COVID-19 and my thoughts to date.

My Coronavirus (COVID-19) update, 

Full disclosure. I've been pretty quiet with my opinions and thoughts regarding all things COVID-19, mainly because 1) there's ample "medical" opinions out there, good and less good, and 2) in this time of widespread fear and anxiety, most 'mericans, and in particular those I don't have a personal relationship with, will basically revert to their baser instincts, and listen to what they want to hear. This blog isn't meant for them, so if that's you, please go away. Thanks. For the rest of you who are used to me, here you go.

With the situation in New York City becoming increasingly dire (no consistent reports of patients needing ventilators not getting them as of this Sunday morning, but that’s fully expected to change), this morning brings essentially no good news regarding the COVID-19 pandemic. Okay, maybe one potential positive. The “doubling rate” in NYC for the disease has increased (good), and it might be an early sign that disease control measures have been working. A continued trend here would be welcome.

Medical Stuff. Factually, the progression of disease has been predictable, painfully so. Those predictions on spread, AND the underlying medical presumptions have thus far appeared pretty accurate. Some of those are: 1) respiratory (droplet) spread. That’s the primary cause of spread, not infected surfaces or carry-out containers. It’s the overwhelming cause, which is why you’re likely to see a shift in recommendations regarding mask usage in public (the government will say “yes” to the mask). Entirely reasonable to continue employing the other recommendations for hand washing and disinfectants as well, and most of all the social distancing recommendations (see my Social part) are all prudent guidance. 2) treatment. For sick people, the treatment remains what’s called in medicine “supportive care”. That means there isn’t a cure, so ill people get treated for their symptoms, like fever, respiratory failure, pneumonia, and NOT (‘cause there isn’t) a vaccine or and antiviral that has “proven” efficacy against COVID-19. So Tylenol (ok, maybe Advil, but I personally would advocate Tylenol) for fever, for those who get hospitalized and have respiratory failure (can’t breathe adequately to get enough oxygen), mechanical ventilation (a “vent”), a machine that essentially helps deliver oxygen to the body, the machines everyone anticipates there will be a shortage of in a few weeks. Pneumonia is not frequently mentioned specifically, but it’s the infection of the lungs associated with COVID-19 that is likely the most common ultimate cause of death. If you can overcome the pneumonia, you live. If you can’t, you don’t live. Kinda that simple. Treatment for the “less ill”, i.e., people not sick enough to get hospitalized, I think it’s reasonable to think of it as either “super bad flu” or “walking pneumonia”. Bad, but for healthier people, who are correspondingly usually younger, they’re likely to survive because their bodies and immune system are better able to deal with the infection. 3) A few random personal (i.e., not proven) geek theories. I think a medical concept of “viral load” is going to come out as significant. It means the longer the exposure to a greater amount of virus is associated with more severe disease. I think it’s why you see younger healthcare workers get really sick; they’re exposed to a far greater viral load. I also think the current “experimental” treatments (hydroxychloroquine, etc…) are ultimately not going to be game-changers, if effective at all. I think it’ll be a year before an effective vaccine/treatment comes along, meaning next spring. I’ll add more when I think of them. I’m using my blog to express a very personal opinion, of which I guess I have some platform of experience to speak from. History (and God, if you believe that stuff. I do) will decide upon “heroes”. I don’t personally think self-promotion is an enduring strategy. So those newly-christened “TV doctors” and experts? No comment.

Social part. This plays into a theme of mine, “everyday heroes”. The social distancing and other infringements on the normal lives of Americans I think are not only effective, they’re also the reason why America now leads the world in infections. WE’RE NOT LISTENING! As a society we ARE a selfish people (or, as the Bible calls them (us) “stiff-necked”), and on a non-religious observation we seem to be at a “day of reckoning”. While we (Americans) don’t have a monopoly on stupidity, the images of spring breakers and some of the comments by “leaders” both political and otherwise, I think have contributed greatly to the predicament we find ourselves in now. On a broader level, the emergence of an “America first” mentality seems to have really curses us here. From our initial willful ignorance that COVID-19 was a China/Italy/other country’s problem has come to bite us in the ass. Specifically, not pivoting to the World Health Organization’s COVID-19 test when our own test (the Centers for Disease Control and Prevention, the “CDC”) didn’t work was a preventable mistake and that delay has proven consequential. Further refusal, on our part, to accept the validity of the Chinese data (they’re not innocent, they (the Chinese) tried to bury the data initially, but then switched gears) has also hindered the American response. But back to the social component. We’re generationally so accustomed to having everything the way we Americans want it, that the ask, even in the smallest ways, to voluntarily relinquish, even temporarily, our “civil liberties” on behalf of a greater societal good has been met roundly by either refusal, derision, or conspiracy theories. I don’t have to venture far from the comfort of my own bed to see this firsthand. There’s no consistent credible American authority that the majority of Americans can rally around, and we’re paying the price for that. It’s really our collective fault. We as ‘mericans have kinda sucked at this virus stuff.

Political part. Typing as I’m watching President Trump’s daily presser on Sunday. Breathtaking in its total disregard for both facts and reality, but something we’ve come to expect. Simply not the source for any credible or actionable information, EXCEPT with the exclusive and notable exception of Dr. Anthony Fauci. Not his first rodeo, and for medical information regarding COVID-19, he’s simply been the only consistently credible source. If you listen to only one person, let it be him. Now back to politics. The federal response has been simply poor or non-existent, and it does indeed stop at the President’s foot. He by the very nature of his position sets the tone for the administration, which has, objectively, on multiple fronts, failed. Is Trump solely responsible for the CDC bungling the initial COVID-19 test? Absolutely not. But he is responsible for not taking the advice of Alex Azar (head of HHS; I’m not a fan) who tried to bring the pandemic issue to Trump as early as January, only to be rebuffed by Trump’s inner circle, those more concerned with reelection and the economy. So yes, he is ultimately responsible. And of course he is responsible for the continued delays in widespread testing. That’s actually more emblematic of how an “America first” bias has really come to bite America in the ass. Instead, when the CDC test was found to not work, the reluctance and refusal to ask the World Health Organization for their working test simply added unnecessary delay (this test is used basically throughout the rest of the world, and seems good enough for them. Further, the waffling between exchanging information with the Chinese regarding disease progression is counterproductive, although simultaneously Trump had no problem trumpeting as of yet unproven therapies initiated in China. Obviously inconsistent, but the end result is confusion and delay. Oh, and death.

But really the worst parts of the federal response have been twofold. Pragmatically the things a federal government needs to do are things that can’t be accomplished effectively on a state level. Things like a standardized testing program, a nationwide plan for civic response (school closures, social distancing, travel restrictions). These don’t all have to be the same nationwide, but a functional federal executive branch should coordinate things, like with other natural disasters. Next is critical shortages of supplies like ventilators and personal protective equipment. Employing the Defense Production Act to produce and distribute those needed supplies should have already been started, as essentially all the models predict shortages in those materials. Trump and the administration have consistently spoken about “public private partnerships”, and for the life of me I’m unclear who in the public that comment is intended for. I also don’t necessarily think this is the time to “let’s invent a new ventilator”. I think it’s time to “let’s get the capable companies to vastly increase the production capability of existing (and working) ventilator designs”. Current estimates on the low side are for a shortage of 30-50k of ventilators. Same with PPE like face masks and gowns. It’d be much better to start production now, versus the seeming plan of waiting a few weeks until those shortages are realized, and we’re forced to play catch up, which seems to have been the theme of the whole federal response.

This has not been the case with many state-level governments. New York, Ohio, Maryland, and Michigan stand out as states where a governor (both Dem and GOP) have stepped up and led in the vacuum of federal guidance. They’ve looked good in this pandemic. I think Andrew Cuomo in particular has been strong, particularly in contrast to NYC Mayor Bill DeBlasio and Trump. But memories are short, and perceptions may change over time. Nothing lasts forever, particularly goodwill.

I initially started this blog for my random thoughts regarding the 2015 Presidential campaign, and once upon a time I “warned” that Trump could win, as there was a level of societal unrest that he very successfully tapped into, furthered by a visceral dislike for the candidate on the other side of the ballot. Despite the destruction and carnage brought forth by COVID-19, at this time I’m still not sure he can’t get re-elected. All bets are pretty much off, but on the upside for Dems, if there’s anyone that can in in November, it’s long been my opinion that’s Joe Biden. Time will tell.

Thoughts are my own, and not representative of any other persons or employers. (disclaimer)