those who can’t afford them, especially for children. Second, provide for insurance transferability when changing jobs.

The only idea I have (and given with some reluctance) for fixing the uninsured problem is that the government establish subsidized clinics where anyone could receive basic medical care. The staff might be government employees or contractors, but would be protected from malpractice suits. Due to costs, the staff would probably include only a few full-strength doctors, with other lessor practitioners being more common. This arrangement would mimic the military clinics that serve dependents, hopefully with different priorities and more money. These clinics would not have access to some of the more expensive technologies, especially those whose benefits were uncertain. Oregon has been playing around with a rationing system that, as distasteful as it may be, may be the only reasonable way to limit costs. Given that about 30% of all health care expenses are incurred in a person’s last year of life, you have to question how much benefit all that money is buying. The quality of the service at these clinics might be described as just adequate, and would be lower relative to what would be available in private service. Yes, a two-tier system. I don’t see how to avoid it. For most health care needs, availability is more important that high quality.

To fix the second problem, the government should pass legislation, beyond Cobra, that would allow for transferability of insurance, or maybe the government becomes the insurer of last resort. The basic problem is often when there’s an existing condition, the new insurance company won’t touch it, forcing the employee to stay at the old job or to risk losing insurance all together. A family with children is especially at risk. With a large number of layoffs, this becomes a major problem with the classic family structure where just the dad works and has 2.1 kids.

None of these options is pretty. I have not yet heard a pretty option. I do think we have to do something to better service a larger percentage of our citizens. The lack of money is one problem, and maybe if we roll Medicaid and Medicare into one comprehensive program, the additional expense won’t be too great.

I’ve seen Canada’s system at close hand, and I guess it works ok, but I don’t think it practical or even desirable in the US. Medical professionals are leaving there and coming to the US, and some Canadian patients are doing the same. One curious benefit of the system is that employers don’t have to fund their employees’ insurance (at least not directly), so hiring entry-level workers is easier to do.

December 28, 2002