Let The Repairs Begin

I don't envy this man, but I am certainly wishing him, his Vice President, and the American people all the best for the future.

After Trump finally has given in and authorized his agency to begin the formal transition, President-elect Biden can now begin the long process of repairs to the country. The workload must feel crushing for any man. But I am sure Joe Biden will be hiring the very best qualified people for the job. 

The long road to normalcy will begin with containing the virus. World leaders are already looking forward to restart normal relations with the United States. Trade wars will come to an end. Regulatory environmental damage done by the Trump administration can be undone. The many vacant government positions from the last 4 years can be filled again. Immigrant children can be released from cages. Honesty from government agencies will return. No more "alternative facts" at press briefings. 

If you want to know more about your new president I recommend to read the book he wrote about the year Joe and Jill lost their son Beau "Promise me Dad"

Congratulations to your new President and First Lady.

The Pandemic is Real Folks!

If you think that the pandemic is a hoax or just a tool to control the people or that the virus is going to be under control any time soon, I recommend you read the story published first by THE ATLANTIC. As much as this story might scare you, the overall daily case numbers in the US have almost reached 200,000 with 2000 deaths, and it is still rising fast. The overall accumulated world case number stands now at 58mill with whereof 12mill Covid cases are in the U.S. , a sad record of negligence. 

Republished

Hospitals Know What’s Coming

Ed Yong  THE ATLANTIC

Perhaps no hospital in the United States was better prepared for a pandemic than the University of Nebraska Medical Center in Omaha.

After the SARS outbreak of 2003, its staff began specifically preparing for emerging infections. The center has the nation’s only federal quarantine facility and its largest biocontainment unit, which cared for airlifted Ebola patients in 2014. The people on staff had detailed pandemic plans. They ran drills. Ron Klain, who was President Barack Obama’s “Ebola czar” and will be Joe Biden’s chief of staff in the White House, once told me that UNMC is “arguably the best in the country” at handling dangerous and unusual diseases. There’s a reason many of the Americans who were airlifted from the Diamond Princess cruise ship in February were sent to UNMC.

In the past two weeks, the hospital had to convert an entire building into a COVID-19 tower, from the top down. It now has 10 COVID-19 units, each taking up an entire hospital floor. Three of the units provide intensive care to the very sickest people, several of whom die every day. One unit solely provides “comfort care” to COVID-19 patients who are certain to die. “We’ve never had to do anything like this,” Angela Hewlett, the infectious-disease specialist who directs the hospital’s COVID-19 team, told me. “We are on an absolutely catastrophic path.”

To hear such talk from someone at UNMC, the best-prepared of America’s hospitals, should shake the entire nation. In mid-March, when just 18 Nebraskans had tested positive for COVID-19, Shelly Schwedhelm, the head of the hospital’s emergency-preparedness program, sounded gently confident. Or, at least, she told me: “I’m confident in having a plan.” She hoped the hospital wouldn’t hit capacity, “because people will have done the right thing by staying home,” she said. And people did: For a while, the U.S. flattened the curve.

But now about 2,400 Nebraskans are testing positive for COVID-19 every day—a rate five times higher than in the spring. More than 20 percent of tests are coming back positive, and up to 70 percent in some rural counties—signs that many infections aren’t being detected. The number of people who’ve been hospitalized with the disease has tripled in just six weeks. UNMC is fuller with COVID-19 patients—and patients, full stop—than it has ever been. “We’re watching a system breaking in front of us and we’re helpless to stop it,” says Kelly Cawcutt, an infectious-disease and critical-care physician.

Cawcutt knows what’s coming. Throughout the pandemic, hospitalizations have lagged behind cases by about 12 days. Over the past 12 days, the total number of confirmed cases in Nebraska has risen from 82,400 to 109,280. That rise represents a wave of patients that will slam into already beleaguered hospitals between now and Thanksgiving. “I don’t see how we avoid becoming overwhelmed,” says Dan Johnson, a critical-care doctor. People need to know that “the assumption we will always have a hospital bed for them is a false one.”

What makes this “nightmare” worse, he adds, “is that it was preventable.” The coronavirus is not unstoppable, as some have suggested and as New Zealand, Iceland, Australia, and Hong Kong have resoundingly disproved—twice. Instead, the Trump administration never mounted a serious effort to stop it. Whether through gross incompetence or deliberate strategy, the president and his advisers left the virus to run amok, allowed Americans to get sick, and punted the consequences to the health-care system. And they did so repeatedly, even after the ordeal of the spring, after the playbook for controlling the virus became clear, and despite months of warnings about a fall surge.

Not even the best-prepared hospital can compensate for an unchecked pandemic. UNMC’s preparations didn’t fail so much as the U.S. created a situation in which hospitals could not possibly succeed. “We can prepare over and over for a wave of patients,” says Cawcutt, “but we can’t prepare for a tsunami.”

A full hospital means that everyone waits. COVID-19 patients who are going downhill must wait to enter a packed intensive-care unit. Patients who cannot breathe must wait for the many minutes it takes for a nurse elsewhere in the hospital to remove cumbersome protective gear, run over, and don the gear again. On Tuesday, one rapidly deteriorating patient needed to be intubated, but the assembled doctors had to wait, because the anesthesiologists were all busy intubating four other patients in an ICU and a few more in an emergency room.

None of the people I spoke with would predict when UNMC will finally hit its capacity ceiling, partly because they’re doing everything to avoid that scenario, and partly because it’s so grim as to be almost unthinkable. But “we’re rapidly approaching that point,” Hewlett said.

When it arrives, people with COVID-19 will die not just because of the virus, but because the hospital will have nowhere to put them and no one to help them. Doctors will have to decide who to put on a ventilator or a dialysis machine. They’ll have to choose whether to abandon entire groups of patients who can’t get help elsewhere. While cities like New York and Boston have many big hospitals that can care for advanced strokes, failing hearts that need mechanical support, and transplanted organs, “in this region, we’re it,” Johnson says. “We provide care that can’t be provided at any other hospital for a 200-mile radius. We’re going to need to decide if we continue to offer that care, or if we admit every single COVID-19 patient who comes through our door.”

During the spring, most of UNMC’s COVID-19 patients were either elderly people from nursing homes or workers in meatpacking plants and factories. But with the third national surge, “all the trends have gone out the window,” Sarah Swistak, a staff nurse, told me. “From the 90-year-old with every comorbidity listed to the 30-year-old who is the picture of perfect health, they’re all requiring oxygen because they’re so short of breath.”

This lack of pattern is a pattern in itself, and suggests that there’s no single explanation for the current surge. Nebraska reopened too early, “when we didn’t have enough control, and in the absence of a mask mandate,” Cawcutt says. Pandemic fatigue set in. Weddings that were postponed from the spring took place in the fall. Customers packed into indoor spaces, like bars and restaurants, where the virus most easily finds new hosts. Colleges resumed in-person classes. UNMC is struggling not because of any one super-spreading event, but because of the cumulative toll of millions of bad decisions.

When the hospital first faced the pandemic in the spring, “I was buoyed by the realization that everyone in America was doing their part to slow down the spread,” Johnson says. “Now I know friends of mine are going about their normal lives, having parties and dinners, and playing sports indoors. It’s very difficult to do this work when we know so many people are not doing their part.” The drive home from the packed hospital takes him past rows of packed restaurants, sporting venues, and parking lots.

To a degree, Johnson sympathizes. “I don’t think people in Omaha thought we could ever have something that resembles New York,” he told me. “To be honest, in the spring, I would have thought it extremely unlikely.” But he adds that the Midwest has taken entirely the wrong lesson from the Northeast’s ordeal. Instead of learning that the pandemic is controllable, and that physical distancing works, people instead internalized “a mistaken belief that every curve that goes up must come down,” he said. “What they don’t realize is that if we don’t change anything about how we’re conducting ourselves, the curve can go up and up.”

Speaking on Tuesday afternoon, Nebraska Governor Pete Ricketts once again refused to issue a statewide mask mandate. He promised to tighten restrictions once a quarter of the state’s beds are filled with COVID-19 patients, but even then, some restaurants will still offer indoor dining; gyms and churches will remain open; and groups of 10 people will still be able to gather in enclosed spaces. Ricketts urged Nebraskans to avoid close contact, confined areas, and crowds, but his policies nullify his pleas. “People have the mistaken belief that if the government allows them to do something, it is safe to do,” Johnson said.

There are signs that citizens and businesses are acting ahead of policy makers. Some restaurants are ceasing indoor dining even without a prohibition. Parents are pulling their children out of schools and sports leagues. “I have heard from more friends and family about COVID-19 in the last two weeks than I have in the previous six months, expressing support and a change in attitudes,” Johnson said.

But COVID-19 works slowly. It takes several days for infected people to show symptoms, a dozen more for newly diagnosed cases to wend their way to hospitals, and even more for the sickest of patients to die. These lags mean that the pandemic’s near-term future is always set, baked in by the choices of the past. It means that Ricketts is already too late to stop whatever UNMC will face in the coming weeks (but not too late to spare the hospital further grief next month). It means that some of the people who get infected over Thanksgiving will struggle to enter packed hospitals by the middle of December, and be in the ground by Christmas.

Officially, Nebraska has 4,223 hospital beds, of which 1,165—27 percent—are still available. But that figure is deceptive. It includes beds for labor and deliveries, as well as pediatric beds that cannot be repurposed. It also says nothing about how stretched hospitals have already become in their efforts to create capacity. UNMC has postponed elective surgeries—those which could be deferred for four to 12 weeks. Patients with strokes and other urgent traumas aren’t getting the normal level of attention, because the pandemic is so all-consuming. Clinical research has stopped because research nurses are now COVID-19 nurses. The hospital is forced to turn down many requests to take in patients from rural hospitals and neighboring states that are themselves almost out of beds.

Empty hospital beds might as well be hotel beds without doctors and nurses to staff them. And though health-care workers are resilient, “many of us feel like we haven’t had a day off since this thing began,” Hewlett says. The current surge is pushing them to the limit because people with COVID-19 are far sicker than the average patient. In an ICU, they need twice as much attention for three times the usual stay. To care for them, UNMC’s nurses and respiratory therapists are now doing mandatory overtime. The hospital has tried to hire travel nurses, but with the entire country calling for help, the pool of reinforcements is dry. “Even before COVID-19 hit, we were short-staffed,” says Becky Long, a lead nurse on a COVID ICU floor. Of late, there have been days when the hospital had 45 to 60 fewer nurses than it needed. “Every time I’ve been at work, I’ve thought: This is going to be the final straw. But somehow we continue to make it work, and I truly have no idea how.”

Before COVID-19, Long worked in oncology. Death is no stranger to her, but she tells me she can barely comprehend the amount she has seen in recent weeks. “I used to be able to leave work at work, but with the pandemic, it follows me everywhere I go,” she said. “It’s all I see when I come home, when I look at my kids.”

Long and other nurses have told many families that they can’t see their dying loved ones, and then sat with those patients so they didn’t have to die alone. Lindsay Ivener, a staff nurse, told me that COVID-19 had recently killed an elderly woman whom she was caring for, the woman’s husband, and one of her grandchildren. A second grandchild had just been admitted to the hospital with COVID-19. “It just tore this whole family apart in a month,” Ivener said. “I couldn’t even cry. I didn’t have the energy.”

Until recently, Ivener worked in corporate America as a retail buyer and inventory manager. Wanting to help people, she retrained as a nurse and graduated this May. “I’ve only worked as a nurse during a pandemic,” she told me. “It’s got to get better, right?”

Christian Hypocrisy

It is a few years ago that one of my readers suggested that Trump was sent by God to rule and govern the United States. Of course, I knew why the person was saying that. She was one of the evangelicals whose world view is dominated by their very own interpretation of the bible. 

However, it is most amazing how the view of these people varies depending on which person they are talking about. 

Here is a 2018 article written by NC Christian Pastor John Pavlovitz:

Dear White Evangelicals,

I need to tell you something: People have had it with you. They’re done. They want nothing to do with you any longer, and here’s why:

They see your hypocrisy, your inconsistency, your incredibly selective mercy, and your thinly veiled supremacy.

For eight years they watched you relentlessly demonize a black President; a man faithfully married for 26 years; a doting father and husband without a hint of moral scandal or the slightest whiff of infidelity. They watched you deny his personal faith convictions, argue his birthplace, and assail his character — all without cause or evidence. They saw you brandish Scriptures to malign him and use the laziest of racial stereotypes in criticizing him.

And through it all, Christians — you never once suggested that God placed him where he was, you never publicly offered prayers for him and his family, you never welcomed him to your Christian Universities, you never gave him the benefit of the doubt in any instance, you never spoke of offering him forgiveness or mercy, your evangelists never publicly thanked God for his leadership, your pastors never took to the pulpit to offer solidarity with him, you never made any effort to affirm his humanity or show the love of Jesus to him in any quantifiable measure.

You violently opposed him at every single turn — without offering a single ounce of the grace you claim the heart of your faith tradition. You jettisoned Jesus as you dispensed damnation on him. And yet today, you openly give a “mulligan” to a white Republican man so riddled with depravity, so littered with extramarital affairs, so unapologetically vile, with such a vast resume of moral filth — that the mind boggles.

And the change in you is unmistakable. It has been an astonishing conversion to behold. With him, you suddenly find religion. With him, you’re now willing to offer full absolution. With him, all is forgiven without repentance or admission. With him you’re suddenly able to see some invisible, deeply buried heart. With him, sin has become unimportant, compassion no longer a requirement. With him, you see only Providence.

And white Evangelical, all those people who have had it with you — see it all clearly. They recognize the toxic source of your duality. They see that pigmentation and party are your sole religion.

They see that you aren’t interested in perpetuating the love of God or emulating the heart of Jesus. They see that you aren’t burdened to love the least, or to be agents of compassion, or to care for your Muslim, gay, African, female, or poor neighbors as yourself. They see that all you’re really interested in doing, is making a God in your own ivory image and demanding that the world bow down to it. They recognize this all about white, Republican Jesus, not dark-skinned Jesus of Nazareth.

And I know you don’t realize it but your digging your own grave in these days; the grave of your very faith tradition. Your willingness to align yourself with cruelty is a costly marriage. Yes, you’ve gained a Supreme Court seat, a few months with the Presidency as a mouthpiece, and the cheap high of temporary power — but you’ve lost a whole lot more.

You’ve lost an audience with millions of wise, decent, good-hearted, faithful people with eyes to see this ugliness. You’ve lost any moral high ground or spiritual authority with a generation. You’ve lost any semblance of Christlikeness. You’ve lost the plot. And most of all you’ve lost your soul.

I know it’s likely you’ll dismiss these words. The fact that you’ve even made your bed with such malevolence, shows how far gone you are and how insulated you are from the reality in front of you.

But I had to at least try and reach you. It’s what Jesus would do. Maybe you need to read what he said again — if he still matters to you.

Are YOU OK With This?

Donald Trump’s Deadly 

Last Stand

By Greg Gonsalves THE NATION

The Republican delay in acknowledging defeat and facilitating the transition will be literally fatal to thousands of Americans.

There are now fewer than 70 days to go until the inauguration of Joe Biden as president of the United States. No matter which candidate you supported in the Democratic primaries, many of us breathed a sigh of relief as the election was called for the former vice president four days after people went to the polls.

As an epidemiologist, watching this pandemic unfold in this country with a ferocity that is still unabated, a weight was lifted off me and others in public health. Finally, we had actually turned a corner. With the announcement of President-elect Biden’s Covid-19 Task Force, which will put a roster of well-known, solid leaders in health at the table, the prospect of normal competence in our pandemic response was—is—now tantalizingly close.

But then. President Donald Trump refuses to concede. He has blocked any transition activities from happening, meaning the usual communications and discussions between incoming and outgoing administration officials isn’t occurring. In ordinary times, this would be a scandal; no sitting president has refused to concede an election and blocked the transition of power like this. Even in normal times, such petulance would be antidemocratic, putschist.

In a pandemic, when time is of the essence, these delays are catastrophic. Cases of Covid-19 are skyrocketing in the United States. On November 10, we had close to 140,000 new cases—an almost 70 percent increase from the previous two weeks and with cumulative cases now passing the 10 million person threshold. We’re well over 1,000 deaths per day now, too, with close to 1,500 as of November 10 and with cumulative deaths now just over 240,000 men, women, and children in our country Instead of breaking with the president, even as world leaders congratulate Biden on his victory, almost all of the GOP members of Congress, the Republican Party—and our own Russia Today, Fox News—have indulged Trump’s antics, risking a protracted stalemate on a transition that drags on for weeks. Count the dead: 1,000 per day, to be conservative. In a week, there will be 7,000 dead. In two weeks, 14,000 bodies buried in the cold, hard ground.

Many of us have been saying for months that this winter was going to be grim. Such predictions were not difficult to make in the context of a complete abdication of federal response to the pandemic, with mini-me Republican governors aping Trump’s nonchalance around the country. But although winter doesn’t actually start until December, the flood of viral transmission we expected—with cooler weather driving people indoors, with all of us tired, just exhausted and frustrated with social distancing measures, and with no visible support from our leaders—is here now.

It’s not clear people recognize the new danger in our midst. As the election returns intimated, many Americans have experienced this pandemic as an economic and social disaster—not an epidemiological one. Many people in the United States still don’t know someone who has contracted SARS-CoV-2, let alone died of Covid-19. So even news reports of a viral resurgence aren’t having the same effect as the first reports of the pandemic in the late winter last year did, prompting many people to shelter in place of their own volition. Right now, most new infections are happening in small social gatherings at home. As the holidays approach, as we crave the social connection we’ve all missed for most of this year, the chance for the virus to party-crash Thanksgiving, Christmas, Hannukah, Kwanzaa, and New Year’s celebrations is high. Set another chair for SARS-CoV-2.

As if the last 70 days of the Trump administration couldn’t get any worse, Senate majority leader Mitch McConnell has signaled that he has no appetite for pandemic relief of any useful size, telling the press: “I don’t think the current situation demands a multi-trillion dollar package. So I think it should be highly targeted, very similar to what I put on the floor in both October and September.” McConnell, of course, hasn’t crunched the numbers with epidemiologists, physicians, public health experts, or economists at his side.

Most people who actually know anything about the virus and its downstream economic and social effects recognize that a massive relief package is needed right now to put into place the public health measures that the current administration has ignored. We desperately need to get real, substantial support to ordinary Americans—not to the corporations who dined so well on the last pandemic relief bill.

Of course, McConnell doesn’t really care about the pandemic. He will continue to dance his one-note samba of political destruction, seeking to bring down the other party at all costs, even as the dead from Covid-19 pile up around him and the economy lies in ruins. While Trump himself may be gone in January, McConnell has high hopes of still being the majority leader in the Senate. If he is, the relief many of us in public health felt a few days ago will evaporate.

Yes, Biden can try to do things through executive order, to use the bully pulpit of the presidency to urge Americans to follow public health guidance. But the scale of the response we need right now to confront the pandemic and its economic and social costs is nothing short of a domestic Marshall Plan. Right now, McConnell is the one thing blocking our road to recovery. He is even deadlier than a virus.