The Price of Imperfection

The numbers are difficult to comprehend.  100,000 to 240,000 Americans dead from COVID-19 if, as Dr. Deborah Birx from the White House Coronavirus Task Force said, “we do things perfectly.”

There is ample evidence that as a country we have most definitely not done things perfectly, and sadly I see little evidence that we will do it perfectly as we move forward.  As I write, the U.S. passed the 5,000 mark in deaths from the virus.  Most experts do not expect the pandemic to peak until late April or early May.  Recall that the day after the peak likely will be the second most cases, the third day the third most, and so on.  The peak is only a measure of how far along we are in trying to mitigate the impact of the disease, not an indicator that the crisis is over.

In difficult times is it hard to know what to criticize and what to praise.  How to stay positive when things look so bleak.  Does one leave criticism of our leaders out of the conversation because we need to focus on the future and not the past?  Do we dissect what could have been done so much sooner to lessen the impact on our fellow Americans or just deal with the present and see what the future brings?  There is so much that could be said but does it help?  I think so.  If we are to deal with the crisis as it unfolds then we need to learn the lessons it is teaching us in order to deal with what comes along in the course of events.

Good leaders enter the fray with a plan.  As I have written in this space before, no plan survives contact with the enemy.  One must be able to adapt and alter the plan as events unfold, which is easier to do if beforehand the leader has thought through possible outcomes, surprises, and has the resiliency to adjust to circumstances as they unfold in order to bring the right resources to bear at the right time.

As resources start to deplete, it is necessary to assess the gravity of the situation in each sector of the battle.  Some places may need more of one thing rather than another.  Some forces are not currently engaged so extra attention is given to the places that are actively engaged while keeping some things in reserve for when the battle moves to a new front.  Forethought, tenacity and resilience are called for in order to vanquish the foe.

I see that leadership ability with governors in New York, Maryland, Ohio and elsewhere. Mayors and other local leaders are showing themselves to be able to cope with the situation by thinking imaginatively and using ingenuity to face the overwhelming impact of this virus.  Unfortunately, it is not evident throughout the country.  Even as we see the horrible impact of the virus in New York, Louisiana and elsewhere, some governors refuse to tackle the issue head on.  Some put in half measures while across the river in another state very stringent requirements are in place.  Both lose out as people are free to cross state lines and they will seek out what they want where they find it.  Consequently, both states will suffer as the virus spreads when people from different areas intermingle and interact.

Likewise, as the White House Coronavirus Task Force claims that states and cities are getting the supplies they need, we see countless reports, most from front line health care providers, begging for more help in acquiring supplies to keep them safe and healthy so that they can take care of their patients.

All of us have learned a new language and new words that we freely throw around when just a few weeks ago we had no clue about such things.  PPE.  COVID-19.  Social distancing.  Ventilators.  Pandemic.  And on and on.  We have learned a lot but we have more to learn.  So who to trust?

Sometimes two things can be true at the same time.  For example, if the White House claims that they shipped 500,000 masks to New Jersey, it seems like a big number.  It is a big number.  But if hospitals in the state are going through 750,000 masks in a few days then it is not enough.  In addition, many hospitals in hard hit areas have already thrown out best practices in order to save PPE.  Gowns, gloves, and masks should be changed for each patient in order to protect the sick as well as the providers.  Most places now issue one set for a shift.  Some now issue one set for a week.  Regardless of the numbers the White House claims to have provided, it is clearly not enough when it comes to the front lines.  If our first responders and health care workers go down, the entire house of cards will collapse.  Unfortunately, PPE do not help them with the emotional and physical toll this crisis is exacting.  What are the plans to relieve those who have been on the front lines for weeks on end?  Where are the psychiatrists and psychologists to help them deal with the stress and pain of losing so many people they pledged to help?  These issues should also be addressed on a large scale.

It does not help when the president gets up before the cameras in his daily reality show and hints that doctors and nurses are selling the masks on the black market and that is why there is not enough to go around as he did on Monday.  “Are they going out the back door?”  “I don’t think it’s hoarding.  I think it’s maybe worse than hoarding.”

It does not help when the president gets up before the cameras in his daily reality show and says “I don’t believe you need 40,000 or 30,000 ventilators” as he did last week.

It does not help when the president gets up before the cameras in his daily reality show and says that the governor of New York should be “grateful” to him for supplying ventilators and that he hit “paydirt.”

It does not help that president gets up before the cameras in his daily reality show as he did a few days ago and brags about his “ratings” being better than “The Bachelor” while saying that some projections are for 2.2 million dead in the U.S. and “so if we have between 100,000 and 200,000 we all have done a very good job.”

It does not help when the president tweets as he did just hours ago that “Massive amounts of medical supplies, even hospitals and medical centers, are being directly delivered to states, to hospitals by the Federal Government.  Some have insatiable appetites & are never satisfied (politics?).  Remember we are a back up to them.”

Funny thing.  When your citizens are dying one expects leaders to pull out all the stops to save them.

Maybe if you give everyone a ventilator that wants one pretty soon nobody will breathe on their own?

Again, two things can be true at the same time.  But here’s the rub.  The hospitals, mayors, governors are on the ground and know how much they need.  More importantly, we are dealing with a situation that projects that upwards of 240,000 citizens will die if we do everything perfectly.  That same projection from the president’s Task Force indicates that it could be between 1.2 million and 2.2 million if the right steps are not taken.  The key fact is that the worst is yet to come.  It does not matter whether current needs are being met if there is nothing left for the future.  Governors and mayors realize that if they are barely meeting demand now, there is no way they can meet it when things get really bad.  On top of that, multiple reports indicate that officials at the Department of Homeland Security report that the national reserves are nearly depleted.

Why is the federal government “a back up”?  This is a national crisis.  Why are states, cities, and even individual hospitals all competing against each other to get what they need?  Profiteering is certainly taking place.  Governors report that orders they expect to have delivered get cancelled because another client offered more money to the manufacturer for the same shipment.

The primary function of the federal government is to provide for the safety and security of its citizens.  All else is meaningless if people are not safe or secure.

It is beyond appalling that the president continues to refuse to step up and organize our response on a national scale.  There should be a centralized procurement and distribution system.  There is an old saying, “lead or get out of the way.”  I think it time for the president to get out of the way.  He has a Task Force formulating the medical response to the crisis.  Daily he puts out misinformation, lies or revisionist history and uses the briefing as a substitute for his rallies.  Just stop it.  Let the scientists and professionals give us the straight information.  What they know — good or bad, what they don’t know, and what are facts versus opinions.

Set up a similar Task Force for procuring and disbursing the needed supplies.  Then get out of the way.  The military is skilled at logistics, let them handle it if no one else in the administration knows what to do.

This is a national problem.  While the media’s and president’s focus seems to be on the New York region, the fact is currently Louisiana has the highest per capita hospitalization rate.  The highest per capita infection rate is in Idaho.  A national problem needs a national, coordinated response.

On a personal note, please keep those suffering on your minds and in your hearts.  This is going to be a long haul.  Remember the first responders and health care professionals that so far have been able to keep this pandemic at a crisis level rather than a national collapse.  Finally, keep yourself safe.

Stay calm and wash your hands.