Thoughts of a Semi-Self-Quarantiner: If You Don’t Like the Weather Wait a Few Minutes

Fenster writes:

Earlier thoughts from semi-self-quarantiner: 1234. 5.

Twain’s comment about the weather in New England is appropriate in the context of the virus.  If you don’t like the situation, give it a day and see what changes.

Steve Bannon has been following the Pandemic closely in a podcast that goes pretty far back.  He has been taking it seriously.  He’s partisan as hell but in the last day or so we have seen his thirst for A LEADER affix itself to both Andrew Cuomo and Bill de Blasio, owing to their recent shift into action mode.

Our system is built to resist aggressive change agents–witness the Establishment’s deep–or rather, Deep –aversion to Trump.  For Bannon– a fan of  disruption, if not disorder, under the proper conditions– this is not a time for partisanship.   If anyone is capable of stepping up and breaking logjams they are to be lauded for the effort.

Strange bedfellows indeed, and Cuomo’s sudden emergence as the Leader We Need Right Now © seems likely to fuel intense and heated discussions among Democrats on how to ditch Biden for a tough and decisive man of action.  Crises can change a lot of things, and quickly.

But clearing the ground for aggressive executive action is one thing. You then have to hope that the leaders who step up push us in the right direction.

For his part, Cuomo’s seen his opportunities and he took ’em.  Right or wrong he is pushing New York State to more flattening of the curve, via the intrusive measures held to be necessary 1) to reduce the contagion 2) to not stress ICUs 3) to bring down deaths.  To his credit, Cuomo has said there is a spectrum of opinion and no one knows what is right.  But he is the Governor, someone has to set a course, and he is going to do it.

That’s a tricky path.  “Flattening the curve to save the ICUs “and its cousin “crush the bastard completely” may well be so toxic to the economy that they cannot be brought to fruition, and half-way measures may be a matter of slicing the baby in half.

The Bright Young Things (and I mean that as a compliment) at the spunky British online journal Spiked argue that the current approach is counterproductive–indeed absurd.  “Humanitarians” might assert that it is better to kill the economy than people.  But killing the economy will kill people too–perhaps many more than the virus.  And the Spiked crew is wise to remind us of how we reacted to similar problems quite differently in the past.  Might it not be time for a reflection not only on the tactics of the fight but the very ground it is fought on?

Do we have a LEADER who will step up and make this argument?  Probably not in the current moment, when all the moral juices are flowing in the direction of the ICUs all across this great country of ours.  Save the ICUs!

There is also is news just in the last day or so about how Italy’s numbers are wrong–way high due to a number of factors like how the deaths are counted.  That might help explain some of the Italy outlier issue.  Perhaps the contagion and death rates are different than the ones assumed in the pessimistic University College model?

It would be good if Italy was shown to be an outlier, and that contagion and death rates are more in line with The Diamond Princess other countries other than Italy.  But pessimism is tempting, especially when presidential leadership is at stake, and given all of the inertial power of flattening the curve.

I read this morning that New York State has 3000 ICU beds and that Cuomo says only 500 or so are free for new patients. So I can see the reason for alarm at ground level.

If it turns out that ICU shortages act as large leverage for bad outcomes there will be recriminations. Some are already asking why we did not observe China’s building of instant hospitals and start our own preparations right away. But that seems to me to be a thin reed of an argument.

Moreover, while a thin reed may not be good at supporting it may be, like a thin blade of grass, capable of cutting, and both ways.

1. More likely that we have constructed a health care system that is both short on beds (South Korea and Japan, the two places that have done well without authoritarian measures, have many more regular beds and ICU beds) AND that lacks resiliency. Did anyone note, as a matter of general policy or in those large scale simulations that were being done, how easy it is to overwhelm the ICU system?  The ICU issue likely has deeper roots than a failure to pay attention two months ago.

2. Why not build our own instant hospitals in 10 days if that is warranted?  Better to just start doing that than blame people for not thinking of it before.  A crash program would cost far less than the damage to the economy.   And while we are at it why not a crash program to build shelters for the healthy vulnerable, in keeping with the herd immunity that we may need to face up to one way or another?

3.  And if the ICU limbo pole is that low, does that not add fuel to the argument that flattening the curve to attempt to snake under it is a fool’s errand?

limbofail

4.  And if the 500 bed problem in New York State is emblematic are we moving heaven and earth for a relatively small number of patients, hospitals and hospital workers?

As a seventy year old I feel entitled to ask the question: do we lose the whole castle for the want of a nail?

About Fenster

Gainfully employed for thirty years, including as one of those high paid college administrators faculty complain about. Earned Ph.D. late in life and converted to the faculty side. Those damn administrators are ruining everything.
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4 Responses to Thoughts of a Semi-Self-Quarantiner: If You Don’t Like the Weather Wait a Few Minutes

  1. Tono Bungay says:

    I’m not anti-market, but it seems clear that the market is shaped by the usual forces of supply and demand, not the extraordinary demands of an epidemic. Why should a profit-seeking hospital have more ICUs than its cost-benefit analysis suggests is right? Why invest in extra ICUs merely so as to be ready in a rare emergency?

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  2. fenster says:

    Some hospitals are for-profit. Some are non-profit. Neither type really operates on market principles given the heavy hand of the health care system in terms of reimbursement and regulation.

    The constant squeeze on costs seems to have led to a system–if you can call it that–that is now still mighty costly but pared down from a capacity POV. The US has fewer regular and ICU beds per capita than other Western nations. That’s for good or bad, or good and bad. The bad part is that between the paring down of costs and the regulation/bureaucracy the system does not seem to be nimble or anti-fragile. So in some ways the distress over an out of control pandemic has been replaced by distress over a heath care system that is not equipped to deal with the problem, even if the problem is way less than originally thought.

    As one wag put it on Twitter “I find it absolutely incredible how civilization so risk averse as to worry about climate in 100 years and so health-obsessed as to worry about trace pesticide exposures and trivial amounts of radiation, is so hopelessly unprepared for a pandemic.”

    It is still unclear to me whether the underlying problem is less than feared (the gist of most of my posts) or whether it is going to get a lot, lot worse, irrespective of the condition of our ICUs (the pessimist view, which may well turn out to be true–I sure don’t know). But in either case it does seem that we did not anticipate this kind of fairly foreseeable risk.

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  3. Pingback: Note to K–, on the virus – Fenster und Gottfried überlegen sich die Frage

  4. Pingback: Thoughts of a Semi-Self Quarantiner Elsewhere | Uncouth Reflections

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