Notes from COVID19 Frontlines

Nobody wants to have a kid go to war, but sometimes it happens.

My brother got sent off to Vietnam, and while our family opposed that war, his choice was a Hobbesian choice, which is to say, not much of a choice.

With respect to NYC right now, doctors who are employed by any of the major hospital health care systems  are more or less conscripted, but they have more choices to avoid service, if they wish.

As the email below mentions, if you are employed as a physician by a hospital system, you can choose not to report for duty--you simply won't be paid. For those who had enough financial cushion, that is an option.

But unless I miss my guess, I am betting even doctors with a lot of cushion will not leave town.  I can think back to docs I knew in NYC and I can name those who have likely already decamped to their places in the Hamptons. Medical practice  for them was never about anything but the money, so hazardous duty makes no sense for them.

But for a lot of docs, like the 60 year old with two coronary stents, he will not fail to step up--he will not fade from the firing line, because if you are a doctor, you show up.

A check out clerk at Market Basket told me, "I did not sign up for this. If I didn't need the money, I wouldn't be here."  I can see that.  She felt that simply standing across the checkout counter was too big a risk. Some grocery stores are installing plexi glass panels to protect the cashiers now.

There are no plexi glass barriers for the doctors and nurses in NYC now.

But for many doctors, they just could not face their colleagues later on, if they were not visibly present now.

Nurses, too.  Nurses especially. Nurses are closer to the patients than doctors mostly.

And it's the innoculum, the number of virions, viral particles, that likely determines who gets the overwhelming infection. 
Also the host. 
The author of this email has underlying asthma. A respiratory infection for him is a far more dangerous thing than for his non asthmatic colleagues.

But there he is.

He is writing his uncle, who is a doctor at Duke, replying to his uncle's inquiry about how things are going in NYC.

On Fri, Mar 27, 2020 at 2:14 PM 

Hi,
How are things going for you in NYC? The evening news makes it look pretty bleak - but hopefully they are exaggerating a bit for effect.

So far Duke Hospital has no cases of COVID-19, although there are two hospitalized at Duke Raleigh Hospital. Only a matter of time before the virus makes its way to Durham.

Hey Unc, (added dad as well)

Things are pretty much at capacity in NYC with the smaller satellites starting to get overwhelmed. I think that trend will progress to our main hubs by next week. As an example, at Brooklyn Kings Highway (a sinai affiliate near cony island) 146 of 220 beds are currently occupied with covid patients, their ICU expanded into their ORs and PACUs. Our colleagues there paint a pretty grim picture, the morgues are only used to about 5 deaths a day, so there is a refrigerated truck taking bodies away.  We have many more covid  patients in Manhattan but obviously way more capacity. As of last count, there were about 50 open ICU beds system wide. 

Surgeons were first told we could volunteer for "platoons" consisting of 2 surgeons and 4 mid levels/ trainees. These platoons would be sent to hot spots to help out in ICUs and ERs system wide. We will be functioning as whatever they need, ICU attending? ER? whatever. We were then told today that these platoons were only voluntary in the sense that we can also choose not to get paid. My immediate boss is in his mid 60s and has multiple coronary stents, and he will go to the front lines with the rest of us. 

A bright spot is it sounds like there is a decent amount of PPE to go around in manhattan, and have not heard stories like they are sensationalizing on the news. 

But yeah, all in all, we are in for a dark couple weeks. I plan on doing what I can on my platoon and being extremely paranoid with PPE. I also think it is quite possible [his wife] had and convalesced from it, so hopefully I already had an asymptomatic case. No way to know without serology (not available)

Bernie Sanders: When Fantasies Crash and Burn

Contemptible you are in your wealth,
You kings of coal and steel!
You had your thrones, parasites,
At our backs erected.
All the factories, all the chambers –
All were made by our hands.
It's time! We demand the return
Of that which was stolen from us.

--The Internationale

The collapse of Bernie Sanders' campaign came as no surprise to Mad Dog.
Had Bernie been more successful, Mad Dog would have been astonished.

Whenever Mad Dog saw Bernie, the words of Mad Dog's father echoed in his ears from years ago:  The NFL players had gone on strike and these players, who were paid millions, were organizing as a brotherhood of workers.  

"I'm all for the workers," my father said. "My parents were union, through and through. But these are not WORKERS."

By which he meant, millionaires are not workers.  Working class people who live in working class homes in working class neighborhoods are workers. These were millionaires complaining about their ill treatment by billionaire owners.

Workers just aren't what they used to be.

In fact, likely, workers haven't been "workers" likely since the end of the Great Depression, or at least since the late 50's.

Workers of the world unite!

But, as Sanders himself as noted, sadly, the Democratic party is no longer the party of the working class. "The Democratic Party has become the party of the more affluent people, while the Republican Party has become the party of the white working class."

Bernie sought to rally all those idealistic young people who reminded him of his own youthful group, the kids who marched against the war in Vietnam, against "The Man" against the controlling, soulless Wall Street rich.  And he would bring them out to vote in numbers un-imagined. Well, not un-imagined, because Bernie imagined them, but the fact is, there were never enough of them.

An African American minister spoke of one of the members of his congregation who told him, "My Medicare isn't for all. I worked for it; it's mine. And now you want to give it away to someone else who hadn't earned it."

There you have in a nutshell, in a single congregant's confession, the nub of the problem: These workers are not singing kumbaya, locking arms with other workers, marching arm and arm for the greater good of the working man, singing "We Shall Overcome," or The Internationale.

This is a man who is not amenable to the idea of supporting someone else, when it comes to health care. He's got his. He earned it. He doesn't want to help deadbeats or people who didn't work as hard as he did.

It's the same thing we heard when a Danish woman was asked by her friend how she could stand to live in America, where they don't have universal health care and the Danish woman asked her friend, "Well, wait a minute. How would you feel if your taxes went to pay for the medical care of an Italian?"
Her friend started, blinking, a deer in the headlights. "Well, but that's different."
"No," said the Danish woman. "The white guy in Wisconsin doesn't want to pay for the healthcare of the Black guy in Kentucky. Same thing."

When Bernie was mayor of Burlington, Vermont, demonstrators picketed the factory which made Gatling guns which were sold to Central American dictators who mowed down demonstrators seeking  democracy. Bernie chose to side with "the workers" who were making the guns, but these weren't really "workers" by my father's definition: Real workers would never have made guns used to suppress other workers by autocrats.  "Remember," Lenin said, "A boyonet is a weapon with a worker at either end."

Workers who are despoiling the environment by fracking  in Pennsylvania or drilling in the Gulf of Mexico aren't dreamy eyed workers dreaming of a workers' paradise.  Bernie had to face the roles these workers played in destroying the climate and his response was "We'll retrain them and pay their salaries while they learn something new."

But that was just a dodge. That was like saying, "We'll convert them to Christianity" and once they have accepted the Lord Jesus, or the environment, they'll want to do good.

Bernie was beaten by the very working class people he claimed to want to fight for and liberate. 

Trouble was, they didn't want to be saved. They just wanted what they thought belonged to them. 

Exeter Road Tree Massacre

Route 27 in Exeter, New Hampshire is called "Hampton Road" and in Hampton it is called "Exeter Road" which confused me mightily when I first moved to the Seacoast a dozen years ago, until I realized the logic: In Hampton, Rte 27 is the road to Exeter.

There are hundreds of prettier roads in New Hampshire, but Route 27 runs straight into the Atlantic Ocean, as it crosses Ocean Boulevard at its terminus. 

Greater Boar's Head, Hampton Beach--Obadiah Youngblood

Once it crosses Route 1, aka "Lafayette Road" the housing prices along that road rise because now you are less than 2 miles from North Beach and you can, on some days, smell the salt in the air.  As you travel away from the ocean, heading West, the homes along the road become more modest, mostly one story ranch homes, until the road crosses over Interstate 95 and heads past open fields and much more upscale homes approaching Exeter.

But between the interstate and Route 1, it's a modest little road, charming only because of the two hundred year old pine trees which line and shade it.

The high school in Hampton is called "Winnacunnet" which means "place of beautiful pines," and pine trees are the main species, apart from the occasional stand of birches, as the soil is loamy approaching the ocean.

One of the strangest rites of Spring in town is the town vote on "warrant articles" which is a package of 40 pages of questions ranging from voting approval for a million dollar renovation of the middle school, to voting yes or not to allow Mrs. Gertrude Jones to plant her petunias on the easement along the road, on the other side of the sidewalk. 

Given that sort of concern about every little thing that goes on in town, Mad Dog was stunned to see the wholesale destruction of the trees along Exeter Road, with nary a mention of what was to befall the road, its trees and the folks who live along the road or who simply drive along it as they head toward town and beyond to the beach.

Sixty foot trees, six feet in diameter, likely 200 years old--Mad Dog lost count, trying to count the tree rings--have been cut down with dreadful efficiency all along the road, transforming a tree lined lane into a sort of Levittown, where denuded lots now stand exposed--all to protect the power lines running along the south side of the road.

Now, Mad Dog values electric power as much as the next man, but really, how much more expensive would it have been to spare the trees and simply bury those power lines?

People who walk their dogs or just stroll along the sidewalk look at each other in stunned silence, as if their town had just been bombed out. 

Who did this? What were they thinking?

It is a sort of New Hampshire terrorist attack: Why? Who? 

The "Why" is pretty evident: they were trying to protect the power lines which would be damaged if large trees or tree limbs fell on them.