BY SARA GENTZLERAPRIL 07, 2020 01:47 PM, UPDATED APRIL 07, 2020 01:47 PM
Intercity Transit will suspend its regular bus service and require advance reservations for people who need transportation for “essential trips” starting Monday, April 13, the agency announced Tuesday.
The public transportation agency, which serves Olympia, Lacey, Tumwater, and Yelm, cites Gov. Jay Inslee’s “Stay Home, Stay Healthy” emergency order in its announcement and says the move is aimed at limiting the risk of COVID-19 exposure for customers and employees.
The Olympia and Lacey transit centers will close to the public while regular bus service is paused, according to an IT press release. Dial-A-Lift, a door-to-door service for people with disabilities, will still be available for essential trips.
“We are absolutely committed to serving our customers and our community throughout this crisis,” said General Manager Ann Freeman-Manzanares in a prepared statement. “To do that in our current environment, we have to make adjustments to ensure the health and safety of our riders and our employees.”
Essential trips, according to the press release, include trips to grocery stores, pharmacies, and medical appointments, along with transportation for essential employees who work for essential businesses.
Representatives will be vetting trips to ensure they’re essential, according to IT.
When The Olympian asked via email whether trips would be considered essential for people experiencing homelessness who rely on public transit to get to the shelter where they stay or to support services, an IT spokesperson replied that the agency is coordinating with local social service providers.
“Intercity Transit is working closely with local social service providers to ensure the populations they serve — including, but not limited to, individuals with limited income, homeless populations, people with disabilities, the senior community — will be able to coordinate with us for essential trips under this new service delivery model with case-by-case flexibility,” spokesperson Nicky Upson wrote in an email.
Service providers can contact IT on a client’s behalf, Upson said.
Riders can make reservations two to five days in advance — not the day-of, according to the agency — and trips will run between 7 a.m. and 9:30 p.m.
The agency will use its many types of vehicles to complete the trips, it says, which will be detailed and disinfected each night. It plans to “re-evaluate whether fixed route service will be restored and to what level” when the end date for the governor’s order draws nearer. Last week, the governor extended his order to May 4.
HOW TO RESERVE A RIDE
Reservations can be made two to five days ahead of a trip by:
Calling IT’s customer service line at 360-786-1881 between 8 a.m. and 5 p.m. Monday through Friday or 9 a.m. and 4 p.m. on weekends; or
emailing DALdispatch@intercitytransit.com.
IT uses an interpreter service for customers with limited English proficiency, which allows it the ability to serve customers in over 200 languages, according to spokesperson Upson.
The agency asks people requesting rides to be ready to provide their names, phone numbers, addresses of origin and destination, and the time they would like a ride.
Riders can start making reservations Wednesday for the service, which starts Monday.
Outfitted with a face mask, an Intercity Transit driver answers a question at the Olympia Transit Center Tuesday. IT will begin requiring passenger reservations on Monday, April 13. STEVE BLOOM SBLOOM@THEOLYMPIAN.COM
The Olympia Transit Center is largely vacant Tuesday as ridership is limited to essential travel. On Monday, April 13, Intercity Transit will go one step further and begin requiring passenger reservations. STEVE BLOOM SBLOOM@THEOLYMPIAN.COM
Medical providers must not engage in “ruthless utilitarianism” in deciding who gets lifesaving treatment for the coronavirus, a federal civil rights officer warned.
“Our civil rights laws protect the equal dignity of every human life from ruthless utilitarianism,” said Roger Severino, the director of the Office for Civil Rights at the U.S. Department of Health and Human Services, in a news release on Saturday.
by Sheri Fink
Dr. Sheri Fink is a correspondent at The New York Times, where her and her colleagues’ articles on the West Africa Ebola crisis were recognized with the 2015 Pulitzer Prize for international reporting, the George Polk Award for health reporting and the Overseas Press Club Hal Boyle Award. Her article “The Deadly Choices at Memorial,” co-published by The New York Times Magazine and ProPublica, received a 2010 Pulitzer Prize for investigative reporting and a National Magazine Award for reporting. Dr. Fink is the author of the New York Times best-selling book “Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital” (Crown, 2013), about choices made in the aftermath of Hurricane Katrina. A former relief worker in disaster and conflict zones, she received her M.D. and Ph.D. from Stanford University. Her first book, “War Hospital: A True Story of Surgery and Survival” (PublicAffairs), is about medical professionals under siege during the genocide in Srebrenica, Bosnia-Herzegovina. “Five Days at Memorial” was the winner of the National Book Critics Circle Award for nonfiction, the PEN/John Kenneth Galbraith Award for nonfiction and the J. Anthony Lukas Book Prize, among others. Her website is www.sherifink.net. She loves to hear from readers and people with story ideas. Please get in touch! March 28, 2020 — The director of the federal health department’s civil rights office said on Saturday that his office was opening a series of civil rights investigations to ensure that states did not allow medical providers to discriminate on the basis of disabilities, race, age or certain other factors when deciding who would receive lifesaving medical care during the coronavirus emergency.
The office released a new bulletin on civil rights during the coronavirus crisis, days after disability rights advocates filed complaints arguing that protocols to ration lifesaving medical care adopted by Alabama and Washington State were discriminatory.
“Our civil rights laws protect the equal dignity of every human life from ruthless utilitarianism,” Roger Severino, the office’s director, said in a news release. “Persons with disabilities, with limited English skills and older persons should not be put at the end of the line for health care during emergencies.”
Mr. Severino said in an interview that in response to multiple complaints, his office was opening the investigations to ensure that state-mandated rationing plans “are fully compliant with civil rights law.” He said his office had heard from “a broad spectrum of civil rights groups, pro-life groups, disability rights groups, from prominent members of Congress from both sides of the aisle, from ordinary people who are concerned about their civil rights in this time of crisis.”
The bulletin “represents an important first step in protecting the rights of people with disabilities in the current crisis,” said Ari Ne’eman, a visiting scholar at the Lurie Institute for Disability Policy at Brandeis University and a senior research associate at the Harvard Law School Project on Disability. He said there was an “urgent need for comprehensive guidance.”
Many states and hospitals are developing plans for how to ration care if the number of critically ill coronavirus patients exceeds capacity. Patients who develop severe respiratory distress from coronavirus infection often require support from mechanical ventilators for days to weeks; the machines are expected to be in short supply in the United States. In Italy, doctors have had to make wrenching choices about who gets them and who does not. While attempts are made to increase production of new ventilators and to expand hospital capacity, these plans lay out who will get care if those efforts are not able to meet the need.
Many of the plans would prioritize patients who were most likely to survive their immediate illness, and who also had a better chance of long-term survival when taking other factors into consideration. Some assign patients a score based on calculations of their level of illness, with decisions between patients who have the same score made by random selection.
Some plans instruct hospitals not to offer mechanical ventilators to people above a certain age or with particular health conditions.
In Alabama’s plan, people with “severe or profound mental retardation” as well as “moderate to severe dementia” should be considered “unlikely candidates for ventilator support” during a period of rationing. Washington’s guidance recommends that triage teams consider transferring hospital patients with “loss of reserves in energy, physical ability, cognition and general health” to outpatient or palliative care.
Dr. Kathy Lofy, the health officer of Washington State, said in an email, “We are very concerned that people believe our scarce resource guidance might discriminate against people with disabilities so we are in the process of setting up time to meet with disability advocacy groups to discuss their concerns.”
“The guidance in Washington around managing scarce resources during emergencies was largely designed to avoid discrimination during the allocation of scarce resource and involves a regional team to ensure resources are being allocated in a fair way,” Dr. Lofy said.
An emailed statement from the Alabama health department said that the state’s ventilator triage guidelines had been “greatly misunderstood” and were “solely intended as a tool for providers” making difficult choices. The statement said the document, which remained on its website on Saturday, was over a decade old and had since been replaced by a more comprehensive set of guidelines for health care emergencies. Those newer guidelines did not address ventilator triage, but said that the allocation of care should not be discriminatory.
Dr. Doug White, who published a proposed framework for rationing critical care in the Journal of the American Medical Association on Friday, said in a webinar that it was important to have “triage guidelines that don’t exclude groups of patients.” He said a score-based approach, endorsed by Pennsylvania, would allow as many patients to be treated as possible, so that “if suddenly 1,000 new ventilators become available, nobody’s sitting without a ventilator.”
Still, some citizen groups who have looked at draft protocols expressed fears that even using predicted survival to determine who would get access to resources — the most common strategy — might be inherently discriminatory.
In a report of a community exercise held in Seattle, some participants said they were concerned that using the likelihood of survival as a rationing criterion was problematic because some groups, such as African-Americans and immigrants, might have poorer health as a result of “institutional racism in the health care system.”
The plans typically include protocols for removing ventilators from people after a certain time period if they do not appear to be improving. In some states, including New York, people who required ventilators long-term, such as those who have certain spinal cord injuries, could be subject to having their ventilators reassigned under the protocol if they were admitted to hospitals during the crisis.
Many of the plans, even if they do not include outright age restrictions, consider stage of life as a factor in assigning ventilators or critical care beds. The civil rights office’s new statement might put that into question.
Mr. Severino said that his office was not telling states how to allocate care, but that the bulletin “puts entities on notice that they need to start considering the civil rights implications of any crisis standards of care plans they may be putting into effect if it were to come to that.”
“It has to be part of the discussion,” he continued.
If the country reached a point where health care rationing standards would be applied, Mr. Severino said, “those standards must comply with civil rights laws.”
“Ultimately the question as to resource allocation is not a scientific or medical one,” he added. “It is ultimately a moral and legal one.”
The bulletin had an important new legal provision. It said that a March 17 declaration by the Secretary of Health and Human Services that provided immunity from legal liability to those developing or using “medical countermeasures” to fight the disease might also provide some immunity from civil rights claims.
Mr. Ne’eman said that finding was “deeply concerning,” adding that “enforcement of our civil rights laws should never be called into question, even in the context of an emergency.”
Mr. Severino said he was “unaware” of any time in which the federal health authorities had placed any limitations on civil rights laws during an emergency. He referred questions about the provision to the Office of the General Counsel, which did not immediately respond to a request to comment on it.
“I want to make sure in this time of crisis, we don’t forget the foundational principles that are part of what makes America so special,” Mr. Severino said. “That we do care for everybody, that every person in America deserves equal dignity and respect.”
He added, “Our response will be a reflection of our national character.”
Deadly protocols lay ahead targeting US seniors already COVID-19 selected by design (w/males in all age ranges suffering double the death rate of females) in a nation with limited (for profit) hospital capacity and macabre epidemiological projections.
Despite all the cheap rhetoric of protecting the most vulnerable, seniors and those with pre-existing medical conditions (who really are the MOST vulnerable) are actually being targeted for the dung heap under the euphemism of ‘triage’ by medical death squads in all but name only. As bad as all that is, it’s consistent with what has already been going on in most nursing homes for decades. Residents are visibly obsequious and fawning toward medical staff because they fully realize the difference between life & death can be as slight as how fast a nurse/CNA responds to the bedside help button. The contemporary COVID-19 triage protocols are even worse. If you’re over 65. and become infected with the virus, without an ICU slot, it’s a 95% likelihood YOU DIE! You’re deemed to be past your pull date…even if you’ve never missed a health insurance premium payment. You might as well hitch a ride on the nearest ice floe.
Imagine (not much of a stretch under current circumstances) the police or fire dept. refused to respond to your emergency because you were over 65 and they were out of water…had been low on water FOR YEARS! How would you feel if the perp who murdered your spouse was only sentenced to a few months because the victim was over 65? What if the library wouldn’t reserve books for you because your remaining years were discounted? Should seniors be permitted to vote or their ballots devalued proportionate to their actuarial life expectancy? Like infants, should seniors have fewer civil/human rights than their contemporaries? If so, where is the breakdown of their social contract’s demise codified? This all smacks of the ‘ethics’ of Nazi death camp procedures where the youngest, eldest and infirm were sent to the ovens first. Our hospitals have begun to resemble Nazi inspired abattoirs. The thought provokes dread rather than hope, their saintly nomenclatures now feel like obscenities.
In the Chinese city of Wuhan, the epicenter of the coronavirus pandemic, doctors made life-or-death decisions last month when 1,000 people needed ventilators to support their breathing, but only 600 were available.
In Iran, where numerous high-level officials have been infected, doctors sought unsuccessfully to get the international community to lift sanctions so they could purchase more of the lifesaving machines.
And in northern Italy, doctors last week took the painful step of issuing guidelines for rationing ventilators and other essential medical equipment, prioritizing the young and others with the best chance of survival.
Such tough choices couldd be ahead for the United States, a nation with limited hospital capacity and grim epidemiological projections estimating that as many as 40 per cent to 60 per cent of the country’s population of 327 million could eventually become infected.
“We are looking at a new war no one as seen before. We have never fought a virus like this with this potential consequence,” New York Gov. Andrew Cuomo said Sunday afternoon. He warned, “It is only a matter of time before ICU beds are full.”
The situation in the U.S. is more complicated than in many other nations due to this country’s diversity, deep political and economic divisions and decentralized decision-making. The Centers for Disease Control and Prevention has laid out general principles for how to allocate scarce resources in a pandemic response plan, but leaves most of the details to individual states and institutions. The result is a patchwork of approaches – with some states proposing broad ethical principles to determine need, and others assigning priority scores using detailed algorithms for patients based on their condition, preexisting health problems and age.
COVID-19 Robotic Sterilizer
In an extreme outbreak, rationing would raise tortured questions: Should someone with a terminal cancer or serious heart disease get more or less priority? Should the CEO of a hospital or a health worker be able to jump the queue? What about pregnant women? How should prisoners or undocumented immigrants be considered? All things being equal, would a lottery or coin flip be an equitable approach?
“These are really hard decisions,” said George Anesi, a critical-care specialist at the University of Pennsylvania. “In a public health emergency, you shift from a focus on individual patients to how society as a whole benefits and that’s a big change from usual care.”
For now, the number of U.S. cases is limited – 3,020 cases of confirmed coronavirus infections and 60 deaths as of Sunday – and hospitals still have capacity to handle more sick if the virus’s spread is slowed using strategies such as social distancing. But the situation is evolving quickly and experts say it’s impossible to predict how many people might become seriously ill and whether they could overwhelm the system’s capacity, as happened in parts of Italy, Iran and China.
Many of the state plans were written following the global devastation of the SARS outbreak in 2002 and Hurricane Katrina in 2005. Some are still in draft form, and none has never been activated in a real crisis. State health officials and hospital leaders say they have been urgently updating them in recent days to address the unique aspects of the pandemic.
Arthur Caplan, a bioethicist at NYU Langone Medical Center who has served on numerous national and international panels addressing resource allocation during Zika, Ebola, and avian flu outbreaks, said no single approach is more “right” than others. But he said that transparency is critical as the crisis develops.
“The public will accept triage and rationing if they understand the process,” Caplan said. “But if it’s secretive or looks like favoritism to politicians or the rich, they will not accept that – whatever the rules are.” [Oh, really? NOT here–NOT if you’re excluding me and my spouse and my neighbors and classmates–NOT by a long shot!] Seniors have no less right to life than any human!
While much about covid-19, the disease caused by the novel coronavirus, is still a mystery – its origin, how exactly it spreads – one thing doctors are sure about is how it kills. It attacks the lungs, leading to respiratory distress. And in these situations, access to oxygen therapy with a mask or nasal cannula for milder cases, or to mechanical ventilation for more severe illnesses can give a patient’s body time to fight the virus and mean the difference between life and death.
The earliest reports from China estimated that about 6% of patients needed ventilator support. But those numbers were misleading, experts says, because so many people never made it to hospitals, or were simply unable to gain access to ventilators. About 25% of those who died had been placed on ventilators.
Newer information from Italy in a March 4 email from University of Milan physicians Maurizio Cecconi, Antonio Pesenti, and Giacomo Grasselli to other critical care doctors around the world showed a much higher number – 10% – requiring mechanical ventilation.
“This happens like a bomb that explodes,” Grasselli said in an interview. “It happens all of a sudden and keeps growing and growing.”
Grasselli said that in his region there were barely enough ventilators and beds to go around but that many patients required 15 days to three weeks of ventilator support. “Clearly when resources are not enough for the number of patients, you have to prioritize patients who have the highest chance of survival,” he said.
The Italian critical-care society sanctioned the idea of placing age limits on access to intensive treatments, and said doctors should “privilege greater life expectancy.”
Angelo Pan, head of infectious disease at Italy’s Cremona hospital, said the high number of patients needing ventilators – about 25% of the 170 people with coronavirus at his hospital in early March – was straining resources.
“I don’t want to be too pessimistic,” Pan said, “but I think this is going to be a problem for all the health care systems.”
By many accounts, the United States is ill-prepared for a such a situation.
A 2005 federal government report estimated that in the event of a pandemic like the 1918 flu, the nation would need mechanical ventilators for 740,000 patients. Currently 160,000 ventilators are available for patient care, with at least an another 8,900 in the national stockpile, according to a February estimate by the Center for Health Security at Johns Hopkins.
Hospital officials and doctors interviewed in several states emphasized that rationing is a last resort and that they have begun to experiment with other ways to increase capacity.
Initially, they said, patients would likely be transferred from more crowded, urban facilities such as Johns Hopkins in Baltimore and the University of Pennsylvania Health System in Philadelphia, which routinely operate at 80% to 90% capacity, to community or rural hospitals that may have more intensive-care beds.
If the number of victims surges beyond that capacity, they say, they may try novel approaches such as having two patients on one ventilator. Tubing for ventilators, which is usually thrown out, could be sanitized and reused. Other types of hospital equipment, such as those used for sleep apnea, could be repurposed as makeshift ventilators. Only if those strategies fail and the sick continue to exceed capacity would rationing protocols be put into place.
– – –
In normal times, U.S. hospitals operate mostly on a principle of first come, first served – “like getting concert tickets” as one clinician put it. In a mass casualty situation, this all goes out the door.
Americans generally agree that in a crisis, the goal should be doing the greatest good. But that concept has shifted depending on the era, setting and culture. During World War II, the greatest good might have been getting soldiers back out to the front lines. When the Titanic hit an iceberg, it was all about saving the women and children, while the men were left to die on the sinking vessel.
U.S. ethicists have historically talked about saving the most lives as doing the greatest good. But with greater recognition these days of factors such as quality of life and burdens on the health-care system, the discussion has shifted from maximizing lives saved to maximizing life years. Saving one child may outweigh the “good” of saving two elderly adults, according to the cold arithmetic of life expectancy.
If a patient is not getting better, has little path to survival, at what point are we willing to move an intervention rather than lose two lives?
Lee Daugherty Biddison, an associate professor of pulmonary and critical care at Johns Hopkins Medicine, said the idea is to give priority to those “most likely to live a long life after they got though the current epidemic”: “The thinking is, ‘Am I going to survive the flu to die of advanced cancer in three months?’ ”
Deciding between lives saved and life years is among the most tortured decisions that doctors will ever make, Anesi said. “Different value steps could push people to different decisions,” he said. Another tough call would be to take a ventilator away from one patient and move it to another, who may benefit more.
“If a patient is not getting better, has little path to survival, at what point are we willing to move an intervention rather than lose two lives?” he said.
Such questions are addressed in many state pandemic strategies, including New York state’s highly regarded 52-page planning document – which notes that the U.S. Department of Homeland Security “views pandemic influenza as both the most likely and most lethal of all threats facing the United States.”
Philip Rosoff, professor emeritus of at Duke University’s medical school and chair of its hospital ethics committee from 2005 to 2019, compared the New York strategy to a battlefield triage plan – except that in the latter there is a finite beginning and a reasonably finite end. But in the case of covid-19, he said, “no one really knows if and when this really ramps up.”
The plan’s basic outlines are simple and “fairly draconian,” Rosoff explained. “If you are in respiratory failure and there is a ventilator available and an ICU bed, and you meet certain medical criteria, you go on the ventilator. You have a certain amount of time to get better. If you don’t, we’ll take you off and give it to someone else.”
“If you take it off someone who is not doing very well,” he added, “the reality is they die.”
To avoid conflicts of interest and the emotional toll of life-or-death judgments, many state plans call for a senior, supervisory doctor or panel of doctors – similar to a “three wise men” protocol developed in Britain for this scenario – who is different from the one caring for the patient.
But state and hospital plans often vary widely in how they deal with issues such as a patient’s age.
Some states do not set specific age cutoffs for ventilators during rationing, while others explicitly exclude access for older people, with access barred to those ranging in age from 65 to 85. A Minnesota panel, for instance, recommended prioritizing children over adults, and young adults over older adults, while the New York group did not use age as a criteria alone.
Most plans include a list of serious conditions that would exclude someone from getting a ventilator if rationing were in effect, and many conditions are more common in the elderly, such as severe cardiac issues, kidney failure, and metastatic cancer.
In Maryland, avoiding discrimination is a major concern for those who drafted the guidelines, Daugherty Biddison said. She explained that disasters – epidemics, wars and attacks – tend to exacerbate society’s inequalities and in discussions about how to ration resources, there’s been tension among politicians, the public and ethicists about how to protect vulnerable groups.
A person with advanced diabetes is likely to have a shorter life span than someone with well-controlled diabetes. However that may be because the second person has greater access to medical care.
“So if you were to say, ‘Look, you are unwell because of diabetes and you’re also not going to get a ventilator,’ you are double penalizing someone who didn’t have access to care,” Daugherty Biddison said.
So while New York’s guidelines exclude people with renal failure from getting ventilator support in an emergency, Maryland’s guidelines include them in the pool of people who would be eligible.
There’s also variation in whether health-care personnel get priority. New York’s working group felt strongly that health care workers should not be prioritized because the group is so large that it would result in denying access to everyone else, including children.
– – –
The most painful cases, providers acknowledge, are situations in which a patient will be taken off a ventilator or will not get one.
Rosoff from Duke believes that part of planning for a larger coronavirus outbreak in the United States should involve ensuring comfort to dying people who will go without the benefit of advanced intensive care. Such situations could be especially agonizing as family members may be absent due to the risk of contagion.
“We have very effective means of making that a comfortable, peaceful death,” he said, citing things such as supplemental oxygen, morphine, chaplains and people trained to talk to those nearing death.
Daugherty Biddison said transparency about how care may be rationed in a pandemic situation may change how doctors talk with their patients about end-of-life decisions.
“I don’t think there will be a scenario where someone will say, ‘Do you want a ventilator or should I give it to a 6-year-old?’ That’s not going to happen,” she said. “But I do think if you’re in this situation, at least people can contextualize their stress on the system and can make a decision accordingly.”
– – –
The Washington Post’s Loveday Morris in Lodi, Italy, Tiffany Leung in Hong Kong and Magda Jean-Louis contributed to this report.
Washington (3-25-20) — It’s time for some uncomfortable truths and frank warnings/talk about seniors, survival, the human condition, and the God complex infecting some public officials as surely as COVID-19 itself. This panic run amok has begun to appear in bizarre pernicious public euphemisms (“triage”) reminiscent of the 3rd Reich’s ‘Final Solution’.
Make no mistake about it, they’re talking about US–at least if you’re older than 65. Lord Of The Flies has assumed the mantle of government and intends to herd seniors into the abattoir with the medical establishment’s blessing. Like geriatric layers, we’re considered past our pull dates. It’s a scene straight out of Logan’s Run coming very soon to a hospital near you. It may not be Soylent Green exactly, but the dead fail to notice such fine distinctions, Moreover, it reveals a deep crevasse and moral hazard in the national character of America which, historically, has always shown its most ugly profile in a crisis. We’re now being told there isn’t room or resources enough for American seniors. Like the Inuit of old, the seniors will have to go onto the nearest ice floe.
An NPR reporter was interviewing a professor of medicine at Johns Hopkins. The question arose of what strategy would be deployed to combat the COVID-19 pandemic given our long anticipated catastrophic failure to have sufficient ICU beds, ventilators, gloves, masks, or adequate protocols in place to meet such a national emergency. “Triage,” she opined. “Seniors over 65yo will be denied ICU bed space without which they had a 95% chance of dying at such a critical stage. Even with ICU ventilator therapy, the odds were no better than 50% survival and a residual 30% permanent reduction in lung capacity.”
“But who will inform the elderly patients of this fate?–their attending physician?” the reporter asked incredulously.
“No. That will be assigned to a special team of triage experts who will evaluate the patient’s number of life years, stages of life lived, and value regardless of the contractual obligations the medical establishment/hospital/health care provider might legally owe the patient,” she predicted.
“Will doctors/health care workers be given extra consideration as critical occupations?” the journalist asked.
“Perhaps not,” she said. “After all, their full recovery may take longer than the curve of the crisis itself–thus their utility might well be considered limited under those circumstances.”
It was a disturbing exchange to hear. But let’s get a realistic perspective on this megalomaniacal proposal and be perfectly blunt: EITHER WE ARE ALL IN THIS TOGETHER, OR WE ARE NOT!
It is one thing to propose an unavoidable lottery such as we had for the draft during Nixon’s administration. It is entirely another to deliberately choose which group/race/gender/creed will live or die like some Nazi death camp guard for new arrivals sent to the ovens. Moreover, we’re constantly instructed to be honorable–to behave in a way that protects others as much as ourselves as part of our social duty in the face of a common enemy.
Well, selective abandonment and death squads in all but name only IS A CARDINAL VIOLATION OF THAT SOCIAL CONTRACT. If seniors are not going to be provided protection from the problem, then you’ve eliminated much of the incentive for them to be part of the solution. This planned ‘final solution’ won’t do for a designer virus apparently already engineered to target the elderly or immune-compromised AND MALES (at double the rate of females) IN EVERY AGE RANGE. What a coincidence! And now our social engineering Nazi mimics want to amplify said targeting by targeting seniors in the throes of our current crisis?
Most seniors/pensioners have worked their entire lives for the guarantee of a stipend and reasonable health care in their final years. It’s called a CONTRACT–A binding contract. It’s a violation of the most fundamental rights to change the rules after the dye is cast. Seniors cannot start over. Reneging on the deal they bargained and worked for is beyond deplorable. It is unconscionable. It is theft and virtual manslaughter.
Under such dystopian totalitarianism and lethal agism, seniors just might decide to abandon their gloves and face masks in pulic–Devil take the hindmost. Those face masks tend to protect others more than the wearer in any event. Seniors can always wait until they get home to wash their hands while avoiding touching their face. In the meantime, they can slime freely on every available public surface. Public officials are already announcing their lives are worthless in this viral crisis. If that’s the case, this is truly the beginning of the end and society will suffer a self induced lobotomy in the bargain.
Choose carefully before sacrificing seniors. The blowback may involve unintended consequences of Biblical proportions beyond your imagination. Oppression (and death) breed resistance. And seniors are not alone. Many have families who love them that will pursue the executioners/death squads. i.e. Honor thy mother and thy father.
Madrid (3-24-20)–The Spanish military has found older residents of some care homes “completely abandoned” and even “dead in their beds,” Defense Minister Margarita Roblessaid in a television interview on Monday.
They were found as soldiers disinfected and provided emergency health care services this week to residential homes across the country. Robles did not give an exact figure for the number of dead bodies found by Spanish soldiers.
With more than 39,000 confirmed cases of COVID-19 and 2,800 deaths as of Tuesday, Spain is the second hardest-hit country in Europe.
On Tuesday, 514 new deaths were registered in a 24-hour period, the worst increase since the outbreak began. Retirement homes have been particularly affected.
Last week, one privately owned home in Madrid reported 20 deaths and 75 infections, claiming it didn’t have adequate material to take care of the sick residents and dead bodies.
While the usual protocol in Spanish nursing homes is to put the body of a deceased person in cold storage until a funeral service picks it up, bodies are now being left in beds until properly equipped staff can remove them.
Speaking in a television interview, Robles said staff in some centers had left the nursing homes after cases of COVID-19 were detected. Residents were abandoned to take care of themselves, even though some were sick and in serious condition.
The defense minister said the government will take action against those responsible. “We will be completely relentless and forceful with the kind of treatment elderly residents receive in these centers,” Robles said. “I know that a vast majority [of centers] are fulfilling their obligations.”
Meanwhile, Spanish prosecutors have launched an investigation into the incidents. In Spain, around 19% of the population is older than 65; the country has one of the longest life expectancies in the world.
Health Minister Salvador Illa said residential care homes are “a high priority during this time” for the Spanish government, and it will exert “maximum control” over these centers.
Prime Minister Pedro Sánchez has called for the nationalization of all privately owned nursing homes, just as he had previously called for the nationalization of private hospitals, to help ensure better access as well as adequate staff and equipment. Over the weekend, Spain’s Defense Ministry made thousands of phone calls to seniors living alone or in vulnerable situations to assess their health.
by Tomas Pueyo (3-19-20)
2 MSc in Engineering. Stanford MBA. Ex-Consultant. Creator of viral applications with >20M users. Currently leading a billion-dollar business @ Course Hero
What the Next 18 Months Can Look Like, if Leaders Buy Us TimeThis article follows Coronavirus: Why You Must Act Now, with over 40 million views and 30 translations. If you agree with this article, consider signing the corresponding White House petition. Translations available in 27 languages at the bottom. Running list of endorsements here. 5 million views so far.Summary of the article: Strong coronavirus measures today should only last a few weeks, there shouldn’t be a big peak of infections afterwards, and it can all be done for a reasonable cost to society, saving millions of lives along the way. If we don’t take these measures, tens of millions will be infected, many will die, along with anybody else that requires intensive care, because the healthcare system will have collapsed.
Within a week, countries around the world have gone from: “This coronavirus thing is not a big deal” to declaring the state of emergency. Yet many countries are still not doing much. Why?
Every country is asking the same question: How should we respond? The answer is not obvious to them.
Some countries, like France, Spain or Philippines, have since ordered heavy lockdowns. Others, like the US, UK, or Switzerland, have dragged their feet, hesitantly venturing into social distancing measures.
Here’s what we’re going to cover today, again with lots of charts, data and models with plenty of sources:
What’s the current situation?
What options do we have?
What’s the one thing that matters now: Time
What does a good coronavirus strategy look like?
How should we think about the economic and social impacts?
When you’re done reading the article, this is what you’ll take away:
Our healthcare system is already collapsing. Countries have two options: either they fight it hard now, or they will suffer a massive epidemic. If they choose the epidemic, hundreds of thousands will die. In some countries, millions. And that might not even eliminate further waves of infections. If we fight hard now, we will curb the deaths. We will relieve our healthcare system. We will prepare better. We will learn. The world has never learned as fast about anything, ever. And we need it, because we know so little about this virus. All of this will achieve something critical: Buy Us Time.
If we choose to fight hard, the fight will be sudden, then gradual. We will be locked in for weeks, not months. Then, we will get more and more freedoms back. It might not be back to normal immediately. But it will be close, and eventually back to normal. And we can do all that while considering the rest of the economy too.
Ok, let’s do this.
1. What’s the situation?
Last week, this curve was published:
It showed coronavirus cases across the world outside of China. We could only discern Italy, Iran and South Korea. So I had to zoom in on the bottom right corner to see the emerging countries. My entire point is that they would soon be joining these 3 cases.
Let’s see what has happened since.
As predicted, the number of cases has exploded in dozens of countries. Here, I was forced to show only countries with over 1,000 cases. A few things to note:
Spain, Germany, France and the US all have more cases than Italy when it ordered the lockdown
An additional 16 countries have more cases today than Hubei when it went under lockdown: Japan, Malaysia, Canada, Portugal, Australia, Czechia, Brazil and Qatar have more than Hubei but below 1,000 cases. Switzerland, Sweden, Norway, Austria, Belgium, Netherlands and Denmark all have above 1,000 cases.
Do you notice something weird about this list of countries? Outside of China and Iran, which have suffered massive, undeniable outbreaks, and Brazil and Malaysia, every single country in this list is among the wealthiest in the world.
Do you think this virus targets rich countries? Or is it more likely that rich countries are better able to identify the virus?
It’s unlikely that poorer countries aren’t touched. Warm and humid weather probablyhelps, but doesn’t prevent an outbreak by itself — otherwise Singapore, Malaysia or Brazil wouldn’t be suffering outbreaks.
The most likely interpretations are that the coronavirus either took longer to reach these countries because they’re less connected, or it’s already there but these countries haven’t been able to invest enough on testing to know.
Either way, if this is true, it means that most countries won’t escape the coronavirus. It’s a matter of time before they see outbreaks and need to take measures.
What measures can different countries take?
2. What Are Our Options?
Since the article last week, the conversation has changed and many countries have taken measures. Here are some of the most illustrative examples:
Measures in Spain and France
In one extreme, we have Spain and France. This is the timeline of measures for Spain:
On Thursday, 3/12, the President dismissed suggestions that the Spanish authorities had been underestimating the health threat. On Friday, they declared the State of Emergency. On Saturday, measures were taken:
People can’t leave home except for key reasons: groceries, work, pharmacy, hospital, bank or insurance company (extreme justification)
Specific ban on taking kids out for a walk or seeing friends or family (except to take care of people who need help, but with hygiene and physical distance measures)
All bars and restaurants closed. Only take-home acceptable.
All entertainment closed: sports, movies, museums, municipal celebrations…
Weddings can’t have guests. Funerals can’t have more than a handful of people.
Mass transit remains open
On Monday, land borders were shut.
Some people see this as a great list of measures. Others put their hands up in the air and cry of despair. This difference is what this article will try to reconcile.
France’s timeline of measures is similar, except they took more time to apply them, and they are more aggressive now. For example, rent, taxes and utilities are suspended for small businesses.
Measures in the US and UK
The US and UK, like countries such as Switzerland, have dragged their feet in implementing measures. Here’s the timeline for the US:
Wednesday 3/11: travel ban.
Friday: National Emergency declared. No social distancing measures
Monday: the government urges the public to avoid restaurants or bars and attend events with more than 10 people. No social distancing measure is actually enforceable. It’s just a suggestion.
Lots of states and cities are taking the initiative and mandating much stricter measures.
The UK has seen a similar set of measures: lots of recommendations, but very few mandates.
These two groups of countries illustrate the two extreme approaches to fight the coronavirus: mitigation and suppression. Let’s understand what they mean.
Option 1: Do Nothing
Before we do that, let’s see what doing nothing would entail for a country like the US:
This fantastic epidemic calculator can help you understand what will happen under different scenarios. Below the graph, I’ve pasted the key factors that determine the behavior of the virus. Note that infected, in pink, peak in the tens of millions at a certain date. Most variables have been kept from the default. The only material changes are R from 2.2 to 2.4 (corresponds better to currently available information. See at the bottom of the epidemic calculator), fatality rate (4% due to healthcare system collapse. See details below or in the previous article), length of hospital stay (down from 20 to 10 days) and hospitalization rate (down from 20% to 14% based on severe and critical cases. Note the WHO calls out a 20% rate) based on our most recently available gathering of research. Note that these numbers don’t change results much. The only change that matters is the fatality rate.
If we do nothing: Everybody gets infected, the healthcare system gets overwhelmed, the mortality explodes, and ~10 million people die (blue bars). For the back-of-the-envelope numbers: if ~75% of Americans get infected and 4% die, that’s 10 million deaths, or around 25 times the number of US deaths in World War II.
You might wonder: “That sounds like a lot. I’ve heard much less than that!”
So what’s the catch? With all these numbers, it’s easy to get confused. But there’s only two numbers that matter: What share of people will catch the virus and fall sick, and what share of them will die. If only 25% are sick (because the others have the virus but don’t have symptoms so aren’t counted as cases), and the fatality rate is 0.6% instead of 4%, you end up with 500k deaths in the US.
If we don’t do anything, the number of deaths from the coronavirus will probably land between these two numbers. The chasm between these extremes is mostly driven by the fatality rate, so understanding it better is crucial. What really causes the coronavirus deaths?
How Should We Think about the Fatality Rate?
This is the same graph as before, but now looking at hospitalized people instead of infected and dead:
The light blue area is the number of people who would need to go to the hospital, and the darker blue represents those who need to go to the intensive care unit (ICU). You can see that number would peak at above 3 million.
Now compare that to the number of ICU beds we have in the US (50k today, we could double that repurposing other space). That’s the red dotted line.
No, that’s not an error.
That red dotted line is the capacity we have of ICU beds. Everyone above that line would be in critical condition but wouldn’t be able to access the care they need, and would likely die.
Instead of ICU beds you can also look at ventilators, but the result is broadly the same, since there are fewer than 100k ventilators in the US.
This is why people died in droves in Hubei and are now dying in droves in Italy and Iran. The Hubei fatality rate ended up better than it could have been because they built 2 hospitals nearly overnight. Italy and Iran can’t do the same; few, if any, other countries can. We’ll see what ends up happening there.
So why is the fatality rate close to 4%?
If 5% of your cases require intensive care and you can’t provide it, most of those people die. As simple as that.
Additionally, recent data suggests that US cases are more severe than in China.
I wish that was all, but it isn’t.
Collateral Damage
These numbers only show people dying from coronavirus. But what happens if all your healthcare system is collapsed by coronavirus patients? Others also die from other ailments.
What happens if you have a heart attack but the ambulance takes 50 minutes to come instead of 8 (too many coronavirus cases) and once you arrive, there’s no ICU and no doctor available? You die.
There are 4 million admissions to the ICU in the US every year, and 500k (~13%) of them die. Without ICU beds, that share would likely go much closer to 80%. Even if only 50% died, in a year-long epidemic you go from 500k deaths a year to 2M, so you’re adding 1.5M deaths, just with collateral damage.
If the coronavirus is left to spread, the US healthcare system will collapse, and the deaths will be in the millions, maybe more than 10 million.
The same thinking is true for most countries. The number of ICU beds and ventilators and healthcare workers are usually similar to the US or lower in most countries. Unbridled coronavirus means healthcare system collapse, and that means mass death.
Unbridled coronavirus means healthcare systems collapse, and that means mass death.
By now, I hope it’s pretty clear we should act. The two options that we have are mitigation and suppression. Both of them propose to “flatten the curve”, but they go about it very differently.
Option 2: Mitigation Strategy
Mitigation goes like this: “It’s impossible to prevent the coronavirus now, so let’s just have it run its course, while trying to reduce the peak of infections. Let’s just flatten the curve a little bit to make it more manageable for the healthcare system.”
This chart appears in a very important paper published over the weekend from the Imperial College London. Apparently, it pushed the UK and US governments to change course.
It’s a very similar graph as the previous one. Not the same, but conceptually equivalent. Here, the “Do Nothing” situation is the black curve. Each one of the other curves are what would happen if we implemented tougher and tougher social distancing measures. The blue one shows the toughest social distancing measures: isolating infected people, quarantining people who might be infected, and secluding old people. This blue line is broadly the current UK coronavirus strategy, although for now they’re just suggesting it, not mandating it.
Here, again, the red line is the capacity for ICUs, this time in the UK. Again, that line is very close to the bottom. All that area of the curve on top of that red line represents coronavirus patients who would mostly die because of the lack of ICU resources.
Not only that, but by flattening the curve, the ICUs will collapse for months, increasing collateral damage.
You should be shocked. When you hear: “We’re going to do some mitigation” what they’re really saying is: “We will knowingly overwhelm the healthcare system, driving the fatality rate up by a factor of 10x at least.”
You would imagine this is bad enough. But we’re not done yet. Because one of the key assumptions of this strategy is what’s called “Herd Immunity”.
Herd Immunity and Virus Mutation
The idea is that all the people who are infected and then recover are now immune to the virus. This is at the core of this strategy: “Look, I know it’s going to be hard for some time, but once we’re done and a few million people die, the rest of us will be immune to it, so this virus will stop spreading and we’ll say goodbye to the coronavirus. Better do it at once and be done with it, because our alternative is to do social distancing for up to a year and risk having this peak happen later anyways.”
Except this assumes one thing: the virus doesn’t change too much. If it doesn’t change much, then lots of people do get immunity, and at some point the epidemic dies down
How likely is this virus to mutate? It seems it already has.
This graph represents the different mutations of the virus. You can see that the initial strains started in purple in China and then spread. Each time you see a branching on the left graph, that is a mutation leading to a slightly different variant of the virus.
This should not be surprising: RNA-based viruses like the coronavirus or the flu tend to mutate around 100 times faster than DNA-based ones—although the coronavirus mutates more slowly than influenza viruses.
Not only that, but the best way for this virus to mutate is to have millions of opportunities to do so, which is exactly what a mitigation strategy would provide: hundreds of millions of people infected.
That’s why you have to get a flu shot every year. Because there are so many flu strains, with new ones always evolving, the flu shot can never protect against all strains.
Put in another way: the mitigation strategy not only assumes millions of deaths for a country like the US or the UK. It also gambles on the fact that the virus won’t mutate too much — which we know it does. And it will give it the opportunity to mutate. So once we’re done with a few million deaths, we could be ready for a few million more — every year. This corona virus could become a recurring fact of life, like the flu, but many times deadlier.
The best way for this virus to mutate is to have millions of opportunities to do so, which is exactly what a mitigation strategy would provide.
So if neither doing nothing and mitigation will work, what’s the alternative? It’s called suppression.
Option 3: Suppression Strategy
The Mitigation Strategy doesn’t try to contain the epidemic, just flatten the curve a bit. Meanwhile, the Suppression Strategy tries to apply heavy measures to quickly get the epidemic under control. Specifically:
Go hard right now. Order heavy social distancing. Get this thing under control.
Then, release the measures, so that people can gradually get back their freedoms and something approaching normal social and economic life can resume.
What does that look like?
All the model parameters are the same, except that there is an intervention around now to reduce the transmission rate to R=0.62, and because the healthcare system isn’t collapsed, the fatality rate goes down to 0.6%. I defined “around now” as having ~32,000 cases when implementing the measures (3x the official number as of today, 3/19). Note that this is not too sensitive to the R chosen. An R of 0.98 for example shows 15,000 deaths. Five times more than with an R of 0.62, but still tens of thousands of deaths and not millions. It’s also not too sensitive to the fatality rate: if it’s 0.7% instead of 0.6%, the death toll goes from 15,000 to 17,000. It’s the combination of a higher R, a higher fatality rate, and a delay in taking measures that explodes the number of fatalities. That’s why we need to take measures to reduce R today. For clarification, the famous R0 is R at the beginning (R at time 0). It’s the transmission rate when nobody is immune yet and there are no measures against it taken. R is the overall transmission rate.
Under a suppression strategy, after the first wave is done, the death toll is in the thousands, and not in the millions.
Why? Because not only do we cut the exponential growth of cases. We also cut the fatality rate since the healthcare system is not completely overwhelmed. Here, I used a fatality rate of 0.9%, around what we’re seeing in South Korea today, which has been most effective at following Suppression Strategy.
Said like this, it sounds like a no-brainer. Everybody should follow the Suppression Strategy.
So why do some governments hesitate?
They fear three things:
This first lockdown will last for months, which seems unacceptable for many people.
A months-long lockdown would destroy the economy.
It wouldn’t even solve the problem, because we would be just postponing the epidemic: later on, once we release the social distancing measures, people will still get infected in the millions and die.
Here is how the Imperial College team modeled suppressions. The green and yellow lines are different scenarios of Suppression. You can see that doesn’t look good: We still get huge peaks, so why bother?
We’ll get to these questions in a moment, but there’s something more important before.
This is completely missing the point.
Presented like these, the two options of Mitigation and Suppression, side by side, don’t look very appealing. Either a lot of people die soon and we don’t hurt the economy today, or we hurt the economy today, just to postpone the deaths.
This ignores the value of time.
3. The Value of Time
In our previous post, we explained the value of time in saving lives. Every day, every hour we waited to take measures, this exponential threat continued spreading. We saw how a single day could reduce the total cases by 40% and the death toll by even more.
But time is even more valuable than that.
We’re about to face the biggest wave of pressure on the healthcare system ever seen in history. We are completely unprepared, facing an enemy we don’t know. That is not a good position for war.
What if you were about to face your worst enemy, of which you knew very little, and you had two options: Either you run towards it, or you escape to buy yourself a bit of time to prepare. Which one would you choose?
This is what we need to do today. The world has awakened. Every single day we delay the coronavirus, we can get better prepared. The next sections detail what that time would buy us:
Lower the Number of Cases
With effective suppression, the number of true cases would plummet overnight, as we saw in Hubei last week.
As of today, there are 0 daily new cases of coronavirus in the entire 60 million-big region of Hubei.
The diagnostics would keep going up for a couple of weeks, but then they would start going down. With fewer cases, the fatality rate starts dropping too. And the collateral damage is also reduced: fewer people would die from non-coronavirus-related causes because the healthcare system is simply overwhelmed.
Suppression would get us:
Fewer total cases of Coronavirus
Immediate relief for the healthcare system and the humans who run it
Reduction in fatality rate
Reduction in collateral damage
Ability for infected, isolated and quarantined healthcare workers to get better and back to work. In Italy, healthcare workers represent 8% of all contagions.
Understand the True Problem: Testing and Tracing
Right now, the UK and the US have no idea about their true cases. We don’t know how many there are. We just know the official number is not right, and the true one is in the tens of thousands of cases. This has happened because we’re not testing, and we’re not tracing.
With a few more weeks, we could get our testing situation in order, and start testing everybody. With that information, we would finally know the true extent of the problem, where we need to be more aggressive, and what communities are safe to be released from a lockdown.
We could also set up a tracing operation like the ones they have in China or other East Asia countries, where they can identify all the people that every sick person met, and can put them in quarantine. This would give us a ton of intelligence to release later on our social distancing measures: if we know where the virus is, we can target these places only. This is not rocket science: it’s the basics of how East Asia Countries have been able to control this outbreak without the kind of draconian social distancing that is increasingly essential in other countries.
The measures from this section (testing and tracing) single-handedly curbed the growth of the coronavirus in South Korea and got the epidemic under control, without a strong imposition of social distancing measures.
Build Up Capacity
The US (and presumably the UK) are about to go to war without armor.
We have masks for just two weeks, few personal protective equipments (“PPE”), not enough ventilators, not enough ICU beds, not enough ECMOs (blood oxygenation machines)… This is why the fatality rate would be so high in a mitigation strategy.
But if we buy ourselves some time, we can turn this around:
We have more time to buy equipment we will need for a future wave
We can quickly build up our production of masks, PPEs, ventilators, ECMOs, and any other critical device to reduce fatality rate.
Put in another way: we don’t need years to get our armor, we need weeks. Let’s do everything we can to get our production humming now. Countries are mobilized. People are being inventive, such as using 3D printing for ventilator parts. We can do it. We just need more time. Would you wait a few weeks to get yourself some armor before facing a mortal enemy?
This is not the only capacity we need. We will need health workers as soon as possible. Where will we get them? We need to train people to assist nurses, and we need to get medical workers out of retirement. Many countries have already started, but this takes time. We can do this in a few weeks, but not if everything collapses.
Lower Public Contagiousness
The public is scared. The coronavirus is new. There’s so much we don’t know how to do yet! People haven’t learned to stop hand-shaking. They still hug. They don’t open doors with their elbow. They don’t wash their hands after touching a door knob. They don’t disinfect tables before sitting.
Once we have enough masks, we can use them outside of the healthcare system too. Right now, it’s better to keep them for healthcare workers. But if they weren’t scarce, people should wear them in their daily lives, making it less likely that they infect other people when sick, and with proper training also reducing the likelihood that the wearers get infected. (In the meantime, wearing something is better than nothing.)
All of these are pretty cheap ways to reduce the transmission rate. The less this virus propagates, the fewer measures we’ll need in the future to contain it. But we need time to educate people on all these measures and equip them.
Understand the Virus
We know very very little about the virus. But every week, hundreds of new papers are coming.
The world is finally united against a common enemy. Researchers around the globe are mobilizing to understand this virus better.
How does the virus spread? How can contagion be slowed down? What is the share of asymptomatic carriers? Are they contagious? How much? What are good treatments? How long does it survive? On what surfaces? How do different social distancing measures impact the transmission rate? What’s their cost? What are tracing best practices? How reliable are our tests?
Clear answers to these questions will help make our response as targeted as possible while minimizing collateral economic and social damage. And they will come in weeks, not years.
Find Treatments
Not only that, but what if we found a treatment in the next few weeks? Any day we buy gets us closer to that. Right now, there are already several candidates, such as Favipiravir, Chloroquine, or Chloroquine combined with Azithromycin. What if it turned out that in two months we discovered a treatment for the coronavirus? How stupid would we look if we already had millions of deaths following a mitigation strategy?
Understand the Cost-Benefits
All of the factors above can help us save millions of lives. That should be enough. Unfortunately, politicians can’t only think about the lives of the infected. They must think about all the population, and heavy social distancing measures have an impact on others.
Right now we have no idea how different social distancing measures reduce transmission. We also have no clue what their economic and social costs are.
Isn’t it a bit difficult to decide what measures we need for the long term if we don’t know their cost or benefit?
A few weeks would give us enough time to start studying them, understand them, prioritize them, and decide which ones to follow.
Fewer cases, more understanding of the problem, building up assets, understanding the virus, understanding the cost-benefit of different measures, educating the public… These are some core tools to fight the virus, and we just need a few weeks to develop many of them. Wouldn’t it be dumb to commit to a strategy that throws us instead, unprepared, into the jaws of our enemy?
4. The Hammer and the Dance
Now we know that the Mitigation Strategy is probably a terrible choice, and that the Suppression Strategy has a massive short-term advantage.
But people have rightful concerns about this strategy:
How long will it actually last?
How expensive will it be?
Will there be a second peak as big as if we didn’t do anything?
Here, we’re going to look at what a true Suppression Strategy would look like. We can call it the Hammer and the Dance.
The Hammer
First, you act quickly and aggressively. For all the reasons we mentioned above, given the value of time, we want to quench this thing as soon as possible.
One of the most important questions is: How long will this last?
The fear that everybody has is that we will be locked inside our homes for months at a time, with the ensuing economic disaster and mental breakdowns. This idea was unfortunately entertained in the famous Imperial College paper:
Do you remember this chart? The light blue area that goes from end of March to end of August is the period that the paper recommends as the Hammer, the initial suppression that includes heavy social distancing.
If you’re a politician and you see that one option is to let hundreds of thousands or millions of people die with a mitigation strategy and the other is to stop the economy for five months before going through the same peak of cases and deaths, these don’t sound like compelling options.
But this doesn’t need to be so. This paper, driving policy today, has been brutally criticized for core flaws: They ignore contact tracing (at the core of policies in South Korea, China or Singapore among others) or travel restrictions (critical in China), ignore the impact of big crowds…
The time needed for the Hammer is weeks, not months.
This graph shows the new cases in the entire Hubei region (60 million people) every day since 1/23. Within 2 weeks, the country was starting to get back to work. Within ~5 weeks it was completely under control. And within 7 weeks the new diagnostics was just a trickle. Let’s remember this was the worst region in China.
Remember again that these are the orange bars. The grey bars, the true cases, had plummeted much earlier (see Chart 9).
The measures they took were pretty similar to the ones taken in Italy, Spain or France: isolations, quarantines, people had to stay at home unless there was an emergency or had to buy food, contact tracing, testing, more hospital beds, travel bans…
Details matter, however.
China’s measures were stronger. For example, people were limited to one person per household allowed to leave home every three days to buy food. Also, their enforcement was severe. It is likely that this severity stopped the epidemic faster.
In Italy, France and Spain, measures were not as drastic, and their implementation is not as tough. People still walk on the streets, many without masks. This is likely to result in a slower Hammer: more time to fully control the epidemic.
Some people interpret this as “Democracies will never be able to replicate this reduction in cases”. That’s wrong.
For several weeks, South Korea had the worst epidemic outside of China. Now, it’s largely under control. And they did it without asking people to stay home. They achieved it mostly with very aggressive testing, contact tracing, and enforced quarantines and isolations.
The following table gives a good sense of what measures different countries have followed, and how that has impacted them (this is a work-in-progress. Feedback welcome.)
This shows how countries who were prepared, with stronger epidemiological authority, education on hygiene and social distancing, and early detection and isolation, didn’t have to pay with heavier measures afterwards.
Conversely, countries like Italy, Spain or France weren’t doing these well, and had to then apply the Hammer with the hard measures at the bottom to catch up.
The lack of measures in the US and UK is in stark contrast, especially in the US. These countries are still not doing what allowed Singapore, South Korea or Taiwan to control the virus, despite their outbreaks growing exponentially. But it’s a matter of time. Either they have a massive epidemic, or they realize late their mistake, and have to overcompensate with a heavier Hammer. There is no escape from this.
But it’s doable. If an outbreak like South Korea’s can be controlled in weeks and without mandated social distancing, Western countries, which are already applying a heavy Hammer with strict social distancing measures, can definitely control the outbreak within weeks. It’s a matter of discipline, execution, and how much the population abides by the rules.
Once the Hammer is in place and the outbreak is controlled, the second phase begins: the Dance.
The Dance
If you hammer the coronavirus, within a few weeks you’ve controlled it and you’re in much better shape to address it. Now comes the longer-term effort to keep this virus contained until there’s a vaccine.
This is probably the single biggest, most important mistake people make when thinking about this stage: they think it will keep them home for months. This is not the case at all. In fact, it is likely that our lives will go back to close to normal.
The Dance in Successful Countries
How come South Korea, Singapore, Taiwan and Japan have had cases for a long time, in the case of South Korea thousands of them, and yet they’re not locked down home?
Coronavirus: South Korea seeing a ‘stabilizing trend’
Speaking to the BBC’s Andrew Marr, the South Korean Foreign Minister, Kang Kyung-wha, says she thinks extensive testing has been the key to South Korea’s low coronovirus fatality rate, and that governments have the responsibility to “guard against panic”.
In the above video, the South Korea Foreign Minister explains how her country did it. It was pretty simple: efficient testing, efficient tracing, travel bans, efficient isolating and efficient quarantining.
Want to guess their measures? The same ones as in South Korea. In their case, they complemented with economic help to those in quarantine and travel bans and delays.
Is it too late for these countries and others? No. By applying the Hammer, they’re getting a new chance, a new shot at doing this right. The more they wait, the heavier and longer the hammer, but it can control the epidemics.
But what if all these measures aren’t enough?
The Dance of R
I call the months-long period between the Hammer and a vaccine or effective treatment the Dance because it won’t be a period during which measures are always the same harsh ones. Some regions will see outbreaks again, others won’t for long periods of time. Depending on how cases evolve, we will need to tighten up social distancing measures or we will be able to release them. That is the dance of R: a dance of measures between getting our lives back on track and spreading the disease, one of economy vs. healthcare.
How does this dance work?
It all turns around the R. If you remember, it’s the transmission rate. Early on in a standard, unprepared country, it’s somewhere between 2 and 3: During the few weeks that somebody is infected, they infect between 2 and 3 other people on average.
If R is above 1, infections grow exponentially into an epidemic. If it’s below 1, they die down.
During the Hammer, the goal is to get R as close to zero, as fast as possible, to quench the epidemic. In Wuhan, it is calculated that R was initially 3.9, and after the lockdown and centralized quarantine, it went down to 0.32.
But once you move into the Dance, you don’t need to do that anymore. You just need your R to stay below 1: a lot of the social distancing measures have true, hard costs on people. They might lose their job, their business, their healthy habits…
You can remain below R=1 with a few simple measures.
This is an approximation of how different types of patients respond to the virus, as well as their contagiousness. Nobody knows the true shape of this curve, but we’ve gathered data from different papers to approximate how it looks like.
Every day after they contract the virus, people have some contagion potential. Together, all these days of contagion add up to 2.5 contagions on average.
It is believed that there are some contagions already happening during the “no symptoms” phase. After that, as symptoms grow, usually people go to the doctor, get diagnosed, and their contagiousness diminishes.
For example, early on you have the virus but no symptoms, so you behave as normal. When you speak with people, you spread the virus. When you touch your nose and then open door knob, the next people to open the door and touch their nose get infected.
The more the virus is growing inside you, the more infectious you are. Then, once you start having symptoms, you might slowly stop going to work, stay in bed, wear a mask, or start going to the doctor. The bigger the symptoms, the more you distance yourself socially, reducing the spread of the virus.
Once you’re hospitalized, even if you are very contagious you don’t tend to spread the virus as much since you’re isolated.
This is where you can see the massive impact of policies like those of Singapore or South Korea:
If people are massively tested, they can be identified even before they have symptoms. Quarantined, they can’t spread anything.
If people are trained to identify their symptoms earlier, they reduce the number of days in blue, and hence their overall contagiousness
If people are isolated as soon as they have symptoms, the contagions from the orange phase disappear.
If people are educated about personal distance, mask-wearing, washing hands or disinfecting spaces, they spread less virus throughout the entire period.
Only when all these fail do we need heavier social distancing measures.
The ROI of Social Distancing
If with all these measures we’re still way above R=1, we need to reduce the average number of people that each person meets.
There are some very cheap ways to do that, like banning events with more than a certain number of people (eg, 50, 500), or asking people to work from home when they can.
Other are much, much more expensive economically, socially and ethically, such as closing schools and universities, asking everybody to stay home, or closing businesses.
This chart is made up because it doesn’t exist today. Nobody has done enough research about this or put together all these measures in a way that can compare them.
It’s unfortunate, because it’s the single most important chart that politicians would need to make decisions. It illustrates what is really going through their minds.
During the Hammer period, politicians want to lower R as much as possible, through measures that remain tolerable for the population. In Hubei, they went all the way to 0.32. We might not need that: maybe just to 0.5 or 0.6.
But during the Dance of the R period, they want to hover as close to 1 as possible, while staying below it over the long term term. That prevents a new outbreak, while eliminating the most drastic measures.
What this means is that, whether leaders realize it or not, what they’re doing is:
List all the measures they can take to reduce R
Get a sense of the benefit of applying them: the reduction in R
Get a sense of their cost: the economic, social, and ethical cost.
Stack-rank the initiatives based on their cost-benefit
Pick the ones that give the biggest R reduction up till 1, for the lowest cost.
Initially, their confidence on these numbers will be low. But that‘s still how they are thinking—and should be thinking about it.
What they need to do is formalize the process: Understand that this is a numbers game in which we need to learn as fast as possible where we are on R, the impact of every measure on reducing R, and their social and economic costs.
Only then will they be able to make a rational decision on what measures they should take.
Conclusion: Buy Us Time
The coronavirus is still spreading nearly everywhere. 152 countries have cases. We are against the clock. But we don’t need to be: there’s a clear way we can be thinking about this.
Some countries, especially those that haven’t been hit heavily yet by the coronavirus, might be wondering: Is this going to happen to me? The answer is: It probably already has. You just haven’t noticed. When it really hits, your healthcare system will be in even worse shape than in wealthy countries where the healthcare systems are strong. Better safe than sorry, you should consider taking action now.
For the countries where the coronavirus is already here, the options are clear.
On one side, countries can go the mitigation route: create a massive epidemic, overwhelm the healthcare system, drive the death of millions of people, and release new mutations of this virus in the wild.
On the other, countries can fight. They can lock down for a few weeks to buy us time, create an educated action plan, and control this virus until we have a vaccine.
Governments around the world today, including some such as the US, the UK or Switzerland have so far chosen the mitigation path.
That means they’re giving up without a fight. They see other countries having successfully fought this, but they say: “We can’t do that!”
What if Churchill had said the same thing? “Nazis are already everywhere in Europe. We can’t fight them. Let’s just give up.” This is what many governments around the world are doing today. They’re not giving you a chance to fight this. You have to demand it.
The Astoria City Council on Sunday voted to ban visitors from staying in hotels and other commercial lodging to help prevent the spread of the coronavirus.
The order will apply for as long as an emergency declared by Astoria last week is in place. Long-term guests and essential workers are exempt. The city gave visitors until the end of the day on Monday to leave hotels, homestay lodging and other short-term rentals.
The Clatsop County Board of Commissioners voted at a special meeting via teleconference on Sunday afternoon to close campgrounds, hotels, short-term rentals and homestay lodging for two weeks starting at noon on Monday.
Seaside also agreed to restrict access to city parks, streams and beach areas and close hotels and other lodging on Monday. Cannon Beach went a step further, closing hotels on Monday and also excluding daytrip visitors through early April.
The Oregon Parks and Recreation Department announced on Sunday afternoon that state parks will close at the end of the day on Monday. The state had previously indicated that parks would close on April 3.
“We would have preferred an orderly shutdown of the system and to remain open for daytime visits, but our concern for the effects on rural health care systems requires us to move up and expand our plans,” Lisa Sumption, the director of the state Parks and Recreation Department, said in a statement. “We know this will cause a disruption, since we’re suspending service to everyone, even people who live near a park.
“Reducing contact between people is more important than recreation at the moment.”
In Washington state, the state closed campgrounds through April, although day-use areas and trails are open.
The moves by Astoria and the county follow the decision by Warrenton on Saturday night to ban recreational camping, homestay lodging and hotel stays in city limits through at least April.
Astoria city councilors praised the sacrifice of locals, many of whom have been laid off during the closure of most gathering spots, to comply with Gov. Kate Brown’s calls for social distancing. But they worried about tourists still coming to the North Coast.
“We cannot let those sacrifices be in vain by allowing thousands of visitors passing through our city, and many stopping in our city or vacationing in our city, during this time,” Mayor Bruce Jones said Sunday before the vote.
Jones issued a message on the city’s website pleading with tourists to stay away.
“We have been appalled by the sight of tens of thousands of irresponsible vacationers flocking to the coast, as if this was just another spring break week, with callous disregard for residents’ health and safety,” Jones wrote.
The mayor said the city’s order has exceptions for critical workers, such as doctors, nurses and patients getting treatment at the cancer center.
“It’s just vacationers that we’re targeting with this resolution,” Jones said.
Property owners and managers who violate the city’s order could be cited in Municipal Court.
For the county’s order, exceptions include people employed as camp hosts, people working in the county, as well as people traveling for work or already registered for longer stays.
Along with the lodging ban, some commissioners wondered if the county could do anything to restrict beach access after fielding numerous concerns from residents.
The county has no authority over beaches, County Manager Don Bohn said. For now, officials will reinforce the message from Brown’s office that people should stay home.
Commissioner Mark Kujala echoed other commissioners in hoping Brown takes coastal concerns seriously. It shouldn’t be cities and counties piecing together rules, he said.
“It should be the state issuing an order to stay home, and that should be in place now,” Kujala said.
Commissioner Sarah Nebeker agreed, but added, “Truly though, we have to realize this is all happening from the ground up across the nation. This is not unique to us.”
But several leaders on the coast faulted Brown for not issuing a stay at home order on Friday night.
“On Friday, we anticipated a strong message from the governor’s office,” Rick Hudson, Cannon Beach’s emergency manager, said during the special meeting of the City Council. “But that strong message that we were anticipating so that we could take action and actually have some enforceable items never happened. It was not an order, but only a plan.
“The plan was to stay home and stay safe. And there was also accompanying messages with that to go outside and enjoy nature along with social distancing.”
Hotels, which typically see a boost in business during the spring, have been coping with the downturn tied to the government’s restrictions over the virus.
The Commodore Hotel in downtown Astoria, recently leased by global hotel group Selina, had already planned to close on Monday.
The Cannery Pier Hotel & Spa announced a temporary closure on Monday. “This is an important step to help prevent the spread of COVID-19,” the hotel said in a statement. “COVID-19 has created an unimaginable situation. We hope you are safe and practicing the (Centers for Disease Control and Prevention) recommended steps to stay that way.”
Ganesh Sonpatki, who leases and operates the Astoria Riverwalk Inn for the Port of Astoria, said the government restrictions will hurt economically, but that he understands why they are necessary.
“We’ll accept any decision that’s passed on for the safety of our community,” he said.
The Riverwalk Inn was already down to a fraction of its rooms rented at a time when the hotel would usually be booked for spring break. Sonpatki said he’ll keep a skeleton crew for safety.
On the Long Beach Peninsula in Washington state, the owners of 21 hotels and lodging properties voluntarily announced a temporary closure to visitors. Soon after, the Chinook Observer reported, Pacific County Health Officer Dr. Steven Krager ordered the closure of all beach approaches and lodging businesses in the county.
“Our visitors are very important to us but this is not the right time to be encouraging people to travel outside their own homes nor to invite them into our community,” Andi Day, the executive director of the Pacific County Tourism Bureau, said in a statement. “If we can all act responsibly right now, this will be behind us in time to enjoy weeks at the beach in the near future.”
Several businesses decided to temporarily close over the weekend to help promote safety.
Seaside Brewing Co. and Funland Arcade were among the ones in Seaside to close.
Lucy’s Books in Astoria closed and Fort George Brewery temporarily ended to-go orders.
In Manzanita, the city ordered all visitors to vacate within 24 hours. “On behalf of our citizens, business owners and our community who depend on the few resources we have, we request civil cooperation,” the city said in a statement.
In Seaside, which declared an emergency on Saturday night, the cool and cloudy weather on Sunday appeared to discourage tourists from visiting.
“Today the tide’s kind of turned,” Shannon Carey, of Dundee’s Donuts, said. “The warning is getting out to people, and there seemed to be a lot of backlash yesterday: ‘Why are they coming here and why aren’t people paying attention?’”
Tsunami Sandwich Co. owner David Posalski sat in his Broadway store, preparing to shut down.
Like other downtown businesses, he had experienced a bit of a surge from visitors on Saturday. “There are a lot of people who don’t realize if they stay home, they’re not going to catch anything,” Posalski said.
“I think a couple of weeks where everyone has a whole lot less interaction may change the curve.”
What will happen to his employees? “They are all without work,” Posalski said.
As for himself? “We’ll continue to pay our bills until we can’t. We’re coming out of the winter, so it’s really the worst time of year for a lot of the businesses here in our town.”
After a crisis, private contractors move in and suck up funding for work done badly, if at all – then those billions get cut from government budgets. Like Grenfell Tower, Hurricane Katrina revealed a disdain for the poor.
There have been times in my reporting from disaster zones when I have had the unsettling feeling that I was seeing not just a crisis in the here and now, but getting a glimpse of the future – a preview of where the road we are all on is headed, unless we somehow grab the wheel and swerve. When I listen to Donald Trump speak, with his obvious relish in creating an atmosphere of chaos and destabilisation, I often think: I’ve seen this before, in those strange moments when portals seemed to open up into our collective future.
One of those moments arrived in New Orleans after Hurricane Katrina, as I watched hordes of private military contractors descend on the flooded city to find ways to profit from the disaster, even as thousands of the city’s residents, abandoned by their government, were treated like dangerous criminals just for trying to survive.
I started to notice the same tactics in disaster zones around the world. I used the term “shock doctrine” to describe the brutal tactic of using the public’s disorientation following a collective shock – wars, coups, terrorist attacks, market crashes or natural disasters – to push through radical pro-corporate measures, often called “shock therapy”. Though Trump breaks the mould in some ways, his shock tactics do follow a script, and one that is familiar from other countries that have had rapid changes imposed under the cover of crisis.
This strategy has been a silent partner to the imposition of neoliberalism for more than 40 years. Shock tactics follow a clear pattern: wait for a crisis (or even, in some instances, as in Chile or Russia, help foment one), declare a moment of what is sometimes called “extraordinary politics”, suspend some or all democratic norms – and then ram the corporate wishlist through as quickly as possible. The research showed that virtually any tumultuous situation, if framed with sufficient hysteria by political leaders, could serve this softening-up function. It could be an event as radical as a military coup, but the economic shock of a market or budget crisis would also do the trick. Amid hyperinflation or a banking collapse, for instance, the country’s governing elites were frequently able to sell a panicked population on the necessity for attacks on social protections, or enormous bailouts to prop up the financial private sector – because the alternative, they claimed, was outright economic apocalypse.
The Republicans under Donald Trump are already seizing the atmosphere of constant crisis that surrounds this presidency to push through as many unpopular, pro-corporate policies. And we know they would move much further and faster given an even bigger external shock. We know this because senior members of Trump’s team have been at the heart of some of the most egregious examples of the shock doctrine in recent memory.
Rex Tillerson, the US secretary of state, has built his career in large part around taking advantage of the profitability of war and instability. ExxonMobil profited more than any oil major from the increase in the price of oil that was the result of the 2003 invasion of Iraq. It also directly exploited the Iraq war to defy US state department advice and make an exploration deal in Iraqi Kurdistan, a move that, because it sidelined Iraq’s central government, could well have sparked a full-blown civil war, and certainly did contribute to internal conflict.
As CEO of ExxonMobil, Tillerson profited from disaster in other ways as well. As an executive at the fossil fuel giant, he spent his career working for a company that, despite its own scientists’ research into the reality of human-caused climate change, decided to fund and spread misinformation and junk climate science. All the while, according to an LA Times investigation, ExxonMobil (both before and after Exxon and Mobil merged) worked diligently to figure out how to further profit from and protect itself against the very crisis on which it was casting doubt. It did so by exploring drilling in the Arctic (which was melting, thanks to climate change), redesigning a natural gas pipeline in the North Sea to accommodate rising sea levels and supercharged storms, and doing the same for a new rig off the coast of Nova Scotia.
At a public event in 2012, Tillerson acknowledged that climate change was happening – but what he said next was revealing: “as a species”, humans have always adapted. “So we will adapt to this. Changes to weather patterns that move crop production areas around – we’ll adapt to that.”
He’s quite right: humans do adapt when their land ceases to produce food. The way humans adapt is by moving. They leave their homes and look for places to live where they can feed themselves and their families. But, as Tillerson well knows, we do not live at a time when countries gladly open their borders to hungry and desperate people. In fact, he now works for a president who has painted refugees from Syria – a country where drought was an accelerant of the tensions that led to civil war – as Trojan horses for terrorism. A president who introduced a travel ban that has gone a long way towards barring Syrian migrants from entering the United States.
A president who has said about Syrian children seeking asylum, “I can look in their faces and say: ‘You can’t come.’” A president who has not budged from that position even after he ordered missile strikes on Syria, supposedly moved by the horrifying impacts of a chemical weapon attack on Syrian children and “beautiful babies”. (But not moved enough to welcome them and their parents.) A president who has announced plans to turn the tracking, surveillance, incarceration and deportation of immigrants into a defining feature of his administration.
Waiting in the wings, biding their time, are plenty of other members of the Trump team who have deep skills in profiting from all of that.
Between election day and the end of Trump’s first month in office, the stocks of the two largest private prison companies in the US, CoreCivic (formerly the Corrections Corporation of America) and the Geo Group, doubled, soaring by 140% and 98%, respectively. And why not? Just as Exxon learned to profit from climate change, these companies are part of the sprawling industry of private prisons, private security and private surveillance that sees wars and migration – both very often linked to climate stresses – as exciting and expanding market opportunities. In the US, the Immigration and Customs Enforcement agency (Ice) incarcerates up to 34,000 immigrants thought to be in the country illegally on any given day, and 73% of them are held in private prisons. Little wonder, then, that these companies’ stocks soared on Trump’s election. And soon they had even more reasons to celebrate: one of the first things Trump’s new attorney general, Jeff Sessions, did was rescind the Obama administration’s decision to move away from for-profit jails for the general prison population.
Trump appointed as deputy defence secretary Patrick Shanahan, a top executive at Boeing who, at one point, was responsible for selling costly hardware to the US military, including Apache and Chinook helicopters. He also oversaw Boeing’s ballistic missile defence programme – a part of the operation that stands to profit enormously if international tensions continue to escalate under Trump.
And this is part of a much larger trend. As Lee Fang reported in the Intercept in March 2017, “President Donald Trump has weaponised the revolving door by appointing defence contractors and lobbyists to key government positions as he seeks to rapidly expand the military budget and homeland security programmes … At least 15 officials with financial ties to defence contractors have been either nominated or appointed so far.”
The revolving door is nothing new, of course. Retired military brass reliably take up jobs and contracts with weapons companies. What’s new is the number of generals with lucrative ties to military contractors whom Trump has appointed to cabinet posts with the power to allocate funds – including those stemming from his plan to increase spending on the military, the Pentagon and the Department of Homeland Security by more than $80bn in just one year.
The other thing that has changed is the size of the Homeland Security and surveillance industry. This sector grew exponentially after the September 11 attacks, when the Bush administration announced it was embarking on a never-ending “war on terror”, and that everything that could be outsourced would be. New firms with tinted windows sprouted up like malevolent mushrooms around suburban Virginia, outside Washington DC, and existing ones, such as Booz Allen Hamilton, expanded into brand new territories. Writing in Slate in 2005, Daniel Gross captured the mood of what many called the security bubble: “Homeland security may have just reached the stage that internet investing hit in 1997. Back then, all you needed to do was put an ‘e’ in front of your company name and your IPO would rocket. Now you can do the same with ‘fortress’.”
That means many of Trump’s appointees come from firms that specialise in functions that, not so long ago, it would have been unthinkable to outsource. His National Security Council chief of staff, for instance, is retired Lt Gen Keith Kellogg. Among the many jobs Kellogg has had with security contractors since going private was one with Cubic Defense.
According to the company, he led “our ground combat training business and focus[ed] on expanding the company’s worldwide customer base”. If you think “combat training” is something armies used to do all on their own, you’d be right.
One noticeable thing about Trump’s contractor appointees is how many of them come from firms that did not even exist before 9/11: L-1 Identity Solutions (specialising in biometrics), the Chertoff Group (founded by George W Bush’s homeland security director Michael Chertoff), Palantir Technologies (a surveillance/big data firm cofounded by PayPal billionaire and Trump backer Peter Thiel), and many more. Security firms draw heavily on the military and intelligence wings of government for their staffing.
Under Trump, lobbyists and staffers from these firms are now migrating back to government, where they will very likely push for even more opportunities to monetise the hunt for people Trump likes to call “bad hombres”.
This creates a disastrous cocktail. Take a group of people who directly profit from ongoing war and then put those same people at the heart of government. Who’s going to make the case for peace? Indeed, the idea that a war could ever definitively end seems a quaint relic of what during the Bush years was dismissed as “pre–September 11 thinking”.
And then there’s vice-president Mike Pence, seen by many as the grownup in Trump’s messy room. Yet it is Pence, the former governor of Indiana, who actually has the most disturbing track record when it comes to bloody-minded exploitation of human suffering.
When Mike Pence was announced as Donald Trump’s running mate, I thought to myself: I know that name, I’ve seen it somewhere. And then I remembered. He was at the heart of one of the most shocking stories I’ve ever covered: the disaster capitalism free-for-all that followed Katrina and the drowning of New Orleans. Mike Pence’s doings as a profiteer from human suffering are so appalling that they are worth exploring in a little more depth, since they tell us a great deal about what we can expect from this administration during times of heightened crisis.
Before we delve into Pence’s role, what’s important to remember about Hurricane Katrina is that, though it is usually described as a “natural disaster”, there was nothing natural about the way it affected the city of New Orleans. When Katrina hit the coast of Mississippi in August 2005, it had been downgraded from a category 5 to a still-devastating category 3 hurricane. But by the time it made its way to New Orleans, it had lost most of its strength and been downgraded again, to a “tropical storm”.
That’s relevant, because a tropical storm should never have broken through New Orleans’s flood defence. Katrina did break through, however, because the levees that protect the city did not hold. Why? We now know that despite repeated warnings about the risk, the army corps of engineers had allowed the levees to fall into a state of disrepair. That failure was the result of two main factors.
One was a specific disregard for the lives of poor black people, whose homes in the Lower Ninth Ward were left most vulnerable by the failure to fix the levees. This was part of a wider neglect of public infrastructure, which is the direct result of decades of neoliberal policy. Because when you systematically wage war on the very idea of the public sphere and the public good, of course the publicly owned bones of society – roads, bridges, levees, water systems – are going to slip into a state of such disrepair that it takes little to push them beyond the breaking point. When you massively cut taxes so that you don’t have money to spend on much of anything besides the police and the military, this is what happens.
It wasn’t just the physical infrastructure that failed the city, and particularly its poorest residents, who are, as in so many US cities, overwhelmingly African American. The human systems of disaster response also failed – the second great fracturing. The arm of the federal government that is tasked with responding to moments of national crisis such as this is the Federal Emergency Management Agency (Fema), with state and municipal governments also playing key roles in evacuation planning and response. All levels of government failed.
It took Fema five days to get water and food to people in New Orleans who had sought emergency shelter in the Superdome. The most harrowing images from that time were of people stranded on rooftops – of homes and hospitals – holding up signs that said “HELP”, watching the helicopters pass them by. People helped each other as best they could. They rescued each other in canoes and rowboats. They fed each other. They displayed that beautiful human capacity for solidarity that moments of crisis so often intensify. But at the official level, it was the complete opposite. I’ll always remember the words of Curtis Muhammad, a longtime New Orleans civil rights organiser, who said this experience “convinced us that we had no caretakers”.
The way this abandonment played out was deeply unequal, and the divisions cleaved along lines of race and class. Many people were able to leave the city on their own – they got into their cars, drove to a dry hotel, called their insurance brokers. Some people stayed because they believed the storm defences would hold. But a great many others stayed because they had no choice – they didn’t have a car, or were too infirm to drive, or simply didn’t know what to do. Those are the people who needed a functioning system of evacuation and relief – and they were out of luck.
Abandoned in the city without food or water, those in need did what anyone would do in those circumstances: they took provisions from local stores. Fox News and other media outlets seized on this to paint New Orleans’s black residents as dangerous “looters” who would soon be coming to invade the dry, white parts of the city and surrounding suburbs and towns. Buildings were spray-painted with messages: “Looters will be shot.”
Checkpoints were set up to trap people in the flooded parts of town. On Danziger Bridge, police officers shot black residents on sight (five of the officers involved ultimately pleaded guilty, and the city came to a $13.3m settlement with the families in that case and two other similar post-Katrina cases). Meanwhile, gangs of armed white vigilantes prowled the streets looking, as one resident later put it in an exposé by investigative journalist AC Thompson, for “the opportunity to hunt black people”.
I was in New Orleans during the flooding and I saw for myself how amped up the police and military were – not to mention private security guards from companies such as Blackwater who were showing up fresh from Iraq. It felt very much like a war zone, with poor and black people in the crosshairs – people whose only crime was trying to survive. By the time the National Guard arrived to organise a full evacuation of the city, it was done with a level of aggression and ruthlessness that was hard to fathom. Soldiers pointed machine guns at residents as they boarded buses, providing no information about where they were being taken. Children were often separated from their parents.
What I saw during the flooding shocked me. But what I saw in the aftermath of Katrina shocked me even more. With the city reeling, and with its residents dispersed across the country and unable to protect their own interests, a plan emerged to ram through a pro-corporate wishlist with maximum velocity. The famed free-market economist Milton Friedman, then 93 years old, wrote an article for the Wall Street Journal stating, “Most New Orleans schools are in ruins, as are the homes of the children who have attended them. The children are now scattered all over the country. This is a tragedy. It is also an opportunity to radically reform the educational system.”
In a similar vein, Richard Baker, at that time a Republican congressman from Louisiana, declared, “We finally cleaned up public housing in New Orleans. We couldn’t do it, but God did.” I was in an evacuation shelter near Baton Rouge when Baker made that statement. The people I spoke with were just floored by it. Imagine being forced to leave your home, having to sleep in a camping bed in some cavernous convention centre, and then finding out that the people who are supposed to represent you are claiming this was some sort of divine intervention – God apparently really likes condo developments.
Baker got his “cleanup” of public housing. In the months after the storm, with New Orleans’s residents – and all their inconvenient opinions, rich culture and deep attachments – out of the way, thousands of public housing units, many of which had sustained minimal storm damage because they were on high ground, were demolished. They were replaced with condos and town houses priced far out of reach for most who had lived there.
And this is where Mike Pence enters the story. At the time Katrina hit New Orleans, Pence was chairman of the powerful and highly ideological Republican Study Committee (RSC), a caucus of conservative lawmakers. On 13 September 2005 – just 15 days after the levees were breached, and with parts of New Orleans still under water – the RSC convened a fateful meeting at the offices of the Heritage Foundation in Washington DC. Under Pence’s leadership, the group came up with a list of “Pro-Free-Market Ideas for Responding to Hurricane Katrina and High Gas Prices” – 32 pseudo-relief policies in all, each one straight out of the disaster capitalism playbook.
What stands out is the commitment to wage all-out war on labour standards and the public sphere – which is bitterly ironic, because the failure of public infrastructure is what turned Katrina into a human catastrophe in the first place. Also notable is the determination to use any opportunity to strengthen the hand of the oil and gas industry. The list includes recommendations to suspend the obligation for federal contractors to pay a living wage; make the entire affected area a free-enterprise zone; and “repeal or waive restrictive environmental regulations … that hamper rebuilding”. In other words, a war on the kind of red tape designed to keep communities safe from harm.
President Bush adopted many of the recommendations within the week, although, under pressure, he was eventually forced to reinstate the labour standards. Another recommendation called for giving parents vouchers to use at private and charter schools (for-profit schools subsidised with tax dollars), a move perfectly in line with the vision held by Trump’s pick for education secretary, Betsy DeVos. Within the year, the New Orleans school system became the most privatised in the US.
And there was more. Though climate scientists have directly linked the increased intensity of hurricanes to warming ocean temperatures, that didn’t stop Pence and his committee from calling on Congress to repeal environmental regulations on the Gulf coast, give permission for new oil refineries in the US, and green-light “drilling in the Arctic National Wildlife Refuge”.
It’s a kind of madness. After all, these very measures are a surefire way to drive up greenhouse gas emissions, the major human contributor to climate change, which leads to fiercer storms. Yet they were immediately championed by Pence, and later adopted by Bush, under the guise of responding to a devastating hurricane.
It’s worth pausing to tease out the implications of all of this. Hurricane Katrina turned into a catastrophe in New Orleans because of a combination of extremely heavy weather – possibly linked to climate change – and weak and neglected public infrastructure. The so-called solutions proposed by the group Pence headed at the time were the very things that would inevitably exacerbate climate change and weaken public infrastructure even further. He and his fellow “free-market” travellers were determined, it seems, to do the very things that are guaranteed to lead to more Katrinas in the future.
And now Mike Pence is in a position to bring this vision to the entire United States.
The oil industry wasn’t the only one to profit from Hurricane Katrina. Immediately after the storm, the whole gang of contractors who had descended on Baghdad when war broke out – Bechtel, Fluor, Halliburton, Blackwater, CH2M Hill and Parsons, infamous for its sloppy Iraq work – now arrived in New Orleans. They had a singular vision: to prove that the kinds of privatised services they had been providing in Iraq and Afghanistan also had an ongoing domestic market – and to collect no-bid contracts totaling $3.4 billion.
The controversies were legion. Relevant experience often appeared to have nothing to do with how contracts were allocated. Take, for example, the company that Fema paid $5.2m to perform the crucial role of building a base camp for emergency workers in St Bernard Parish, a suburb of New Orleans. The camp construction fell behind schedule and was never completed. Under investigation, it emerged that the contractor, Lighthouse Disaster Relief, was in fact a religious group. “About the closest thing I have done to this is just organise a youth camp with my church,” confessed Lighthouse’s director, Pastor Gary Heldreth.
After all the layers of subcontractors had taken their cut, there was next to nothing left for the people doing the work. Author Mike Davis tracked the way Fema paid Shaw $175 per sq ft to install blue tarps on damaged roofs, even though the tarps themselves were provided by the government. Once all the subcontractors took their share, the workers who actually hammered in the tarps were paid as little as $2 per sq ft.
“Every level of the contracting food chain, in other words, is grotesquely overfed except the bottom rung,” Davis wrote, “where the actual work is carried out.” These supposed “contractors” were really – like the Trump Organization – hollow brands, sucking out profit and then slapping their name on cheap or non-existent services.
In order to offset the tens of billions going to private companies in contracts and tax breaks, in November 2005 the Republican-controlled Congress announced that it needed to cut $40bn from the federal budget. Among the programmes that were slashed: student loans, Medicaid and food stamps.
So, the poorest people in the US subsidised the contractor bonanza twice: first, when Katrina relief morphed into unregulated corporate handouts, providing neither decent jobs nor functional public services; and second, when the few programmes that assist the unemployed and working poor nationwide were gutted to pay those bloated bills.
New Orleans is the disaster capitalism blueprint – designed by the current vice-president and by the Heritage Foundation, the hard-right think tank to which Trump has outsourced much of his administration’s budgeting. Ultimately, the response to Katrina sparked an approval ratings freefall for George W Bush, a plunge that eventually lost the Republicans the presidency in 2008. Nine years later, with Republicans now in control of Congress and the White House, it’s not hard to imagine this test case for privatised disaster response being adopted on a national scale.
The presence of highly militarised police and armed private soldiers in New Orleans came as a surprise to many. Since then, the phenomenon has expanded exponentially, with local police forces across the country outfitted to the gills with military-grade gear, including tanks and drones, and private security companies frequently providing training and support. Given the array of private military and security contractors occupying key positions in the Trump administration, we can expect all of this to expand further with each new shock.
The Katrina experience also stands as a stark warning to those who are holding out hope for Trump’s promised $1tn in infrastructure spending. That spending will fix some roads and bridges, and it will create jobs. Crucially, Trump has indicated that he plans to do as much as possible not through the public sector but through public-private partnerships – which have a terrible track record for corruption, and may result in far lower wages than true public-works projects would. Given Trump’s business record, and Pence’s role in the administration, there is every reason to fear that his big-ticket infrastructure spending could become a Katrina-like kleptocracy, a government of thieves, with the Mar-a-Lago set helping themselves to vast sums of taxpayer money.
New Orleans provides a harrowing picture of what we can expect when the next shock hits. But sadly, it is far from complete: there is much more that this administration might try to push through under cover of crisis. To become shock-resistant, we need to prepare for that, too.
Main photograph: AP Photo/Palm Beach Post/Gary Coronado.This is an edited extract from No Is Not Enough: Defeating the New Shock Politics by Naomi Klein, published by Allen Lane at £12.99. To order a copy for £11.04, go to bookshop.theguardian.com or call 0330 333 6846. Free UK p&p over £10, online orders only. Phone orders min p&p of £1.99.
http://amicuscuria.com/wordpress/wp-content/uploads/2020/03/COVID-19video.mp4
The panicked response to the COVID-19 pandemic has unleashed social and economic chaos. A global economy that was teetering on the brink of recession is being pushed over the edge. Medical and social services are overwhelmed, entire populations are thrown into distress, and anxious hoarding is making basic necessities scarce.
Even before the virus hit, 59 percent of adult Americans were living paycheck to paycheck, 44 percent were carrying credit card debt, and only 38 percent had any kind of emergency fund. Any loss in pay or a loss of job would upend their lives. When you stand on shaky ground, it doesn’t take much to tip you over.
Is panic justified?
We do not know if COVID-19 is more lethal than seasonal influenza. The CDC estimates that between 9 and 45 million people get sick from the annual ‘flu, and between 12,000 and 61,000 die. For the sake of comparison: every year 47,000 Americans kill themselves, and motor vehicle collisions kill another 36,000.
We do not have an accurate fatality rate for this virus (the number of deaths divided by the number of infections) because we do not have an accurate count of how many people are infected, including those who did not get sick or suffered only minor illness. A lack of widespread testing means that mild infections are unlikely to be identified, making the virus seem more deadly than it actually is. Also, we do not know how many people test positive who are not infected, how many test negative who actually are infected, and to what extent the different tests in use are equally accurate in identifying this specific virus.
Because we lack such vital information, we cannot know if the current panicked response is warranted, or if mass quarantine, travel restrictions, event cancellations, social isolation, loss of income, and personal crises will end up causing more harm than the virus.
Regardless of the outcome, this crisis reveals hidden truths about capitalism and offers an opportunity for revolutionary transformation.
Hidden truths
Diseases flow across political borders. Despite persistent efforts to divide humanity, the global spread of COVID-19 reminds us that we truly live in one world.
A global challenge demands international cooperation. The capitalist class have proved to be too distrustful, too ambitious, and too competitive to cooperate at the level required.
Science does not guide public policy. Epidemics emerge on a regular basis, most recently SARS in 2002-2004 and H1N1 in 2009. After each pandemic, authorities pledge to prepare for the next one. It’s just talk.
The current epidemic was predicted back in 2015, and detailed strategies to reduce its impact were developed. Nevertheless, the 2019 Global Health Security Index found that no country in the world is fully prepared to handle an epidemic or pandemic. Prevention costs money, and there is no profit in it. When epidemics emerge, both cash-strapped public medical systems and for-profit ones are reluctant to invest in widespread testing and treatment.
When COVID-19 first appeared, American officials did nothing for almost two months. They rejected an early test kit developed by the World Health Organization in order to privilege American providers who failed to produce an accurate test quickly enough and in sufficient numbers. The result has been colossal system failure, a lost opportunity to contain the epidemic, and much unnecessary suffering.
When epidemics escape containment, there are two options. One is to allow the infection to spread until herd immunity is achieved. This strategy is most effective when medical systems have the capacity to treat all cases. When they do not, some people will be left to die.
Modern medical systems are designed for maximum cost-efficiency (lean production) so they have no margin to manage periodic surges in demand. Under such conditions, the only option is to impose mass quarantine, or social distancing. Such measures do not reduce the total number of infections and may not reduce the number of deaths. However, they do slow the speed of transmission, easing the load on medical systems, enabling more people to be treated, and buying time to develop a vaccine.
Social crises reveal the extent of social inequality and also deepen it. Travel bans target some nations and not others. While some industries are forced to close, others continue to operate. The public are ordered to maintain social distance, yet inmates trapped in overcrowded prisons do not have access to soap and hand sanitizers. Virtual classrooms benefit the few, leaving the rest further behind. And where testing and treatment cost money, those who are most likely to get sick are least able to pay.
Worker safety is not prioritized. Epidemics place unbearable pressure on front-line workers, and a planned shortage of personal protective equipment (PPE) puts them in danger. Yet these workers have no say in how public services are funded, equipped, staffed, or organized.
While sick workers should isolate themselves to protect others, 24 percent of all American workers and 69 percent of low-paid ones (making less than $10.80 an hour) have no paid sick leave, and recent US legislation will not help them. Without sick benefits, workers will stay on the job because being broke is worse than being sick.
The ruling class panic when disease threatens them or their bottom line. Nevertheless, they refuse to eliminate the environmental degradation and impoverished conditions that breed disease.
Globally, more than 2 billion people lack access to safe drinking water, 4.5 billion lack basic sanitation services, and close to a billion people do not get enough food. Deadly yet treatable diseases such as TB and HIV/AIDs continue to spread. In 2017, 1.7 million people were newly infected with HIV and 770,000 died from AIDS-related illnesses. When the means exist for everyone to be well, the acceptance of poverty-bred disease can only be understood as a means for eugenically reducing the numbers of destitute people.
The capitalist class respond to every crisis as if it were a war they must fight with weapons of social control. Ordinary people are not treated as valued problem-solvers, but as victims needing saving or as potential troublemakers who must be isolated, kept fearful, and coerced into obedience.
Opportunities
Is it possible to prevent epidemics? What is the best way to contain them? What must we do differently?
COVID-19 has caused enough panic to put seemingly radical reforms on the agenda, including: universal access to medical care; fully funded social services; sick leave benefits for all workers; housing the homeless; and ensuring that everyone is well nourished. Such measures would require a massive transfer of wealth from the capitalist class to the working class. However, the purpose of capitalism is to transfer wealth in the opposite direction, from the many to the few. This is why billions of people are exposed to preventable distress, disease, disability, and premature death, why capitalists fail to act responsibly in response to crises, and why they exploit every crisis as an opportunity to increase their wealth and tighten their grip on society.
The only way that anyone can be truly safe is if everyone is safe. That can happen only when the majority step up and organize themselves to make it so.
Unions around the world are pushing for more effective measures to contain the epidemic and to protect front-line workers. However, the capitalist class resist implementing such measures. That leaves two options: mount enough public pressure to compel authorities to do the right thing (reform); or remove the capitalist class from power so the rest of us can do what needs to be done (revolution). What might that second, revolutionary, option look like?
Where the capitalists stoke fear of others as a source of contagion, we would mobilize the well to care for the unwell.
With the working class in power, we could open the banks and release enough money to massively expand medical and social services. People could organize themselves in every workplace, school, and neighborhood, forming democratic councils to share information, conduct free testing, and ensure free treatment for all who fall ill, financial support for the sick, social support for the quarantined, food for the hungry, and housing for the homeless.
We would give full amnesty to all undocumented persons so they can be tested and treated and join the collective effort to test and treat others.
Overcrowded, unsanitary conditions breed disease, so we would immediately release all immigrants in detention, along with all prisoners being held for non-violent offenses. Once their medical and social needs are met, they could join the social mobilization.
We would eliminate all political borders in order to coordinate local, regional, and global efforts and to enable personnel and equipment to travel where needed.
Wars breed disease and devastation. Ending them would enable us to vastly improve the health of the planet and everyone on it.
In short, we would completely transform our relationships with each other, from divided consumers to united producers. We would also change our relationship with the non-human world, nurturing it so that it can nurture us in return.
If you think such measures are impossible, pie in the sky, a pipe dream, consider this: When all ‘reasonable’ solutions have proved inadequate to the task, then the only road left, however improbable, is the one we must travel.
https://www.king5.com/traffic-cameras
The above link contains a map of cameras with up to the minute photos of traffic across WA State along its interstates.
