Hyperventilation Nation

I didn't know until yesterday, when I heard it from Andrew Cuomo's lips, that 80% of the patients put on ventilators never recover, which means ventilators really aren't the "life-saving" miracle machines we often read about in recent headlines. That seems to be on the high (meaning pessimistic) side of the percentages I've seen reported, but it's fair to say that patients have a pretty low probability of ever getting off a ventilator once they're on one. 

The machines can be helpful in prolonging life, in other words, giving some percentage of users a fighting chance, but most of the people who use one won't make it. How much more life these machines buy for patients -- how many more days or hours, on average -- I do not know. I'm sure those statistics exist somewhere. But all most of these machines are good for is delaying the inevitable and prolonging suffering for the doomed. Do ventilators lower the overall mortality rate? Not by very much, relative to all the focus they receive. I've also seen reports that ventilators sometimes can do more harm than good; that they themselves can be a conduit for infections that kill; that they may have been OVERUSED as a treatment for COVID19.

None of this argues for not using ventilators in situations where they're helpful, or for withholding this technology from lost causes and just writing them off. But it does point to a disconnect between public perceptions about ventilators and their real-world medical utility in the midst of this crisis. And that misperception could have repercussions, depending on how the politics of this play out.   

So . . . did I have a point? My point, I suppose, or my question, is why all the obsessive focus on ventilators for the past three or four weeks, given that the projected "shortage" was based on bogus models and they have a marginal medical benefit to begin with? Now, just as the curve is being flattened, states that only a few weeks ago were making a federal case out of the lack of ventilators -- like New York -- have MORE than they need and are shipping them out to other hotspots, which will themselves be cooling off by the time the machines arrive.

So were ventilators ever really the issue -- or were they weaponized to advance partisan political agendas that had nothing to do with saving lives? And will the weaponization of ventilators end here? I doubt it. Democrats will next be making a scandal out of what we paid for this tidal wave of surplus ventilators, even as the need for them steeply declined and their utility as "life-savers" came into question. They'll then begin blaming Trump for browbeating companies into overproducing them, after having blamed Trump for the alleged ventilator shortage.

No matter where the Coronavirus crisis takes us from here, "Ventilatorgate" already has proven, once and for all, that this country is certifiable insane. Let's do what we can to fix the bodies. That's the top priority. But what we can do to fix our sick and broken "body politic" is a much more daunting question.

Keeping It All in Context

There have been 193 deaths in Colorado attributed to COVID19 as of yesterday afternoon. That's a lot of pain, suffering and heartache for victims and their loved ones. But here are some data points that might help put the scale of this in context.

Each month in Colorado, on average,

652 people die from cancer
590 people die from heart disease
577 people die from influenza/pneumonia
253 people die in accidents of various kinds

I'm not sharing this to diminish COVID19 impacts on those who have become ill or died. But death happens, all the time, and at much greater rates than most of us imagine because we're normally not obsessing about it and keeping a running tally 24/7.

Maybe that should change. Maybe we need to post a scrolling tally of deaths, broken out by causes -- a National Death Clock, similar to the National Debt Clocks we occasionally see -- on massive billboards along our freeways or looming over Times Square, to remind us all that time is short, life is fleeting and fragile, every day matters and no one here gets out alive.

Seeing The Crisis Clearly

After a wobbly start, governments at all levels seem to be doing a better job of tracking and reporting Covid19 infection rates and deaths. That's clearly a top priority right now. You can't peruse the news, in print or online, without seeing the tragic tally creep higher each day, sometimes by fits, sometimes by starts. Statistics are tricky little devils so an alert reader must parse the numbers with care and put them in context. But at least they're out there now. It's a good way to remind us that human lives are riding on how we weather the storm and get back to "normal," whatever that means now. 

But the relentless focus on just one set of stats, as important as they are, also can tend to encourage a certain tunnel vision, or maybe it's more like myopia, obscuring our ability to see the "big picture" and know entirety of what we're dealing with. We understandably want to know who is sick, who has died, how the outbreak is evolving, where the "hot zones" are. But too tight of a focus on just that data may blind us to the wider but also real repercussions that stem not just from the virus but from our response to the virus.

There's been an earthquake. We're looking almost exclusively at the epicentre, however, trying to triage the temblor's immediate casualties, while forgetting or ignoring the aftershocks rippling through wider society. Some naturally prefer a narrow focus. It feeds the sense of urgency and crisis that helps hasten the public and private sector response. They frankly may not want to look at secondary or tertiary impacts indicating that we cured the disease but killed the patient, which is a topic of growing debate right now. They want to focus on the benefits of their actions, while ignoring or discounting the equally real costs, as if it's creepy, cold-hearted or inhumane to even consider a cost-benefit analysis in times of such duress.

Plunging tax revenues, spiking unemployment claims, a change in state GDP; these commonly used metrics all will help us grasp the larger implications. These are "lagging indicators" that will roll in over time, like waves on a beach, but they're also reasonably reliable. Other social impacts are harder to find metrics for, unless you make a special effort. And I think Colorado should make that effort.

Therefore, my suggestion is for Governor Polis to begin tracking and reporting an additional set of metrics as we move forward, aimed at measuring the wider social repercussions not just of the virus, but of the state's response to the virus, so that we don't fall prey to tunnel vision and can grasp the situation comprehensible. Here's my starter list of suggested indicators, which I may amend over time. I believe all these, except for the homelessness number, are there for the unearthing if you dig for them.

• Business closures
• Bankruptcies (business and personal)
• Divorces
• Suicides
• Domestic Abuse Calls
• Crime trends 
• Homeless trends 

Please email me at SeanPaige@msn.com if you can suggest measurable metrics I overlooked.

I really believe the Governor will be doing Coloradans a disservice if these metrics aren't as closely monitored as COVID19 infection rates and fatalities.

Instant Revisionism Meets Convenient Amnesia as Blame Game Begins

A slow and bumbling bureaucracy can kill you: that's one immediate takeaway from this wire story that jumps out at me. And hubris doesn't help -- which is something we've known since ancient Greeks themed their tragedies around the idea. The President also comes in for some criticism, in this arguably-slanted but still relevant retelling of an unfolding story, for allegedly sugarcoating the seriousness of the situation and putting a glibly optimistic spin on things, in his usual shoot-from-the-lip style.

But . . . . 

There's always a "but," or what would be the point of blogging?  

But the question remains, would Joe Biden, Hillary Clinton, Bernie Sanders or any other Democrat have done a better job of dealing with an unprecedented situation under identical circumstances? I seriously doubt it.  

Let's remember, Biden and other Democrats were quick to jump on the President as a xenophobe and sinophobe when he clamped down on inbound flights from China, suggesting that they would have been even slower to respond, for fear of offending Chinese sensibilities -- something Trump actually seems to relish, which was a potential strength at a time when China wasn't just spreading a contagion but was covering-up the facts and deflecting blame for it.  "Republican Xenophobia Is Going to Make the Pandemic Much Worse," warned The Nation, reflecting the left's conventional wisdom at the time. It's thus impossible to argue that liberals would have put a lid on travel from China, or taken any other containment steps, with any more speed than Trump did.  

Would any one of the Democrat contenders have overruled CDC's fateful and flawed recommendation to not use the German test, which in retrospect seems to be where good old hubris (or bureaucratic inertia and bumbling, flip a coin) came back to haunt us? That claim, too, is dubious, if not laughable, given the deference all good "progressives" pay to bureaucratic expertise and efficacy.

Let's also remember what the press and political elite were obsessing about 24/7 for critical weeks when the outbreak was gaining early momentum -- impeachment. But you won't see that latter bit of context anywhere in the AP's account either.

Another takeaway for me (which is a topic I'll only touch on today) is that a competence gap seems to be plaguing America -- something CDC's botched response highlights in such starkness. I don't mean political competence, though that's often a problem too, but technical competence, especially on the government or bureaucratic side. The rather sad state of the once-great NASA may offer the best shorthand illustrate of what I'm pointing to here. NASA was once the best of the best: today it can't out a man in space unless he or she is riding there on a Russian rocket.

Our scientific and technical prowess just may not be what it's cracked up to be anymore; that's a troubling subtext to this that hasn't gotten enough attention, in my view. Germany had a viable and reliable diagnostic test available in relatively short order, but rather than use that test, our supposedly elite CDC chose a go-it-alone, we-can-do-better approach that badly backfired in an embarrassing fashion.

Was it foolish pride, or maybe cocky overconfidence, or perhaps bureaucratic territoriality that colored that fateful decision? Was that the President's call to make, or did he simply trust in what the overconfident technocrats told him, resulting in the misfire? I suppose that will all come out in the wash eventually. Right now the priority must be saving lives and "flattening the curve."

I'm sure, once the dust settles, that there will be "Blue Ribbon Commissions" organized to fully probe (but hopefully not further politize) how our US response stumbled from the starting gate. And such a review is certainly warranted (assuming it doesn't take seven years and cost $200 million to complete, which would just underscore the problem I'm touching on). And perhaps we'll emerge from all this with our confidence shaken, which wouldn't be the worst thing if it spurs us to address the competence gap and strive to regain the technological edge we long (but mistakenly) took for granted, thanks to this reminder that maintaining that edge really can be the difference between life and death.