Wednesday, March 18, 2020

Opportunity Or Denial

Taking Choices,

We, here in Austin, Texas have taken steps to slow the spread of coronavirus, before seeing evidence with our own eyes of people getting sick and dying. 
This community effort in slowing down and distancing is now completely supported politically.
I say that because they have shut the strip clubs. 
They shut all bars and restaurant dining rooms yesterday, and that includes the politically powerful strip clubs.
I saw rush hour traffic getting a bit less last week, including last Thursday, it was notably decreased on my bike commute Thursday, but markedly decreased Friday, when they closed schools the last day before spring break. 
That was a powerful Friday the 13th message. 
Friday the 6th, they had canceled South By Southwest, the big signal flare.
The Friday evening traffic out of Austin was much, much less than the week before. Traffic this weekend was very light. I should not really call it "traffic" now.
 I worked at People's Community Clinic Monday. I will no longer take Mondays off. 
We were setting up the adult and pediatric patient flows for respiratory precautions, masks, gowns, gloves, swab-testing, cleaning the small set of rooms we are using for that, and isolating people to wait outside in chairs if they are going into that flow. I had no patients scheduled as I was point-man for the first kid (with suspicious and defensive dad) and first adult, then 4 more adults.
We discovered lots of things we needed to adjust, lots of kinks and catches, lots of expenses and limitations of supplies.   We are very short of test kits. We can really only test people with a high suspicion of symptoms of coronavirus, nobody who is asymptomatic. 
We have lots of spring pollen allergies, some colds, still some influenza, lots of worry, and anxiety-patients are all worse than usual.
 I did our first parking-lot visit yesterday, because it was so much less wasteful of resources than using a dedicated room and protective gear for a young mom, there for anxiety/depression, whose very active 4 y/o daughter had allergies and a little cough. The daughter hung out of the back seat window "I'm on top of the world", as I stood outside the driver's door with pen and paper, having reviewed the medical record first, and printed up a few pages for reference.
Tomorrow a team of us will go to the first outdoor tent clinic set-up, being completed today, where I used to do urgent-care work. We will see what we should take, and what we should modify, as we set up our outdoor facility.
 All of this seems quite mundane, and it is a benefit to us, to be able to work out our procedures while things still feel mundane. 
 We have not yet had a positive test result at People's Clinic, though there were 10 confirmed cases reported in Austin yesterday, mainly because of when tests became available and the turn-around time on reporting. This morning there are 7 more confirmed cases here.

 Returning to the community response, it has been wholehearted at all levels, as much as such a thing can be. 
My marker as a bike commuter is the traffic. 
Traffic looks like something well under 10% of usual. It feels like 5-7% of usual. It's just not "traffic".
Everybody in stores and public places ha been showing reserve in their body motions for a week, keeping distances, being careful how they touch things, and there are fewer in the stores, somewhat fewer.

 There are a lot more people out walking as couples, walking dogs, walking with kids and riding bicycles in groups.
 Most of Austin is far more spread out than Asian and European cities, so this is completely safe and sanctioned activity.
Here we see a hidden cost of high-density living, which community planners have been pushing for decades.
 High density occupation is the perfect culture medium for dread contagion. If everybody goes outside the apartment in Wuhan, everybody is mingling in the street in close proximity. There are only some areas of central Austin with dense apartment blocks, of fairly recent construction. I'm concerned about those big, dense apartment blocks and dormitories.
Suburban layout is far safer for social distancing.
 Vegetable gardening is the ideal activity in suburban quarantine, where you are good to walk the dog and ride your bike.
It's funny. All employees are now routed into People's Clinic through the vegetable garden I keep, into the downstairs kitchen-break area, where we get temperature screened before starting work. I intend to post to everybody to grab the sugar-snap peas and gobble them. Delicious, at their prime, and each one untouched-by-human-hands.

 Here at home, the birds and pill-bugs have taken all of the cucumber sprouts I planted last week. I've just planted again, and planted some beans in there to be decoys for the hungry critters. 
I hope it works.

A good epidemiological overview of the situation in the US. 3-4 months of social-distancing will mitigate impact, maybe more than the ultimate mortality. I am not personally optimistic about our being able to do more than that. I don't think we can stamp this out in America, before it smolders through all of society, but that is my personal opinion. I will do my best.
​ ​T​​otal cases in Italy, UK, and Iran have been going up for 1 month (see above). South Korea, with great measures in place, has just stabilised after 1 month. The US, arguably, has bad measures in place. So I estimate 1-2 months of total cases going up.
​ ​Next, people infected start to recover, or die (1-7%). But new people get infected, so the curve becomes flat. The curve was stable for 1-2 weeks in South Korea and China, with good measures in place.
​ ​Then most people have been exposed. You either got it, didn't get it, got sick and recovered, or you're dead. So cases go down. Active cases in China have been going down for 1 month. But people are still dying, and have another 2-3 weeks to go.
​ ​Based on the above, I predict 3-4 months total.

​NPR story seems to show that abstract concept of "threat" is more acceptable, and as the mechanisms to deal with it become closer and personal, more people retreat into denial of the threat. That's not quite how NPR spins this, focusing on political affiliations. I have seen lots of denial of need for personal change from people who feel affiliated with both dominant political parties. 
Poll: As Coronavirus Spreads, Fewer Americans See Pandemic As A Real Threat
​ ​In the face of the coronavirus worsening across the U.S. and reordering the daily life of millions of Americans, fewer people view the pandemic as a real threat, according to a new NPR/PBS NewsHour/Marist poll.
​ ​Just about 56% of Americans consider the coronavirus a "real threat," representing a drop of 10 percentage points from last month. At the same time, a growing number of Americans think the coronavirus is being "blown out of proportion."

"This is like a war"​, some human experiences from inside Italy, where there IS public health infrastructure, but it is overwhelmed by delayed response, and the aggressive spread of virus. (Don't you feel like checking out for awhile? A LOT of my coworkers decided to take this spring break week off. When did they decide that? I just heard about it Friday.)
This man gave his dying sister mouth-to-mouth resuscitation, and stayed with her body at home for 2 days, because bureaucratic regulations did not allow the mortuary to come get her body. How does that feel?
“The reality is this virus is spreading like wildfire. Death is not certain, but the contagion is real,” said Luca Franzese, whose sister, Teresa, 47, died at home in Naples on 7 March.
 “My parents are heartbroken, they are destroyed,” he told the Guardian
​ ​Teresa, who lived with her elderly parents, sister, brother-in-law and their two children, suffered from epilepsy but was otherwise in good health. A week before she died, she came down with the flu.

“My parents called her doctor but they refused to come to the house despite knowing she had a disability,” said Franzese.
“She went into a coma on 7 March, we tried to call the emergency hotline, they arrived after 40 minutes. In the meantime, I tried to give her mouth-to-mouth resuscitation.”
​ ​Teresa tested positive for the virus postmortem...
​ ​It was only after he made an appeal for help via Facebook that a local funeral company eventually came to collect her body. But as with other coronavirus victims, she was buried quickly and without ceremony to mitigate the risk of infection posed by her corpse. Her parents, who have underlying health issues, tested negative for the virus, as did Luca and a nephew. The rest of Teresa’s immediate family of seven have tested positive.

Well, there's that...
The UK Only Realised "In The Last Few Days" That Its Coronavirus Strategy Would "Likely Result In Hundreds of Thousands of Deaths"

​Trump and Pence have Oh-Shit-moment:
'Terrifying' New Research Warns 2.2 Million Could Die From Coronavirus in US Without Drastic Action
"Only now is the White House coming out of denial and heading straight into saying it could not have been foreseen."

​Oh, it even affects the ARMY? What about war. Does everybody just stop for 3 months to be safe?
NATO was on the cusp of initiating a massive war drill called Defender-Europe 20. The 40,000 solider war game would have included 20,000 US troops and accompanied by heavy weaponry but was called off on Monday amid the Covid-19 outbreak across Europe.

​Paul Craig Roberts sees the end of global supply chains and profits and a return to more local economy. The parasitic financial institutions that built this ponzi scheme should net be bailed out, but nationalized, and the indebted citizens should be bailed out to allow a new economy to form. We need a start-over. All of us do.
​ ​For most Americans nationalization is a dirty word, but it has many benefits.  For example, a national health care system reduces costs tremendously by taking profits out of the system.  Additionally, nationalized pharmaceutical companies could be made more focused on research and cures than on profit avenues.  Everyone knows how Big Pharma influences medical schools and medical practice in line with Big Pharma’s approach. A more open-minded approach to medicine would be beneficial.

​Jim Kunstler, who has long predicted a "long emergency", says Things Have Changed.
There will be economic roles and social roles for all those willing to step up to some responsibility. Young people may see tremendous opportunity replacing the wounded economic dinosaurs wobbling across the landscape. It’ll be all about going local and regional and making yourself useful in exchange for a livelihood and the esteem of others around you — aka, your community. Government has been working tirelessly to make itself superfluous, if not completely ineffectual, impotent, and rather loathsome in the face of this crisis that has been slowly-but-visibly building for half a century. Something old and played-out is limping offstage, and something new is stepping on. Aren’t you glad you watched all those debates?

​ Bernie Sanders has suspended his campaign. I think he is still on the ballots everywhere. Swiss-cheesehead Joe Biden is the DNC's choice. 
 Tulsi Gabbard is still running. I have to go sit in the corner now for saying that. She also proposed the $1000/month per adult legislation​ that is getting credited to Mitt-hedge-fund-Romney. He's just saying it's for one-month, though.



  1. God speed with all your efforts. I am proud you are my doctor. Linda

  2. Thanks Linda, We are ahead of the rest of Austin public health at People's Clinic.
    Community Care believed on Thursday that there was no treatment for coronavirus, just go sit at home with your diagnosis until ....