Medicynic

Willful ignorance is no excuse. Trump gutted the US government’s agencies that were to track and prepare for epidemics. He denied the possibility of a pandemic as the disease spread in other countries. His stoppage of flights from China was a farce–400,000 people retuned from China AFTER the epidemic began and 40,000 more after the so-called, widely ballyhooed, stoppage. They were poorly monitored, kept waiting for hours in crowded airport queues on return. His poorly implemented policy actually increased the risk to the US.

AND:

“The utter unpreparedness of the United States for a pandemic is Trump’s fault. The loss of stockpiled respirators to breakage because the federal government let maintenance contracts lapse in 2018 is Trump’s fault. The failure to store sufficient protective medical gear in the national arsenal is Trump’s fault. That states are bidding against other states for equipment, paying many multiples of the precrisis price for ventilators, is Trump’s fault. Air travelers summoned home and forced to stand for hours in dense airport crowds alongside infected people? That was Trump’s fault too. Ten weeks of insisting that the coronavirus is a harmless flu that would miraculously go away on its own? Trump’s fault again. The refusal of red-state governors to act promptly, the failure to close Florida and Gulf Coast beaches until late March? That fault is more widely shared, but again, responsibility rests with Trump: He could have stopped it, and he did not.”

“The lying about the coronavirus by hosts on Fox News and conservative talk radio is Trump’s fault: They did it to protect him. The false hope of instant cures and nonexistent vaccines is Trump’s fault, because he told those lies to cover up his failure to act in time. The severity of the economic crisis is Trump’s fault; things would have been less bad if he had acted faster instead of sending out his chief economic adviser and his son Eric to assure Americans that the first stock-market dips were buying opportunities. The firing of a Navy captain for speaking truthfully about the virus’s threat to his crew? Trump’s fault. The fact that so many key government jobs were either empty or filled by mediocrities? Trump’s fault. The insertion of Trump’s arrogant and incompetent son-in-law as commander in chief of the national medical supply chain? Trump’s fault.”

PeaceHealth, a multi hospital Catholic healthcare organization in the northwest, like most facilities in the country was unprepared for the coved-19 epidemic. They have experienced severe shortages of PPEs and have compensated by compromising the standard rules of asepsis. The hospital management cites a CDC guideline that allows these bad practices while dealing with a shortage of supplies. This is pragmatic but inadequate and our medical staff is rightly concerned. Denying there is a problem is dishonest and inherently Trumpian.

This is the hospital’s statement. “Caregivers and physicians currently have the PPE they need to care for COVID-19 patients, i.e., patients who require special precautions. However, given the national shortage with PPE, we are using a preservation strategy, recommended by the CDC and supported by our infection preventionists, to help ensure that we can meet the need long term, i.e., should we receive a surge of COVID-19 patients,”

“This preservation strategy is coupled with our efforts to procure and/or manufacture more PPE from local and worldwide sources, including from our community in the form of donations, which are coordinated through Whatcom Unified Command,” Karlapudi said.”

“Those same CDC guidelines allow one surgical mask to be allocated to a caregiver for use for eight hours, provided it doesn’t become compromised or soiled, Karlapudi added.”

The nurses concerns are outlined in the article. They are using one mask a day, some homemade and being asked to reuse them with inadequate procedures to clean them. “In its complaint, the Washington State Nurses Association said nurses were told to re-use and share personal protective equipment such as “PAPR without proper cleaning per manufacturer guidelines” and that “nurses were directed to remove masks before leaving a patient’s room.”

More in the article.

Medicynical note: PeaceHealth could possibly be excused for its lack of preparation, as no one else, including our President responded appropriately. But in their anxiety over criticism PeaceHealth fired an ER doctor who recognized and called attention to the hospital’s lack of preparation. A reprehensible act taken to silence well founded criticism.

For weeks, the Trump administration pushed states to procure their own protective gear, like masks, gloves, ventilators and face shields. But a new effort by the administration to create a hybrid system of distribution — divided between the federal government, local officials and private health care companies — has led to new confusion, bordering on disarray, and charges of confiscation.

“Either be in or out, folks,” Governor Polis said on CNN. “Either you’re buying them and you’re providing them to the states and you’re letting us know what we’re going to get and when we’re going to get them, or stay out and let us buy them.”

In a lengthy conference call with governors on Monday, Vice President Mike Pence, the FEMA administrator and the Navy admiral tapped to lead the government’s logistical “air bridge” tried to lay out how the new system worked.

“What the president has stood up through FEMA today is essentially a control tower at the airport,” Mr. Pence said.

Medicynical note: He’s running it like his businesses……the fraudulent and bankrupt ones.

He’s been wrong since the start. It’s a “media hoax” ; it will disappear “like a miracle”; we’ll have all the tests we need “next week”; “no, I don’t take responsibility at all”. So now, Trump, an uninformed lay person recommends drug treatment for the covid-19 infection based on a small study from a notoriously unreliable French investigator. A guy a little like Dr. Oz or Dr. Drew. Is there any reason to take his advice? The short answe is no. The long answer follows:

“Anthony Fauci is not among the impressed. The day the study came out, Fauci, the leading infectious-disease expert advising the White House’s coronavirus task force, downplayed the findings as “anecdotal.” The report was not a randomized clinical trial—one in which many people are followed to see how their health fares, not simply whether a virus is detectable. And Oz’s “100 percent” interpretation involves conspicuous omissions. According to the study itself, three other patients who received hydroxychloroquine were too sick to be tested for the virus by day six (they were intubated in the ICU). Another had a bad reaction to the drug and stopped taking it. Another was not tested because, by day six, he had died.”

Medicynical note: How fitting, the man who denied the data and refused to accept that the epidemic was real, now, instantly, becomes a self proclaimed medical expert……..a bad one. And yes, you have a lot to lose.

“Even though officials knew since mid-January that hospitals in China were being overwhelmed by patients who required ventilators, getting the attention of the president and other top officials proved difficult. Instead, the federal government left much of the responsibility to acquire supplies to the states, creating a messy patchwork that saw governors outbid each other for desperately needed equipment. Meanwhile, President Donald Trump seemed to spend more time dismissing talk of the virus as exaggerated and some of his top health officials downplayed the risk to Americans.”

Medicynical note: Our leadership (sic) was too busy first calling a pandemic a hoax and then relying on ignorant hunches to prepare.

Trump continues to deny and mismanage. He tells governors that they are in charge and then publicly undercuts them. I wonder whether he learned this management style in college or from his multiple failed businesses.

“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.