I had to take a class yesterday on “Racial and Community Violence” in order to renew my license to practice. There were only three articles used as curric[ulum].
(1) The first was regarding the mystery of why ordinary Americans support Trump. It said among other things, “Trump is an insult clown….and he is “A gold-plated buffoon who draws the enthusiastic endorsement of racists across the spectrum of intolerance, a gorgeous mosaic of haters, each of them quivering excitedly at the prospect of keeping a real, honest-to-god bigot in the White House. The Trump movement is a one-note phenomenon, a vast surge of race-hate. Its partisans are not only incomprehensible, they are not really worth comprehending.” (maybe from The Guardian?)
The second article was titled “Ferguson Isn’t about Black Rage Against Cops. It’s About White Rage Against Progress.” (Washington Post?)
The last article was titled, “The Decline and Fall of White America: Inside the Study that Shocked the Public-Health Community” (Slate?)
I got my CEUs [continuing education units?]. The class was produced and offered by The American Psychological Association. I paid them $80 for it. It is 3 hours to meet my multicultural requirement.
In September 2009, I wrote “Health Care Reform”. Essentially the government would take the $trillions being spent on Medicare and Medicaid and put it into buying every American a reasonably good HMO policy.
each resident will be given a voucher good for signing up at the clinic or HMO of his or her choice; the amount of the voucher will depend on the resident’s age and sex (the weighted average of all vouchers will equal $2,000 or whatever we’ve decided we want to spend)
a clinic or HMO that wishes to get any revenue from the federal government will be required to take any person who submits a voucher, regardless of preexisting conditions
a resident of the U.S. can switch clinics annually, let’s say on May 1.
the clinic is responsible to pay for the resident’s emergency medical care at another facility
A note:
One likely side effect of this reform is the return to centrality of the primary care physician. Joe Medicare Patient often does not have any doctor who understands much less coordinates his care. If Joe has seen six specialists, he may be on drugs that are working at cross purposes. If Joe is in the ICU at a typical hospital, the multiple doctors treating him may never talk to each other. Each one knows what tests and procedures he or she has ordered, but, except by looking at the patient’s chart, has no idea what the other doctors are investigating. One primary care doctor who reviewed this proposal said “The first item I address with new patients in my office is to try to get them off as many drugs as possible; when a 70-year-old is on 11 meds you better believe there are many unintended interactions.”
How has this aged and what would be different during coronaplague?
Most of all, Trump is the man who doesn’t care. He doesn’t feel your pain. He doesn’t mourn the dead, comfort the grieving, or support the struggling. He doesn’t consider his words or worry that they could have consequences. He doesn’t listen to experts or ponder his options.
Congress is almost finished with its “work” for this session. If the Republicans want to win in November, why not make Americans feel that the they are loved and cared for? We don’t care about money anymore, right? We are happy to spend 100 percent of our accumulated wealth hiding from coronaplague if that is what it takes to cut the death toll slightly. We are happy to print and borrow trillions. A universal HMO policy for every resident of the U.S. wouldn’t have to cost any more than the current bleeding for Medicaid and Medicare plus whatever employers pay for mid-range coverage.
Will anyone, other than folks in the industry, miss the current system? A couple of recent news items:
At least to judge by my Facebook feed, Americans are convinced that, despite the lack of any effective therapy for Covid-19 and despite the fact that the Feds pick up the tab when the uninsured are treated for Covid-19, universal health insurance would hugely cut the number of Covid-19 deaths.
Readers: What do you think? Could Trump and the Republicans take most of the wind out of the Democrats’ sails with one big health care hand-out? (of course, all of the money for this would just come from taxpayers themselves, but somehow Americans never seem to consider that they will ultimately have to work for whatever the government “gives’ them)
Bonus pictures of the house that Medicaid and Medicare built, in Nome, Alaska, from September 2019. This single building is likely worth more than all of the rest of the houses and commercial real estate in the city.
In the first 10 days after the World Health Organization’s March 11 declaration that COVID-19 was officially a global pandemic, smartphone users worldwide showed a 5.5% decrease in mean daily steps (287 fewer steps).
In the first 30 days, mean daily steps dropped 27.3% (1,432 fewer steps), reported the group led by Geoffrey Tison, MD, MPH, of the University of California San Francisco. Their paper was published online in the Annals of Internal Medicine.
For example, people in Italy had a 48.7% maximal decrease in daily steps, whereas those in Sweden showed only a 6.9% maximal reduction in steps. The difference may have stemmed from government responses, as Italy issued a lockdown on March 9, whereas Sweden has yet to implement such a measure.
(I like the last part. There is still hope among the righteous for saving Swedish souls by converting them to the Church of Shutdown.)
“This is an interesting natural experiment that has health implications for global and regional populations, and especially those with underlying chronic health conditions who are particularly vulnerable to COVID-19-related morbidity and mortality and who may depend on routine physical activity as a preventive measure,” according to Messiah.
i.e., it will be interesting for a “scientist” (named “Messiah”! As someone who evaluates coronaplague “science” from a comparative religion point of view, this is my dream fulfilled!) to watch fat people die.
From the Newport Jazz Festival, 2005 (canceled until a hardier breed of Americans can be produced?):
The author of Medical School 2020 said that he was going to be taking “bystander training.” I responded with “So you’ll know what to do if you see a car accident, like Tom Cruise?” It turned out to be something different:
We are excited to bring Bystander Training to [the school]. This program was built by [a person with a female-typical first name and degrees in psychology and women’s studies] and designed to train citizens to safely intercede when they see another individual at risk of sexual harassment and/or sexual assault. This evidence-based program is regarded highly as one avenue through which sexual harassment and sexual assault can be successful combatted.
This training will prove helpful not only in your interpersonal interactions privately, but also in your interpersonal interactions professionally. Unfortunately, sexual harassment and sexual assault are found in every setting. Learning how to navigate extremely challenging moments in time can prove invaluable to everyone involved.
This training is required for all M1, M2, and M3 students.
[signature from an administrator with a female-typical first name]
I met with a cardiologist friend last night. He says that he is working roughly 60 percent as much as he was pre-coronapanic. “Where we would do five procedures per day, we can now do only two,” he said. “That leaves enough time for deep cleaning between patients. Also, they’re reserving 20 percent of the rooms in the hospital for Covid patients, just in case.”
He and his colleagues have already had multiple patients die while waiting for heart valve procedures that were considered “elective”. (see “StayHomeSaveLives or #StayHomeTradeLives?” and the link to the NEJM article) He gets paid in full despite the reduction in work and billing, and is at a vulnerable age for Covid-19 (70s), but is nonetheless anti-shutdown: “It was only a few years ago when parents were supposed to make sacrifices for their children. Now it is the other way around.”
Today is #ShutDownSTEM day. Plenty of righteous posts on Facebook from friends who are professors of various flavors of nerdism. They’ve been sitting on their butts for three months now, taking baby steps in the direction of online teaching (nowhere near as competently as faculty at Western Governor’s University, which has been online since the mid-1990s). Today they will sit on their butts even more firmly? It has been a struggle for me to refrain from asking “How could you possibly do less than you’ve been doing since mid-March?”
(Not all professionals are idle. A friend Facebook messaged me today about some divorce litigators who are fully engaged on an issue of life insurance. The defendant father wants to have the beneficiaries of his life insurance be a trust for the children (tweens). The plaintiff mother wants to ensure that the life insurance cash is paid to her, to compensate her for any reduction in profits from alimony and child support. The parties are divorced, but the litigation lives on (legal fees on both sides paid for by the father’s earnings that would have been the children’s inheritance).)
Speaking for myself, I participated in a Zoom meeting regarding some health records data analysis today, but all of the coding was in SQL so I am not sure if that qualifies as “STEM”! Later today it will be time to fly the helicopter, which can be considered a “STEM” activity by American journalists when a member of an officially recognized victim group is at the controls. One of the participants in the call is a third-year medical student. He won’t be able to do a clinical rotation until about a month from now (i.e., he will miss at least three months of clinical training).
From a neighbor’s front yard, “Science is Real” (but also not so important that you’d want to do it every day?):
From a recent visit to the doctor’s office in Concord, Massachusetts to get some blood drawn in advance of a regular checkup:
(any of 50+ gender IDs is okay, but we will depict, recognize, and give priority to only two?)
A righteous Church of Shutdowner on Facebook regarding the infidels of the frozen north:
The Swedish approach makes sense if and only if you are certain that everyone is going to get the virus in the end. If you think there is going to be a vaccine available within 18 months, it means far more deaths than necessary.
[“far more deaths than necessary” in Sweden to date translates to half as many as in Massachusetts (adjusted for population size). Their failure with continuity looks pretty good compared to our success with shutdown!]
I asked why he was confident regarding vaccine development:
We produced a vaccine for Ebola within months of the disease appearing. And right now we have every vaccine lab in the world and more looking for the COVID vaccine. The question hasn’t been time, it has been whether immunity was possible. If you have thirty world class labs each taking a shot at producing a vaccine that has a 10% chance of success, you are pretty much certain to succeed if it is possible with that approach.
I certainly hope that he is right (he’s a computer programmer, not a virologist, so he is guessing just like the rest of us!), but I decided to check out Wikipedia on Ebola and discovered that it first broke out within humans in 1976 and an approved vaccine become available 43 years later, on December 17, 2019 (i.e., we were perfectly set up to fight the last war almost to the day that the next war broke out).
(The press release might have to be walked back a bit, given recent events: “The first-ever FDA approval of a vaccine for the prevention of Ebola is a triumph of American global health leadership.”)
A friend in medical research and I were joking about people who claim to have hindsight regarding coronavirus. I said that I alternate between bragging about my garage full of N95 masks and ventilators and, if someone else says that it should have been trivial for Donald Trump to foresee, if I can come over to his/her/zer/their house to borrow some of the stockpiled N95 masks and ventilators.
He said “We were actually the worst.” What could that mean? “We [doctors] were still holding huge conventions, flying on packed airline flights, meeting by the thousands in hotels, and then returning home with whatever we’d caught to our patients, often some of the sickest and most immune-compromised people in the U.S.” Until when? “March 10.”
(note that the typical school system in Massachusetts shut down on the afternoon of March 12 or 13 and a lot of companies went to work-from-home after March 13)
For decades the government has been telling people that smoking cigarettes is bad for their health. For about a decade, the government has been telling people that smoking marijuana is good for their health (cures most illness!).
We know that coronavirus attacks smokers. Americans right now are as scared of coronavirus as they’ve ever been of anything. Could it be that the coronaplague will get people to stop smoking both tobacco and marijuana?
Cigarettes are taxed at the federal level, right? So we should be able to get clean data on how many are sold, no? All that I could find was a December 30, 2019 report on tobacco sales in 2018 (i.e., it took a year to get the data and report together).
Quite a few Boston-area businesses have shut down their physical offices. Employees of Amazon, for example, are working from home. Towns and cities, however, can’t close down their respective Town Halls and City Halls because the only way to access quite a few government services is to show up in person. The same enterprise of state/local government that tries, via its public health department, to get everyone to stay home, may ironically end up being one of the only information processing operations that insists that everyone show up and get within contagious distance.
Supposedly Estonia allows citizens to do almost anything that they’d do at a city hall from the disease-free safety of their own homes.
The U.S. track record for government-run IT is admittedly mixed, e.g., with the $1 billion healthcare.gov insurance site. But maybe if we could adopt the Estonian system unmodified for state and local transactions we would be able to save time in non-plague periods and save lives in plague periods.
Readers: What do you think? Should people have to brave coronavirus to get (or issue) a building permit?
e-governance (from Estonians themselves): “Estonia is probably the only country in the world where 99% of the public services are available online 24/7. E-services are only impossible for marriages, divorces and real-estate transactions – you still have to get out of the house for those.” (don’t get too excited about those family law transactions; they are not as lucrative as in the U.S. From a 2017 post: “In all three Baltic countries I learned that having sex with the richest person in the country would yield only about 200 euros per month in child support” (similar to nearby Sweden))
