The Wrong Leader At The Wrong Time

Earlier this month I opined that Donald J. Trump was the worst president ever in our great country.  I have had nearly two weeks to reconsider that opinion and upon sober reflection I concluded that I was right.  He has only done more and more to solidify in my mind that he is, without doubt, the worst ever.

Besides demonstrating his total lack of intellectual ability or common sense by advocating for the ingestion of cleaning fluids to rid the lungs of the coronavirus (I hope that Mrs. Trump has child proof locks on the bleach cabinets in their house) and advocating for the revocation of journalists “Noble” Prizes (not a typo as he repeated it more than once — it appears he meant “Nobel” Prize but the actual award is a Pulitzer Prize in journalism), he continues to show a blinding lack of any leadership or organizational ability.  Perhaps we are lucky, in one sense, as his professed managerial acumen resulted in six bankruptcies.  A stable genius, indeed.  But then, what should we expect from a man that tells lies as easily as he breathes?  To date Mr. Trump told over 18,000 lies since assuming office.  Maybe that was cute, or Trump being Trump when he was holding his campaign rallies.  We are long past that.  Now, his lies are costing people their lives.  His response?  “I don’t take responsibility at all.”

We have no national effort to combat the biggest health threat to our country since 1918 and the biggest threat to our economy since the Great Depression.  Instead, we have a hodge-podge of fifty different governors trying their best to provide for their citizens.  Some are doing way better than others.  I live in one state on the East Coast so I cannot pretend to know what is best for the folks in the Dakotas or Kansas or Oregon, but we all know that the COVID-19 knows no boundaries and cares not about one’s ethnicity, social status or wealth.  The virus is truly an equal opportunity killer.

It is not an East Coast or West Coast phenomenon.  On a per capita basis, at the moment the worst hit county in the country is Lincoln County Arkansas.  The second worst is Bledsoe Tennessee.  Three counties in New York state are in the top ten but other top ten counties are in Nebraska, Iowa, and two in Ohio.

Yet, we continue to pretend that the worst is behind us even as the experts tell us the worst is still ahead.  Think of that.  As I write we are approaching one million people in the U.S. known to have been infected, roughly one-third of all known cases in the world.  The death count in the U.S. stands at 56,037 and rising, roughly one-quarter of all the COVID-19 deaths in the world.  Is the U.S. lacking in the knowledge and technical capability to fight this pandemic or do we have incompetent national leadership?

Now states are starting to loosen social distancing requirements and opening businesses, even as we still have a long, long way to go to attain testing levels that can sustain a prolonged effort to protect everyone.  In Georgia today one can get a massage but that same person cannot get a coronavirus test.  The masseuse cannot get one either.  What could go wrong?

Here is my question of the day.  Why did we essentially shut down the country in the middle of March when there were roughly 20,000 coronavirus cases in the entire country if we are going to reopen it when many of those states have over 20,000 cases just in their state alone?  How does this make sense  when experts — not Pollyanna politicians or wannabe “patriots” — say that we will certainly have a second wave of infections and having lifted our basic precautions, it will certainly be worse than what we have experienced.

Don’t believe it?  Look at what happened in the U.S. in 1918-1920 with the Spanish flu.  There was no vaccine then.  They practiced wearing masks and social distancing.  The parallels are startling.  Cities that relaxed their precautions had a devastating second wave.  That pandemic lasted two years with ups and downs.  There were three outcomes:  you died, you survived and gained immunity, or you did not get it.  Pretty much where we are a hundred years later.

Yesterday, Dr. Deborah Birx of the White House Task Force said that we will not rid ourselves of this curse until there is a significant “breakthrough” in medical technology in the form of a new type of testing.  Experts do not see a viable vaccine for the public for at least a year, a time frame most think is wildly optimistic.

Clearly, we can judiciously re-open some businesses as we learn what is doable and what is not.  Take small steps to see how things develop.  There is near unanimity that the only way out is a comprehensive, organized, coherent strategy to implement testing, contact tracing, and isolating those infected.  Period.  Wishing it away, willing it away, or pretending it’s no big deal does not solve the problem.  Pitting cities and states against each other does not solve the problem.  Mr. Trump complaining in his best Rodney Dangerfield impersonation that “I don’t get no respect” does not solve the problem.  It takes money, lots of people, patience, and a will to make it happen across the country.

We know what we have to do.  With no national leadership it is infinitely more difficult.


The Road Ahead

It is obvious that we are not yet through the terrible ramifications of our pandemic and resulting economic crisis.  Public health concerns need to be balanced with economic concerns in order to reach some kind of “new normal.”  I am sure that none of us know what our country will look like in the next six to twelve months but what is clear is the need for some kind of road map for our national recovery that is consistent with the necessary steps to keep all of us safe and to prevent a second major wave of disease that could result from lifting current restrictions too soon.

The president is, according to his remarks on his daily Trump Show, looking forward to reopening the country to business as usual with a “big bang.”  Aides suggest that the date will be roughly 1 May or perhaps earlier in parts of the country.  This makes it sound like some kind of ribbon cutting at the grand opening of a new mall rather than a sober analysis of the pros and cons of particular actions.

As the death toll passes 16,000 Americans, we are still deep into this crisis.  The good news, if it can be called anything like that, is that models seem to indicate that the total death toll by August will “only” be about 60,000.  Imagine.  Only 60,000 Americans dead. That is down from 100,000 to 240,000 but nothing to rejoice about or to suggest that we have this crisis under control.  We are not even a third of the way towards that horrible number and the president seems to want to do away with the measures that have helped to get a small grip on the horrors of this pandemic.

Americans of all political stripes, age groups, ethnic groups and socioeconomic means seem to have come together to embrace, for the most part, social distancing and accepting that things will be tough economically for awhile but that the only way to get this outbreak under control is by working together.  Patience is a virtue.  The results of what we do today will not be seen for two or three weeks down the line.

I have no trouble with the president and his administration looking ahead to what we should be doing in the next month, six months or a year.  I hope that someone or some group of professionals is in fact doing that.  But I see no evidence of a coherent, realistic plan.

During his daily reality show, the president seems intent on focusing only on the next 15 minutes rather than the next 15 months.  He continues to spread lies and misinformation.  For example, health care professionals uniformly declare that the only way to get the country back on its feet is to have a robust testing regime in place to determine who is sick, who is not sick and who may have already recovered from coronavirus without ever going to a doctor or indeed, without ever knowing they had it.

The Trump Administration has made continual promises on testing that have come nowhere near being factual.  As just a few examples, remember that on 10 March Vice President Mike Pence said that over a million tests had been distributed and that by 14 March four million more would be available.  A few days later the president said that 5 million tests were available.  And of course a week before that on 6 March the president said that, “Anybody that wants a test can get a test.  That’s the bottom line.”

A month later roughly two million tests have been administered so far in the entire country.

The president continually points out that the United States has tested more people than any other country in the world, and he is correct.  But he misses several key contextual aspects to that. The state of New York has more confirmed cases than any country on earth.  All by itself.  Obviously the United States as a whole is the sickest on earth so far.  This includes China (which nearly certainly under reported the number of cases), India, Indonesia and several others with much greater populations.

Most importantly, per capita we are failing badly.  Well less than one percent of our country has been tested.  In my state only medical personnel on the front lines and those with a referral from their doctor based on symptoms can get tested.

Just by the force of numbers alone, it is clear that the United States, the greatest country on earth, badly bungled this crisis.  Dithering and wishful thinking frittered away a chance to get ahead of the pandemic and here we are.

So, my question.  What is the long-term strategy?  I have heard nothing from this administration that looks ahead to how we know we are “winning.”  What are the measures of effectiveness (MOEs) that will determine how we are doing and whether it is safe to open up parts of the economy?  So far we only hear about flattening the curve — an indicator that social distancing is working — but not what “safe” numbers of infected may be.  If the curve flattens out at 1500 dead a day is that a good thing?  I think not.  The numbers are not dropping everywhere and across the country the totals continue to increase.

Numbers are great.  To say we have tested more people than any other country is nice, but meaningless. Since this all began, we have tested roughly 2 million people.  Total.  If we test one million Americans a day — a day mind you — it will still take roughly nine months to test everyone.  And a test only shows whether you have the illness at the time of testing.

Am I advocating for every American to be tested and until then we keep our daily lives on hold?  No.  Not realistic.  But what is realistic?  What are the MOEs?  When is the risk/reward equation in our favor?  How do we know when it is safe to eat in a crowded restaurant or go to a sold out college football game? What percentage of testing is adequate to give a good sense of the pervasiveness of the disease in a particular area?  What number of sick people in an area is an indicator that it is safe to go out in a crowd? Are certain precautions sufficient to reopen a particular business that may not work in another?  Until we have some measurable indicators beyond the number of people currently in the hospital we don’t really know where we stand.  This is especially true as we know that some people are asymptomatic carriers that unknowingly pass the virus to others who then become very sick.

Psychologically I think it will take a long time for many of us to feel totally safe in a crowd.  Having actual data from the experts rather than “cheerleading” “aspirational” statements that turn out to be false from the president would go a long way in helping each of us to understand where we stand.

Life has risks in everyday endeavors.  Nothing is perfect.  However it is possible to understand our world around us when presented with facts, not lies, or wishes or wannabe situations.

Many pundits in the right wing media are starting to attack the medical professionals claiming that they are part of the Deep State or to opine that some kind of Social Darwinism is at work with COVID-19 and it should be allowed to run its course. Weed out the weaklings. The president has at times opined that it is not as bad as the media says it is and that they are only trying to hurt his re-election.  Might I suggest that those people go to work in a hospital or a grocery store or a pharmacy without proper protection?  Or perhaps the president could visit a COVID-19 ward without PPE?  Cheer up the troops.  Oh right.  No one can now come into contact with the president and vice president without being tested for COVID-19.  Yesterday they even required testing of the White House press pool before they could attend his daily reality show.

Nothing is impossible for the people that don’t have to do it.

It is time to listen to the experts.  Health care professionals should take the lead and economic professionals base their analysis on what is healthy — literally impacting one’s health — for the country as a whole.  Perhaps a regionally focused approach would work, although I would be concerned that folks with “cabin fever” in stay-at-home states would gravitate to those open for business.

A national approach, based on facts and realistic MOEs is the only way we will find our way out of this crisis.  The worst thing that could happen is to prematurely lift the measures we know are working only because the president is impatient and has a gut feeling that everything is good to go.  A second wave of pandemic would do even greater damage to our country.  If there is a time for a very conservative approach, this is it.

Patience coupled with verifiable facts is the only way to go.

 

 


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.