December 3, 2020

Stress Testing in an Engineering Lab

I was going to write my next update in these Accidental Plague Diaries tomorrow but I woke up this morning with a feeling that I better write today and generally, when I have one of those moments, there’s something in the recesses of my brain trying to burst out and the best thing that I can do is just start typing away until my limbic system (or is it my frontal lobe?) says enough, you’re done and generally I feel a bit better in general. I don’t feel bad today. I’ve been a bit lazy the last couple of days. I’ve made starts on my next round of home projects but I haven’t put in the hours and hours that they’re going to need. Instead, I have spent time in reading junk novels, doing a jigsaw puzzle with far too many monochrome pieces, and assembling the holiday gift basket for my family in Seattle and hauling it off to the UPS store for shipping.

I think the thing that has me screaming inside is the incredible escalation of Covid numbers over the last few weeks which has been met by a collective shrug by our government and with society as a whole as the latest shenanigans of various Republican lawyers try to overturn the presidential election without a shred of objective evidence and the financial chicanery of the presidential fund raising apparatus, busy fleecing the flock with The Grift of the MAGA, push other stories off of the front pages. We are now at 14 million cases of Covid. There were 9 million at Halloween, less than 5 weeks ago which means we are adding 1 million cases a week. We now have over 100,000 people hospitalized nationally which is more or less the inflection point for national systemic strain and that number is going up. Roughly 2800 people died yesterday alone. That’s more than were killed at the World Trade Center on 9/11. In two days, we are losing more citizens than China, with its 1.3 billion people, has lost since the beginning of the pandemic. Their official total death toll since last December is fewer than 5,000.

Indian elementary school in the time of Covid

I expect these numbers, which are horrific, are going to take a sharp increase over December as we have yet to see the impact of the Thanksgiving holidays. Cases caught over the holiday weekend won’t start showing up in hospitals for another two or three weeks; just in time for everyone to start gathering for Christmas, New Years, and other end of the year festivals. The level of societal denial that’s going on at the moment is breathtaking. I woke this morning to news that one of our ritzier suburbs is planning on a huge holiday party/dance for the middle schoolers at a local country club. Just what in heaven makes people think putting 500 tweens in a ballroom midwinter bouncing around to the latest hits is a good idea? I understand parents wanting to provide some normal socialization but these are not normal times. A recent study from India (which has a different culture so you can’t just generalize) which involved hundreds of thousands of cases and contract tracing showed that the major vector of spread was schools. Children are walking petri dishes for viral illness. They always have been. It’s part of the necessary process of developing a healthy body. Put them together in enclosed space, and then have them mingle with children’s normal behaviors and they’re going to trade germs like crazy and then carry them back home.

We’ve reached the point where Covid is becoming a significant stress test on our societal systems. I view it sort of like when structural engineers test models in wind tunnels to determine what sorts of architecture can withstand a category 5 hurricane. We’re putting societal infrastructure, which has been deliberately hollowed out by various decisions over the last fifty years, out there and subjecting it to a simultaneous 8 on the Richter scale earthquake, F-5 tornado, and wildfire storm. It’s no wonder things aren’t doing so well.

The piece of society I am the most familiar with is the healthcare system. What was once the most advanced health culture and the envy of the world in the decades following World War II was changed from a system whose goal was improving American lives to an industry whose goal was improving American businesses bottom lines, executive compensation, and stock profits. It wasn’t deliberate, no one person or thing orchestrated it, but starting in the mid-70s, the sector was taken over by business minds focused on the manufacture of health as measured in data points and the system was stripped of excess capacity in order to make it lean and mean. Physicians and others skilled in healing lost control of the system to those with skills in accountancy, marketing, and data management. This has all coincided with my career in medicine (I having entered the training in 1984) and its been both fascinating and nerve wracking to watch all of this happen. With the stress of Covid out of control, we don’t have hospital capacity, we don’t have staff capacity, decisions are made based on financial risks to institutions, we continue to lose smaller and rural hospitals, especially in states which refused the Medicaid expansion for political reasons (many of these the same states in which the infection is spreading like wildfire as the same political trends push the population to ignore sound public health advice). My generation of physicians is getting pummeled and fed up and will likely begin retiring at a relatively young age. I don’t see many of us working into our 80s in the way that an earlier generation did. And we aren’t going to have a new generation to replace us as the system pushes graduates into specialties of high remuneration rather than of societal need. We haven’t been able to attract a single fellow for training in geriatrics at UAB for three years.
The hollowed out educational system is hurting. Teachers were having to make do with significant funding cuts as back as far as the Reagan era and with salaries so low that many work second jobs to make ends meet. The move from having teachers teach to manage data metrics and preparing students for standardized tests which came from the No Child Left Behind act, caused another huge issue. Now teachers are being asked to work two full time jobs. As in person classroom teachers and as on line teachers to students whose families have opted to keep their children out of the classroom due to Covid risks. It can’t be borne and the older generation will retire and the younger generation will burn out. The lack of leadership from the current administration’s Department of Education, run by someone whose sole qualification was donating huge amounts of money to right wing causes, is just the icing on the cake.

What can I say about our government? On the federal level, the executive branch decided to politicize a worldwide pandemic into an us vs them exercise, spending months feeding misinformation to the public about risk, public health measures, and basic scientific laws. When the pandemic blossomed out of control, which was inevitable in the face of this attitude, they simply ignored it, kicking responsibility to the states with the results that more conservative states, following federal example, chose to act as if nothing was happening and poured even more gasoline on the fire. State governments, with the exception of a few large rich states such as California and New York do not have the resources to deal with world problems. It is the role of federal government. Things may begin to change on January 20th but that’s still seven weeks away. In the meantime, at current trends, another 7 or 8 million people will get sick and another 350,000 will die.

So keep up the good fight, wear your mask, wash your hands, social distance and stay out of crowds.

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