Reopening the USA -Mitigating the Virus and Bad Decisions

Update May 2nd: 

Just as your gut told you, it appears that the corona virus came our of their laboratory, not the seafood market.  The last part of this film is political but don’t let that negate the first part. Link

I guess it might have made sense to listen to Neil Ferguson at first, although he has a long track record of overestimating the impact of a pandemic virus and there were a bunch of other very qualified epidemiologists in the world who had alternative plans of action. Time to change the course of our response to something more functional. Link

Dunderhead, absolutist thinking is for the poorly educated minimally capable progressives. We need a varied and tailored response to COVID, and that requires the nimble, the bright, and the creative. Why not granularize our response down to the level of each regional hospital? My local hospital has 4 COVID patients and probably 100 beds available, no one has died, we went from 2 to 4 patients over a period of 3 weeks making our observed infection rate about 3%/day, typical hospital stay for COVID survivors is 12 days-clearly under current conditions our hospital would not have a problem managing COVID patients. Meanwhile, I and many others have medical time bombs ticking in our bodies. I have two: a bulging aorta and cysts in my pancreas-these need to be looked at regularly.  Clearly fixating on one medical problem to the exclusion of many others is dangerous, and politicians are ill equipped to judge the risks. Three California counties, Yuba, Sutter, and Modoc have opened up despite the governor’s order. Yuba and Sutter on order of Dr. Phoung Luu. Idea: Put doctors in charge of local responses to COVID19. While doctors are risk adverse, they are not as much so as politicians because they understand the math and science, and risks and trade offs. To politicians, any risk is too much, which makes them rudderless decision makers. It should be possible to scale models down to a regional level, and with doctors in charge they fine tune the model to evaluate the risk of death and hospitalization within their region.  

Update: The most reliable information is always thirdhand, right?  Okay take this for what it is: Met a neighbor today, who stopped and told me that a doctor friend had had an uncle in Southern California die, and that the hospital had paid the immediate family $20,000 each in order to be allowed to declare COVID19 as the cause of death. I believe this would be both illegal and unethical, and I also find the story to be fishy, but who knows?

Democratic Congress has declared they cannot return to congress because the possibility of COVID exposure is “too dangerous” for them. So let’s see if I have this right: It’s not too dangerous for healthcare workers, who work in the midst of verified COVID19 patients, but it is too dangerous for Democrat congressional members to even have the remote possibility of being exposed. It’s not too dangerous for nursing home residents to have active COVID19 patients brought into their facility on order by Democrat Governor Cuomo, but it is too dangerous for Democrat Congresspersons to guide this country through these times. It’s not too dangerous for truck drivers, grocery clerks, police, firemen, military, delivery drivers, and all the others who are keeping this country going, but it is too dangerous for Democratic Congresspersons to execute their fiduciary duty to the people of the USA.  

That’s what they are saying, right?

Sue your local and state governments for over extending their hand: As hospitals throughout most of the country are not impacted by the virus, many governmental bodies double down and extend the shelter in place order, which was originally deemed necessary to keep hospitals from being overrun. Just to give you a clue, New York had 950 deaths per million people, while the rest of the country had 140 or so per million. If you took New Jersey, Massachusetts , and Connecticut and added them to New York, the difference would be even greater. Most the hospitals throughout the US were never in danger of being overrun. In fact, now most hospitals are in financial danger because they are not getting enough business because shelter in place orders prevent elective, but often essential surgeries. Also many businesses are in financial ruin when they could operate safely. So if you are in a jurisdiction that does not allow your business to operate and your hospital is not impacted and you could operate safely at some level, join with your fellow businesses and sue the local and state governments for loss of income, or whatever your lawyers can drum up. These jurisdictions are prone to drag their feet for fear of being sued for wrongful death, if someone should die from COVID after they allow their jurisdiction to open. Give them something else to fear, or they will not open until everyone is vaccinated a year from now and their lawyers tell them they are no longer liable for wrongful death suits-really that is the way they think.

Original Essay:

When you look at what we’ve been put through and the damage caused, you have to wonder, did anyone think before they jumped-at any point in the process? Can we get them to think and act according to common sense principles now?

For instance, their latest diatribe has been “follow the science,” this coming from the propagandists, who love laughing at Trump for suggesting that disinfecting blood might be a method to use against COVID19. Turns out that true scientists did consider that and that it was a technique (irradiating blood with ultraviolet light) used in the 1940’s and 50s to treat various diseases including polio and tuberculosis, and it went out of practice because antibiotics proved better. The idea was much like chemotherapy in that it killed body cells as well as the pathogens. The hope was that the body would be able to regenerate its cells faster than the pathogen could produce new ones. Even so it was believed that only 10% of the blood could be treated safely. But as Trump also said, leave to the doctors to figure out; it is NOT something for the uneducated, e.g. a journalist, to try on their own. But the upshot here, i.e. the joke on the journalists is that science advances through trying unconventional things, and Trump is more in tune with it than they are. The scientific method is basically to have new ideas and then to test them. Science is not about the acceptance of conventional wisdom without question.

So here’s the deal. I am going to suggest some things that might help deal with  the COVID-19 pandemic in a more directed and efficient way than the blanket lockdown has. Hopefully everything I can think of has already been thought of by the scientists and doctors who are working nonstop on this, and that they are pursuing all promising leads. There is always the possibility that one idea here will prove useful. Feel free to join in and present your own ideas through written comments.

Now that I think about my first idea, I know that some of my ideas have not been tried.

  1. NY has been the epicenter of COVID19 outbreaks and deaths in the USA. At one point, NY made up about half of cases and deaths for the entire USA. Many of the deaths occur in elder care and nursing home facilities. I don’t have time to do heavy duty research, but a quick perusal of the Internet yields these numbers:  20% of all COVID deaths occurs in nursing homes nationwide- I think this is an underestimate; 40% of the deaths in NY occur in nursing homes; in another state 43% is attributed to nursing homes.  NPR tried to make the case that nursing homes that are occupied by people of color are harder hit- an eyeball review of their data suggests that their case is weak or non-existent. In any case, given that the elderly are more susceptible to dying from COVID19 how could  Governor Cuomo of NY be so callused, uncaring as to force nursing homes to take active COVID19 patients? Is he insane, insensitive, or demonic fan of Dr. Mengele? Clearly, the ensuing deaths in these nursing homes shows this decision to be heinous or murderously incompetent.  This action was tragically more dangerous than Trump talking about the disinfection of blood. My idea on this aspect of the COVID19 crisis is simple: Stop killing people by injecting active COVID19 patients into the highly vulnerable population of nursing homes and elder care facilities. 
  2. I understand that Governor Newsom of the Californian Nation State has tried to inject active patients into nursing homes and has gotten some push back from the doctors in charge there. I beg the governor to desist from this or he will ruin the good will he has gained by the way he has managed the COVID19 crisis in California. Instead he should spearhead my next suggestion: Figure out how to make nursing homes and elder care centers “bullet proof” against the COVID19 virus. That is convene a team of doctors, engineers, and systems people to review nursing home practices, find the weak points, develop “best practices,” and present them to the president and enforce them in California. When you look  at the Italian death tables by age group (previous post), you see that deaths could be reduced to 10% of the current level simply by isolating, rather than exposing as Cuomo did, people older than 70 from the virus. Isolate does mean isolate, but this is not a rare human condition. The elderly and vulnerable may have to live in a cloister, as medieval monks did. The staff who supports them may have to live there as well, perhaps in month or longer 24/7 shifts, the only contact being limited to food delivery and other essential interactions which are controlled and decontaminated. A hardship for the workers, not seeing their families? Well sailors do it, offshore oil workers do it, soldiers on the warfront do it. Now, it’s their turn. At least they have a job. Pay them well for it.  How much better off would we be now, if the government had supplemented these workers’ salaries, while letting the economy run in a more normal fashion, rather than shutting down everything and then trying to prop up the entire economy? The fact that NO congressman, governor, or government official suggested this shows that the whole boatload of them are NOT leaders, NOT even instigators to leaders. They lack the insight to lead, most only know the rote chants of their political party.  Gavin, when given a choice, always choose to be the hero.
  3. This has been said before and I pointed it out in my previous post: We must replace the essential/not essential paradigm with the more robust safe/not safe paradigm. While one must concede that this plague came on us rather quickly, and it was natural to accept the directives of the CDC, WHO, and other authorities, which pushed the essential/nonessential paradigm worldwide, now we can secondary guess that. Indeed, Trump should have convened a think tank immediately when the economy was shut down to consider and develop alternative paths. Certainly, we know that the Democrats and world consensus handcuffed him with their  threats and obstructions. We also know that the Democrats had beaten him down with their childish and destructive impeachment vendetta, but still we need him to challenge the experts to think of a more targeted (elderly cloistering) control while letting safe activity go on. Furthermore, the president should have called upon industry and labor groups to formulate methods which they could institute to operate safely during these times. And remember once the elderly have been truly protected, rather than unduly exposed as Cuomo did, the death rate, probably also the hospitalization rate would drop to 10% of the current levels. My idea:  Move to the safe/not safe paradigm, and ask industry and union groups to develop best practices that would allow their economic units to function in a COVID19 active environment.
  4. Using emerging data, such as the Italian death tables to sort the vulnerable from the resistant. There will be some mistakes. Some might die, but those people who inadvertently are severely impacted by the virus will not be facing overrun hospitals because these best practices have been instituted. Idea: Instead of giving massive handouts to restaurant, bar, retail store, and other businesses and their employees, let them continue to work. Instead use a fraction of the government handout to pay general practitioners to keep their offices open, and spend their staff’s time and their time, and maybe even hire additional staff to review the record of every patient of the doctor to determine if that patient is vulnerable or not.  If they are vulnerable notify them that they must cloister with the elderly for some period of time. The government can pay restitution for this imposition to the few that are affected rather than give willy-nilly handouts to everyone.  Those patients who are borderline can come in for tests to see whether they should shelter or can go to work.
  5. I’m certain that we are pursuing every possible cure, therapy, and preventative measure out there. We have heard and read about dozens of each, and the Food and Drug Administration has streamlined their rules to allow quicker testing and vetting of these systems. I think we need to push beyond the strict safety standards. I know this can be dangerous, but the danger must be compared in decision analysis fashion against the alternative. Safety standards can not be stand alone absolutes. Idea: Allow the early distribution and more robust testing of new promising systems, particularly allow the vulnerable to step up and participate, given that their alternative may often be death anyway. If they die from the remedy, at least they had the chance to try and they died knowing that the information about their experience may sooner rather than later help others. For example, within an elder care facility, if agreed by a number of the residents, they can take a vaccine, and serve as test subjects while possibly providing herd immunity within their cloister.
  6. Sweden is the only European country to take a contrarian tack. That is they left social distancing to the discretion of their individual citizens rather than instituting a police state shutdown. In that regard they may have the right to claim that they are now the Land of the Free. Epidemiologically, they looked at their arsenal to fight the virus and saw that, like us, they had no vaccine, they had no cures, they had only a handful of facilities to make the equipment and stuff to support their doctors and hospitals, but they saw something most other nations missed; they saw that they had 10 million environment monitoring, self-evolving high tech chemical and biowarfare plants, i.e. their citizens could develop immunity within their own bodies, kind of like animal life has been doing for several billions years, and they decided to rely on that to be their most powerful weapon against the virus. Recently, their chief epidemiologist announced that he believed they would achieve herd immunity in a matter of weeks. While Sweden is laughed at and condemned by the court jesters in the press, all thinking individuals have to realize that the absence of a viable, distributable vaccine for more than six months leaves us all basically no choice but to someday remingle and since 95% of us have no antibodies, it is almost predetermined that the virus will reignite as early as next fall if not sooner. We all face the dilemma of having to develop herd immunity or watch our economic system unravel, which stated in the perceptive terms of ABC (America’s Bartending Clown), “Rent will come due and no one will be able to pay it.” So either the pharmaceutical companies will have to extremely fast track a vaccine, or we will have to develop herd immunity ourselves. There are no other viable options. Our shutdown of society has only delayed the inevitable, which in the beginning was all it was expected to do, and that is to allow the hospitals to get prepared for and handle a more moderate flow of critical cases. Idea: Keep an eye on Sweden, because we will all be on that road one day in the near future. 
  7. Modular reopening. While we have all been cloistered away we have kept in contact with close friends, distant family, and neighbors. Since testing even now is not ubiquitous, we don’t have data regarding who has the virus and who does not, and even if we did, the test only gives us moment in time status; tomorrow it may change; yesterday it may have been different. So, just as our medieval ancestors, we can only go by what we observe, and the wise among us will proceed cautiously on that basis. One might observe that a dear neighbor’s family has seemed virus free over the last month and that they also have observed good isolation standards and continue to do so. One might therefore assume that they can extend their family unit to include that family unit and meet and eat and visit together, while continuing to distance from other unknown units. Idea: Gradually reopen your family unit to seemingly safe other family units and over an extended period of time slowly add other units to your group. 
  8. The COVID19 pandemic is handled on the state level within the USA, however just as a states are different, so are regions within states. It’s simply LAZY for governors to handle their entire state as one homogeneous unit with the same guidelines and opening date. It certainly is not logical, nor is it beneficial to the regions within the state nor to the state as a whole to be treated uniformly without regard to regional distinctions. At one point Dr. Brinx said, “We have information on the pandemic on a very granular, county by county basis. Well, use that! Some regional hospitals have not had a surge, and as such there is no reason for the region they serve to be on lockdown. Again repeating: The purpose of the lockdown was to relieve impacted hospitals; no impact; no need for a lockdown. Idea: Get off your lazy asses and examine the COVID19 issue locality by locality within your states, governors. If a regional hospital is not impacted then reduce the severity of the lockdown within that region. It  benefits the entire state, even those who are still locked down when any region of the state is able to get back to normal life. In fact, recalcitrant governors who insist on holding us hostage until June, give us targets for reopening so that we’ll know when we are there.  For instance the San Francisco Bay Area has reduced our infection growth rate from 25%/day!!!! about four weeks ago to 2-3%/day, and our local hospital is not impacted. When are we, here in my town, able to reopen, Governor Newsom?  Give us the goal for US!
  9. Some may feel that more intense testing is needed before a region within a state can be opened. Idea: Create mobile testing units.  If, based on hospital data and other statistics, a region of the state is a candidate for the early relaxing of the lockdown, then send in multiple mobile testing units to quickly saturate the region with tests to validate the early opening of that region. After the region opens move the units to the next candidate region, etc. 
  10. Okay after having so many good ideas, maybe it’s okay to have a quack one. You never know what might work, although I believe that the scientists have already tested many of the seemingly goofy ideas.  I was asthmatic as a child. In those days they didn’t have many of the modern drugs and techniques to relieve asthma. Whenever I had an attack, my mother would boil a pan of water, toss in a tablespoon or so of Vicks Vapor Rub. Once the Vicks had dissolved she put the pan on the table and used a newspaper to make a little tent under which I would have to put my nose and mouth and I would have to breath the steam and fumes coming off of the hot water. Whether my desire to escape the toxic gases caused me to use mind over matter to bring my attack under control, or whether the Vicks actually helped, I don’t know; but, wait long enough, it would always work. One thing I know is that humans can breath some rather hot, steamy, and polluted air. Is it possible that some hot, steamy concoction can reduce the presence of COVID19 in the lungs, particularly if used early on in the infection? Now I have to post a disclaimer, being that the modern educational system does not teach reading comprehension, particularly to journalism students, and some may act upon my words as if they were facts, rather than being subjunctive in nature: This is a question-One should not experiment with unproven medical techniques.

I’m probably not out of ideas if I were to keep thinking, and maybe I’ll come back to it. However, now it is your turn. Add your ideas by submitting them as comments.   

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