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It’s Not Panic; It’s Reality

Doctor writes to say his hospital has no capacity for COVID19 overflow -- and nearby hospitals probably don't either
Seattle Area Continues To Implement Precautions To Curb Outbreak Of Coronavirus

A reader writes (I’ve concealed details to protect his privacy):

I’m an emergency doctor in [greater capital region of major state].
For the past 5 years or so we’ve had a chronic intensive care bed shortage.  One factor is well intentioned state mandated nurse to patient ratios. These don’t apply in the emergency department but they do in the ICU. Our hospital has 12 ICU beds, but is routinely staffed with 2 nurses who can care for only 2 patients each.  There are other potential places within the hospital to provide ICU level of care, such as recovery rooms (now called PACU’s, post anesthesia care units) and day surgery areas. The hospital does not spend the money to have the nurses to do this. Also, the hospital cannot hire or retain enough nurses to fill the positions it is willing to pay for.
We often have to transfer patients from our emergency department to other hospitals that have ICU beds. Frequently there aren’t any – none at [name], the biggest hospital in the state, or [list of other major hospitals in the capital city], nor at other area community hospitals.
This is our baseline. We have no capacity for a surge of patients who can’t breathe because of Covid-19.
I read this e-mail after reading this short, informative piece from Bloomberg News, about how coronavirus kills people. Excerpts:

Infection generally starts in the nose. Once inside the body, the coronavirus invades the epithelial cells that line and protect the respiratory tract, said Taubenberger, who heads the viral pathogenesis and evolution section of the National Institute of Allergy and Infectious Diseases in Bethesda, Maryland. If it’s contained in the upper airway, it usually results in a less severe disease.

But if the virus treks down the windpipe to the peripheral branches of the respiratory tree and lung tissue, it can trigger a more severe phase of the disease. That’s due to the pneumonia-causing damage inflicted directly by the virus plus secondary damage caused by the body’s immune response to the infection.


“When you get a bad, overwhelming infection, everything starts to fall apart in a cascade,” said David Morens, senior scientific adviser to the director of the National Institute of Allergy and Infectious Diseases. “You pass the tipping point where everything is going downhill and, at some point, you can’t get it back.”

That tipping point probably also occurs earlier in older people, as it does in experiments with older mice, said Stanley Perlman, a professor of microbiology and immunology at the University of Iowa in Iowa City, who has studied coronaviruses for 38 years.

Still, even healthy younger adults have succumbed to the illness. Li Wenliang, the 34-year-old ophthalmologist who was one of the first to warn about the coronavirus in Wuhan, died last month after receiving antibodies, antivirals, antibiotics, oxygen and having his blood pumped through an artificial lung.

Some people may be more genetically susceptible, possibly because they have a greater abundance of the distinctly shaped protein receptors in their respiratory epithelial cells that the virus targets, Taubenberger said. It’s also possible certain individuals have some minor immunodeficiency or other host factors that relate to underlying illnesses.

I have a weakened immune system because of Epstein-Barr virus. I am 53 years old. This is all very real to me.

You readers who think this is all silly panic ginned up by the media and the Democrats, feel free to nurture your comforting illusions. This doctor I quote above is on the front lines. He’s telling you that if you come to his hospital unable to breathe with coronavirus, they will not be able to take you … and chances are, none of the hospitals in his major American city will have room for you either.

You reader who prefer to live in reality, take note, and please protect yourselves. Most of us who get sick from this stuff will be fine without too much trouble. Some of us won’t. People like me, because of my immune system, are in more danger. People like you, if you’re over the age of 60, or have diabetes, you’re in trouble too. In normal times, you might have been able to go to the hospital, get intensive treatment, and come out fine. None of that is guaranteed now, not with what’s coming.

Please, do your very best to avoid, or at least delay, getting the virus. You want the hospital to have a bed for you if you need it. This is not panic; this is reality. The media isn’t making this happen. The Democrats aren’t making this happen. The coronavirus is making it happen. We are not powerless here, folks. If we will avoid crowds, and stay at home as much as possible, we can avoid or delay getting the virus.

This morning, the financial markets are crashing, but President Trump continues to message like Baghdad Bob (‘memba him?):

There are more. Even by the, shall we say, expansive standards of presidential conduct to which we’ve grown accustomed under Trump, this is absolutely extraordinary.

This is not a fake crisis! Read the letter from the ER doctor above. It’s not a crisis caused by irrational panic. Yes, people do panic, but investors are not destroying trillions of dollars of wealth for nothing. There really is radical economic uncertainty now. In Lombardy, the public health system is on the verge of breakdown. There is every reason to expect something similar in the US, over the next couple of weeks. If we avoid it by some miracle, well, thank God. But even as we hope for the best, we must prepare for the worst. 

Having a president who does not take any of this seriously is incredibly destabilizing. Don’t know if you saw this, but this is what he tweeted on Sunday evening:

Notice that this was not tweeted by an enemy of Trump, but by Trump himself! Could it possibly be that Donald Trump is the only non-crackhead street bum adult in America who has never heard of Nero fiddling while Rome burns?

I write all this as someone who has never liked Trump, and who didn’t vote for him (or for anybody) in 2016, but who has been grateful for some of what he’s done — especially on judges — and had resolved to probably holding my nose this fall to vote for him, because the idea of the Democrats, who have gone far, far off the deep end on social issues, appointing judges genuinely frightens me. As I’ve said before, I’m a social and religious conservative, and as such, I believe that in the years to come, the federal judiciary is going to be the last effective line of defense against aggressive liberalism, of the sort that has no respect for First Amendment freedoms — of religion, of speech, and so forth. I say that because the younger generations are much more left on these issues than Gen Xers and older, and are much less favorable towards the First Amendment when it is seen to harm the dignity of their favored victim groups. That leaves social and religious conservatives out in the cold. In a democracy, the Congress and the presidency will eventually reflect this reality. This is why it really is so important to get conservative judges in place now, while we have power.

I don’t have to love Donald Trump to recognize that it is massively important to the causes I really care about — religious liberty, free speech, and abortion — to keep the Democrats out of the White House. The things that Trump ran on — immigration policy, less interventionist foreign policy, a more nationalistic trade policy — are also things that are important. Not as important to me personally as judges and social policy, but still significant.

And now, with his deranged response to the coronavirus crisis, he’s blowing it all. He does not have to do this! All he has to do is act like a normal president. What the people around him need to realize, and to act on, is that however you feel about Donald Trump personally, he is putting at risk everything that all of us in the Trump coalition believe in.

There are people who will never abandon Trump no matter what he does or says. But they aren’t enough to win him re-election. If the people who aren’t particularly pro-Trump, but inclined to vote for him anyway, decide that it’s simply too dangerous to have such an unstable, manic president in charge in a crisis like this — then Trump will lose, and not only will he lose, but he might bring down the Republican Senate too. This month — the Ides of March are coming! — will be critical. This president will be judged in the fall in large part by the way he has responded to this crisis. If America somehow dodges this bullet — and we have no reason to believe it will, but let’s just say that it does — then Trump will not suffer. But if it looks here like it looks in every other country that has faced its outbreak in the general population, then Trump will have established himself as a reckless fool.

I don’t think Trump is consciously lying to the country. He’s working a rope line in Florida this morning. If he were afraid of coronavirus, he wouldn’t be doing that. But good grief, he is living in total denial about the threat to the country, and — to speak in a purely political vein — to himself, and to the causes he supports.

It’s driving me nuts. As I wrote yesterday, the failure of the Tsarist regime to respond effectively to the 1891-92 famine in Russia was a catalyzing moment in building opposition to the imperial system. The Marxist parties were fairly marginal prior to that. But the Tsar’s failure opened the minds of the Russian middle classes to Marxism, because it offered an explanation for why the government failed. Within twenty years, one of those radical parties, the Bolsheviks, had seized dictatorial control of Russia, and had turned the state into a charnel house. The famine response was not the sole cause of the revolution, of course, but historians agree that it was a big turning point in the decline and fall of the regime.

Conservatives who have influence with this administration need to wake up, now. There are lots of conservatives who admire Trump for his defiant response to the disease, but they are completely blind to the political risk here. Nobody really knows what is coming to the US from this. We will know over the next month or two. Trump is very, very far out on a limb with his extreme, radical response — and it stands not only to completely discredit him, but also to discredit his causes. That’s just how politics works. The risk is extreme. 

The reason Nero fiddling while Rome burned is still a metaphor we use 2,000 years later is because it is such a powerful symbol of a narcissistic autocrat who cannot see beyond his own ego to grasp the seriousness of the crisis around him. Trump is so ignorant, and so absorbed in himself, that he actually made that comparison of himself to Nero. If thousands die in this crisis and millions lose their jobs in the economic destruction related to it, think of how this is going to look in Democratic ads throughout the autumn:

If Trump goes down, a lot of us, and the causes we care about, are going with him. It will not have been a political murder; it will have been a political suicide.

Anyway, enough about politics. The most important thing you, reader, can think about today is protecting yourself and the ones you love. You are not powerless. Become a leader of your little platoon.

UPDATE: This just in from the Wall Street Journal’s White House reporter:

This has to be the message he’s been dictated to state. Breathtaking.

UPDATE.2: Some reality from former USAID official who dealt with Ebola outbreak:

UPDATE.3: The COVID19 death stats are based on Chinese government numbers, which, if false, are almost certainly worse than being shown here. Even if the death rate in the US is only half of what it has been in China, that’s still catastrophic. Point being, do not believe our president, readers:



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