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“A “Catch-22” is “a problematic situation for which the only solution is denied by a circumstance inherent in the problem or by a rule.”^[13] For example, losing something is typically a conventional problem; to solve it, one looks for the lost item until one finds it. But if the thing lost is one’s glasses, one cannot see to look for them — a Catch-22. The term “Catch-22″ is also used more broadly to mean a tricky problem or a no-win or absurd situation”

You mean there’s a catch?”

“Sure there’s a catch,” Doc Daneeka replied. “Catch-22. Anyone who wants to get out of combat duty isn’t really crazy.”

Or as in the current covid-19 response by federal and state governments there is an inherent contradiction……a catch 22. In its attempt to avoid responsibility Trump’s administration has forced the 50 states, each alone, to seek and purchase medical supplies to fight the coved-19 pandemic, often in competition with each other. This, instead of a federally organized more centralized purchase and triage of resources–the approach used successfully in the past.

However there is a catch….. and this is actually happening

“But what I’m more interested in are reports of federal authorities confiscating physical shipments en route to states, local governments or regional hospital systems. The most publicized case of this came at some point in March when, according to Massachusetts Gov. Charlie Baker (R), a shipment of 3 million masks ordered through BJ’s Wholesale was seized by federal authorities in the Port of New York. Baker did not say which agency confiscated the goods or under what authority. That incident was what led to the widely reported and successful effort to fly goods in from China using the New England Patriots jet.”

Medicynical note: in its embarrassing response to the coved-19 pandemic the government under Trump has gone full schizoid. On one hand the states and municipalities are told by Trump and his feckless son-in-law that they are on their own and must seek resources without federal aid– a totally chaotic (read that Trumpian) approach. And on the other hand, simultaeously Trump’s government blocks and seizes those purchases.

Catch-22

Trump’s amazingly ineffective response to the covid-19 epidemic is again highlighted.   Thank you China.

“The New York governor said Saturday the Chinese government was facilitating a shipment of 1,000 donated ventilators to his state, highlighting the extreme measures leaders are taking in what has become a cutthroat scramble to independently secure enough lifesaving devices during the coronavirus pandemic. ”

And our President who has presided over the dismantling of our government’s epidemic response team over the past three years wants to be thanked for his too little too late dysfunction.

“Leaders like Cuomo have been forced to go outside normal channels and work with authoritarian governments and private companies”

“The rush to secure supplies has prompted intense squabbling between the states and federal government at a moment the nation is facing one of its gravest emergencies.”

“Trump said states are marking inflated requests for medical supplies when the need isn’t there and suggested he had a hand in the ventilator shipment arriving from China to New York. Trump also said he’d like to hear a more resounding “thank you” from Cuomo for providing medical supplies and helping quickly add hospital capacity.” (emphasis medicynic)

Medicynical Note:  Trump’s chaos defines the U.S. response.  No organization; Inexperienced staff:  Mixed messages; and of course always the need for trumped up praise for our totally out of the loop leader…….you know who.

Trump’s only action to interdict the coved-19 epidemic before mid March was to decrease the number of direct flights from China. This action not only failed to stop the spread of the disease into the country and it, of course, failed to stop the spread within the country.

In fact : “Since Chinese officials disclosed the outbreak of a mysterious pneumonialike illness to international health officials on New Year’s Eve, at least 430,000 people have arrived in the United States on direct flights from China, including nearly 40,000 in the two months after President Trump imposed restrictions on such travel, according to an analysis of data collected in both countries.”

“The bulk of the passengers, who were of multiple nationalities, arrived in January, at airports in Los Angeles, San Francisco, New York, Chicago, Seattle, Newark and Detroit. Thousands of them flew directly from Wuhan, the center of the coronavirus outbreak, as American public health officials were only beginning to assess the risks to the United States.”

“Flights continued this past week, the data show, with passengers traveling from Beijing to Los Angeles, San Francisco and New York, under rules that exempt Americans and some others from the clampdown that took effect on Feb. 2. In all, 279 flights from China have arrived in the United States since then, and screening procedures have been uneven, interviews show.”

Medicynical note: Trump’s claim that stopping flights from China save lives, like most of his claims, is false. It didn’t save lives and he didn’t stop flights. His is the least effective worst managed most disastrous administration in U.S. history.

In Animal Farm, by George Orwell one of the key actions of a satirical revolutionary government was to weaponize propaganda to justify the actions of the governing pig. In it, you will recall Napoleon’s initial edict written on a wall sign proclaiming that “All animals are equal” morphed into “All animals are equal but some are more equal”

This narrative came to mind today as the Trump administration, in the midst of one of the worst crises our government has ever faced, retreated from one of the traditional roles of government in supporting states.

“Kushner on Thursday evening offered a novel argument about the national stockpile. He said some states still had stockpiles that they hadn’t been employing for the coronavirus outbreak and that localities should go to them first. And then he suggested that the national stockpile wasn’t even meant for them.”

“And the notion of the federal stockpile was it’s supposed to be our stockpile,” Kushner said. “It’s not supposed to be states’ stockpiles that they then use.”

“As reporters quickly noted, that didn’t match with how the Department of Health and Human Services was describing the program. On its website, it said. “Strategic National Stockpile is the nation’s largest supply of life-saving pharmaceuticals and medical supplies for use in a public health emergency severe enough to cause local supplies to run out.” It continued to say, “When state, local, tribal, and territorial responders request federal assistance to support their response efforts, the stockpile ensures that the right medicines and supplies get to those who need them most during an emergency.”

But overnight the HHS website’s description changed, a little like the pigs alteration of the sign in animal farm……

it now says. “Many states have products stockpiled, as well. The supplies, medicines, and devices for life-saving care contained in the stockpile can be used as a short-term stopgap buffer when the immediate supply of adequate amounts of these materials may not be immediately available.”

Here are the before and after statements.

Medicynical note: This change in the handwriting on the wall is not surprising when one considers that the leader of our country lies several times a day. And when he’s reminded of the lie, which was made in public and on video recordings, he denies it. It’s only a small step from that to following the actions of Napoleon the pig. If it weren’t so tragic, the imagery would be a cause of hilarity.

Trump’s CV reads like a comedic list of bad practices. His companies went bankrupt five times….each time screwing his investors. Trump University (sic) was revealed to be a massive scam; his “charity” was deemed bogus.

Sadly that wasn’t enough. Through the aberration in the U.S. electoral system that allows election as president with a minority of votes, he became president and doubled the country’s yearly deficit by giving a tax cut to the wealthiest 1% in the country by spending on everything but essential services. He’s encouraged homophobia, racism, and white supremacy. He gutted environmental laws, appointed incompetents to the judicial system, and undermined health care to name a few of his “accomplishments”.

So come a real health emergency, the US has virtually no defenses in place. Nobody in charge. Chaos.

After ignoring warnings about the epidemic in China, he played a “hunch” that it would all go away (he was wrong) and he hoped for a miracle (nope). As if that were not enough after very preliminary reports that a drug might work, Trump declares the drug a miracle. In typical Trumpian hyperbole he “claimed the use of the drug in combination with azithromycin, an antibiotic, could be “one of the biggest game changers in the history of medicine”. the drug was hydroxychloroquine, and as is usually the case with Trump…….he seems to be wrong

Medicynical note: Trump has a limited ability to analyze. He disregards data and doesn’t trust science. So rather than waiting for information to develop he jumps to erroneous conclusions. Recently he’s been wrong more than the often cited stopped clock.

Give credit where credit is due. His actions and inaction are literally killing us.

It’s clear that the U.S. didn’t respond quickly enough to this epidemic. “You know who” thought it was a hoax that would disappear like a miracle.  He also had fired the staff and funding of the NSC group that was tasked with planning and preparing the country for such an epidemic and cut the CDC staff and funding, here and in China, tasked with following and reporting on epidemics elsewhere.  We are unprepared for the  rapid acceleration of cases and need for equipment.

As is his tendency to speak without serious analysis “you know who” recently raised the question as to whether physicians and nurses were hoarding or otherwise nefariously creating a face mask and ventilator shortage. He doesn’t understand why a city might need a hundred of thousand or more face masks each day and postulated that the professionals were purposely and illegally creating the nationwide shortages.

Because “you know who” is, to put it gently, data naive, lets analyze his accusation in regard to face masks.  Lets say you are New York City in the midst of a once in a century accelerating epidemic that has killed several hundred residents in the space of three weeks.  It’s very infectious from exposure in the air and on surfaces.

Lets also say for the sake of simplicity that each acute care hospital in the city (there are 62) has 1000 employees interacting with patients and the public, some hospitals will have many more and  some  may have fewer. But to keep it simple for “you know who” lets call it 1000/hospital.

Each staff member interacting with people and patients during the epidemic needs to wear a mask. (that is everyone on a hospital staff).  Lets say for the sake of simplicity again for “you know who”, that 400 employees of each hospital are not in direct patient care but interact with the public.  And that 600 are in direct contact with patients.

The first group  will change their mask on an average of twice a day.  Some may change more often, some less but for the sake of “you know who” lets estimate that they change twice daily.  Why?  breathe into a mask for 8 hours straight and it becomes moist and contaminated.

For this group of employees the usage  totals 400 employees X 62 hospitals X 2 =  49,600 masks/day. 

The other 600 will change their mask more frequently.  Best practice is that a new mask be used for each patient seen.  For an ER doctor that might be 20 patients in a shift.  While a ward nurse might be responsible for anywhere from 4-8 patients depending on the type patients they are caring for.     Lets say again for simplicity and “you know who” that each of these professionals changes a mask and average of 5 times a day.  Not ideal but this is an epidemic and there is a supply shortage.

For this group of employees usage totals 600 employees X 62 acute care hospitals X 5 = 186,000 masks a day.  

If they were to change after every patient seen, say an average of 10 times a day the totals would be 600 X 62 X 10 = 372,000 masks per day.

Medicynical note:  Mr. “you know who” your track record on this epidemic is abysmal when you make “off the cuff” assessments.  The epidemic is not a media hoax; the epidemic has not gone away like a miracle; It would have been better to have planners following the course of the epidemic in China but you fired them.  Your assessment of the shortage of face masks is obviously ridiculously uninformed.  Please stop it. 

An oft quoted law professor, Richard Epstein, earns the right….to be fired

Mr. Epstein is so certain and wrong that he may qualify to be the next Trump U.S. Medal of Freedom recipient–a very exclusive group that is distinctive for their influence over our fearless leader and their penchant for being embarrassingly, completely,………. wrong. The link above refers to a New Yorker interview during which Epstein’s talent for obfuscation and false analysis is unveiled.

“President Trump, who at one point called the coronavirus pandemic an “invisible enemy” and said it made him a “wartime President,” has in recent days questioned its seriousness, tweeting, “WE CANNOT LET THE CURE BE WORSE THAN THE PROBLEM ITSELF.” Trump said repeatedly that he wanted the country to reopen by Easter, April 12th, contradicting the advice of most health officials. (On Sunday, he backed down and extended federal social-distancing guidelines for at least another month.) According to the Washington Post, “Conservatives close to Trump and numerous administration officials have been circulating an article by Richard A. Epstein of the Hoover Institution, titled ‘Coronavirus Perspective,’ which plays down the extent of the spread and the threat.””

“Epstein, a professor at New York University School of Law, published the article on the Web site of the Hoover Institution, on March 16th. In it, he questioned the World Health Organization’s decision to declare the coronavirus outbreak a pandemic, said that “public officials have gone overboard,” and suggested that about five hundred people would die from covid-19 in the U.S. Epstein later updated his estimate to five thousand, saying that the previous number had been an error. So far, there have been more than two thousand coronavirus-related fatalities in America; epidemiologists’ projections of the total deaths range widely, depending on the success of social distancing and the availability of medical resources, but they tend to be much higher than Epstein’s. (On Sunday, Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, estimated that there could be between a hundred thousand and two hundred thousand deaths in the U.S.) In a follow-up article, published on March 23rd and titled “Coronavirus Overreaction,” Epstein wrote, “Progressives think they can run everyone’s lives through central planning, but the state of the economy suggests otherwise. Looking at the costs, the public commands have led to a crash in the stock market, and may only save a small fraction of the lives that are at risk.””

Medicynical note: Who can believe the uninformed info that this guy spouts?……oh I know. He and others like him are regular guests on that fount of mis-information, FOX news.

“From the debacle over testing to Trump’s months-long denial about the scale of the threat and his constant political point-scoring, the US has showed itself to be anything but a model for the rest of the world to emulate.”

“Stephen Walt, a Harvard University professor of international relations, has argued that worldwide faith in US competence has been one of the pillars of its global standing, and is currently crumbling.”

“”Far from making ‘America great again,’ this epic policy failure will further tarnish the United States’ reputation as a country that knows how to do things effectively,” Walt wrote in Foreign Policy, in a commentary titled “the death of American competence”.”

Medicynical note: Trump appears to have successfully undermined the “administrative” state to the point that it cannot successfully respond to a nationwide threat, much less be of assistance to others. Planning and anticipation are no longer in the U.S. government’s armamentarium. Instead we have a leader with the attention span of a gnat making policy based on bad hunches and suggestions from uninformed TV and radio hosts. His VP is shifting dullness personified as he follows his leader down the path of infamy.

We are left with 50 governors, many quite able, competing with each other for scarce resources for which the federal government has failed to anticipate the need. Our hospitals, staffed by brave but overwhelmed professionals are short of basic protective clothing and life saving equipment. I’ve seen this before in third world countries around the world. Not making America Great seems to be a unique a Trumpian skill.

Trump seems less accurate than a stopped clock. He lies constantly and is proven grotesquely wrong on a daily basis. And by some accident of history, thank you Vladimir, he is the president of the United States.

His lies have consequences.

“Hours after the United States became the nation with the largest number of reported coronavirus cases on Thursday, President Trump appeared on Fox News and expressed doubt about shortages of medical supplies, boasted about the country’s testing capacity, and criticized his predecessor’s response to an earlier outbreak of a different disease.”

“”I don’t believe you need 40,000 or 30,000 ventilators,” he said, alluding to a request by Gov. Andrew Cuomo of New York. The president made the statement in spite of government reports predicting shortages in a severe pandemic — and he reversed course on Friday morning, calling for urgent steps to produce more ventilators.”

“Speaking on Fox on Thursday, Mr. Trump suggested wrongly that because of his early travel restrictions on China, “a lot of the people decided to go to Italy instead” — though Italy had issued a more wide-ranging ban on travel from China and done so earlier than the United States. And at a White House briefing on Friday, he wrongly said he was the “first one” to impose restrictions on China. North Korea, for one, imposed restrictions 10 days before the United States.”

Medicynical note: All presidents at one time or another get caught in speaking not quite the truth. In Obama’s case while drumming up support for the Affordable Care Act he assured people that they would be able to keep their insurer. He was wrong because there were a few insurers who refused to and/or were unable to meet the requirements for participation in the program. But the act resulted in several million more Americans having coverage. Obviously a net good.

In Trump’s case it’s hard to focus on one lie because in every public utterance he includes multiple falsehoods and juvenile attacks on others. Truth is the exception in his comments……..and yet he is tolerated and maintains his supporters. That, of course, is another facet of the current American pathology.

But now people are dying in part because of his slow response to a pandemic. He lies and hurls insults at each daily briefing seemingly unable to comprehend fully what is happening before our eyes. Obviously a net negative.

The least qualified most politically biased man in the world will judge the risk of covid-19 infections. Just a month ago it was his judgement that the epidemic would disappear like a miracle. Now his unique (because no one agrees with him) insight is that more people will die beacause of quarantine than from the disease.

“President Trump said Thursday that he planned to label different areas of the country as at a “high risk, medium risk or low risk” to the spread of the coronavirus, as part of new federal guidelines to help states decide whether to relax or enhance their quarantine and social distancing measures.”

“”Our expanded testing capabilities will quickly enable us to publish criteria, developed in close coordination with the nation’s public health officials and scientists, to help classify counties with respect to continued risks posed by the virus,” Mr. Trump said in a letter to the nation’s governors.”

Medicynical note: His gaffes so far have facilitated the spread and mishandling of the pandemic. He wants to do more. I say spare us.