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Archive for April 6th, 2020

The lack of testing means we don’t actually know what’s happening

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From a VoxCare newsletter:

Today’s coronavirus snapshot, as of 4 pm ET Monday:

  • 352,546 confirmed US cases (1,324,907 worldwide)
  • 10,389 US deaths (73,703 worldwide)
  • 1,778,487 tests conducted in the US (5,406 tests per million people)

I’ll be frank, today’s edition is a little selfish because it’s a question I really wanted to see answered. But the truth is, we need to start thinking right now about how to help rural America deal with this crisis. The outbreak is already there.   — Dylan

Until now, it’s been easy to think of the coronavirus as a problem for cities and maybe suburbs, but not for the towns and villages dotting the rest of America. But that really isn’t the case anymore — and the coming crisis could hit rural America just as hard, if not harder, as it has hit our urban centers.

To dispense with the idea that Covid-19 is only affecting cities, this map from Johns Hopkins illustrates the point better than any sentence I could write. You will notice the red dots representing the location and concentration of cases are … pretty much everywhere.

Today’s coronavirus snapshot, as of 4 pm ET Monday:

  • 352,546 confirmed US cases (1,324,907 worldwide)
  • 10,389 US deaths (73,703 worldwide)
  • 1,778,487 tests conducted in the US (5,406 tests per million people)

I’ll be frank, today’s edition is a little selfish because it’s a question I really wanted to see answered. But the truth is, we need to start thinking right now about how to help rural America deal with this crisis. The outbreak is already there.

—Dylan

Until now, it’s been easy to think of the coronavirus as a problem for cities and maybe suburbs, but not for the towns and villages dotting the rest of America. But that really isn’t the case anymore — and the coming crisis could hit rural America just as hard, if not harder, as it has hit our urban centers.

To dispense with the idea that Covid-19 is only affecting cities, this map from Johns Hopkins illustrates the point better than any sentence I could write. You will notice the red dots representing the location and concentration of cases are … pretty much everywhere.

I had actually assumed urban areas would be more fertile ground for the coronavirus and that’s why we were seeing more cases there. More people, in closer proximity, sharing parks and public transportation and the like. But Tara Smith, an epidemiologist at Kent State University, waved me off that notion.

“I’m not sure if it’s really population density versus more access to testing in urban areas,” she told me late last month. She pointed out that in her (and my) home state of Ohio, Covid-19 had actually shown up early in Stark County (a smaller county that contains Canton but not much else in the way of urbanity) but most of the testing had been concentrated in Cleveland.

“I think we just have no idea what’s going on in some of the less-populated areas,” she said.

And when the virus does hit our rural communities, they will have even less medical capacity than New York City or Los Angeles or Seattle. Lois Parsely laid out some sobering statistics for Alaska in a piece for Vox this weekend:

While New York state still has the highest per capita rate — 1,995 cases per million people as of March 26 — there are also significant clusters of Covid-19 in rural areas in the Midwest and South, including Arkansas, Mississippi, Georgia, and South Carolina. Every US Health and Human Services region also has shown a sharp uptick in non-flu-related influenza-type illness.

On Friday, Alaska reported 85 cases and its first Covid-19-related death. Shana Theobald, another doctor on Kodiak Island, explains the grim calculus for her state: Given that experts from the CDC estimate 40 to 70 percent of the state’s 737,500 people may eventually contract Covid-19, at least 295,000 Alaskans could get sick. Based on initial reports, 20 percent, or 59,000 people, will need hospital care.

Alaska only has 1,500 general hospital beds. And even if as few as five percent of Covid-19 patients become critically ill (a conservative estimate), that’s a minimum of 14,750 people needing ICU beds. And Theobald estimates that Alaska only has around 200. If that many people get sick over the next one to three months, only one in 25 people who need intensive care will be able to get it. Even if you halved the number of Alaskans infected with Covid-19 to 20 percent, the system will still be over capacity — by thousands of people.

It’s these kinds of equations that make epidemiologists particularly concerned about rural America. “If we believe that the way seasonal flu spreads through the country is likely similar to Covid-19, the rural eruptions tend to be later and briefer, but more impactful than in big urban areas,” said Roger Ray, a retired neurologist, physician executive, and physician consulting director with The Chartis Group.

After reading Lois’s piece, I did some crude math for Knox County, Ohio, where I grew up. It’s a county of 61,000 people; the biggest locality, Mount Vernon, has fewer than 17,000 residents. It’s an hour northeast of Columbus and about 90 minutes south of Cleveland.

If you assume half of the county’s residents get sick and 20 percent of those will need to be admitted to the hospital, you’re talking about 6,100 people who will need a bed — not all at once, but still. That’s the demand.

Knox Community Hospital, the only hospital in the county, has 115 beds. You can get to Columbus in an hour or Mansfield in 45 minutes, but those bigger cities will be dealing with their own coronavirus cases. Once you start doing the math, it gets scary quickly.

You can see why New York has instituted the plan it has, turning its entire state into one hospital system. More states may be forced to follow the same path.

We need to be doing everything we can to prepare rural America for Covid-19 — right now. Knox County has a handful of confirmed coronavirus cases. The virus is already there.

Written by Leisureguy

6 April 2020 at 4:55 pm

There Is No Plan for the End of the Coronavirus Crisis

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“Plans?” says the Trump administration. “We don’t need no stinking plans…. We have Jared Kushner.” David Wallace-Wells writes in New York:

For a month, American journalists and public-health experts have praised the coronavirus response of South Korea and Singapore above all others. On Tuesday, Singapore will close its schools and most businesses to guard against an out-of-control outbreak; South Korea just extended its social-distancing policy. In the early months of this pandemic, the most developed parts of Asia have visibly outperformed the rest of the world — a differential that has produced a string of viral charts showing the benefits of mask-wearing and universal testing. But in recent days, Hong Kong and Taiwan, noting a rise of new cases arriving via international visitors, have shut their bordersCases are spiking in Japan, and a second wave of infections is feared in China, as well. Which means that, all told, many of the nations desperate Americans have spent the last few months praising as exemplary models of public health management do not actually have the virus under control — or at least not to the degree it appeared a few weeks ago, or to the degree you might be hoping for if you expected a (relatively) quick end to quarantine measures and economic shutdown followed by a (relatively) rapid snapback to “normal” life and economic recovery.

If the countries held up as models for how we should proceed can’t figure it out, what does it mean for the U.S., which is saddled with broken institutions and has already bungled and delayed its response at nearly every stage? Here in New York, we are about to enter our third week of sheltering in place; in San Francisco and Seattle, the social-distancing orders have been in effect even longer. Yet there is no clarity to be found from the federal or state or local level for how long these measures will last. And there is no public or concrete plan for, and little visible discussion about, what it would mean to sunset them: how and at what point and in what ways we will try to exit this temporary-but-indefinite wartimelike national bunkering almost all 330 million of us now find ourselves in. What, exactly, is the endgame here?

Some of this ambiguity is inevitable — it may be hard to remember, given the way the coronavirus has distended our sense of time, but this crisis is just a few months old and the scientific and public health wisdom just as preliminary. But while it may not be possible to pinpoint a date, or a month, at which point we can expect to transition out of bunker living, no one seems to have any sense of how we’ll arrive at that determination, how much we will have wanted to contain the outbreak, at what levels, before moving forward, and what steps moving forward would then entail. That there is no coherent federal plan to deal with the outbreak as it currently stands is horrifying enough — an absolute evacuation of presidential leadership that has already cost thousands of lives and will likely cost tens of thousands more. But the fact that there is also no planning to speak of for how we might leave behind the present crisis means all we can see looking forward from the darkness — is more darkness.

Last week, Helen Branswell of Stat news reported that public-health experts in the U.S. are increasingly worried that the public is underestimating how long the coronavirus “disruptions” are going to last — with many Americans assuming a sort of national reopening will begin in early May and most public-health experts expecting at least a month beyond that. Possibly more, even considerably more.

But the bigger question isn’t how long our shutdown will last; it’s what will follow it. In theory, lockdowns of the kind that are now in place in much of the country are designed to contain an outbreak before it gets out of control — this is why China instituted its shutdown in January. But even relatively modest spread of a disease requires more than simple lockdown; it requires an aggressive program to identify those infected, isolate them, and monitor those they may have come into contact with, to be sure those people aren’t themselves spreading the disease. This is the “test and trace” method of pandemic containment; among public-health experts, it is the ideal. But in the U.S., and indeed throughout Europe, as well, the pandemic has progressed much too far for this approach to work. And so — again, in theory — the current lockdowns could provide another opportunity, as well: buying the country time to ramp up a comprehensive testing regimen. We would shelter in place until such a program was ready to go, then reenter “normal” life through that portal of medical surveillance. This program would be a dramatic change to American life — obligatory temperature checks, intrusive testing, and mandatory isolation in quarantine camps for anyone who’d even come into contact with a positive case — but it is the fastest path out of our current predicament. Beyond Twitter, the periodic suggestion from Trump’s executive pals that we should “reopen” the economy, and a few op-ed pages sketching out vague pathways, there is no sign of any real plan to do it at any level of government.

The Nobel Prize–winning economist Paul Romer has suggested that, while imperfect, an aggressive testing regime without “tracing” would also be effective, at the population level, allowing a country like the U.S. to emerge from shutdown without imposing quite as aggressive a medical surveillance state. That is potentially promising, since the latter would be enormously challenging at the logistical, legal, and cultural levels here. But the U.S. is very far from instituting that kind of testing regimen. The only COVID-19 testing being done anywhere in the country is of symptomatic patients coming to doctors and hospitals. Nowhere are we doing the kind of “community” testing Romer envisions, nor are we testing for coronavirus antibodies to confirm how many people have already had otherwise undetected cases of COVID-19. And since we are still so hopelessly short on testing equipment needed to even test all the patients complaining of symptoms, we are very, very far from being able to even imagine a massive nationwide rollout of testing that would allow us to not just swab everyone but continue to swab everyone pretty regularly over the next few months. On top of which, the tests we are using may have a failure rate of about 30%. That means about one in every three people being tested could be getting the wrong result. You can’t build any kind of public-health response on top of information that faulty.

In this context, the complete absence of federal leadership I’ve written about before is especially conspicuous. The White House has offered no . . .

Continue reading.

Written by Leisureguy

6 April 2020 at 3:25 pm

You Should Worry About Coronavirus in the South—Just Not for the Narrow-Minded Reasons You’re Sharing

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Becca Andrews makes some good points in this article in Mother Jones, but still it should be noted that Southern governors did not take timely action and quite deliberately ignored and minimized the risk — indeed, even now some are not acting to protect the public.

Today, as was inevitable, a map from the New York Times made its rounds on Twitter showing where Americans are not staying home (answer: the Southeast) and it was taken wildly out of context—used to more or less say, look at those ignorant Trumpers below the Mason-Dixon line!

My colleague, Kevin Drum, called the map “infuriating” and explained the concentration of continued movement in the South over the past few weeks in this way:

The map doesn’t look this way because people in the South are idiots. It’s almost certainly because they’re conservative and they watch a lot of Fox News. They also listen to President Trump. And Rush Limbaugh. And what they heard was that the coronavirus was “just a bad cold.” That “within a couple of days it’s going to be down to close to zero.” That the hysteria was nothing but a “new hoax” from Democrats who want to bring down the president.

For weeks that’s what they heard. And they believed it. And so they resisted taking it seriously. That’s starting to shift now that Trump and the conservative noise machine have changed their tune, but it’s several weeks too late. What a shameful performance.

While I agree people in the South are not idiots, and that President Trump has whiffed in showing any real leadership during this pandemic—a fact that has real consequences—I respectfully disagree with the broader point here.

For weeks, all over the internet, the message has been “stay home,” “stay the fuck home,” “stay home or you’re a monster who will bring about the apocalypse and the ultimate collapse of human civilization.” Yes, stay home. But what if you can’t?

We don’t often discuss that the ability to stay home is a privilege, one that is a lot more common in places like the Bay Area, where I live. My privilege in this situation is mostly a product of sheer, stupid luck, not some moral high ground, and it is also partly due to the fact that now I live in urban California, in an area where leadership has taken the threat of the virus seriously and where my job can be conducted pretty easily with a laptop and some WiFi—a luxury in and of itself.

My family and many of my friends back home in the South are generally not so fortunate. It doesn’t make them lesser people. And it doesn’t mean they settle into their living rooms at night to watch Fox News, dumbly absorbing whatever nonsense is spat out at them by blonde women with impossible hair or white men with rage etched into their faces. Sure, those people exist—but a whole shit ton of people watch Fox News, and data shows that it’s very much not just in the South. It’s simply unfair to assume that COVID-19 has gained a stronghold there because of conservative propaganda and blind loyalty to Trump. It is because of inequality, poor infrastructure, poverty, food deserts, and a whole host of other reasons, some of them political.

Poor leadership certainly plays a significant role here, and plenty of blame rests with those in power who do take their cues from the president (who takes his cues from Fox News). My colleague Tim Murphy wrote about how the nation’s Trumpiest governors—that “cohort of mini-Trumps,” as he writes—have turned a massive health crisis into a game of politically motivated chicken. And I’ve already written about how Gov. Bill Lee in Tennessee, my home state, has taken absurdly inadequate steps to protect the state. That he only just decided today, Thursday, April 2, to issue a stay-at-home order (previously it was just a “safer-at-home” order) means that my father, who is at a higher risk for severe illness due to the virus, has not been able to “stay the fuck home” without losing his job, which, economically, is not an option for my family. I do not know if this new order even means he will finally get some reprieve. Instead, my father uses the PTO he has to take days off here and there, trying to mitigate his risk, but also lessening the chance of a real vacation after all of this is over.

There are also other reasons for not being able to stay the fuck home beyond the necessity of remaining employed. . .

Continue reading. There’s more. Later in the article:

Written by Leisureguy

6 April 2020 at 2:47 pm

Listen to an asshole!

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Modley speaks. Modley obviously is too naive or too stupid to realize that his (stupid, lying) speech would be leaked.

Listen to this. And note the running comments under the progress bar.

Written by Leisureguy

6 April 2020 at 12:26 pm

Posted in Military, Politics

How New York City’s Emergency Ventilator Stockpile Ended Up on the Auction Block

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Justin Elliott, Annie Waldman, and Joshua Kapla report in ProPublica:

In July 2006, with an aggressive and novel strain of the flu circulating in Asia and the Middle East, New York City Mayor Michael Bloomberg unveiled a sweeping pandemic preparedness plan.

Using computer models to calculate how a disease could spread rapidly through the city’s five boroughs, experts concluded New York needed a substantial stockpile of both masks and ventilators. If the city confronted a pandemic on the scale of the 1918 Spanish flu, the experts found, it would face a “projected shortfall of between 2,036 and 9,454 ventilators.”

The city’s department of health, working with the state, was to begin purchasing ventilators and to “stockpile a supply of facemasks,” according to the report. Shortly after it was released, Bloomberg held a pandemic planning summit with top federal officials, including Dr. Anthony Fauci, now the face of the national coronavirus response.

In the end, the alarming predictions failed to spur action. In the months that followed, the city acquired just 500 additional ventilators as the effort to create a larger stockpile fizzled amid budget cuts.

Even those extra ventilators are long gone, the health department said on Sunday. The lifesaving devices broke down over time and were auctioned off by the city at least five years ago because the agency couldn’t afford to maintain them.

Today, 14 years after the pandemic plan was released, the death toll from the novel coronavirus is climbing by the hundreds daily, and the shortage of ventilators threatens to push it higher still. On Friday, Mayor Bill de Blasio said that the city, which entered the crisis with around 3,500 ventilators, would run out of the machines this week. New York Gov. Andrew Cuomo said he was authorizing the state’s National Guard to seize ventilators from less overwhelmed hospitals to be used where they are more urgently needed.

Early hopes that the federal government could use its Strategic National Stockpile to adequately supplement New York’s supply of ventilators have faded amid revelations that key federal agencies were themselves woefully underprepared for a pandemic. The COVID-19 crisis has exposed the national stockpile as poorly maintained by the Trump administration and far too small to meet the competing demands that have predictably poured in from many states as the pandemic hurtles across the country. Indeed, some of the ventilators in the stockpile suffered from the same problem faced by New York — they fell into disrepair.

On Friday, President Donald Trump faulted New York and said he could not assure the state of more ventilators. “No,” he told reporters. “They should’ve had more ventilators at the time. They should’ve had more ventilators.” (Trump himself has been widely criticized for ignoring early warnings and downplaying the threat of the virus in the face of mounting global evidence of its lethality.)

New York City, with its plan 14 years ago, recognized that the nature of a pandemic — striking in many places in rapid and devastating succession — would mean that the city, in many ways, would be on its own.

“Since the pandemic will be widespread in the United States, the supplies from the federal Strategic National Stockpile may not be available and local caches will need to be relied upon,” the 2006 report said.

In a newspaper interview that year, Dr. Isaac Weisfuse, then a deputy commissioner at the health department involved in pandemic planning, said the city could not count on the federal government. “We do understand that New York City will be responsible for New York City in terms of dealing with any pandemic,” he said.

The story of New York’s ventilators, as with many of the pre-crisis pandemic reports that have come to light at the federal level, is one of grave vulnerabilities that were made plain by experts but never were made budget priorities by policymakers. . .

Continue reading.

Tax cuts have consequences. An underfunded government cannot be effective. The Republican party has worked very hard to make sure the government does not have the funds it needs to do its job.

 

Written by Leisureguy

6 April 2020 at 12:13 pm

It’s Hardly Shocking the Navy Fired a Commander for Warning of Coronavirus Threat. It’s Part of a Pattern.

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Christian Miller and Megan Rose report in ProPublica:

Capt. Brett Crozier, fired this week from command of the aircraft carrier USS Theodore Roosevelt, joins a growing list of Navy officers who attempted to raise concerns about the safety of their ships and crew, only to pay with their jobs.

Crozier wrote a letter dated March 30 warning that an outbreak of the coronavirus on his ship was a threat to his crew of some 4,000 sailors unless they disembarked and quarantined.

“We are not at war, and therefore cannot allow a single sailor to perish as a result of this pandemic unnecessarily,” Crozier wrote. “Decisive action is required now.”

We do not know all the facts that prompted the letter. But we know that once it was published in the San Francisco Chronicle, the acting secretary of the Navy, Thomas Modly, relieved Crozier of command. Crozier, 50, had been a rising star in the officer corps. He will remain in the Navy at his current rank, though his career future is uncertain. In viral videos, Crozier’s sailors can be seen cheering him loudly as he disembarks the Roosevelt, alone, before driving away.

Navy experts believe that the cumulative effects of the service’s decisions over the past several years to punish those who speak out will result in silencing sailors with legitimate concerns about their health and safety.

“This may have the effect of chilling the responses of other commanding officers because it will be perceived, fairly or not, as a shoot the messenger scenario,” said James Stavridis, a retired admiral and former head of the United States Naval Institute, who called for an investigation into the circumstances surrounding the dismissal.

The Navy’s top officer, Adm. Mike Gilday, initially praised Crozier’s attempt to warn his superiors. But the next day, Thursday, Modly, the Navy’s civilian boss, reversed course, telling reporters that he fired Crozier because he lost confidence in the officer for not using a secure email network to properly route his complaint.

Crozier’s unclassified email wound up with 20 or 30 other individuals and at some point was provided to the Chronicle reporters. Modly said the public airing of the complaint had unnecessarily alarmed sailors and provided enemies with information that exposed weaknesses on one of the country’s most important warships.

As part of our 2019 investigation into the incidents in the Navy’s 7th Fleet, its largest overseas presence, ProPublica found repeated instances of frontline commanders warning superiors of risks the fleet was facing — a lack of training, exhausted crews, deteriorating ships and equipment. Those warnings, all sent through the normal chain of command, were met with indifference.

Disaster in the fleet struck in June 2017, after the USS Fitzgerald, a destroyer, collided with a cargo ship in the Sea of Japan. Two months later, a second destroyer, the USS John S. McCain, collided with an oil tanker in the Singapore Strait. The two accidents cost the Navy 17 sailors — the biggest loss of life in maritime collisions in more than 40 years.

Navy investigations laid blame on nearly the entire chain of command in the 7th Fleet, punishing commanders and sailors for failing to properly train and equip its crews and ships.

Adm. Joseph Aucoin, the head of the 7th Fleet, was fired. Vice Adm. Thomas Rowden, who oversaw training, was forced from his job. Cmdr. Bryce Benson, captain of the Fitzgerald, was recommended for court-martial.

But ProPublica reported that all three men had repeatedly tried to warn higher-ups of dangerous safety issues in the vaunted fleet, based at Yokosuka, Japan. They argued to their superiors that the Navy was running ships in the 7th Fleet too hard, too fast. Their warnings were dismissed. . .

Continue reading. There’s more. The US Navy has fallen into the hands of careerists.

Written by Leisureguy

6 April 2020 at 11:38 am

Posted in Military

Thanks to commenters: A well-focused photo of today’s shave set-up

with 4 comments

The light level in the early morning doesn’t allow for a fast shutter speed, and I could not keep the came still enough for a sharp image. But yesterday achy and Chris R both suggested using the camera timer so that I can press the button and then step away, with the photo taken after the timer finishes its countdown. Brilliant, and of course why cameras have timers.

My camera’s timer offers two options: a 2-second countdown, for the situation I faced, and a 10-second countdown, for when you want to include yourself in the photo. The above is the result: crisp focus even in low light (about 1/6 second exposure time). Click the image to view full size and you’ll see.

So much for the photo. What about the shave? I unearthed this Tcheon Fung Sing soap in the move, and I realized that for some reason — likely the package design — I had avoided it. So today I decided to give it a fair trial, with a life or death decision (for the soap, not me) after trying it. The brush is the Vie-Long ambiguous brush: sold as boar, but seems like horsehair to me — and whichever it is, a very nice little brush. I like the handle style, the size, and the performance.

I do soak this brush — whether boar or horse, soaking is needed — and after my shower I loaded the brush with soap. The lather was excellent. The sandalwood fragrance is more muted than in, say, the Art of Shaving sandalwood, but still quite nice.

My DLC-coated iKon slant (now made with a B6 coating, which is tougher) I wanted to try because it has been a little uncomfortable, throwing off a few nicks. I thought that my discovery using the Fine slant — keep the handle farther from the face — might work for this razor as well, and indeed it seemed to: three passes, quite comfortable, and a totally smooth result.

A splash of Van Yulay’s excellent aftershave splash, this one in Sandalwood, and I’m ready for a new week.

Written by Leisureguy

6 April 2020 at 8:46 am

Posted in Daily life, Shaving

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