"It Didn't Go So"

"It didn't go so," she said under her breath. —Erna Brodber, Myal, p.84.

Unremarkable deaths of social distancing - 01 Apr 2020 22:25

//Tags: //

This piece was picked up by the critical theory journal Telos.

If a global region has a low incidence of COVID-19, (eg. Africa in the bar chart below), or a US state has a low incidence (eg. "flyover country" in the heatmap below) that does not mean it is well. Social and economic disruptions in the wake of this spring's virus will be unevenly distributed in intensity and time. Socially-distanced rural suffering will long outlast the news cycle and panic.

who-31mar.PNG

COVID-19 is a real crisis. It is unique for being concentrated for once in places where global travelers, professionals, and creatives live. When risk for those populations is controlled to a level they can accept, expect panic and restrictions to ease. Our world happily tolerates death tolls far in excess of the worst projected for COVID-19 when only rural people or people with a high school education or less are at high risk.

cases-county-30mar.PNG

Kentucky, where I live, expects our COVID-19 crisis to peak on Saturday, 16 May, with 1,600 hospitalized and 240 in ICU beds on that day. By then, New York is expected to no longer need any COVID-19 beds. Their peak will have been a month and a half previous. Kentucky (more accurately, Lexington and Louisville) will probably be fine when we peak. Tennessee (e.g. Nashville and Memphis) probably won't. Expect the news to have moved on by then.

Kentucky expects less than 900 COVID-19 deaths this year. We also still expect our normal of upward of ten thousand heart disease and cancer deaths, 3,500 chronic lower respiratory disease deaths, 3,300 accidents (1,600 of the accidents will be drug overdoses. 730 will be firearm deaths, mostly suicides), and over 2,000 strokes. According to the CDC, the next seven causes of death in Kentucky — which all remain more likely than death by COVID-19 — are Alzheimer's disease, diabetes, kidney disease, septicemia, and flu/pneumonia. If the 10th cause of death is redefined as flu/cov/pneumonia, it will nearly double and take the spot below stroke in the Ky mortality list. Early death from all these causes will remain most likely among rural people and people with less than a high school education, and is unremarkable.

suicides-16.jpg

It is too early to say how impacts of this spring, such as missed medical appointments, furloughed health care workers, small businesses failing or being bought out by monopolies and private equity firms, higher health insurance premiums, local government budget shortfalls, distressed and broken families, and a possible economic depression will affect normal causes of death in Kentucky. Since at least Durkheim's 1897 study on the topic, it has been known that social isolation increases the suicide rate. Without significant political pressure, increases in hazard that are largely contained away from professionals and creatives will be tolerated.

Globally, the unremarkability of early death in less cosmopolitan classes and places is more extreme. The nearly landlocked Democratic Republic of the Congo, for example, is arguably in Africa's "flyover country," despite its megacity, Kinshasa. It has no or nearly no cases of COVID-19. However, the country is in a grade 3 public health emergency, the same WHO rating as Italy.

Risk factors for COVID-19 death, by income
Image Unavailable

Why? First on the list is a virus I can't even spell: Chikungunya virus disease. Also the fifth year of a cholera outbreak, the third year of an Ebola virus outbreak, the second year of a Measles virus outbreak, the third year of a Monkeypox outbreak, the second year of a "Plague" nobody with research dollars cares enough about to do the science to specify what exactly it is, the third year of a vaccine-associated acute paralytic polio, and — the kicker — the aftermath of war.

The economic interests that destabilized the public health capacities of Europe and the US in the last 25 years (most acutely since the Global Financial Crisis) cut their teeth with structural adjustment and imposed austerity programs in Latin America in the '70s, Africa in the '80s, and the former Soviet Union in the '90s. The people who did most of the dying during those apocalypses are remembered as, well, just the sort of people who die.

In a fiery essay in the Players Tribune (W 25 Mar), Miami Heat's power forward Udonis Haslem described the consequences of the selfishness of Miami spring-breakers.

You see that video going around of these silly ass college kids down in South Florida on spring break? Talking about, 'If I get corona, I get corona, bro,' and all that nonsense? …When the average person in Middle America thinks about…social distancing…, maybe they picture a bunch of schools shutting down and then these kids going home to a bunch of nice houses and chilling for a couple months. Eating snacks, playing video games. Mom's working from home, doing conference calls….

For a lot of kids, the truth is that school is the only structure they got. It's the only food they can count on. It's the only safety that’s guaranteed. You take that all away? You better be prepared to protect them…. If you got a roof over your head and some food in your fridge and you don't have to go to work to feed your family, just do the easiest thing in the world, man. Fuck your spring break. Just keep your ass at home.

Mortality in Kentucky
Image Unavailable
The mortality rate from suicide, drug overdose, and alcoholic liver disease mortality in Kentucky by educational attainment, for white non-Hispanics age 45-54 who have a bachelor's degree compared to those who don't. From Deaths of Despair and the Future of Capitalism by Anne Case and Angus Deaton.

What he wrote about spring-breakers could easily be said about cosmopolitan entrepreneurs (social or otherwise), nonprofit managers, partiers, artists, and urban professionals in the hardest hit cities—New York, New Orleans, and Detroit. It's maybe no coincidence that those three cities were the most attractive to highly mobile creative-class people I've known in the last decade. Through conferences, weddings, vacations, and other irresponsible travel, mobile professionals and creatives and their wealthy patrons are vectors for a plague that will ultimately hurt them far less than it will hurt people they don't think matter.

I live in a poor county within an afternoon drive of some of the poorest in America. The last two hospitals I worked in routinely take patients from 300 miles away and employ staff who commute a hundred miles each way (eg. Lost Creek to Lexington). Helen Epstein, in the New York Review of Books (R 26 Mar), described how my rural neighbors may react to an economic shutdown over the coming months with suicide, conspiracy theory, and physical pain, but no political mobilization. While these things may endure, the COVID-19 panic will last only as long as our betters are at risk.

no-car-no-market.jpg

As I socially distance, I check in with my brother, my neighborhood, the truck stop, my workplace, and the places and people I love. What do forgotten people who live in our neighborhoods or our counties need, materially and culturally? What will we need once our betters feel safe and have liquidity, but the place we used to work has closed forever? It's time to somehow carry those we love with us, not through a snowstorm, but through a long winter.

We live together on the Titanic. If first class cabins are taking on water, steerage was long ago flooded to its roof. Governors have worked to protect us, but the federal executive and legislature of my country are now enacting policy like the CARES Act that pumps water out of first-class into the few remaining airspaces of second and third-class cabins. Debt forgiveness, uncapped federal programs with clear qualifying events, and the universal, legally-enforceable right to healthcare and paid work would be a whole new boat.

I'm not suggesting more grants for the Bill and Melinda Gates Foundation to do plague research in Africa. Nor do I argue that Kentuckians should defy social distancing orders and go to church. I'm merely noting that the source of our present panic is an apocalyptic moment spread by and touching the lives of those who at best administrate the apocalypses of others in what they consider normal times. - Comments: 0

SARS-CoV-2 links - 22 Mar 2020 17:31

//Tags: //

This page is updated three times a week. I watch the world from below and to the left. I like universal socialism and decisions that strengthen the resources of particular communities and traditions. Links added on W 15 Apr have red date.

incid-10apr.PNG

43 days since 100th known US case. News:

  • 2 days since IHME predicted US peak, 6 days til Ky peak.
  • Observed peaks are likely a false result produced by a lack of increase in testing, and not suggestive of true case rates. The future is expected to be "fat tailed" (highly uncertain). Based on observations in Europe, new case discovery may reach a steady state rather than decreasing in the near-term.
  • Starting in mid-March, partial lockdowns were imposed state by state in the US. Starting in mid-April, there is increasing pressure to lift stay-at-home orders.
  • Senators Bernie Sanders (I-VT), Richard Blumenthal (D-CT), Mark Warner (D-VA) and Doug Jones (D-AL) introduced the Paycheck Security Act, a bill similar to one introduced by Josh Hawley (R-MO), and worth lobbying your senator about. If passed, it will:

cover payroll and benefits for all employees up to $90,000 in salary, and “a portion of fixed operating costs” for businesses affected by the crisis, large and small (unless they have very large cash reserves), for the next six months. Recipients of the grants would not be able to cut pay and benefits for workers and would have to offer previously laid-off workers their job back. There would be restrictions on stock buybacks and dividends (remember big companies would be eligible too), caps on CEO compensation, and protection of collective bargaining agreements. Obviously, by keeping people on payroll, it protects employee health care for those who have it.

Economic numbers:

  • The lockdown-induced global jobs crisis is the deepest and most sudden on record. In four weeks, 22 million unemployment claims were processed in the US. Many more were filed but systems couldn't handle the volume. Furloughs continue.
  • In the first two weeks, 3.5 million workers likely lost their employer-provided health insurance. Tens of thousands of news and healthcare industry workers lost jobs. Finance and insurance did not experience significant job loss.
  • US Congress passed the CARES Act, a $2 trillion relief bill, half the size of the federal budget and the largest relief legislation ever passed by Congress. Multiple Federal Reserve actions preceded and followed it.
  • 80% of the bailout that reached individuals went to people earning more than $1 million/yr, due to a tax break bigger than the airline bailout.
  • $6 trillion got to investors via Federal Reserve vehicles quickly, buoying the stock market.
  • Money to the rest of the population passed through slower and less dependable institutions: the Small Business Association (via loans originated by local banks), unemployment insurance, and IRS checks sent to local banks.
  • The Fed will soon own 3/4 of debt in the US.

Virus numbers:

  • The US is the world's only country to exceed 200,000 (W 1 Apr) and 700,000 (F 17 Apr) confirmed cases.
  • 153,000 global COVID-19 deaths (6% of 2.6 million avg annual respiratory infection deaths). 37,000 deaths in US.
  • Half of US cases and 60% of US deaths are in NYC and its metro area.

Send me links or data you want to see posted.

Live data

Cases, fatalities, recovered, tested:

Treatment and mutual aid:

Policy guidance:

cases-county-10apr.PNG

News watchers

Mutual aid resources

Telework, intimacy without proximity, and big tech

  • My thoughts:
    • Older/poorer people1 are silenced when they don't know how to DM in Slack or unmute themselves in Zoom, when they have bad or no internet, a pay-as-you-go hotspot, or internet only through their phone.
    • Consider slowing pace and bandwidth, promoting more autonomous work. What can be done by phone or dial-in conference-call, email (lists), mail or delivery with groceries, or by newsletter? How do you promote meetings so people don't miss them? School buses are dropping off and picking up class assignments and lunches in many places. How can work, education, or organizing be more distributed and democratic, on and beyond the internet?
    • Older ways of communicating require more work/cost/thought from the sender (eg. using carbon paper or tracing paper and screen printing to produce newsletters). Digital communication requires more (sometimes an overwhelming degree more) from the reciever.
    • Learn about mail art. Send some. Make and mail masks. Send letters. Send mix CDs or homemade crafts. Send money. Think something complex all the way through with a buddy by mail, maybe a buddy in prison, an expert in their field, or a buddy in another country. Mail isn't only for recieving packages.
  • Work, school, family, church, and accessing benefits have become largely computer-mediated. For example, over 90,000 schools in 20 countries moved classes to Zoom videoconferencing.
  • Fight Amazon is the beginning of a conversation about how local retail can fight Amazon (with tech/marketing/logistics) and survive.
    • People can buy books from bookshop.org without hurting local bookstores.
    • Restaurants are considering how to deliver without losing up to 25% to predatory startups like DoorDash or Grubhub (restaurant profit margins are already razor-thin, like 3%-5%).
    • The conversation is an important complement to antitrust law (eg. as applied by the EU, FTC, and DOJ) and to the Senate's proposed Paycheck Security Act.

Benefit programs

  • IRS for getting $1200 economic impact payments direct-deposited (warning: US Bank and other banks may take it under certain circumstances).
  • SNAP for your state, to apply for food stamps.
  • Dept of Labor state resources, including unemployment application, labor rights, and help finding a job. Unemployment insurance has been extended to self-employed and gig workers.
  • NCOA resources for seniors, including Meals on Wheels, transportation assistance, Medicare help, and assistance with utility bills and prescription drug costs.
  • NIDA resources for finding online alcohol/drug recovery support meetings, guidance for treatment providers, and changes to court, jail, and prison policy in your state.
  • SBA page to find a lender eligible to issue a loan under the Paycheck Protection Program (PPP). Terms: The PPP provides 2-year loans of up to $10 million for businesses with under 500 employees. The loan will be forgiven if at least 75% goes to payroll and employees are kept on for at least 8 months. (Currently out of money, F 14 Apr).
  • CFPB information on student loans, mortgage relief, etc.
  • USA.gov coronavirus page for a comprehensive list of government agencies' COVID-19 pages.
stages-cov.png

Care and testing

[Care in early stages:] Often the virusemic period is…like a slight cold: malaise…, a slight [subfebrile] temperature…. Take good care of the nasal mucosa and oropharyngeal area…. [Rinse the nasal mucosa with saltwater. Use] non-prescription [decongestants]…. Make a good [saltwater rinse of] the oropharyngeal area behind the uvula…, too…. [Don't just squirt it up your nose, gargle it deep down your throat] and rinse it out…. [Repeat] until you…[have free, unobstructed] airways….

I would advise those people who can afford to buy a nebulizer [aerosol, with ultrasound]. When a cough starts, it is desirable to still apply the medications that we prescribe for patients with bronchial asthma…[like] Berodual, or Ventolin, or Salbutamol…. These drugs improve mucociliary clearance, relieve spasm…. [Use expectorant/mucolytics like] ACC and Fluimucil…. What you can't do is use glucocorticosteroids [like] prednisone, methylprednisolone, dexamethasone, betamethasone [these impair immune response].

[Therapy in later stages:] [If] the cough increases and…there is shortness of breath…: stop, this is a qualitatively different patient…. A cold is one thing…a viral-bacterial pneumonia…is a fundamentally different thing…. We…usually prescribe fourth-generation cephalosporins…in combination with vancomycin [for pneumonia]. This combination is broad, because very quickly there is…a change of gram-positive and gram-negative flora. What immunomodulatory drug to prescribe is a question for scientific research…. In this situation…immunoglobulin…substitution therapy [can help]….

If this situation is not controlled and the disease progresses, then…a person cannot breathe on their own…. Cardiogenic pulmonary edema can be treated with certain medications, [but] this pulmonary edema can only be treated with a mechanical ventilation machine or advanced methods such as extracorporeal hemoxygenation.

What are the tests we need to detect coronavirus infection?
…PCR [polymerase chain reaction] testing, look[s] for viral RNA to determine whether a person is infected…. PCR testing…is now ramping up very, very rapidly in state and local labs as well as in academic medical centers and in the commercial sector…production will grow tremendously. Roche has a machine that will run 1,000 samples at a time. If you go to a commercial lab, they take a swab, they package it, they quite often send it to another facility somewhere else. The turnaround time is typically 72 hours. In that period, it's very, very hard to manage patients and their contacts. It's a nightmare for the healthcare worker.

[Antibody tests are a crucial tool to combat this epidemic.] We need point-of-care tests…you use a finger stick, drop the blood on a small device, and have a readout in 15 minutes. These tests measure antibody response to the virus and are extremely useful. Yet we don't have a single [rapid] test licensed in the US. In China, in South Korea, and in Europe, those tests are used. The manufacturer for this rapid test is producing a million a day.

Study populations in China are reporting significant co-infection rates with COVID-19 and influenza. Yes, you can have both….

Church; Library

Policy, economy, civic virtue

anatomy-of-cares.jpg

Rich people getting things, asset prices rising, large military spending and corporations getting bailed out…doesn't…cause the fragility of our system…in any direct and straightforward way. Our system is fragile for specific and direct reasons: we don't have the infrastructure to respond to crises.

We don't have an indefinite mandatorily funded Medicare for All system which quickly and proactively responds to crises. We don't have a legally enforceable right to a job. We don't have government bank accounts for all residents of the United States (but hopefully congress will pass Tlaib's bill and change that). We don't have a system for providing grants to every business in the United States. No amount of money going to where we don't think it should have gone reduces our capacity to create this infrastructure….

This is the largest, fastest economic crisis that has ever happened…. We need 3.5 trillion dollars distributed to households at a minimum — let alone the support system we need for businesses.

Human social institutions are phenomenally durable. We are, as a species, fond of genocide, warlords, raiding, subjugation and misery, but also collective education, storytelling, celebratory feasting, and religion, and it's remarkable how the latter group have historically survived the worst depredations of the former. It seems really crazy to think that oil shortages or inflation would render libraries and fire department fish fries irrelevant, or that hiding out protecting your patch of jerusalem artichokes would somehow be a better use of your one lifetime than fixing roads or otherwise maintaining civic engagement…. Don't give up on other people just yet.

Proud of my state

In the chart below, light bars are tests until 18 March. Dark bars are confirmed cases. (As of 17 Apr, there are 129 confirmed case deaths in Kentucky and 142 in Tennessee. The confirmed case rate is much higher in Tenn, but the risk of death from a confirmed case is higher in Ky).

ky-vs-tn.jpg

Kentucky news

This week's news: rural cases are rising most rapidly in institutionalized populations, people who work in institutions, and counties where many people commute to big cities to do work that can't be done from home. Layoffs of healthcare workers continue, reaching Ky's biggest healthcare systems. Volunteer labor is replacing previously paid care and supply chain jobs.

News aggregated by the Kentucky Office of Rural Health, updated Mondays.

- Comments: 0


Unless otherwise stated, the content of this page is licensed under Creative Commons Attribution-ShareAlike 3.0 License