Journaling the coronavirus, Friday April 3: Jared speaks, milk is spilled, masks are debated, Bolsonaro’s antics trump Trump’s

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Global cases of the virus have topped one million. Today New York reports its highest number of deaths in a single day (more than 500); yesterday the state had 10,000 new cases in a single day, passing 100,000 in confirmed infections. The stock market is down. Boeing and General Electric are just among the latest of the kings of capitalism to announce layoffs. The Congressional Budget Office reported unemployment will be >10% in the second quarter.  A Navy captain was removed from his post for sounding the alarm about the infection rate on his ship; a Russian doctor critical of the Kremlin’s ability to handle the crisis was recorded being surrounded by officers and dragged into a police station.  Dairy farmers are dumping tens of thousands of gallons of milk, unable to get it to market, where, in stores, customers are limited to 2 dairy items per person, and the prices have risen 11%, because demand is so high. If that makes you mad, stop reading, I won’t be offended. It’s a mad world we live in, now.

The door 
At the start of each briefing, the team for the day emerges from behind a blue pocket door to the left of the podium, a door that has for some days now been clearly, smearily imprinted with the oil residue of fingerprints. No one in the room wears a mask or gloves and there is no handy dandy automatic hand sanitizer dispenser like some hospitals are featuring at the entrances and exits of rooms where people gather.

Often different cabinet members will appear at one of the White House briefings.  One day it was Besty DeVos; other days, Mike Pompeo or Ben Carson or Steve Mnuchin will make an appearance. Today it was Jared Kushner’s turn and I confess to being interested in hearing what his voice sounds like. When it’s his turn at the podium, he speaks quickly without appearing to take a breath.  He uses the terms ‘informed’ and ‘data driven’ a lot. He assures us he is not running a shadow task force. (“The vice president asked me to assist, I talk to him five, sometimes six times a day, accomplishing and focusing on the objectives the president has prioritized.”)

What he is doing, he tells us, is asking states to provide their daily utilization rates for better mobilization of the federal stockpile of ventilators.

“A lot are asking for stuff they don’t really need” ~Jared Kushner

Jared’s not-shadow-task-force is “asking for information so the federal government can make much more informed decisions on where to position the ventilators” and remonstrates with reporters,

“I would just encourage you when you have governors saying the federal government isn’t giving them what they need, ask them if they are looking.”

I wouldn’t want to be the one to interrupt Governor Cuomo’s briefings – a tour de force of competence, data and decision-making – Hey are y’all sure you looked in all the right places and there aren’t a whole bunch of ventilators around that you just didn’t know about? In New York, there are 3,731 ICU patients who need ventilators, and the situation looks bleak. Governor Cuomo today has deployed the National Guard to take unused ventilators from clinics and private firms. It looks like people are going to die for lack of equipment.

Dr. Birx assured everyone that “We’re triangulating data that we know from the case numbers, testing numbers, the supply chain numbers to create an integrated picture so we can support hospitals in their needs and that level of granularity is really critical” which seems to be a long-winded way of saying, some hospitals will get ventilators when they ask, and some won’t, and it’s our decision, and we’re making it and then telling you.

The fondness for repeatedly stating large, impressive sounding numbers out of context is the hallmark of this administration. As a country we are horrifically unprepared for something we predictedwould happen, and instead of saying “The national shortfall of ventilators (or any other equipment) is x and here’s how we’re attacking that” we hear “The US started with 5x the number of ventilators they have in Europe.”

Best question of the day: Jared, what triggers a ventilator going to the state, how sick does someone have to be to get a national ventilator?

A: It’s a simple formula, the states should know what’s in their state, they should be able to give the utilization data, that is the first thing a good manager will do. We need competent mangers during a time of crisis, and certain people are better managers than others.”

Touche.

In God we trust
Earlier this week the World Health Organization urged leaders in the Americas to “urgently expand patient-care capability while implementing social distancing measures that may have to remain in place for at least three months.”  From the news reports we can only conclude the Americas aren’t listening:

The president of Brazil Jair Bolsonaro is like Amy Winehouse, singing no no no, he ain’t going to rehab, or quarantine, and neither is anyone else. He is calling on all but elderly Brazilians to get back to work.

“God is Brazilian,” he says, and also says Brasilians can be dunked in raw sewage and “don’t catch a thing.” He is not the only president who thinks his citizens are blessed with a naturally hardier constitution (so to speak): yesterday President Trump  told reporters that “In 1917 they just noticed people are dying all over this place. I ask, why didn’t more people die? We lost a lot but relatively very few compared to Europe.” One hopes it will not come to a raw sewage dunking contest between north and south Americans to prove whose side God is really on, maybe a Tough Mudder: Pandemic Edition.

In Nicaragua the Vice President, who in a feat of dare-you-to-stop-us corruption is also the First Lady, has said the country could not come to a standstill and that “with faith we can conquer fear.”

It’s not just those other countries behaving badly; in the US pastors keep being charged with violating public orders against large gatherings, including a megachurch in Tampa Bay and another in Baton Rouge. Both pastors kept holding services and so were charged with showing a reckless disregard for human life (a misdemeanor). In South Dakota, two state legislators (R) are accused of being drunk during coronavirus proceedings. In Georgia, the governor improbably said he “just found out 12 hours ago” that people can infect others without symptoms so is now belatedly implementing a shelter in place order. Just yesterday in San Jose California police officers recorded 56 violations of the shelter in place order, everywhere from hair salons, restaurants, gyms, even a billiards hall (I didn’t know they still called it “billiards” which sounds so much better than “pool”).

In San Francisco you can’t say you didn’t know about the order because last night some busy elves put door hangers on every door in the city.  This is a stupendous undertaking requiring a veritable army of folks – I know, because I door hangered for a political campaign all through the first quarter of this year, and in a hilly, dense city like San Francisco, to hit every door in a matter of days is a tremendous feat of mobilization of people and money.  I also noted that the door hanger was not union printed, but oh well.

Ship of fools
Across New York, hospitals are being retrofitted to accommodate the surge, which has grown from 100 COVID patients on March 20th to more than 2,800, with about 25 percent in ICUs.  Patients have died before being hooked up to a ventilator; so many people are dying that the city is running low on body bags. Meanwhile, the big ships sit mostly unused because per Navy protocol ambulances must first take patients to a city hospital for a lengthy evaluation — including a test for the virus and 49 other medical conditions that would exclude a patient from admittance to the ship — and then pick them up again for transport to the Comfort or the Mercy.

Together the ships with their 2000+ bed capacity contain less than 20 patients. It’s enough to make one scream in frustration “There are sick people and empty beds, figure it out!!”  Another man, train engineer Eduardo Moreno, was apparently equally frustrated and tried to ram his locomotive (yes, you read that right) into the Mercy, telling police later he feared the ship was “part of a federal government plot to control our lives.” The train engine did not have the momentum it needed to crash into the ship, coming to a halt 250 yards shy of the hull which must have felt like a real let down to Eduardo.  He was charged with one count of train wrecking, not to be confused with trainspotting, a book (also a movie) that will not cheer you up in these dark times except to demonstrate that things could, indubitably, be worse.

Having your back vs. being back-up
Governors continue to call on the federal government for crucial supplies: ventilators and respirators personal protective equipment like masks, gowns, gloves. In response, President Trump reminded us all “We’re not an ordering clerk, we’re a back up and we’re doing an unbelievable job.” and that some governors are not being straight with him.

To my face they are very nice, I guess they assume I don’t watch them or something but I watch them very closely.

In recalcitrant tones President Trump reminded us that states are calling him asking, Can you build a hospital, can you deliver a ship? “We have done an unbelievable job but we’re a backup,” he explains. “Ideally those states should have had all this equipment and I think next time they will.”

Every speaker – mostly the President and Jared Kushner, but Dr. Birx too – subtly underscores the accusation that Governor Andrew Cuomo has all along been asking for more ventilators than he needs, that he’s selling them out the back door, that he wasn’t adequately prepared.

New York got off to a late start and should have pushed harder.  ~President Trump

When one reporter reasonably asks, But how would they have known to start sooner without federal guidance? The President says “Well don’t they have experts? How did *I* know to cut off China? I just did! I cut off Europe early! You have to make a decision, people knew bad things were going on. If we didn’t cut off China we would have been in some big trouble and we cut it off way early.” He did not pat himself on the back exactly but you could hear it in his voice.

In summary, it’s like Governor Cuomo says: “Assume help is not coming, and you are on our own.”  It’s every state for itself, looks like. Hope your governor is a good one (mine is, whew).

A preponderance of polysyllabic phraseology
A reporter asked if the ACA healthcare exchanges would be opened now that 10 million Americans are freshly out of a job and the Vice President gave a 5 minute non-answer that ended with the assertion that “We’re going to do better than that – we are going to try to get a cash payment to the people – a certain group of people.” I still don’t know the answer regarding the exchanges being opened, and now I’m wondering what the president meant by “certain group.” That’s the thing with these briefings – a lot of questions are asked, a lot is said…and more questions are raised. They are exhausting to listen to.

The Vice President reiterated the point that “No American has to worry about the cost of testing, and we’re working everyday to make sure no American has to worry about the cost of treatment, we’re going to use some of the money to compensate the hospital directly for treating uninsured people.” This means, treatment as of now is going to cost you, a fact that officials don’t seem to recognize will keep ill people working and in contact with others until they are forced to stop because they are hospitalized, dead, or recovered – and in each ease, continue spreading the virus.

There was a message for the 30 some odd million uninsured: “The President  has directed the task force to find a way to pay for your treatment and the president will be deciding that and announcing it tomorrow.” Friday’s briefing will be a big one then, as far as news goes.

Masks, masks, masks
A big topic of the pandemic is masks, because we’re in short supply nationwide, and because watching this incompetent administration, along with “God is Brazilian” idiots like President Bolsonaro, are so reminiscent of the elites who gathered to party while the virus burned itself out among the peasantry in The Masque of the Red Death (guess who comes to dinner?)  The question of the day therefore: “Mr. President, New Yorkers have been directed to wear masks – are you going to be recommending that?”

Here is the presidential directive (for now), straight from the source:

If people want to wear them they can. In many cases the scarf is better, it’s thicker. They can do that if they want. I will say this: they can pretty much decide for themselves.

There is a confused moment where Dr. Birx seems to imply that the president won’t issue an order for everyone to wear masks because of the false sense of security it will give them, which is like deciding not to put a fire alarm in a movie theatre because the sight of it might make people less likely to report a fire when they see one.

Bottom line, reader: the reason there is so much weird misinformation about masks is, the US flat out doesn’t have enough for everyone to buy a few to wear. We’re short on a massive, national scale, and the scarcity of masks is definitely spreading the infection.  No one wants to say “of course you should wear a mask!” because saying so will just exacerbate the problem our healthcare workers are facing.  Think of masks as bullets and healthcare workers as soldiers. Are you going to take the ammunition out of the hands of our troops on the front line? Of course not. That’s why they can’t say “yes, you need a mask” because we don’t have them and they don’t want you to focus on that, so there’s all this shalala about droptlet distances etc. and meanwhile everywhere they have successfully bent the curve they are wearing fucking masks.

Testing the curve
Testing continues to ramp but we’re still far behind, as a country, where we should be. Of those tested, infection rates range from 3% (areas where there is almost no testing) to  35% in New York, meaning, one in three people who get the test in New York are confirmed to have the virus. 

California is at 8% but the real news is, no one I know in the Bay Area knows how to get a test, and three people I know have been sick with the hallmark symptoms and still can’t get a test, and testing data just isn’t available so who the hell knows what that 8 percent represents. Here in San Francisco we did start sheltering in place sooner than the rest of the country, however, it is *also* true that people were flocking to the beaches right up til the end of March, so it’s hard to know if our low percentage is just a low information number, or an actual outcome of countermeasures.

There is a lengthy discussion about which states have “flat lined” by which they mean, flattened the curve of the rate of infection. It’s pretty well understood that these states with the low infection rate curves are really more a reflection of an utter lack of testing than following guidelines of social distancing etc.  The curves look flat because they have no data is the real story, but the theme I detected earlier this week is still in play –  the administration is playing the lack of data as though it is an outcome, and are already using this as a leading indicator of when it will be safe to get back to work.

Reporter: All the states have the virus, right?

DJT: Some states are a lot better at staying inside. We have states that have been really incredible the fact they have kept so low.

No testing data are shared. We are given verbal assurances: “We know people are waiting for tests. We prioritized hospitals and nurses and doctors and front line workers.” When a reporter asks, again, when will people like me be able to get a test, Dr. Birx replies earnestly but nonsensically “I tried to give you how we’re using data in a very granular way.”

We heard that the new fast <15 minute test is going out now, there were 1200 quickie tests ready yesterday (but as Mike Pence warned, having tests ready to go and having them administered are two different things, so who knows).  At any rate Dr. Birx assures reporters “They are being made, they are moving very quickly. There are 18,000 machines already out there, we are trying to find where every single one is, if people would allow it to be loaned to a hot spot, 18,000 machines is a huge amount and it gets to your question how we can prioritize what we have.”

Brevity as the soul of clarity is not something these folks believe in.

The Presidential guidelines for coronavirus were repeated a lot, in sum:  you shouldn’t be having dinner parties and cocktail parties. The slope of the US curve relative to the Italy curve is not good – meaning it’s worse, because Americans, like many Italians before them, aren’t heeding the guidelines. Wear a mask.

We see other countries beginning to bend their curves but we need to change our behavior to bend ours.  ~Dr. Birx

Good News: Russia sent the US a large plane of ‘very high quality medical supplies’ which President Trump called “very nice”.

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