Patterico's Pontifications


Shocka: Trump Ignored the Coronavirus Warnings

Filed under: General — Patterico @ 7:32 pm

Shane Harris and others in the Washington Post:

U.S. intelligence agencies were issuing ominous, classified warnings in January and February about the global danger posed by the coronavirus while President Trump and lawmakers played down the threat and failed to take action that might have slowed the spread of the pathogen, according to U.S. officials familiar with spy agency reporting.

. . . .

Intelligence agencies “have been warning on this since January,” said a U.S. official who had access to intelligence reporting that was disseminated to members of Congress and their staffs as well as to officials in the Trump administration, and who, along with others, spoke on the condition of anonymity to describe sensitive information.

“Donald Trump may not have been expecting this, but a lot of other people in the government were — they just couldn’t get him to do anything about it,” this official said. “The system was blinking red.”

Of course, the notion that Trump ignored the warning signs was obvious for a while, but this reporting makes it especially clear that he had information within the government that he ignored. If only they had put it on Fox & Friends!

Trump now pretends he always knew this was a pandemic. Um, not so much, as a brutal new ad makes clear:

Ethics Of Rationing Health Care If System Becomes Overwhelmed

Filed under: General — Dana @ 6:26 pm

[guest post by Dana]

In light of the pandemic and the limited number of ventilators available nationwide, inevitable discussions about the prioritizing of treatment if the system becomes overwhelmed, have begun. From The Los Angeles Times:

Three patients — a 16-year-old boy with diabetes, a 25-year-old mother and a 75-year-old grandfather — are crammed into a hospital triage tent and struggling to breathe. Only one ventilator is left. Who gets it?

Do they allocate intensive-care beds on a first-come, first-served basis? Do they pull one patient with a limited chance of survival off a ventilator to give it to another with better odds?

If two patients have equal medical need and likelihood of recovery, do they pick the youngest? Or the one with the greatest number of dependents? Should physicians and respiratory therapists, or even police officers and firefighters, be jumped to the front of the line?

With the upward trajectory of Americans testing positive for coronavirus, medical professionals are faced with decisions about who should receive treatment if there is a very limited number of ventilators and hospital beds available. In the U.S., we are at the discussion and planning stages. In Italy, planning is long over with – the hard decisions are already being made:

Without enough ventilators to deal with the influx of patients, doctors are denying services to the elderly in favor of young and otherwise healthy patients.

“There is no way to find an exception,” a doctor in northern Italy told the New England Journal of Medicine. “We have to decide who must die and whom we shall keep alive.”

To see the problem in the starkest of terms, Johns Hopkins reports that the U.S. has fewer than 100,000 intensive-care beds. But it would probably need a total of 200,000 in a moderate outbreak and 2.9 million in an outbreak akin to the 1918 Spanish flu.

In Washington state, which has been hit extremely hard by the outbreak, about 280 clinicians and officials from across the state, participated in a conference call concerning the difficult subject of prioritizing treatment of patients if the system becomes overwhelmed:

Fearing a critical shortage of supplies, including the ventilators needed to help the most seriously ill patients breathe, state officials and hospital leaders held a conference call on Wednesday night to discuss the plans, according to several people involved in the talks. The triage document, still under consideration, will assess factors such as age, health and likelihood of survival in determining who will get access to full care and who will merely be provided comfort care, with the expectation that they will die.

Cassie Sauer, chief executive of the Washington State Hospital Association, said that the decision was being made statewide in order to keep individual doctors from having to make the difficult decision:

“It’s protecting the clinicians so you don’t have one person who’s kind of playing God,” she said, adding, “It is chilling, and it should not happen in America.”

Dr. Chris Spitters, interim health officer for the Snohomish Health District, explained that medical professionals will be better off having an actual plan in place, rather than just hoping it gets better:

“I would love to learn a month from now that the social distancing measures we adopted did indeed curb the outbreak enough to avoid going into that crisis zone of activity,” Dr. Spitters said. “But that would be poor planning — to simply hope.”

Determining the criteria:

“They look at the criteria — in this case it would likely be age and underlying disease conditions — and then determine that this person, though this person has a chance of survival with a ventilator, does not get one,” Ms. Sauer said.

“This is a shift to caring for the population, where you look at the whole population of people who need care and make a determination about who is most likely to survive, and you provide care to them,” she said. “Those that have a less good chance of survival — but still have a chance — you do not provide care to them, which guarantees their death.”

Fordham University’s Charles Camosy, who is an associate professor of theological and social ethics, and whose work focuses on ethics and policy, explains why he disagrees with making any rationing decisions based soley upon age:

The Italians have already faced the bedeviling moral dilemmas of rationing, and in a guidance to providers, the Italian government has recommended that resources be rationed by age… age-based rationing is “a way to provide extremely scarce resources to those who have the highest likelihood of survival and could enjoy the largest number of life-years saved.”

Bioethicists like me disagree over which values should guide rationing, but we generally agree about focusing on those who can benefit from the treatment. If the age of a patient makes it unlikely she would benefit, the hard truth is that limited resources will likely go to someone else.

But then there is the “number of life years” the patient could “enjoy,” as the Italians put it. This consideration comes from providers’ growing tendency to think either implicitly or explicitly about how many “quality-adjusted life years” their interventions might produce. It is a poisonously utilitarian and inherently discriminatory mentality. It is ageist — discriminatory against the elderly — and ableist — discriminatory against the disabled — to its core.

He then explains the danger of using a “quality of life’ argument: we know that throughout Europe, it is believed that babies born with Down syndrome are deemed so without quality of life that they are better off not having been born at all (see: Iceland):

But anyone who loves someone with Down syndrome knows that they are some of the most joyful people on earth. What if a corona victim competing for a bed or ventilator has Down syndrome? Even some US hospitals are considering using “quality of life” as part of their rationing process.

So who should make the decision about care rationing?

It should not be up to physicians to decide whose subjective quality of life deserves to be prolonged. Physicians almost always rate the quality of life of their patients significantly lower than patients do themselves — and miss the fact that their patients often prefer length of life to quality of life (whatever that means). In short, they are terrible deciders about who should live and who should die.

Camosy points readers to protocols established in 2008 by the state of New York, in case of a pandemic likethe one we are currently facing. “Allocation of Ventilators in a Public Health Disaster” informs decision-makers that “age and health problems or disabilities unrelated to what is causing the epidemic shouldn’t serve as the basis for rationing. Prognosis for recovery is what matters.”

In other words:

A New York hospital could choose to give its last ventilator to the 72-year-old marathon runner rather than to the 57-year-old pack-a-day smoker. Again, based only on prognosis for recovery. The objectivity of the standard removes much of the physician’s subjective ideology from the picture.

The protocol also says that the public should make sure our views are reflected in state and hospital policies when an epidemic hits. We are late to the party, but there is no time like the present to be heard and hold the health-care community to transparent ethical standards.

Again, physicians and hospitals are doing heroic work under traumatic conditions. We are beyond blessed to have them. But it is in supremely difficult conditions like the current one when cultures tend to abandon their core values.

If rationing arrives, we must stand up unambiguously for the marginalized and vulnerable, the elderly and disabled, lest what Pope Francis has decried as the modern throwaway culture deems them expendable.

Prayerfully, it doesn’t come to this.


Momentum Builds to Postpone Summer Olympics

Filed under: General — JVW @ 12:46 pm

[guest post by JVW]

USA Swimming has formally asked the United State Olympic Committee to request that the International Olympic postpone this summer’s Olympic Games, scheduled to open in Tokyo just over four months from today. The USA Swimming Olympic Trials are supposed to begin June 21, two days after the track and field trials begin. Four days later the gymnastics trials are to commence. USA Basketball planned to be holding training camps right about that time to select the men’s and women’s teams. But with the ability to conduct these events now in question for arguably the four most popular Summer Olympic sports, it’s likely that the USOC will join in the call to push the games back, perhaps even into next year.

This will of course be disastrous for the host country, Japan, who has like so many other host nations already seen the games become a financial sinkhole long before the coronavirus emerged. The Japanese government is estimated to have spent around $16 billion in preparation for the games, more than double the initial projection, with the expectation that roughly ten times that sum would flow through the Japanese economy from spectators, advertisers, merchandisers, and other people affiliated with the games. They further hoped that hosting the Olympics would generate nearly two million jobs over a period of two decades. Annual tourism to Japan had already tripled over the past five years, and the transportation minister had set a goal for 40 million visitors this year, a forty percent increase from last year.

So even a postponement — not to mention a disastrous cancellation — will have a devastating effect on the Japanese economy, which will of course cause ripples throughout Asia, the Pacific region, and even Europe. The Tokyo Olympic Games Planning Committee met with members of the Japanese government earlier this week, but as of now they continue to plan for their July 24 opening. I doubt they will be able to keep up this brave facade for too much longer. The fallout from this damn pandemic is going to be massive.


California on Lockdown; Senators Sold Stock After Coronavirus Briefing While Reassuring Public

Filed under: General — Patterico @ 8:22 am

So California is on lockdown:

California ordered its 40 million residents to stay at home except for essential activities beginning Thursday night in the largest such lockdown in the U.S., as the nation’s total coronavirus cases rose to more than 14,000 and an intensifying outbreak in Europe pushed State Department officials to advise citizens not to travel abroad.

Gov. Newsom estimates that 56% of Californians will be infected within eight weeks. That seems high to me; the experts I have heard have said 30-50% of the U.S. population is likely to be infected in the first year. That said, it stands to reason that the virus will spread more readily through populated areas, and California has those in abundant supply.

The numbers out of China are looking better, but a) they might be phony and b) China’s response was quite a bit more vigorous than ours (once they got around to ending the cover-up, that is). In Italy things are … not so good. Their death toll as of yesterday was 3405, which had overtaken China’s reported numbers since the beginning of the outbreak. Italy extended its quarantine to the entire country eleven days ago. We’re about two weeks behind them. Buckle up. It’s coming.

Speaking of a government covering up the danger posed by the virus … we have news that several U.S. senators sold stock shortly after a closed briefing on January 24 that warned of the dangers the virus posed. Some of the GOP senators were telling the country everything was fine even as their stock was being dumped.

Soon after he offered public assurances that the government was ready to battle the coronavirus, the powerful chairman of the Senate Intelligence Committee, Richard Burr, sold off a significant percentage of his stocks, unloading between $628,000 and $1.72 million of his holdings on Feb. 13 in 33 separate transactions.

. . . .

On Thursday, Burr came under fire after NPR obtained a secret recording from Feb. 27, in which the lawmaker gave a VIP group at an exclusive social club a much more dire preview of the economic impact of the coronavirus than what he had told the public.

. . . .

Burr’s public comments had been considerably less dire. In a Feb. 7 op-ed that he co-authored with another senator, he assured the public that “the United States today is better prepared than ever before to face emerging public health threats, like the coronavirus.” He wrote, “No matter the outbreak or threat, Congress and the federal government have been vigilant in identifying gaps in its readiness efforts and improving its response capabilities.”

To be fair, on February 27 it was fairly obvious to people paying attention that we were headed for a tremendous amount of economic pain. The stock market slump had already started by then (Trump blamed it on the Democrat debates!) and I said on February 28:

National Economic Council head Larry Kudlow says the Trump administration has “contained” the “caronavirus”, while the CDC has said of a spread of the virus in the U.S.: “It’s not so much of a question of if this will happen anymore but rather more of a question of exactly when this will happen.”

Americans will have to decide whether the Trump administration and its top officials like Kudlow would be more likely to put Donald Trump’s interests above those of the United States, and whether they would say false things to calm markets and benefit Trump politically. There is a rich history of material from the past three years with which Americans could make such a decision. A lot of it is in books.

I should have included “GOP allies in Congress” in the group of people putting Trump, and their personal stock holdings, above the interests of the country they were failing to warn.

Burr is not the only U.S. senator who dumped stock after the briefing. The names include Sen. Kelly Loeffler, a GOP senator from Georgia and the wife of the CEO and Chair of the New York Stock Exchange. As she was dumping millions of dollars worth of stock (and buying up Citrix, a company that offers teleworking software) she was telling the citizens Trump had everything well in hand:

Sen Loeffler says she was told about the sale three weeks later. To my knowledge, she hasn’t said whether she had told her broker about the nature of the closed door meeting.

Other Senators who dumped stock after the closed briefing were our own Sen. Dianne Feinstein, Democrat from California (“between” $1.5 million and $6 million) and Senator Jim Inhofe, Republican from Oklahoma (“up to” $450,000). (Senator Ron Johnson has been named as having sold stock but even lefty site Raw Story admits it was sales of private stock in a family business having nothing to do with coronavirus.)

Frankly, I am less incensed at these folks selling stocks as I am that they were not (to the extent they were not) out there warning the public how dire the situation was. All the stock sales show is what they assuredly believed privately — to the extent they were involved in the sales. For Sens. Burr and Loeffler to publicly assert everything was fine was patently false and indeed dangerous.

I’m sure there will be investigations and consequences. This is likely to have a real impact on the GOP’s chances of holding the Senate.

Powered by WordPress.

Page loaded in: 0.0650 secs.