March 20, 2020

Dear Interested Readers,

 

There Is Evidence That We Deserved A Better Effort

 

I hope that you are well and accommodating to this strange collective experience. All is safe and well in my new world where social distancing directs our relationships toward learning a new way to dance through the day. My youngest son and his wife escaped from Brooklyn, and are self quarantined in our garage apartment. My nephew’s wedding in South Carolina was cancelled. There are some early conversations about alternatives to consider like a “Zoom” ceremony, followed by a reception whenever the storm passes. There is a family precedent for telecommunicating a wedding. In 2009, my mother was not healthy enough to come to New Hampshire for the wedding of my son who now lives in Santa Cruz, so she attended by Skype. Video streaming the wedding wasn’t easy with the Internet speeds that were available in rural New Hampshire in 2009. Who knew, as we developed our Internet capacity to stream video that it would become a critical survival tool? 

 

Three of the greatest advantages our species has are our ability to anticipate potential harm, our ability to work together to avoid bad outcomes, and our ability to learn from experience, especially from our errors. One of the greatest liabilities of humankind is our ability to use collective denial to negate the benefits of our capacity for good judgement and protective prospective actions. Inconvenient truths that demand personal and collective sacrifice make us uncomfortable and initiate our use of our robust capacities to rationalize away the benefits of our good judgement. We can become the victims of our own enormous collective denial. We are in trouble when our anxieties or the self interest of the status quo trump our capacity for insight, planning, and learning.  

 

A fourth beneficial characteristic is that we generally like to be around someone who demonstrates intellectual, physical, and emotional strength. We will grant the people whom we think have those characteristics the authority to lead us. Our problem is that we can be fooled. Sometimes we confuse bragging and hyped up accomplishments with intellect, character, and emotional stability. Abraham Lincoln is credited with the quote: “You can fool all the people some of the time and some of the people all the time, but you cannot fool all the people all the time.” What honest Abe failed to consider was that given the unusual mechanics of the Electoral College, you don’t even need to fool half of the people some of the time to get elected president if you can get a small majority in a few critical states. 

 

This would be a difficult moment for us and for our leader even if we had a leader who was insightful, truthful, and concerned more about the health of all the of people around the world than he was about how the DOW, NASDAQ, and the S&P 500 appeared at the end of each trading day, and how he might blame shift enough blame for his failures to get reelected. We are dealing with two sequential and interconnected disasters. The first is the pandemic that threatens the lives of people around the world. The president has decided to call the coronavirus that has caused COVID-19 the Chinese virus. He likes to use nicknames as slurs. Even if nicknaming the coronavirus the Chinese Virus is not meant to be a racial slur, using nicknames to communicate a message to his base is a routine part of a larger exercise that always delivers a coded message. This time the nickname is also part of a strategy to deny any responsibility for the negative outcomes that are likely to occur before the threat abates, and set the stage for presenting himself as the “very stable genius” who will save the day. The second disaster that we will experience with certainty is a severe blow to our national economy that will touch everyone and take years to overcome. For those who survive the first threat, the chance of surviving the second threat is directly related to what their wealth and position in society was before the collapse of our markets and the extended disruption to production and service began. The first threat doesn’t care what you own. The second threat will surely affect people through an inverse relationship to their income and resources. The social determinants of health will apply to both your physical health and your fiscal health. 

 

The New York Times editorial board has published a video entitled “The President Is Lying About Coronavirus.”  The piece is less than four minutes long. I wish that I could demand that you watch it. I hope that you will watch it, and then share it with others. The piece dramatically chronicles the misinformation that our president has passed off during the last six weeks. Each one of his misleading statements is balanced by a more objective assessment from someone who is a trustworthy authority. The irony is that most of those authorities offering contradictory opinions work for him. The tragedy is that while he was misleading rather than leading, the virus was spreading through our nation. Now we are left with the reality that many people will die, and those who survive will be living in a very different world. The best we can hope for is that our recovery will be hastened by huge public investments that undoubtedly will complicate and compromise our ability to effectively invest in a better future. Lives will be interrupted. Opportunities will be lost, and he has the audacity to give himself “a perfect ten” for his performance. To the jaw dropping amazement of those of us who were watching in disbelief, and as many news sources documented, he denied that anyone could have done it better. 

 

During the White House’s daily coronavirus news briefing, Yahoo News reporter Hunter Walker brought up the president’s previous comments about not being responsible for the country’s lack of testing.

“Very simple question: Does the buck stop with you?” Walker asked. “And on a scale of 1 to 10, how would you rate your response to this crisis?”

“I’d rate it a 10,” Trump answered. “I think we’ve done a great job.”

 

The president has used daily midday press conferences that are ostensibly meant to keep the nation informed as a platform for denial and self serving distortions of reality. These “infomercials” meant to educate us and give us the hope that our distress will be short lived have become “dear great leader” endorsements by a host of sycophants, led by Vice President Pence, that stand cheek to jowl behind him. The exercises of praise, promises, and distorted information are followed by a daily Q&A with the press where any honest question about his accountability is meet with his usual brutish dismissal and a medley of his favorite riffs on how unfair the press is to him. As the crisis has evolved, he has used the platform to blame others like his predecessors, Democrats in Congress, and failures of  other countries, for the dual crisis. He has long been a very special genius when it comes to using possibilities and half truths. Yesterday he demonstrated this talent once again with the suggestion that chloroquine might be a miracle drug. He continued his self serving distortion of the truth with his reports about progress on vaccines that was more likely a fantasy than a fact. The people who are working on the vaccines say that having a vaccine in one year would be a remarkable accomplishment that we should not expect with certainty. As the administration tries to convince the country of the importance of social distancing, the coronavirus team is crowded behind the president and he shakes hands with each one as a perfect example of what not to do, as they come to the podium. During Thursday’s session the press was spread out in a nod to compliance with the policy which led to his derisive comments about having fewer reporters there to distort his accomplishments. 

 

As the reports of new cases and deaths have increased over the last few days, the president has doubled down on his efforts to distort the record of his performance and hide his costly failure of leadership. Fortunately his nemesis, The New York Times, has continued its efforts to expose the depth of his inadequacy. Yesterday morning, David E. Sanger, Eric Lipton, Eileen Sullivan and Michael Crowley published a remarkable exposé entitled “Before Virus Outbreak, a Cascade of Warnings Went Unheeded: Government exercises, including one last year, made clear that the U.S. was not ready for a pandemic like the coronavirus. But little was done.”

 

It is a remarkable article describing a “war games” like exercise called “Crimson Contagion” that was performed about the time last summer when the president was busy shaking down the Ukrainians. The exercise demonstrated severe inadequacies of our local, state, and federal governments in their preparation to defend against a pandemic of the magnitude that we are now experiencing. I will let the authors set the stage, but I have bolded what I think is important.

 

Asked at his news briefing on Thursday about the government’s preparedness, Mr. Trump responded: “Nobody knew there would be a pandemic or epidemic of this proportion. Nobody has ever seen anything like this before.”

The work done over the past five years, however, demonstrates that the government had considerable knowledge about the risks of a pandemic and accurately predicted the very types of problems Mr. Trump is now scrambling belatedly to address.

Crimson Contagion, the exercise conducted last year in Washington and 12 states including New York and Illinois, showed that federal agencies under Mr. Trump continued the Obama-era effort to think ahead about a pandemic.

But the planning and thinking happened many layers down in the bureaucracy. The knowledge and sense of urgency about the peril appear never to have gotten sufficient attention at the highest level of the executive branch or from Congress, leaving the nation with funding shortfalls, equipment shortages and disorganization within and among various branches and levels of government.

 

We have heard the president disparage the responses of the Obama administration to the H1N1 epidemic of 2009 and the Ebola threat of 2014. What he doesn’t tell us is that those episodes were carefully studied and recommendations were made that would increase our preparedness for the inevitable future challenges. The most significant recommendations were published within the government in July 2016 and communicated to the president when he assumed office. The work continued and resulted in the Crimson Contagion exercise. The inadequacies observed during the exercise were analyzed and recommendations were circulated within the Trump administration and were ignored or given inadequate attention. Trump’s current claim that our lack of preparedness was the result of the failures of others is not supported by Beth Cameron, the NSC executive who was the leader of the White House pandemic team. She described earlier this week in the Washington Post her disbelief and fear when the president ignored the recommendations for the work to be done that had been transitioned from the Obama administration, and then disbanded the efforts of her group in 2018. 

 

Sanger, Lipton, Sullivan and Crowley continue their description of Trump’s management failure and corroborate the testimony of Beth Cameron:

 

The October 2019 report in particular documents that officials at the Departments of Homeland Security and Health and Human Services, and even at the White House’s National Security Council, were aware of the potential for a respiratory virus outbreak originating in China to spread quickly to the United States and overwhelm the nation.

 

The president’s ignorance of what he should have known can not be explained by blaming it on the inadequacies of an administration that he constructed, and regularly abuses. The authors give us the background for why the NSC and those responsible for our emergency responses needed to evaluate how prepared we were for the next pandemic that many infectious disease experts were predicting was sure to come.  

 

The Centers for Disease Control and Prevention estimates that ultimately there were about 60.8 million cases in the United States, along with 274,304 hospitalizations and 12,469 deaths associated with H1N1.

The virus turned out to be less deadly than first expected. But it was a warning shot that officials in the Obama administration said they took seriously, kicking off a planning effort that escalated in early 2014, with the outbreak of Ebola in West Africa and ensuing fear that it could spread to the United States.

Ebola was less contagious than the flu, but far more deadly. It killed 11,000 people in Africa. But it could have been far worse. The United States sent nearly 3,000 troops to Africa to help keep the disease from spreading. While the containment effort was considered a success, inside the White House, officials sensed that the United States had gotten lucky — and that the response had revealed gaps in preparedness.

 

If you want to know what was learned when the work was completed in the summer of 2016 and what was passed on to President Trump. I suggest that you read the executive summary of the 73 page report written by Christoper M. Kirchhoff, Ph.D. and submitted to Susan Rice, the head of the NSC. The Obama administration tried to impress the incoming Trump administration with the importance of preparing for the possibility of a pandemic. He now would have us believe he never got the message. If he missed that handoff, he should have gotten the confidential report of the “Crimson Contagion” report which came out in October. Perhaps he was distracted by the attempt to defend himself against impeachment. You owe it to yourself to peruse this 63 page report written following the Crimson Contagion exercise that is stamped “CONFIDENTIAL.” At a minimum scroll to the conclusion and read what was written in October as a very accurate description of what we are experiencing in March.

 

Do you remember that embarrassing moment during one of President Obama’s State of The Union addresses when a Republican Congressman from South Carolina shouted out “You lie.”? When I hear the president claim that there was nothing that he could have done to mitigate what we are experiencing I want to pull a “Joe Wilson” and yell “You lie!” at my TV.  I am jaded after three years of his lies and misrepresentations of reality. At best he is a fool, more likely he is just a liar. As a fool and a liar he is a threat to the nation. The authors of the article are kinder:

 

The full story of the Trump administration’s response to the coronavirus is still playing out. Government officials, health professionals, journalists and historians will spend years looking back on the muddled messages and missed opportunities of the past three months, as President Trump moved from dismissing the coronavirus as a few cases that would soon be “under control” to his revisionist announcement on Monday that he had known all along that a pandemic was on the way.

What the scenario makes clear, however, is that his own administration had already modeled a similar pandemic and understood its potential trajectory.

 

Paul Krugman described my position quite well:

 

So Donald Trump is now calling Covid-19 the “Chinese virus.” Of course he is: Racism and blaming other people for his own failures are the defining features of his presidency. But if we’re going to give it a nickname, much better to refer to it as the “Trump pandemic.”

True, the virus didn’t originate here. But the U.S. response to the threat has been catastrophically slow and inadequate, and the buck stops with Trump, who minimized the threat and discouraged action until just a few days ago.

 

I began this piece by cataloging what we can do well compared to other species. We can anticipate. We can plan in ways that allow us to avoid adversity. We can learn from our errors, and we can make plans that enable a better future. Or not. The “or not” occurs when we are in a state of denial, and our denial is enhanced in its danger when we embrace leadership that tells us what we want to hear, that we are smart, we are virtuous, and we deserve more. Such “false prophets” clinch their sale when they tell us that we are not responsible for what ails us. Those leaders tell us whom we should blame for our problems. They never accept their share of the responsibility for the disappointments of the moment, and many of us buy their story. I am not afraid of COVID-19 or of the long and tedious economic recovery that lies ahead of us. I am afraid that through some perversion of the process or the collective response of the easily fooled minority magnified by the distortion chamber of the Electoral College we will be stuck with this deadly force for four more years after another disastrous November.

 

I did have one very positive COVID-19 experience yesterday. When I was fuming over the president’s attempts to manipulate reality, I heard the ding that announced the arrival of a new email. I noticed that it was from the Guthrie Clinic. I have described my positive experiences on the board of Guthrie in previous posts. Guthrie is the largest provider of care in the “Twin Tiers” of New York and Pennsylvania. The system serves several hundred thousand people with five hospitals and about thirty outpatient offices that cover a large rural geography from Cortland and Ithaca to the north, west to Corning, east to Binghamton, and south past Towanda and Sayre in Pennsylvania. Fortunately there have been no cases yet of COVID-19 in this large geography. The email contained a link to a news conference that the Guthrie leadership presented to local media. It was a beautiful example of a responsible transfer of information.

 

Dr. Joseph Scopelliti, the CEO, and Dr. Michael Scalzone, the Chief Quality Officer, led a discussion that included the system’s chiefs of surgery and medicine. There was total transparency. Guthrie manages its network with a Lean operating system. Dr. Scalzone described the daily huddles that were used for the development and management of their response to the challenge. They announced that the system was discontinuing elective surgeries and moving much of its medical management to its telehealth platform. Patients were instructed about how to use the system, and what to expect when they asked for help. Most hospital systems are dependent on elective surgeries for their margins and more. Dr. Scopelliti asserted that Guthrie had adequate reserves and would use all of its resources to protect the communities of the Twin Tiers.

 

I offer the recording to you as a model to be emulated by systems across the country. The presenters even practiced social distancing as they moved to and from the podium and the microphone. None of them talked about how smart they were. All of them demonstrated that their only concerns were for the health of the communities they serve, the individuals that depend on the system, and for the safety of the providers of care. I was very proud to be a small part of the infrastructure of this system that is an example of thoughtful preparation.  

 

Sometimes, I get off track in these notes. I had planned to write to you about the upside of the trauma that we are currently experiencing. I do believe that there will be many positive changes and some innovations that evolve as we solve our current problems. I just got side tracked by the Crimson Contagion report and the president’s overblown assertions about the hope of chloroquine. I hope that you will return next Tuesday when I promise to give you my perspective on what our hopes might be, and what we can embrace with joy at this time. In the meantime follow the advice that you can get if you listen to the professionals who stand behind the president. I wonder what is going through their heads as he presents his word salad of self acclaim, his inflated assertions about progress, and his denial of responsibility for anything but his innate heroic genius. 

 

Looking Beyond This Spring To A Better Day

 

Yesterday we woke up to a beautiful blanket of fresh snow on the first day of spring. There is nothing like a pristine covering of fresh snow to hide the blemishes of any landscape. It’s not that we usually have anything to hide, but we are rolling into “mud season,” and the fresh covering of snow offered a day of reprieve. Some people in New England look for relief from the weather in mid winter. I hate to leave town in the mid winter because invariably the “best snow” of the winter falls while I am away, and I miss the experience. It happened again this winter while we were in Florida for an event at my granddaughter’s school. I was looking forward to a “mud season” get away trip to the Carolinas this year for the wedding of my nephew. As I sadly reported earlier, that event has been cancelled because of the need for social distancing. 

 

Back in the day when I was making rounds in the hospital or dealing with people in my office who were struggling with an exacerbation of their chronic disease, I would often ask, “What are you looking forward to?” The query was based on my extension of two pieces of information that made sense to me. First, was the concept that good health was based on the mindset associated with something to do (purpose), someone to love (connections), and the expectation of something positive (hope). Second, studies had been published showing a fall in death rates in elderly Chinese and Jewish people as they anticipated important family events like the Chinese New Year celebration or the family gatherings associated with the Jewish High Holidays. It just made sense that there might be a good reason to use the possible positive benefit of anticipating joy for its therapeutic benefit. I have always tried to live in a state of positive anticipation while practicing a realistic assessment of the moment. In my darkest hours, the concept of “this too shall pass” has always been a comfort, but there is a little extra boost from the anticipation or hope that after the challenge is over what follows has promise. 

 

I find that trying to visualize that better day lifts my spirits and provides a little energy for the work at hand. I lifted the picture that is today’s header from the back of our town’s annual report. It was taken by my neighbor who does the drone videos that I love to view. The picture reveals the beautiful heart of my little town at a better time near the end of last summer. I am hoping that by the end of this summer, or perhaps by the summer of 2021, people will gather once again to sit on their blankets and lawn chairs around the bandstand to listen to live music while eating their picnic suppers with family and friends.  

 

Be well! Practice social distancing. Wash your hands frequently. Don’t touch your face. Cover your cough. Stay home as much as you can, even if you feel well. Follow the advice of our experts. Assist your neighbor when there is a need you can meet. Demand leadership that is thoughtful, truthful, capable, and inclusive. Let me hear from you often, and don’t let anything keep you from doing the good that you can do every day,  

Gene