One of the things that I have learned in meetings with a big health insurance company whose claims data we use in the classroom: emergency room (“ED”) visits are expensive. A long wait followed by a temperature and pulse ox test then advice to take two Tylenols will cost the employer who sponsors a health plan at least $1,000.
One idea that I came up with around a conference table with the insurance folks was to put a doctor and nurse in a motorhome crammed with all of the stuff that one would typically find in a primary care clinic. Tell folks enrolled in the plan “You can go to the hospital and wait two hours to be seen and pay a $125 co-pay. Or you can stay comfortably at home and the doctor will be there in four hours.”
This is plainly a bad idea because it is obvious and yet no insurance company is doing it. Maybe it is bad because the U.S. is so short of physicians that it is intolerably inefficient to have the physician idle when driving from one house to another. France has a lot of doctors per capita and they do still make house calls (see this 2009 article).
Perhaps the idea is a little less bad in the Covid-19 age. Do we want people congregating in hospital waiting areas now that we can be pretty sure that at least one of the waiting patients is plagued? If the patients are seen at home, at least there is no patient-to-patient contact/transmission.
We already have the technology and skills to build the motorhome-based clinics. Matthews Specialty Vehicles seems to have built a bunch, for example. Odulair in Wyoming has everything up to mobile CT and mobile MRI (these are perhaps overengineered for checking on a person who has flu-like symptoms). Laboit says that they can fit a primary care clinic with a single exam room into a 28 ft. Class C RV:
Massachusetts’ education department is reportedly issuing guidance on the amount of remote learning schools should use based on the coronavirus risk level in their communities.
As school districts scramble to submit reopening plans to the Department of Elementary and Secondary Education by Friday, superintendents received a memo from Commissioner Jeffrey Riley Tuesday night that would limit the use of online learning, according to The Boston Globe.
Here’s the map….
From a linked page:
Chelsea, Everett, Lynn and Revere are included in the high risk category, meaning they have over eight cases per 100,000 residents. Twenty-nine other communities, including Auburn, Belchertown, Boston, Brockton, Charlton, Chicopee, Fall River, Framingham, Georgetown, Granby, Holyoke, Hull, Lawrence, Longmeadow, Malden, Marlborough, Maynard, Middleton, Northampton, Peabody, Salem, Saugus, Springfield, Quincy, Randolph, Taunton, Winthrop Worcester, Wrentham, are in the moderate risk category, meaning they have between four and eight cases per 100,000.
In other words, if your town is packed with welfare-dependent People of Color and migrants… no school (“remote learning” in your crowded public housing apartment). The rich white kids in Wellesley and Dover can go back to school, though!
I spent some time recently with two Harvard undergraduates who are camped out in a Cambridge apartment. I’m the oldest person that they’ll have any contact with for the foreseeable future, yet these 20-year-olds behave as though they either worked or lived in a nursing home for 90-year-olds. Asked why they put so much effort into mask-wearing and deny themselves so many social opportunities that they would previous have jumped at, they say that they are personally afraid of getting coronavirus. They’re not obese or chronically ill, so their statistical risk of being felled by Covid-19 is low (see
from mass.gov, statistics that have now been removed), but they seem to perceive Covid-19 as the main risk to their lives and health. They won’t take off their masks, for example, even when outside in mostly-deserted Cambridge. After talking to and observing them, I concluded that, at least for young Americans, Covid-19 is now primarily a disease of the mind. Support for my theory: “We’ve Hit a Pandemic Wall” (NYT, August 5)?
New data show that Americans are suffering from record levels of mental distress.
Let’s start with the numbers. According to the National Center for Health Statistics, roughly one in 12 American adults reported symptoms of an anxiety disorder at this time last year; now it’s more than one in three. Last week, the Kaiser Family Foundation released a tracking poll showing that for the first time, a majority of American adults — 53 percent — believes that the pandemic is taking a toll on their mental health.
This number climbs to 68 percent if you look solely at African-Americans. The disproportionate toll the pandemic has taken on Black lives and livelihoods — made possible by centuries of structural disparities, compounded by the corrosive psychological effect of everyday racism — is appearing, starkly, in our mental health data.
Turns out the extra ten extra pounds around my middle have moved in and unpacked, though I’d initially hoped they were on a month-to-month lease.
The newspaper that has been cheerleading for Shutdown now is surprised that there are some negative consequences? How did the coastal elites not figure out that not everyone’s shutdown experience would be positive? A friend in the Boston suburbs, who was a work-from-home consultant long before the Age of Shutdown, was telling me that his 8th grader hadn’t minded being at home for three months with minimal instruction being provided by the lavishly funded public school. Therefore, he concluded, shutdown was not a big deal, and if the school shutdown lasted another year that was okay too. His son would do fine practicing on the grand piano, learning from Ph.D. Dad and super smart stay-at-home Mom, etc.
I pointed out that not every American child lived in a 6,000 square foot $2 million house with two biological parents who get along at least reasonably well. Would he acknowledge that an inner-city child crammed into a two-bedroom public housing unit with mom, a step-sibling, and mom’s latest boyfriend might have a less favorable view of school shutdown? (he did!)
This is like the Twin Towers imploding all over again – except this time, one story collapses each day, and there is no ground floor.
The pandemic in and of itself is stressful but then add the stress of Trump’s daily tweets. The thought that he might get re-elected makes the stress almost unbearable.
What I think has caused the national stress-out, Ms. Senior, is that America now knows that it’s on its own. We don’t have a president who actually understands and cares about us.
I stress over the corrupt Republican leadership, so unconcerned for 99.9% of Americans that they let a a spoiled child throw our health, education, and welfare out the window, …
A coworker yesterday confided that about 15 of her relatives are COVID positive after a big family graduation party 10 days ago. I couldn’t hide my disgust. She is a very highly paid executive. We work for a research university health system!!! My neighbors just had a 40-person party for their 9-year-old. And seemed miffed and befuddled that many of us on the block declined to attend. They were all crammed under a tent shoulder to shoulder. Nary a mask in sight.
Maria from Maryland: The thing is, a lot of us are coming to the conclusion that all our problems are the same problem. Botched coronavirus response? Republicans. Insisting on doing things that spread the disease? Same. Economic deprivation? Republicans again. Two generations of failing to address racial issues? Again. Two generations of banging our heads against the same gender barriers? You guessed it. Failure to deal with climate change? Do you need to ask? Guns? Infrastructure? Science? Arts? They’ve been at it my whole adults life, ruining everything. And at their apex, they produced the very worst man in the world. There will be a vaccine for the virus, but what about the humans who are ruining our lives?
Coronaplague wouldn’t bother them at all, apparently, if Joe Biden were the Great Father in Washington right now!
Coronaplague obviously is a real problem for the elderly/vulnerable. And in societies where it is allowed to run wild, e.g., Sweden, it will kill approximately 0.05 percent of the population within a few painful months. But will readers agree with me that if young people are afraid of getting the disease personally, despite having no actual or planned contact with the old/vulnerable, then coronavirus has mutated into something whose main effect is mental illness?
Joe Biden is calling for a nationwide protective mask mandate, citing health experts’ predictions that it could save 40,000 lives from coronavirus over the next three months.
”Wearing the mask is less about you contracting the virus,” Biden said. “It’s about preventing other people from getting sick.”
“This is America. Be a patriot. Protect your fellow citizens. Step up, do the right thing.”
“Every single American should be wearing a mask when they’re outside for the next three months at a minimum — every governor should mandate mandatory mask wearing,” Biden declared.
Is it fair to characterize this as “Old fragile person comes up with a way for young healthy people to sacrifice in hopes that it might benefit him somehow”?
Given this example by Joe Biden, I think that I might have some leadership potential for the national stage. Whenever I am around teenagers these days, I ask “Would you mind staying in a cardboard box for the next three years? It might help me avoid getting Covid-19 and I don’t think it will be uncomfortable for you because it is a pretty big box. You will have Netflix and Zoom.”
A friend wears a mask while flying solo in his open-cockpit Ercoupe (when you fly a 70-year-old single-engine piston aircraft, is Covid-19 your biggest risk?).
“Certain face coverings may be worse than no mask at all, preliminary Duke study finds” (ABC): “Like the common sense of just putting your hand in front of your face, we really thought that any mask would be better than nothing,” Dr. Eric Westman of Duke University said. … “We attribute this to the fleece, the textile, breaking up those big particles into many little particles,” Fischer said. “They tend to hang around longer in the air. They get carried away easier in the air. So this might actually be counterproductive to wear such a mask. So it’s not the case that any mask is better than nothing.” (also covered by Washington Post: “Wearing a neck gaiter may be worse than no mask at all, researchers find”)
We recently flew a Cirrus SR20 to Martha’s Vineyard, an instrument training flight for an IFR student that, of course, turned into an actual IMC experience (thanks, Maskachusetts weather!).
We brought his 12-year-old daughter along in the back seat. After touring around the island for a bit, it was time to change into bathing suits. We availed ourselves of the government-run public restrooms for this purpose. The 12-year-old complained about their filthy condition. Of course, I responded with “Remember that the country that hasn’t ever been able to provide clean public restrooms will beat the coronaplague via superior hygiene.”
She then shared her idea: “People who are on welfare, instead of just sitting at home to get checks and benefits should have to clean public bathrooms.” (that would be a workforce of at least 70 million!) She had previously been disparaging Dr. Donald J. Trump, M.D. and singing the praises of Democrats, presumably a result of her years of contact with unionized public school teachers here in the Boston suburbs. I told her “you know, there is actually an established political party in the U.S. that is already lined up with your thinking.”
One of the clean public restrooms in every Shanghai Metro station:
(Bonus: While taking these photos, I learned how the locals say “What is that stupid white guy doing?”)
If you go to a private shopping mall, which are spaced at intervals of just a few blocks in many areas, the level of luxury is a lot higher:
Note, in both cases, the provision of low sinks for children. Also note the Chinese conception of (1) possible gender IDs for humans, and (2) most likely family structure.
Separately, we received a notice from our Town Administrator:
Effective Monday August 10, 2020, Notary services will temporarily be unavailable at Lincoln Town Offices due to the inability to maintain safe social distancing. Notary services will resume when deemed safe to do so. In the meantime, you can contact the following local businesses that advertise notary services…
In other words, it isn’t safe for government workers (who could easily walk a few steps to meet a taxpayer outside and the town hall already has a covered-from-the-rain entry), who will be paid at 100 percent regardless of how much or little they do. So let’s make private-sector employees, who need to work in order to get money, take the risk of close encounters with the public.
I have been asking Harvard undergraduates how their online learning experience was. “Terrible,” was a typical response. “I stopped watching after a month or so.” I asked a math major if she had been able to get help with proofs from teaching assistants during the purported virtual learning portion of last semester. “Only if I knew someone and arranged it privately,” she answered. “There was no structured tutoring provided.”
Asking around the rest of the U.S., the consensus seems to be that the bricks and mortar universities are nowhere near as good at delivering online education as the schools that have been doing it for decades, e.g., Western Governors University. Occasionally a student will praise an individual professor for being good at delivering an online experience, but that was never due to any institutional commitment.
How about for the fall? What have the brilliant administrative minds backed up by multi-$billion endowments managed to arrange? An Oberlin professor told me that the school was switching to trimesters and telling students to show up for only two out of three. He complained that it was a lot of work to redesign the curriculum, but said it was necessary due to a lack of dorm space. “We want every student to have a single room,” he explained.
Now that I’ve been defriended for heresy by everyone on Facebook I need to offend people before we are even friends. So, on this group video chat I said “The Chinese built a hospital for 5,000 patients in 10 days. Oberlin is sitting in the middle of farms and can’t set up a few extra dorm rooms in six months?” This was, I learned, a completely unfair comparison.
How about other schools? Most of them seem unable to come up with the idea of renting out blocks of hotel rooms to serve as dormitories (has there ever been a better time to get a long-term lease on a 400-room hotel?). Harvard, for example, is telling most undergraduates that they can’t return to campus (but the ones with a compelling victimhood narrative are welcome!). So the undergrads will meekly isolate in mom and dad’s house (well, actually mom’s house under most U.S. states’ family law systems, even if dad may not realize it yet)? No! Boston-area landlords are now besieged by groups of 6 Harvard undergraduates seeking to crowd into 2BR apartments. So they’ll be in Boston and they’ll get infected with coronaplague, but Harvard can argue that their infections occurred off campus. (See “12 People in a 3-Bedroom House, Then the Virus Entered the Equation”: “Overcrowding, not density, has defined many coronavirus hot spots. Service workers’ quarters skirting Silicon Valley are no exception.”)
From Harvard Yard in March:
Answer: 4 of them are in a 1BR apartment in Porter Square.
I know every family is doing something different in terms of house rules with Covid, but I’m curious to know what those who are pregnant or with newborn are asking of their au pair. I’m due 9/1 and as things open up and 9/1 approaches we want to institute stricter rules. It would be helpful to know what others are doing especially if pregnant/with newborn.
For example, does it seem reasonable to say only building you can enter is our house, no public transit or anyone’s car? Tell us anytime you are leaving house where you’re going? We want to track your phone?
The other Karens in the au pair host mom group approve:
we are in the same boat! Good to hear other families are doing similar things
think that’s reasonable given your situation. AP might not but I would have an honest conversation. Also does she have access to your car? [Answer from Original Karen: “she doesn’t have access to our car. She doesn’t need it for her job and tbh I don’t want her driving it”]
How do these au pairs even get to the U.S. anymore? They can’t, which has led to “The Great Au Pair Rush” (NYT). Exactly when Government Daycare (i.e., K-12) shut down, the cruel Trump Administration also shut down the supply of foreign daycare labor.
Our national strategy for dealing with a virus that attacks fat people has been to order everyone to stay home and make trips to the fridge every 15 minutes since mid-March.
Since our coronapanic lifestyle shows signs of becoming permanent, how about the following: timelocks on the refrigerator and/or kitchen doors so that cower-at-home Americans can hit the fridge only at mealtimes? No more midnight snacking. No more second breakfast.
Readers: Would this be a good strategy for minimizing the Covid-19 death rate going forward (a thinner population is a safer population!) and also for minimizing the deaths associated with our shutdown?
Certainly this is potentially relevant for elementary school children whose parents are 82-year-olds with underlying health conditions (Maskachusetts statistics). And, if this were a realistic scenario for more than a handful of children on Planet Earth, we could make a lot of money building orphanages in Sweden, since their schools never closed, even in the midst of a raging coronaplague. We could also make money building orphanages in most of Europe, since their schools reopened in April or May while coronaplague at least simmered.
The image made me wonder if we already have a solution to (a) protecting American Karens from the viral monster under their beds, while (b) educating American children: ἀγωγή (agōgē). This was the system set up by Sparta in which all state-run schools for children were residential schools. Boys lived in the school from age 7-21 and thus wouldn’t be able to spread any viruses to their parents. Of course, today we would not limit the agōgē to children who identify as “boys”, but would instead host a full rainbow of gender IDs.
As an added bonus “in these times” (my favorite expression!), the Spartan system promoted the LGBTQIA+ lifestyle and most boys were ultimately persuaded of the shortcomings of cisgender heterosexuality (see “Status of homosexuality in ancient Sparta?”).
Readers: What do you think? Time for residential schools for every American K-12er? For extra protection we can limit teachers to those under age 50 and also have the teachers live in the school.
Mystras, 2004, near the site of ancient Sparta:
Related:
Twitter post by a law professor regarding the Arlington County Public Schools: “My wife, who is apparently a glutton for punishment, listened to an entire Arlington County school board meeting last night. She reports there was great concern expressed about, and discussion of how to help: (1) the teachers, especially those who will have kids at home; (2) the staff, as the county wants to avoid layoffs even for those who will have nothing to do with school online, such as extended day staff; (3) poor kids who rely on school lunches; and (4) poor kids who have trouble accessing the internet. Other than (4), there was essentially no discussion how educating students, which is indefinitely online (and was a disaster in the Spring), nor concern expressed for parents who can’t afford childcare, can’t afford tutors to help their kids, and who are otherwise experiencing a looming disaster with indefinite school closure. The way at least my county school system has reacted to this crisis would have been considered outrageous ideological propaganda if a libertarian-oriented public choice scholar had predicted it.” (Due to being next to Washington, D.C., the source of much wealth in a mostly-planned economy, this is one of the richest counties in the U.S.)
Hundreds of thousands of motorcyclists will gather starting today in Sturgis, South Dakota. SD was the only state that did not attempt to lock its residents down (though unionized schoolteachers were protected from potential harm via a public school shutdown!).
it might be time to deliver some unsolicited Covid-19 education, perhaps quoting from the twin saints Fauci and Cuomo. And to gently suggest a mask to match the following more traditional Harley-rider T-shirt:
I would pay to watch a Bay Area or Maskachusetts Shutdown Karen trying to re-educate a group of Harley riders!
Maybe EAA AirVenture needs to be moved to South Dakota where it can be safe from the Wisconsin governor’s whims! Call it “Oshkosh in Sturgis”? The 5100′ runway of 49B would not support a lot of the aircraft that come into KOSH. Maybe come to an arrangement with Sioux Falls? Two huge runways, just like KOSH (though, unfortunately, intersecting). My personal favorite airport in SD is the “Philip Airport”, and I have actually landed there and purchased self-serve fuel. But the 4000′ runway will never work.
Related:
“‘If We Get It, We Chose to Be Here’: Despite Virus, Thousands Converge on Sturgis for Huge Rally” (NYT): Attendance on Friday was on par with previous years, said Dan Ainslie, City Manager for Sturgis. … The rally, which has taken place every summer in Sturgis since 1938, commenced amid strong objections from residents. In a city-sponsored survey, more than 60 percent of the nearly 7,000 residents favored postponing the event. … Little could be done to stop the event, said Doreen Allison Creed, the Meade County commissioner who represents Sturgis. Ms. Creed said the county lacked the authority to shut down the rally because much of it takes place on state-licensed campgrounds. When it became clear that it would go on as planned, the city said in a news release that changes would be made to safeguard residents from the coronavirus, including adding hand-sanitizing stations to the downtown area. The city plans to offer coronavirus testing for its residents once the rally concludes on Aug. 16. (This puts South Dakota/Sturgis on the same level as never-shut Belarus! Sweden’s rules, in place since March, wouldn’t allow a gathering of more than 50 people. So the U.S. has whipsawed through ordering people to stay at home to gathering by the hundreds of thousands.)
