Wednesday, April 22, 2020

Covid Journal 5 - For want of a nail and a swab...

Here in NH, we have not felt the pain of major cities, and the urge to reopen the economy is sparking some debate on local Facebook groups. Recently, someone posed an article about Catholic Medical Center furloughing over 400 employees. That got me to thinking about why this is happening.

If we go with the President's idea that we are at war, simply put, they are collateral damage caused by failing to engage the enemy in a timely and strategic fashion.

Have you ever heard the ancient story that starts, "For lack of a nail, the horse was lost"? This version was penned by Ben Franklin.

For Want of a Nail
For want of a nail the shoe was lost.
For want of a shoe the horse was lost.
For want of a horse the rider was lost.
For want of a rider the message was lost.
For want of a message the battle was lost.
For want of a battle the kingdom was lost.
And all for the want of a horseshoe nail.

That's what is going on today. The nail in this case could be swabs, the horse would be test kits, and so on.

The CMC employees are out of work because of lack of testing. Had the Defense Production Act been used as it should have been, and testing ramped up as it should have, it's possible if not likely, that elective surgery would never have stopped in NH.

There are plenty of elective surgery centers not in hospitals. There are elective surgeries done in doctor's offices. They are not in the battle against coronavirus. If testing was widely available they  might be opening now.

Testing ramp up was a month late in coming. We are at the very least suffering in a shutdown that is going to be a month longer than it need be, and it's impossible to tell how much damage it has done to our economy.

At this point someone chimed in with the opinion that nail was PPE that was needed and Ventilators that weren't needed, both were depleted by our previous administration causing the use of the DPA for those items.

The problem with playing the blame game is that it does nothing to solve the problem that exists today. The PPE and ventilators have nothing to do with testing. In the nail and swab analogy, they have no real status. Test is what it critical to opening the economy. Even if there was an abundance of PPE and ventilators, we would be in the exact same place we are today.  Pointing fingers doesn't save lives!

My contention was that the most important thing we need is this fight is DATA. Data can only be collected with adequate testing. Our testing is nowhere near where it needs to be. A look at the testing supply chain sees it is broken in many places. Without swabs, you can't test. It's like having a million horses waiting to be shod.

I don't think the poster understood the supply chain dynamics or the point I was trying to make. More importantly it doesn't appear he understands the nature of a pandemic, because he said, "I agree but if this were a pandemic they could use these people to assist in helping patients like they are in NY. They're saying they have empty beds. That's because we don't have the cases NY does (thankfully) but now elective surgeries are on hold for nothing at this point."

"If this were a pandemic?" It's not a bomb that's dropped on us. It infiltrates our ranks and spreads from there. I doesn't pop up out of nowhere. It has to be carried by someone. Once it enters an area, without proper testing and social distancing, it will grow exponentially.

As far as elective surgeries being on hold for nothing at this point, I say elective surgeries are NOT on hold for nothing. It goes right back to the swabs. They are on hold because we have no way of knowing if the doctors and nurses treating you have covid 19 and visa vera. That's is a formula for disaster. If we could be test whenever needed, elective surgeries might not be on hold.

When it comes to opening up, the people in state government are doing one of two things. They are either doing what they feel is best based on the data and erring on the side of caution, or they want things open, but are covering their asses. If they open early, and things go wrong they know they will be out on their asses for opening up without the data that EVERYONE acknowledges we need. If the testing was in place, their asses would be covered, because when things go wrong when they open up, they can blame bad data.

To that the the poster said, "Art Wolinsky but isn’t it up to them to procure and perform the tests for their own data. It’s not up to the Fed to do this. Even Cuomo agreed."

The poster left out one small detail. In order for states to be able to procure their own tests, there have to be tests for them to procure. If there is no product, we have stated bidding against each other for what little there is. ONLY federal government can use the Defense Production Act to get supplies into the supply chain so that states can procure the test.

I finally got some agreement when he said, "But haven’t they? Yesterday there were 50,000 testing kits sent out to states."

He was making my point for me, because 50,000 test kits is a drop in the bucket compared to what's needed. On top of that, they were sent out yesterday, but should have been shipped a moth ago. What we should be doing right now is antibody testing. The covid test kits will soon be there for those with the symptoms meeting current protocols, but the antibody tests are what are really needed in order to open the economy again.

The reply was, "I know I know. I’m saying it’s a good start."

Really? I would agree if a one month late start is a good start. I have always said there are students who blossom because of teachers and there are those who blossom in spite of them. We will come through this and we will blossom, because of who we are as nation. We will blossom in spite of the early failure of the federal government to take the lead.

The retort? "I think it’s unfair for you to think we are one month late based on bad information. Its a weak argument at best."

To answer that, I pointed to the fact that during the past few press conferences when asked what actions were taken in February, Trump answers were attacks on the reporters. He also claimed he has hardly been out of the White House in the past two months.

Then when questioned about the campaign rallies, he couldn't remember them. I went to a Trump rally and I will NEVER forget it. He held FIVE in February and doesn't recall? Was he lying or is it time for Article 25? He certainly wasn't inspiring confidence or gaining the trust of the public. What information would you like to share that shows we were doing a good job?

I then pasted a post which orginated with Robert Braunstein, right after Trump claimed he was distracted by the Impeachment

Dec 18th - House Impeaches Trump
Jan 8th - First CDC warning
Jan 9th - Trump campaign rally
Jan 14th - Trump campaign rally
Jan 16h - House sends impeachment articles to Senate
Jan 18th - Trump golfs
Jan 19th - Trump golfs
Jan 20th - first case of corona virus in the US, Washington State.
Jan 22nd - “We have it totally under control. It’s one person coming in from China. It’s going to be just fine.”
Jan 28th - Trump campaign rally
Jan 30th - Trump campaign rally
Feb 1st - Trump golfs
Feb 2nd - “We pretty much shut it down coming in from China."
Feb 5th - Senate votes to acquit. Then takes a five-day weekend.
Feb 10th - Trump campaign rally
Feb 12th - Dow Jones closes at an all time high of 29,551.42
Feb 15h - Trump golfs
Feb 19th - Trump campaign rally
Feb 20th - Trump campaign rally
Feb 21st - Trump campaign rally
Feb 24th - “The Coronavirus is very much under control in the USA… Stock Market starting to look very good to me!”
Feb 25h - “CDC and my Administration are doing a GREAT job of handling Coronavirus.”
Feb 25h - “I think that's a problem that’s going to go away… They have studied it. They know very much. In fact, we’re very close to a vaccine.”
Feb 26th - “The 15 (cases in the US) within a couple of days is going to be down to close to zero.”
Feb 26th - “We're going very substantially down, not up.” Also "This is a flu. This is like a flu"; "Now, you treat this like a flu"; "It's a little like the regular flu that we have flu shots for. And we'll essentially have a flu shot for this in a fairly quick manner."
February 27: “One day it’s like a miracle, it will disappear.”
Feb 28th - “We're ordering a lot of supplies. We're ordering a lot of, uh, elements that frankly we wouldn't be ordering unless it was something like this. But we're ordering a lot of different elements of medical.”
Feb 28th - Trump campaign rally. “This is their new hoax.”
March 2nd - “You take a solid flu vaccine, you don't think that could have an impact, or much of an impact, on corona?”
March 2nd - “A lot of things are happening, a lot of very exciting things are happening and they’re happening very rapidly.”
March 4: “If we have thousands or hundreds of thousands of people that get better just by, you know, sitting around and even going to work — some of them go to work, but they get better.”
March 5th - “I NEVER said people that are feeling sick should go to work.”
March 5th - “The United States… has, as of now, only 129 cases… and 11 deaths. We are working very hard to keep these numbers as low as possible!”
March 6th - “I think we’re doing a really good job in this country at keeping it down… a tremendous job at keeping it down.”
March 6th - “Anybody right now, and yesterday, anybody that needs a test gets a test. They’re there. And the tests are beautiful…. the tests are all perfect like the letter was perfect. The transcription was perfect. Right? This was not as perfect as that but pretty good.”
March 6th - “I like this stuff. I really get it. People are surprised that I understand it… Every one of these doctors said, ‘How do you know so much about this?’ Maybe I have a natural ability. Maybe I should have done that instead of running for president.”
March 6th - “I don't need to have the numbers double because of one ship that wasn't our fault.”
March 7th - Trump golfs
March 8th - Trump golfs
March 8th - “We have a perfectly coordinated and fine tuned plan at the White House for our attack on CoronaVirus.”
March 9th - “This blindsided the world.”
March 13th - [Declared state of emergency]
March 17th - “This is a pandemic,” Mr. Trump told reporters. “I felt it was a pandemic long before it was called a pandemic.”
March 18th - "It’s not racist at all. No. Not at all. It comes from China. That’s why. It comes from China. I want to be accurate."
March 23th- Dow Jones closes at 18,591.93
March 25th - 3.3 million Americans file for unemployment.
March 30th - Dow Jones closes at 21,917.16
April 2nd - 6.6 million Americans file for unemployment.

I was then corrected about my response to bad information when he said, "I’m saying bad info from China." and he pointed to the fact that only about 100 people were dead in February.

Seriously? Bad information from China, really? You mean President Chi wasn't being transparent? I think any 5th grader could have tipped him off. When have we EVER relied on China giving us good information? We didn't push and we praised them for their efforts. Good thing the WHO did the same thing, because that allowed Trump to defund them for doing exactly what he did. He didn't listen to his advisors or the intelligence. As far as the number dead goes, I have two words. EXPONENTIAL GROWTH. The ramp up should have started BEFORE we had our first case, not after we had our 100th.

The conversation then turned to the number of tests needed when someone else said, "...sadly, there are 325 million of us in USA. You need to be conducting 10 million a day to test everyone in a month. The response from the poster was, "...that’s just stupid to think EVERYONE needs to be tested. Absurd."

Finally a point of agreement, and I said, "On this one we actually agree. Testing everyone is absurd and I don't know of a single expert who supports that. What is needed is widespread testing to the extent that we can test anyone who needs a test and get results quickly, but we are nowhere near that. Dare I mention the word swabs?

Check this quote, and follow the link for a better idea of what is needed in testing. "We're only able to do approximately 1,000 to 1,200 tests a day because of limitations in supplies like swabs ... chemical reagents that actually do the test," said Dr. Bruce Meyer of Jefferson Health, which operates 14 hospitals in and around Philadelphia, in an interview with NPR Tuesday. "So our capacity to test is really limited."  Read the full article here

That's where things left off yesterday.  This morning there was a new development that aplifies the need for adaquate testing. A phenomonon being dubbed Covid Toe, is starting to look like a way of identifying asymptomatic Covid carriers. Unfortunately, there is no testing of these people and there is no way of determining if this can be used as a solid indicator. Here's the full article.

So who wants to take the literary challenge and write the poem, For Want of a Swab?

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