November 24, 2020

The worst is yet to come (Part 2)

How is the U.S. doing in the pandemic?

“I don’t think you can say we’re doing great. I mean, we’re just not,” said Dr. Fauci, with habitual frankness on July 9. That America ended up where it is today, it isn’t for the lack of warning. On March 11, Dr. Fauci told us that “the worst is yet to come.” And again, on May 13.  The number of new COVID-19 cases on July 16 in the U.S. was the equivalent of Bethlehem’s population. That number was reached again the following day. And the next day again.

Many Americans still don’t believe that COVID-19 is very serious. They rebel against the medical authority with juvenile naivety. They criticize Dr. Anthony Fauci, a virus expert who has commanded battles against horrifying HIV / AIDS, Ebola, respiratory syndromes (SARS and MERS) and flu, for decades, of serving under six presidents.

Instead of starting one more discussion based on abstractions and “shoulds” and “should-nots” it may be prudent to hear the anonymous account of a doctor from the New York’s Elmhurst Hospital, in late March, at a time when the number of cases hadn’t yet reached the peak.

The hospital is held together by a shoestring in the best of times, now is pushed to the brink. Long lines to receive medical care, ER in chaos, supplies and equipment dwindling dangerously low, overfull morgue. The hospital typically had 1-2 deaths a day, now reaches 13 a day.

The hospital is low on PPE. Some people bring in face shields from home. Some are wearing goggles. Some are wearing hair nets. Some are walking around in cutaway scrubs. Some have yellow gowns on top of the scrubs. Some people have helmets. They don’t even change in and out of PPE. They gear up one time, and that’s it for the whole shift.

You’re supposed to wear an N95 mask with a face shield down, gloves, and when you’re done, you’re supposed to throw everything out. Now, there’s a shortage. People are very scared so they’re wearing one N95 all day. I have one face shield that I have to keep rewashing after seeing every patient.”

Hospital workers are anxious, morale in the ER is low. I saw people crying in the hallway twice today.

People are concerned about getting the virus. ‘I’m terrified. I have a young child. When I was in training, I never thought about a day like this.’

Intubated patients suffer and die in silence. No family allowed. Too much suffering, too many deaths. [In another hospital, Medical Director Lorna Green could no longer live with the memories of the tragedy. She died by suicide.]

A 15-bed at the intensive care unit for a variety of respiratory patients suffering life-threatening buildup in the lungs is now full of COVID-19 patients. And so is another nine-bed ICU. And a 30-bed stepdown unit. And the general medicine floor.

The hospital used to have four pulmonology doctors now attending six-times more patients than in normal times. Then one doctor got sick. Another left.

I don’t want to be a hero. I don’t want to be brave. I didn’t sign up for any of this. I feel extremely vulnerable and kind of trapped. If I don’t do this, I’ll lose my job, and if I do it, I could die. And it’s not a heroic feeling. It feels like being thrown into the fire. You’re a body, and you can take care of a ventilated patient — give it a shot. I would way rather not be doing this.

(Adapted from a BuzzFeed News article by Joseph Bernstein on March 26).

This is what Dr. Fauci wanted to prevent all along. Many hospitals in the country are ill equipped. Millions of Americans have been deprived from Obamacare. Given such vulnerability, his goal was to consciously and patiently let the curve flatten and then move on, as was done overseas.

How is that a few countries were able to control the pandemic? Germany, South Korea, Denmark, New Zealand (Box 1) are back to normal.

In simple words, their strategy had three components or directives, if you will.

First, under an effective leader they identified the problem and ascertained its gravity.

Second, they recruited medical experts to define the best strategy; since isolation (quarantine) was needed and it meant unplugging the economy thus impacting labor, finances, education, welfare, so it had to be well coordinated.

Third, leaders had a very clear message. A mature communication, candidly sharing the extent of the problem, challenges ahead, plans of action, uncertainty inherent to the unknown disease, potential need to change plans. Aiming at the common good, governments committed to full support and asked every person’s cooperation.

Wildfire-like COVID-19 demanded quick and effective response (see Part 1 of this series). By March, South Korea was running a massive testing campaign. [For easy understanding, in a sample of 100,000 people, 490 were tested, whereas in the U.S. only 27 were]. On March 16, New Zealand closed its borders. Prime Minister Jacinda Ardern would “make no apologies,” firmly taking responsibility. Taiwan, under President Tsai Ing-Wen, quickly generated and implemented 124 measures to protect the country’s 24 million people.

Evidently in addition to avoiding / treating the disease, having the economy unplugged was critical. People needed to survive during and after the pandemic. Under Prime Minister Mette Frederiksen, Denmark allocated $42 billion, 13% of the country’s GDP — a very expensive package — to avoid workers layoffs and business bankruptcies. Angela Merkel’s Germany also delivered a package that minimized the trauma of economic paralysis. 

What about the U.S.?

Under President Trump, America, involuntarily has been playing Russian roulette in 2020.

Late in February Trump said: “one day it’s like a miracle, it [coronavirus] will disappear.”

By then, there were some 90,000 cases worldwide. The U.S. was still untouched.

“The time to repair the roof is when the sun is shining,” was President Kennedy’s advice.

This would’ve been the time to learn from Obama’s valuable 2016 reports such as “Playbook for early response to high-consequence emerging infectious disease threats and biological incidents,” and “Towards epidemic prediction: federal efforts and opportunities in outbreak modeling.”

This would’ve been the time for the world’s richest country to correct past deficiencies, equip hospitals, make tests available, build ventilators, prepare the healthcare workforce for the challenge and educate people.

This would’ve been the time to recruit the brightest scientific minds available in America to team up with medical experts to find options to minimize the economic, financial, social impact of unplugging the economy. In parallel, implement a strong dialogue of federal and state’s governments and work closely with the World Health Organization, since this is an international crisis.

Trump’s America rejected this path. Not even a consistent plan was established.

While effective countries were acting maturely, the American President congratulated himself in early March: “I like this stuff. I really get it. People are surprised that I understand it… Every one of these doctors said, ‘How do you know so much about this?’ Maybe I have a natural ability. Maybe I should have done that instead of running for president.”

147,000 lives have been lost so far. This is the population of Bethlehem multiplied by two.

Trump wasn’t prepared to be a president, according to somebody who knows him and his family well: his niece. “I saw firsthand what focusing on the wrong things, elevating the wrong people can do, the collateral damage that can be done by allowing someone to live their lives without accountability,” said psychologist Mary L. Trump, Ph.D.

Four years ago, many people believed Trump’s well-crafted tale of being a self-made man:

“Brash, the hottest and the most enterprising billionaire,” reads the back cover of “The art of the deal,” written in 1987 by Tony Schwartz, who latter regretted having done it, according to a June 2016 article in The New Yorker.

People had forgotten or never learned about dubious, failed deals: bankrupted Plaza Hotel and Atlantic City casinos (Taj Mahal liquidated at four cents on the dollar), Trump Shuttle, Trump University.

Some voters believed that being successful in business, was an automatic passport for being a successful president. Not at all. Businesses and governing a country aim at different things.

The sole goal of a business is profit. The goal of a country is people’s welfare. A country’s return on investment cannot be reported quarterly or even annually. Education, healthcare and infrastructure require time. They have a high cost and may be dismissed by businesspeople as losses.

What reasonable people want is a president to be compassionate, capable of planning and continual improvement, able to setup a team and work with it and learn from various sources (not just one Cable TV station).

Trump and compassion don’t mix. He mocked disabled journalist Serge Kovaleski during the electoral campaign. During the 9/11 tragedy, live-TV journalists wanted his comments on the event, that would end up costing 2,600 lives (workers, children, firemen). He chose to focus on the height of his building at 40 Wall St., in downtown Manhattan. 

“…When they built the World Trade Center, it [40 Wall St.] became known as the second tallest. And it’s the tallest now,” said Trump with childish selfishness, in a quote that has been fact-checked by PolitiFact.

There is more to Donald Trump that doesn’t add to the profile of a leader needed to unite the country during the pandemic:

First, a real estate businessman looks at the potential. “You can take a mediocre location and turn it into something considerably better,” says the “enhance your location” card — success recipe — in “The art of the deal.” 

Whereas, others see a marshy land, a real estate a developer sees a luxurious profitable building. What others see as a half-empty cup, he sees as half-full or even full. In governing a country, however, recognizing a problem is essential. Supposing rather the cup to be empty — worse-case scenario — may be more effective to resolve the problem. During the pandemic Americans saw and heard their president repeatedly claiming that “things are under control.”

Second, the former reality-show star fills his days creating polemic, accusing, blaming, just as he did in the “The Apprentice.” Even “disgraceful” Pope Francis and “over-rated actress Meryl Streep” couldn’t escape Trump’s fury.

Aggressive tweets, speeches, interaction with journalists, lack of ethics (19,127 factchecked lies in 1226 days).

“Trump didn’t fit any model of human being I’ve ever met; he was obsessed with publicity,” said Tony Schwartz, in The New Yorker article. Three decades ago, Schwartz wrote an article about Landlord Trump, a nightmare, using low blow to tenants; unexpectedly Trump praised the article and contacted Schwartz. He then became a ghostwriter for the “Art of the deal.”

Third, Trump has shown a chronic scorn for the law, former Judge James Zirin argured in “Plaintiff in Chief. A portrait of Donald Trump in 3,500 lawsuits.” He sued at the drop of a hat. He sued for sport, he sued to achieve control and he sued to make a point. He sued as a means of destroying or silencing those who crossed him. He became a plaintiff in chief,” Zirin wrote.

Pushy Trump is used to getting his way. He forces things to the limit, a lesson learned from Roy Cohn, counselor to Senator McCarthy. A recent example was pardoning jailed Roger Stone.

Fourth, Trump doesn’t trust experts, be it intelligence or medical. “It pays to trust your instinct,” it’s written in “The art of the deal.” In late November 2018, he clarified how he makes decisions: “my gut tells me more sometimes than anybody else’s brain can ever tell.”

Fifth, reelection is Trump’s obsession, according to John Bolton’s memoir. It makes the President ambiguous. To keep the loyalty of his electoral base, typically deniers of common-sense, he never tells good from bad. In Charlottesville, VA, neo-Nazi flag carriers, anti-Jew chanters, KKK protesters were “fine people”. On July 19, he told Fox News’ journalist Chris Wallace, that he won’t mandate mask usage, he will not take people’s freedom away.

Two articles evaluated Trump’s atypical leadership: Anne Applebaum’s “A study of Leadership” in The Atlantic and professor of leadership and ethics Donna Ladkin’s “What Donald Trump’s response to COVID-19 teaches us: It’s time for our romance with leaders to end.” Ladkin listed four factors that make it difficult for the U.S. to implement the type of anti-pandemic directives followed by successful countries: size, the American trait of being indomitable, megadonors in the digital age and its health care system. 

As to size, indeed, New Zealand, Denmark are tiny, each with under six million people, but Germany and South Korea are not that small. (Box 1)

“Live free or die,” epitomizes the refusal of Americans to accept mandates. Of course, during the pandemic this is dangerous, specifically when neglect by one individual, “freedom” exercise, violates the freedom of another, this one will end up suffering the consequences, i.e., illness contagion and financial cost.

In the digital age, while people are distracted by Trump’s noise, billionaire donors take subtle action, for example the Koch brothers (pro “Tea Party”) and Dick and Betsy Devos (implicated in the anti-lockdown movement).

When unsatisfied with any politician they had helped get elected, megadonors can, via media, stir the masses and exert “popular” pressure. Such action endangers democracy, for example by discrediting measures of virus precaution and even covering bail and fees for demonstrators arrested for defying virus protective measures, as has happened in Wisconsin.

In countries that effectively fought COVID-19, healthcare systems are universal and comfort their populations. In the U.S., after decades of marginalized existence, low-income Americans finally got health insurance through Obamacare.

During his campaign, on October 24, 2016, Trump vowed “getting rid of immediately Obamacare, which is a disaster.” He promised “more coverage” “covering everybody, “not letting them die.” The “beautiful,” “unbelievable,” “terrific” Trumpcare never materialized.

Then COVID-19 irrupted. Chaos followed.

“It’s straightforward to say [Trump], has killed people by his response already and will continue to kill people if he wants to reopen the country,” the anonymous Elmhurst Hospital doctor told journalist Joseph Bernstein on March 26.

On July 2, responsible Americans were shocked a second time when the president said it’s “going to sort of just disappear.” And again, the same magic thinking took place a third time on July 19.

The U.S. never followed the anti-COVID-19 script of successful countries. Six stormy months and 147,000 deaths into the crisis, record new cases on July 19 exceeded 70,000. And on July 24 again.

COVID-19 fatalities today exceed the deaths in Vietnam and WWI wars combined — or seeing it from a different angle, it equals half the fatalities in WWII.

“It is what it is,” stated the president with inhumane indifference.

The first recipe of success employed by model countries never materialized in the U.S. COVID-19 is not seen as a problem by American mavericks, who challenge medical experts daily. People remain confused.

It was up to the president to set the example.

“Ask not what your country can do for you – ask what you can do for your country,” President Kennedy said. He walked the talk. He had been wounded in the battlefield. Not only was he the president, he behaved as such, an accountable leader. Not Trump.

An example of not recognizing the problem is the refusal to mandate wearing face masks and the practice of social distancing. Trump rallies violate both repeatedly. “It should be so simple,” COVID-19-recovered Tom Hanks said.

After a few infections in the White House by May 12, Trump mandated the West Wing to wear a mask. He never wore one.  On June 17, the mandate was downgraded to recommendation, turning mask usage optional.  

Moreover, current and former officials ingratiate themselves with the president by not wearing a mask. Their obtuse justifications reveal plain ignorance.

Congressman Gaetz (R-FL) wore a big gas mask at a House session for the purpose of mockery.  “I don’t have the coronavirus, I won’t wear a mask” Congressman Louie Gohmert (R-TX) said. “There is no authority in the constitution that authorizes the government to stick a needle in you against your will, force you to wear a face mask,” Congressman Thomas Massie (R-Ky) tweeted. “Wearing a ‘burqa’” (face-cover used by Islamic women) is a signal of submission,” said Sebastian Gorka, Trump’s former Assistant. 

So, the common people also feel entitled to bypass mask-wearing policies at Wegman’s (Hannover, PA) Cotsco (Colorado), Starbucks (California), Home Depot (Chicago) and so on.

“Driven by an insatiable hunger for money, praise and celebrity,” is how Schwartz defined Trump in The New Yorker. Subordinates generously praise the chief when given the chance. 

Joni Ernest (R-IA) harshly criticized Obama’s “failed leadership” because of two Ebola deaths in 2014. Asked if the 130,000 deaths (at the time) were a failure, she denied it on July 4. “Trump is stepping forward on COVID-19.”

“I want the people of Florida to know we’re in a much better place thanks to the leadership of President Trump,” said Vice President Pence on July 2. [Having rushed to reopen, Florida is now the epicenter of the disease, registering record 173 deaths in one day on July 23].

Second, the medical problem was never fully trusted to medical experts. Dr. Anthony Fauci was challenged daily. After an interval of weeks, on July 21, Trump called a briefing on the “China virus.” Dr. Fauci was not invited.

Moreover, following on the steps of the leader, other people believe to be entitled to discredit Dr. Fauci. “Fauci doesn’t know what he’s talking about,” said Texas Lt. Governor Dan Patrick, a former talk-radio host. Trump’s assistant Peter Navarro unfairly criticized Dr. Fauci in a USA Today op-ed.

Even a physician recovering from COVID-19, the son of a physician, Senator Rand Paul (Libertarian-Ky) attacked Fauci on June 28: “if society meekly submits to an expert and that expert is wrong…” 

In 2018, Trump deactivated the pandemic readiness team to cut costs; he cut funding for coronavirus research in late April and is removing the U.S. from the World Health Organization.

Third, communication with the public was divisive, catastrophic. Instead of quenching the fire, Trump adds gasoline. The coronavirus briefings, a daily opportunity for open talk, turned into a magnifier of political grievances. The Washington Post estimated 63% of the time was taken by Trump, 8% by Dr. Brix and 5% by Dr. Fauci on the first round of briefings.

In agony, responsible Americans watched the daily science-denigrating spectacle. [Dr. Birx, medical adviser in Pence’s task force, lacked the courage to firmly cut out outrageous hypotheses, such as use of disinfectant or UV light on COVID-19 patients.]

Fox News, Rush Limbaugh — Trump’s Medal of Freedom — and White House Press Secretary Kayleigh McEnany felt entitled to attack Dr. Fauci’s expertise.

Against the advice of many national and international health experts, the government’s next move is to reopen schools. Democrats disagree. Fox News’ Laura Ingraham attacked Democrats on July 7: “they cite the rising COVID infection rates in certain states to sell their latest panic porn.”

But hope is not dead. Responsible Americans still trust science and scientists and not a gambler’s “gut and instinct.”

“If Fauci says the next two weeks are critical, we need to take him seriously,” Fox’ Chris Wallace said.

“Dr. Fauci is one of the finest public servants we have ever had. He is not a partisan. His only interest is saving lives. We need his expertise and his judgment to defeat this virus. All Americans should be thanking him. Every day.” said Liz Cheney (R-Wy) on May 12.

 “The worst is yet to come.”

COVID-19 has tested Trump.

 “[Trump] is utterly incapable of leading this country, and it’s dangerous to allow him to do so,” Mary Trump said about her uncle.

“For courage — no complacency — is our need today. Leadership — not salesmanship. And the only valid test of leadership is the ability to lead, and lead vigorously,” President Kennedy said.

Fortunately, in a democracy we all are agents of change.

Change can happen on November 3.

Box 1: COVID-19 fatalities in select countries.

Country President (Executive Lead) Population (millions) COVID-19 deaths / 100,000
Denmark Mette Frederiksen 6 10.5
Germany Angela Merkel 84 11
New Zealand Jacinda Ardern 5 0.45
South Korea Moon Jae-in 51 0.57
Taiwan Tsai Ing-Wen 24 0.03
U.S. Donald Trump 330 42.83
Brazil Jair Bolsonaro 213 37.6

https://www.worldometers.info/world-population/population-by-country/

https://coronavirus.jhu.edu/data/mortality

(Contact the author of this article, Jesus Zaldivar, associate-editor of The Commuter: jzaldivar@nullspartan.northampton.edu)

Jesus Zaldivar

Jesus Zaldivar, associate-editor of The Commuter, is a freshman at NCC. Previously, he conducted biomedical / environmental research in South America, Europe and six states in the U.S. (Contact: jzaldivar@spartan.northampton.edu)

View all posts by Jesus Zaldivar →
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