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As The Pandemic Worsens, Politics and Ego Are More Important Than Public Health

Originally published at http://www.commondreams.org/views/2020/12/08/pandemic-worsens-politics-and-ego-are-more-important-public-health

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Good, crisp review from Jim Goodman. Maybe he buried the lede a bit:

There is still a shortage of personal protective equipment (PPE), which could have been corrected, had the Administration effectively used the Defense Production Act (DPA) early and often to actually produce PPE. Yet most of the CARES Act allocation for PPE allocated under the DPA was spent not on medical equipment, but military equipment, because the Pentagon decided they could.

Moving deeper into this dark winter, as hospitals fill to capacity still facing equipment shortages, the most dire shortage may be that of medical professionals who can care for patients. Hospital rooms can be re-purposed to intensive care, overflow convalescent centers can be set up, but without trained professionals to staff them, the system crashes.

The peak crisis of denied care, the nationwide hospital crash, is just barely showing up in the stats today – most strikingly in the upward bend of the death-rate, starting in the wake of Halloween, pushing steeper now after Thanksgiving. Only a week ago, USA passed the once-per-minute threshold. This morning, according to the 7-day moving average, someone in USA dies of Covid every 38 1/2 seconds. Twice-per-minute is not far off. (In the 15 minutes it’s taken me to compose this message, 24 more US Americans have perished. Sorry about that!)

STATE COVID-19 OUTBREAKS

Ranking is based on Johns Hopkins’ test-positivity factored with “per-capita newcases” & “immediate mortality” – the ratio of totals on hand for deaths and cases.

>                        JH       per-capita     immed
>                    positivity    newcases    mortality
>                        %            %            %
>  1. South Dakota      48.9        117.8         1.95
>  2. Iowa              41.8         95.2         1.06
>  3. Kansas            41.2         87.3         1.05
>  4. Idaho             47.5         75.3         1.00
> --- ---------------------- ------------ ------------
>  5. Wyoming           16.7        111.3         1.04
>  6. Pennsylvania      31.9         56.0         1.25
>  7. Utah              19.7         92.2         0.34
>  8. Montana           17.5         91.1         1.00
>  9. Alabama           30.1         50.4         1.23
> 10. North Dakota      10.4        121.4         1.45
> 11. Wisconsin         14.5         91.7         0.96
> 12. Arizona           24.7         54.8         0.76
> 13. Nebraska          12.7         99.8         1.05
> 14. Minnesota         11.7        104.8         0.82
> 15. Missouri          19.0         65.7         1.04
> 16. Indiana           13.1         92.3         0.98
> 17. New Mexico        13.2         89.1         1.22
> 18. Nevada            15.8         70.4         0.80
> 19. Tennessee         16.4         65.2         1.11
> 20. Oklahoma          14.9         73.3         0.61
> 21. Ohio              14.9         69.8         0.70
> 22. Mississippi       20.2         48.3         1.28
> --- ---------------------- ------------ ------------
> 23. Illinois          10.7         82.8         1.28
> 24. Arkansas          15.4         59.0         1.30
> 25. Michigan          11.8         69.0         1.31
> 26. Colorado          10.6         79.0         0.77
> 27. Rhode Island       8.0         98.3         0.78
> 28. Kentucky          12.0         64.4         0.65
> 29. Alaska             6.1         85.7         0.38
> 30. Texas             11.9         39.8         1.25
> 31. Delaware           8.8         54.2         0.50
> 32. West Virginia      7.8         55.5         1.21
> 33. New Jersey         9.5         46.5         0.82
> 34. Louisiana          8.6         46.6         0.97
> 35. Georgia           11.2         34.8         1.17
> 36. Connecticut        6.0         57.8         0.99
> 37. South Carolina     9.6         35.2         1.14
> 38. North Carolina     9.2         36.8         0.88
> 39. California         8.7         39.8         0.50
> 40. Florida            8.4         37.1         0.97
> 41. New Hampshire      8.0         36.6         0.64
> --- ---------------------- ------------ ------------
> 42. Virginia           9.9         28.2         0.73
> 43. Washington         8.5         31.2         0.76
> 44. Massachusetts      4.6         47.8         0.97
> 45. Maryland           6.1         37.3         1.07
> 46. New York           4.3         35.1         0.62
> 47. D.C.               3.5         27.6         0.95
> --- ---------------------- ------------ ------------
> 48. Oregon             1.9         29.8         0.96
> 49. Maine              2.8         16.5         1.33
> 50. Vermont            2.1         15.8         0.93
> 51. Hawaii             1.9          6.8         1.68

This is an awful look for Pennsylvania, which suddenly leapt into 6th place, at nearly 1/3 test-positivity. When I see a state’s move led by steady escalation in positivity, it’s promising in the worst way. Alabama and Arizona look similarly ominous, in the pace of their outbreak-rises lately.

The point of this ranking is a topological question: What is the national outbreak epicenter? At one point it was in Santa Clara County (just south of me, here in CA), but nobody knew until much later. Then it moved to Washington briefly, before really drilling down in New York and New Jersey. The epicenter of the outbreak for now can be discerned in the top four heartland states, which have led for weeks.

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What is the current IFR in the US?

Vaccines and Healthcare for All.
Trend-Line: In the USA, we are on schedule to have a mandatory vaccine & immunity card program. Whether you are for or against vaccines, you will have to decide your position now asto whether you will accept the upcoming vaccine to you and to your family…This is coming and has been planned for, for quite some time…You can hear it as you listen to NPR news reports and follow world events… You will have to assess the consequences of taking this vaccine to your health, your employment status and to your mobility and access to services in this country… This is coming, you have time now to plan for your decision and its consequences…

As this government once again, both Dems & Repubs, has approved another $750Billion Military Spending Package, one has to wonder, why do we not have the financial resources and will and courage to have health care for all people here… as sickness & illness do not respect artificial boundaries… …

So if one really wants to safeguard the health of this country, one must really examine how best to increase the health of each one of us… If you think technology and vaccines will do this, ok then, but if not, consider the alternatives.

I believe Infection Fatality Rate (which I usually refer to as case-fatality) for USA is a hair below 2% while the world’s rate is a hair above. That’s approximately 1/3 of where case-fatality was running back in March (worldwide) because now we know more about how to keep Covid patients from dying. Note: Our “immediate mortality” ratio for South Dakota is close to exactly where USA’s case-fatality ratio lies (though these respective ratios measure distinct relationships, temporally).

Worldwide, case-fatality has dropped to about a third of what it was in March, due to improved care. But now that USA seriously hits the wall, after carelessly burning through caregivers like kleenex (zero ICU beds in Santa Clara County this morning, for instance), we can see the consequent mass denial of care reflected in a rapidly rising death rate.

~https://ourworldindata.org/grapher/daily-covid-deaths-7-day

OWID’s 7-day average sees someone dying in USA every 39 seconds, at this writing.

More than a constant shortage of PPEs or actual hospital beds (ICU), there is a shortage of trained medical staff to provide needed care. California has out paced services and is relying of staffing agencies now.

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That’s what they say on the news. You hear about “travelling nurses” – as if there’s any clean corner of the country for nurses to travel from! You’re absolutely right, fern: When people hear “ICU beds” they should realize you could set up the equipment for ICU care any number of places, in an emergency, but without the caregivers to manage that equipment, you don’t have any more ICU beds. We’re totally out of caregivers, all over the country now. The cavalry ain’t coming, as they say, though we’ve allowed so many frontline troops to fall.

It royally pisses me off (as someone with CNA experience) that they’re talking about emergency measures like early graduation and recall from retirement to get more staff – while not managing to adequately protect medical workers lucky enough to still be alive. This is what we call a labor problem.

One of our dearest family friends is a retired nurse. If she goes back now, I’ll kill her!

They’re so low on help all over, we hear reliable reports of staff ordered to report to work despite testing positive, so long as they’re asymptomatic. Just wow: It’s ominously serious care-scarcity, right now.

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Excellent points. Most telling are the bare bones staff/patient ratio in various settings.

Yes, it is a very sharp learning curve, I’ve worked in therapeutic environments too. Still helpful to have people in the community with this type of experience.

It is a tough call, I hope your friend listens to you carefully. My moms hospice nurse had been an ICU nurse for 37 years and another one, I had worked with years before, she actually did my training. I always told anyone that would listen how hard she made me work too.

We have to appreciate these brave people that work everyday in this field.

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For-profit Health Care works…until it doesn’t.

Our Rube Goldberg system was bound to fail under pressure.