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CV-19, the US, race and doing the right thing
Last Post 01/20/2021 09:06 PM by Orange Crush. 20 Replies.
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79pmooney

Posts:2543

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12/15/2020 01:39 PM
Got up this morning and read the NY Times daily briefing. Sandra Lindsay, a Black critical care nurse got the very first American vaccine shot yesterday morning in Queens, NYC. My first thought - Yeah!! A Black woman getting it before thousands of far more "important" white men. And she was quoted as saying "I feel like healing is coming”.

I've been observing that Black women are represented in far greater numbers than the US as a whole in the pictures and videos I see of the CV-19 front lines - the ICU units. I have a soft spot for Black nurses. I have seen very few in my hospital trips (nearly all-white Portland) and none stand out except a nurse at Portland's trauma hospital where I was taken with broken ribs, collapsed lung and massive shoulder damage. This one nurse, a very large, imposing woman, was the only person who could roll me over in bed without excruciating pain that went right through the massive amounts of opiates I was on. She was on the (trauma unit intensive!) weekend shift. I was there Saturday afternoon to Wednesday. Early am hours Sunday and Monday I rang for a nurse to get rolled over. (I'm a side-sleeper.) She could do it. Hurt a lot. AM Tuesday I rang again. This week shift nurse was normal sized woman. Barely strong enough to roll me over. And the pain! A solid 10 - with opiates. Never rang again. When I went back for follow-up, the doctors all said, yeah she (the Black nurse) is our best.

10 years later, visiting my dad in his last months at an Alzeimers facility. Locked doors. You checked in at the lobby then they opened the door, you entered and they locked behind you. Jamaica Plains, Boston, 2010. Every staff member inside the doors was Black, either Haitian or native to Boston.

And an aside - my home town, also my dad's lifelong home, was entirely white when I was growing up. Its long border was Boston. Some of the adjacent Boston neighborhoods were black but there was near zero cross-over. My dad made it a point of telling us that we were to to give everybody a chance to show what they could do. We saw that with his very limited dealings with non-white. Adult years - I sailed with my day across an ocean and to many places that were not white. The boat had a tiny diesel engine that we didn't run much and that saw some real storms; the boat being rolled 90 degrees and the like. Not real diesel "tickled pink" conditions. We would put into small town wharves in places like Blanc Sablon, Labrador and ask for the local diesel mechanic. At Blanc Sablon we got the ferry mechanic. The ferry, a small ocean going ship that could run the open water straight between Labrador and Newfoundland year 'round. Mechanic was a local Native American, little education but had a lifetime of experience with diesels. My dad, from old New England roots, Harvard, MIT. All of which came through his speech all his life. Mechanic had never dealt with an engine that small! One he could have dropped through the fuel injectors of his "baby" the ferry engine that stood 20 feet high. (Well, not quite.) At first it was clear the mechanic was far off his element with the engine and far more with my dad. After a while, he realized we needed his skill; that our life could depend on this tiny engine working - and that this little thing was just a diesel engine with all the same stuff his baby had, just radically smaller. Using that logic, he traced his way to the parts that had to be causing the symptoms we described, removed them and did as needed to get them working again. And came to realize that we needed him and his skill. That my dad knew that all his background and education was nowhere near a match for that man's knowledge.

So, back to the Alzeimers unit. I got to see my dad in a place where the only whites were fellow Alzeimers and dementia patients with whom he felt little connection. My dad was far enough "gone" that he barely knew who I was; his first child. First visit, no sign of recognition. Second, he called me my brother's name. But I got to see that he genuinely loved the staff. That they loved him. (And over my two visits, many took me aside and told me just that.) That my dad did indeed get to live out what he told us early on we had to do; that it was so core to him that when he was past rational thought, he just did it.

So, long ramble. I know this little matter that I am celebrating today isn't going to change a lot of minds. Still ...
79pmooney

Posts:2543

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12/24/2020 02:30 PM
Local news this morning. The first flight from the UK to PDX since the new COVID strain was identified landed this morning. Prediction: in about 5-6 weeks we will hear of the first super-infectious case here. NYC: 2-3 weeks. (Do we yet have the resources to detect this virus in NYC medial community? I'm guessing yes.) Oregon is currently at about 1000 new cases a day. The vaccine won't be out in numbers large enough to make a real difference 'till spring or summer.

It's a race - the super virus vs the vaccine. Vaccine gets a head start, the Super-V starts slow but has that exponential kick.

Edit: Didn't think of this when I wrote it. "Super-V". My uncle used to race Formula V's long ago at Lime Rock, CT. I like this term so it's official. the S is capitalized
longslowdistance

Posts:2226

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12/26/2020 03:42 PM
About 4 months ago more or less a particular strain pretty much took over in the free world due to a successful mutation. Here we are again, and not in a good way.
There is some good news. The vaccines out so far work great, and more are in the pipeline a few weeks or months out. More good news is modern medicine is way better at managing more severe Covid than last spring, and many of the new infections now are among younger folks who mostly do great (although not sure how much immunity they gain).
Orange Crush

Posts:3182

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12/26/2020 05:02 PM
They found the new British strain in a couple in Ontario with no known travel history. Which means it’s already more widespread than we know.

There are also new mutations in Nigeria and South Africa. Not much known about those yet.

But yes the vaccines are a remarkable piece of engineering in that they can handle these (minor) mutations that retain the protein being targeted. As to second wave hitting mostly young people. Yes, but it has jumped from them again to older generation in care homes. It’s interesting how in last week the daily case load has tanked but death rate continues to be high, all in care homes again. From graphs it looks like death rate is lagging about a month behind new case load. So it will take a while for it to subside. And then of course I suspect a new wave following out of Christmas break because of people being people.
longslowdistance

Posts:2226

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12/26/2020 06:25 PM
OC you speak the truth. The parrot idiots who compare Covid to a URI (idiots) or 1918 (idiots) have some clout and will kill millions thanks to their willful stupidity. Gotta give Trump props for his influence.
This sucks. A lot.


Orange Crush

Posts:3182

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12/26/2020 06:38 PM
I’ll put the Trump factor at best at 10% though. Yes he’s very visual and vocal but the idiocy exists everywhere in places far beyond his reach. This is largely a fight against people’s personal behaviours. Trump is merely the most obvious marker of those behaviours As was his entire reign, a symptom of much a cause of little.
79pmooney

Posts:2543

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12/27/2020 12:04 AM

Posted By Orange Crush on 12/26/2020 06:38 PM
I’ll put the Trump factor at best at 10% though. Yes he’s very visual and vocal but the idiocy exists everywhere in places far beyond his reach. This is largely a fight against people’s personal behaviours. Trump is merely the most obvious marker of those behaviours As was his entire reign, a symptom of much a cause of little.


No, the Trump factor is far higher because of what he did (and didn't do) before COVID even existed. He fired the emergency manager he was a require by law to start his term with. (George W created the law that started that position. Obama had that manager and got us through SARS and Ebola nearly unscathed.) That manager was as I understand it, an Admiral. He came on with his full staff. So we had someone who geared his life around being "that guy" who takes charge and accepts full responsibility. Someone who knows how to delegate. Had he still been employed, he would have been the one to see to it that between the FDA and CDC, testing that worked would have been in place radically faster. Maybe he would have put contact tracing in place.

Early on, apparently that Admiral spoke up when he saw something that required comment. Got fired. Trump never replaced him. Had we a responsible person in charge, the early weeks would have been very different. That could haver made a 50% difference. Maybe more.
Orange Crush

Posts:3182

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12/27/2020 12:49 AM
Aggravating actions yes but to think absence of those would have fundamentally altered the course is wishful thinking.

There was a pretty detailed expert analysis done on key differences in trajectories between Canada and US some time ago. It cut roughy as one third factor being US having a lot larger urban centres (population density). The second third came down to US having poorer antecedent health care conditions (our medical system is better and has been a long time). The final one third came down to politics which again cut further into state responses (presumably like in Canada the main responsibility level) and federal responses. That’s where you get to that 10ish percentage all of the antics notwithstanding.

Canada incidentally sits at about 40% of per capita death rate of US but the situation in Quebec is essentially the same as US average. As are about 15 or so other mostly European countries that crossed the line of 1 death per 1000 inhabitants before US did (numerous countries have started crossing that line in recent weeks). As bad as the guy is the blind focus on Trump is not doing anyone any favours and just avoids the hard questions on personal and societal responsibility. BC incidentally sits at about half the Canadian rate or 20% of US average but as our top doc will remind everyone a lot of it just comes down to dumb luck. Btw - did W start that position before or after he botched Katrina?

longslowdistance

Posts:2226

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12/27/2020 12:50 PM
SARS and ebola were the real motivators. The agency that Trump dismantled was built mainly under Obama.
79pmooney

Posts:2543

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12/27/2020 01:04 PM
OC, after Katrina. One of his last acts in office. The law means that each cabinet office must sit down with its successor, brief them on what the job entails and the resources available so that the contentious hand-offs like Clinton to Bush don't happen. Also created the new post so there was someone in the White House with he sole responsibility of being ready to step up and take charge in emergencies. (While all is quiet, he is expected to be there to hear the concerns of the FDA, CDC, Army Corps of Engineers, etc. He would have been expected to point out that the Army Corps needed a few million to beef up the levies in New Orleans. Note that CDC had concerns on the low levels of stuff needed for a pandemic, etc.)

Thanks to Bush, the hand-off to Obama went very smoothly and we got to see it work. (Except a massive pandemic that doesn't happen doesn't get great press. Just the usual "botched job" because a few dozen or hundreds died. Yes, both SARS and Ebola are far less contagious than COVID so the numbers would have been an order of magnitude or two smaller but they are also more deadly.) Obama made it a big point to do the same good hand-off to Trump and it actually went very well. Sadly, before they were needed, all the recipients of the knowledge and resources were long gone

The large batch of tests Trump was promising (100,000? Million? I forget the decimal place.) ... good idea, but - the man to step up, take charge and see to it that all the "i"s were dotted and "t"s were crossed was gone. Instead, Trump's son in law ran the ship. He was clueless. One of the "t"s was that the tests had to be refrigerated the whole time. Granted a detail that an Admiral would not know, so Trump's in-law can be forgiven, BUT that Admiral would have delegated the ordering to someone who's job it was to get all those details right.
Orange Crush

Posts:3182

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12/27/2020 02:28 PM
They actually sunk 15 billion into long overdue levee upgrades post Katrina but it is still not to a sufficient enough design standard. They lowered the standard to keep cost down from initial recommendations.

That is typical situation with emergency preparedness. When Canadian feds started looking at their pandemic supplies they found that everything had been budgeted away and the stockpile to support provinces was pretty useless bunch of outdated crap. Many countries found the same thing. Human attention spans are short and people prefer lower taxes.

I’d rate our federal involvement in pandemic response at maybe 10%. Border closures, CDC knowledge sharing, vaccine approvals. That is about it. 90% is provinces doing their thing with vastly different approaches and outcomes which largely is a reflection of provincial politics and propensity of population to follow instructions. Those last two aspects go hand in hand. Areas and countries with populations that are willing to listen to authority have generally fared much better than areas and countries with rugged individualism (the Netherlands has a lot of the latter surprisingly). This is the one overarching theme that seems to hold true globally. Enter Belgium with a per capita death rate that is highest in world (close to 2x US) where no one listens to government because the last time government made sense was many decades ago. If you cross the language border walking the streets of Brussels the Covid guidelines will change day to night such is the measure of chaos. That admiral got lucky, he would have fought a losing battle, Covid is a far more challenging beast than SARS or Ebola. BCs top doc who battled both is finding that out. It’s fortunate that she operates at a provincial level where she can actually make a difference. At a federal level she would have been lost in the waves, too far removed from the trenches (ok they don’t actually have any trenches in the navy).
79pmooney

Posts:2543

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12/27/2020 03:04 PM
The navies do deal with trenches, but they really try to not drop their ships in them. (Recovery from 20,000 feet is expensive. And the whole (military) world knows you have valuable secrets down there.)
79pmooney

Posts:2543

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01/08/2021 12:50 PM
Yeah!

https://www.nytimes.com/2021/01/08/world/biden-vaccine.html

Releasing all the vaccine shots available for first shots! Yes, we do not get vaccinated correctly. We will probably have more than a few vaccinated get sick. But the big challenge is to slow a huge tidal wave. We need to stick as many arms as we can to slow this monster. 100s, 1000s, even 10,000s of deaths from no second shot are small compared to what is happening right now. (We are on schedule to match the WW2 deaths late April.)

Action. Common sense. Looking at the big picture. What a concept!
Orange Crush

Posts:3182

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01/08/2021 02:36 PM
Curious how this squares with previous note that vaccines were being unused and going to waste? These are two very different problems.

Releasing more vaccines is easy (Biden is basically mimicking Israel's approach) but you have to be able to effectively administer them at the same pace (a much harder problem that happens in the trenches and at local government scale). Opening up more vaccination centres (which sounds like it is being worked on but specifics are lacking) will be the crucial part.
79pmooney

Posts:2543

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01/08/2021 04:11 PM
OC, sadly those details are up to the person in charge or whomever he delegates. And for now, Biden isn't that person. I hope he can put that person in charge fast so we get an overall plan of action that can be carried out, something we haven't seen yet at any level.
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