June 26, 2020

Dear Interested Readers,

 

Frustrated, Frightened, But Hoping 

 

I have read hundreds of thousands of words about the COVID-19 epidemic. There are several great writers at The Atlantic who have provided excellent reports and analysis, and the magazine is offering their output on the pandemic for free on the Internet. You should check it out.  

 

As usual, the New York Times has provided data and commentary that go far beyond the reports one gets from the briefings and the press conferences of any federal agency or state governor. I am very impressed with their graphics, and would recommend that you spend some time with the graphic article they published this week entitled “How the Virus Won.”

 

The Kaiser Family Foundation and the Commonwealth Fund publications are “wonky,” which is fine with me. Their articles go into great depth on interesting angles that many superficial reviews don’t consider. I would suggest that you read “The Impact of the COVID-19 Pandemic on Outpatient Visits: Practices Are Adapting to the New Normal” published yesterday by the Commonwealth Fund. I know two of the authors personally, David Cutler and Michael Chernow, health economists from Harvard, and anything they write deserves your attention. I would also highly recommend “Eligibility for ACA Health Coverage Following Job Loss” from the Kaiser Family Foundation. Have you asked yourself what will happen to the millions of Americans who “loved” their employer provided health insurance now that they have lost their job, or worse, their employer has permanently closed the business? It’s the perfect time for the Trump administration to ask the Supreme Court to throw out the ACA.

 

The Washington Post has “upped its game. They are now on a daily basis giving a chronological review of breaking news related to the pandemic. I subscribe to The Post and four other daily papers for the access I desire, but their articles on the pandemic are provided for free to everyone on the Internet. In a prominently displayed message they say: 

 

Note to readers: The Washington Post is providing our daily live updates, comprehensive guide to the pandemic and our Coronavirus Updates newsletter for free, so that all readers have access to this important information about the coronavirus pandemic.

 

To access their “Live Updates” for today I would recommend that you go to “Live updates: Texas, Florida pause reopening plans; new coronavirus cases hit single-day record in U.S.”and read what flows from there.

 

Vox and its podcasts have also been good resources that are “free.” I highly recommend the recent conversation between Ezekiel Emanuel and Ezra Klein. They begin the program debating what country has the best healthcare to serve as a model for us to consider as we transform our care, and they end up talking about the pandemic in ways that connect this moment to the inevitable changes that will evolve as the pandemic continues and we move through the November elections. 

 

I faithfully check the regular columnists and the guest opinion writers at the New York Times and Washington Post. Of all the opinion pieces about the pandemic that I have read, my award for the best one written so far goes to Tom Friedman of the Times. It was published a month ago and was entitled: “Is Trump Challenging Mother Nature to a Duel?: He can’t beat her coronavirus.”

 

I have bolded my favorite lines in the introduction to my favorite, so far, COVID-19 piece:

 

…For the first time in the life of our generation of human species, Mother Nature has the whole world in her hands. The entire planet is collectively facing the same challenges from the same coronavirus at the same time.

That has been the starting point of all my analyses. I try to ground all my thoughts on how to deal with this pandemic in the logic of Mother Nature and the laws of natural systems. If you don’t — if instead you start your analysis with politics or ideology, or the fact that you’re just tired of being locked down so what the hell, let’s throw back a few with the gang at the local bar and the virus be damned — you’re actually challenging Mother Nature to a duel.

And no one seems to be doing that more these days than President Trump, who’s practically been sounding the all-clear lately, Mother Nature’s powers be damned.

 

There is much more wisdom in the piece. It’s the sort of wisdom that should unite thoughtful people who can realistically balance the way they wish things could be with the fact that they must manage problems on the basis of the facts that define what they are:

 

…if you define wearing a mask, or restrictions on the size of religious gatherings, as a sign of disrespect for your personal freedom — not an act of respect for Mother Nature when she has the whole world in her hands — you’re making a huge mistake.

Let’s remember, Mother Nature is just chemistry, biology and physics, and the engine that drives her is one thing: natural selection. That is the quest of all organisms, to survive and thrive in some ecological niche as they engage in the struggle to pass on their DNA to their next generation and not end up among those that get returned to the manufacturer and decommissioned.

And that’s what viruses do, too: try to survive and replicate. 

 

This line of reasoning may seem familiar to you. You might have picked up the basic information sometime between the seventh grade and the third year of medical school.  Engineers, and even plumbers and electricians must also understand the basic realities of science, for if they don’t, buildings fall down, pipes leak, and the lights don’t come on. Friedman is just reminding us that magical thinking and what we wish would happen does not move Mother Nature. She determines the rules. We have made a lot of progress over the last 500 years by learning her rules and playing by them. What is more amazing than the fact that Mother Nature is just doing her thing, is that through some unbelievable sequence of events we find ourselves being led by someone who has not learned Mother Nature’s rules.

 

Perhaps the best quote of the week comes from Teresa Hanafin at the Boston Globe. She and several other sources report that David Blumenthal, the President of the Commonwealth Fund, aptly described the pandemic as “a public health train wreck in slow motion,”  Ms. Hanafin quoted Dr. Blumenthal in her very funny piece entitled “No wonder Europe wants to ban us” and included the dysfunctional relationship between Mother Nature and our leader who wasn’t paying attention during seventh grade science. She writes:

 

…as Dr. David Blumenthal, president of The Commonwealth Fund, put it, the coronavirus pandemic in the United States is like watching a “public health train wreck in slow motion.” And the Choo-Choo-in-Chief is at the controls, either completely befuddled or completely callous. Take your pick.

 

If you happened to read the “Strategy Healthcare” post of April 28 entitled “Words of Wisdom From Tom and Dennis,” you were exposed to the same ideas from Friedman that he published in the May NYT column.  In that post I reviewed the YouTube presentation of a seminar that Friedman and Ambassador Dennis Ross had done for Temple Kol Shalom in the greater Washington area. My friend and faithful reader, Eve Shapiro, is a member of the Kol Shalom congregation, and had forwarded a link to me. In that presentation Friedman made all of the same points about how you do not mess with Mother Nature. In the Times column that was published three or four weeks after the YouTube presentation he added the literary flourish that is the essence of his craft, but the same message comes through: Don’t mess with Mother Nature, and if you do, expect no compassion. It is what it is. 

 

Mother Nature is not only all powerful, she’s also unfeeling. Unlike that merciful God that most humans worship, Mother Nature doesn’t keep score. She can inflict her virus on your grandmother on Monday and blow down your house with a tornado on Wednesday and come back on Friday and flood your basement. She can hit you in the spring, give you a warm hug in summer and hammer you in the fall.

 

You might not say it the same way, but your personal experience in the physical world probably confirms the truth about the natural world (Mother Nature) that Mr. Friedman is trying to get us to notice. With that in mind, and considering our scientific expertise and self proclaimed world leadership in science and innovation, it is really hard to explain how we got to this moment when we seem to be on the precipice of another surge of hospitalizations and deaths from the coronavirus. Yesterday, we recorded, yet again for this week, a new record number of cases for the day with more than 40,000 positive tests. Memorial Day was a blast for many folks and now we seem to be getting the blow back from Mother Nature. It is interesting that there seems to be a lower than expected number of new cases coming from the Black Lives Matter demonstrations following the murder  of George Floyd. Those demonstrations are not in crowded bars, and a large number of the participants have been wearing masks and trying to practice social distancing. 

 

Governors in red states like Florida, Texas, and Arizona are scrambling to put a halt to the rise of a problem they helped create by not listening to Mother Nature and listening instead to the Choo-Choo-in-Chief.  The New York Times article, How the Virus Won,  that I referenced earlier in this letter, explains how it all happened as they were following the president’s inclination to disregard the power of reality and science in favor of wishful thinking, and were emulating the arrogance of a man who always expects to be “the winner.”

 

Considering the events of the past week, I wonder how long it will be before all of the excellent practitioners of journalism (the fake news as the Choo-Choo-in-Chief prefers to call them) will be writing about how the virus (Mother Nature) won round two. Those articles may be a further source of concern if they contain reports of success as the administration of the Choo-Choo-in-Chief asks the Supreme Court to cancel the ACA. The trifecta of disaster would be some manipulation of reality that gave the president a second term. 

 

Some people, like the Germans, did utilize their knowledge of how Mother Nature works to their advantage. Germany has a population of 83 million, and they have had about 194,000 cases with about 9000 deaths. We have 328 million people, and 2,400,000+ (the CDC suggests maybe 20 Million), cases with 122,000+ deaths. Do the math. On a comparable population basis they have been much better in their effort to match wits with Mother Nature. Less than 3 people per thousand have been infected in Germany, 1 in 10,000 have died, and the disease seems to be under some control, and they have the wisdom to test and do the contact work that they hope will allow them to contain future attempts of Mother Nature to do her thing before there is an effective vaccine. In the USA, 7 people per thousand have been infected so far that we know for sure. About 4 in 10,000 have died, and the disease seems to be spreading rapidly in the south and west with the record numbers of new cases in the last week giving birth to pointless debates as to whether this is a continuation of the “first wave” or the emergence of the “second wave.”  

 

There is little solace in the fact that the disease is not as lethal as some once feared, if what we hear is true that we may have undercounted the number of infected people by a factor of ten. We still have more than 122,000 real deaths, high unemployment, and trillions of dollars of lost wealth. You need not have lost your job to be economically hurt by the mismanagement of the pandemic. 

 

Well, you might say we got frustrated with the lock down. That is understandable. We are all tired of having no fun. We are tired of being worried about bills that we can’t pay. We are done with masks and Zoom cocktail parties. Some of us can charge the state capital with our flags and assault rifles demanding a return to normal as frustrated “good people” do sometimes. Tom Friedman tells us that Mother Nature neither notices, nor does she care about how frustrated we might be.  

 

As such, telling her that you’re fed up with being locked down — that it’s enough already! — doesn’t actually register with her.

 

As the experience of the Germans and the experience of some of our states reveals: 

 

…she [Mother Nature] rewards a president, governor, mayor or citizen who, first and foremost, respects her power. If you don’t respect her viruses, wildfires, droughts, hurricanes, floods and so on, she will hurt you or your neighbors or your citizens.

 

Unfortunately, we can’t leave the loose union of states that we call our nation. We are members of a big dysfunctional family headed by an abusive father figure. Ultimately, we seem to be doomed to suffer together because of all of our focus on our “state’s rights” and our individual freedoms. My neighbor is effectively saying that he does not care about anyone but himself when he defiantly follows the example of the president and refuses to wear his mask. When the governors of Georgia, Florida, and Texas allow their economies to open prematurely, or if they never even closed, then they are saying that their right to be stupid to the detriment of the nation exceeds the right of more reasonable states to expect their cooperative participation in a collective effort. The pandemic has revealed many ways in which our society is flawed and vulnerable even as it looked like it was doing so well to those who were doing so well at the expense of others. We are like potential roadkill frozen by the headlights of Mother Nature’s 18 wheeler. Friedman addresses the core problem as he personifies it as an aspect of our president’s world view:

 

President Trump doesn’t respect Mother Nature, because he measures everything in terms of money and markets. He has no feel for natural systems, except golf courses, where he developed the illusion that he could tame nature, even building man-made waterfalls.

Mother Nature also rewards leaders whose adaptive responses are the most thought-through and coordinated. She evolved her viruses to be expert at finding any weakness in your personal or communal immune system. So, if your family or community is not utterly coordinated in its response to her viruses, they will find the tiniest cracks and make you pay.

…If your adaptation strategy is grounded instead in ideology or election-year politics, she will mercilessly expose that.

 

Like a hurricane, the pandemic will not go on forever. The question is how will we use our knowledge to weather the storm and get through to either natural herd immunity, effective treatment, or a vaccine.  

 

One continuing paranoid fear I have connects the president’s election strategy to the vaccine. I must say that anything that is called “Operation Warp Speed” seems to be as much designed for its potential publicity impact as for its effectiveness. I get it. We are using competition and government funding to drive the rapid production of much needed relief. My skepticism arises from the previous empty promises of this president about how well things were controlled, how much it was just like our annual experience with the flu, how much testing was being done, how we could open up by Easter, and how effectively he was guiding the nation’s response to this challenge from China. The truth is we will not have a vaccine by November, and if we did, we do not yet have the infrastructure to produce and distribute mass numbers of doses. In the interim, Mother Nature moves on and an effective use of “the promise” of a vaccine coupled with false or inflated reports of progress adds up to election strategy. Since there is documentation that he has lied to us almost 20,000 times, why would we trust him on this?

 

As the experience of Germany and other nations that have enjoyed more effective leadership suggests, we did not need to come to this moment when prudent people wonder if we should lock it down again. More than a month ago Friedman pointed out that there was an alternative path that could be followed.

 

For all these reasons it’s clear, or should be, that the holy grail every nation needs to be looking for is what Dr. David Katz, a public health expert, argued from the beginning of this crisis: a “sustainable strategy of total harm minimization.” That means a strategy that would save as many lives and as many livelihoods as possible at the same time. We have to be trying our very best to do both, and we can.

“Our choice never had to be accepting millions of deaths from the virus or from economic ruin,” said Katz. We could have, and still can, acknowledge that different members of our population face different risks from Covid-19 “and therefore develop strategies that protect the most vulnerable in our populations and let the least vulnerable return to work — and thus achieve the best of both ‘lock it down’ and ‘open it up.’”

 

Friedman ends by talking about what could have been and what might come. It’s now more than a month later and what was likely then is now fact. Europe is moving forward with its situation under better control. People from more sane countries may soon be welcome again in Paris and Prague, Comparing us to those saner countries that had a coordinated response to Mother Nature, Friedman finished his great piece by saying:

 

America, by contrast, is a mess. In some places you see reopenings that respect Mother Nature’s power, are coordinated and grounded in science, and in other places you see crowded restaurants or a gym owner defying his governor’s guidelines as cheering demonstrators wave signs that read “My freedom doesn’t end where your fear begins.”

The people making those signs, and the morons on Fox cheering them on, don’t get it. We’re not up against each other. We’re all up against Mother Nature.

We need to reopen and we need to adapt, but in ways that honor Mother Nature’s logic, not in ways that court a second wave — not in ways that challenge Mother Nature to a duel. That is not smart. Because she hasn’t lost a duel in 4.5 billion years.

 

Mother Nature never changes. We do have the capacity to learn and change. To learn and change collectively we require effective leadership and the will to work together against a common challenge. Until we learn those lessons, we will remain frustrated and freighted by the reality that we are riding in a train that is in a “slow motion wreck.” There is some hope that we will not be totally off the tracks by the time we can hire a new Choo-Choo-Driver-in Chief in November.

 

The Gift of the Loons 

 

Mother Nature can threaten us, especially if we abuse her, but everytime I look out my window I am reminded of all the beauty and joy she offers to us. I hope that you do not mind that the header for this post is another picture of the loon family. Our days are filled with the loons. We hear them calling early and late. Sometimes I think that I can almost “speak loon.” Some of the calls sound like, “Hey, where are you? Come get this kid. It’s my turn for some free time.” Other calls sound distressed like, “Come quick! I see the eagle and I am not sure I can protect junior by myself.” Frequently there are several exchanges that go back and forth across the lake. I get the sense that a regular dialog begins with a question like, “Where are you?” The response may be, “I am down at the west end of the lake in the cove in front of the green house.” Followed by, “Well, do you plan to stay there all day?” To which the mate replies, “Junior likes it down here, and it seems safe. Why don’t you join us, and stop fretting?”

 

We are the occupants of the green house at the west end of the lake, and given the fact that the lake has over six miles of shoreline, we feel quite lucky that for some reason the loons like parking just offshore from us. My wife has spent a lot of time trying to get the perfect picture of the loon family. Like all family pictures, getting all the subjects to simultaneously smile and not blink is hard. In some of the pics one of them is looking away, or one of them suddenly puts its head under water. The perfect picture is yet to come. For me the perfect picture would be a combination of classic loon “poses.” Perhaps one of the loons would rise up and spread its wings while the other looked on with admiration with the baby between them. If nothing else, we are documenting a lot of growth from week to week. The baby has learned to dive! It also seems calm when both parents go down for a dive at the same time leaving it alone on the surface. I hold my breath and scan the sky for the eagle when that happens. 

 

The loons do not have the whole lake to themselves. Each summer we have a family of mergansers. They are beautiful birds with tan bodies and reddish heads. As I was heading out in my boat for a little fishing on Wednesday evening, I saw them for the first time this summer. There are usually eight or nine chicks in a “v” formation behind mom. I saw nine moving along the shoreline without much organization and no mom. I hope all is well. Time will give me the answer. 

 

Everything moves in a cycle. By late August the loon chick will be taking flying lessons. That is fun to watch because flying is almost a lost art with loons. As the leaves turn in October, the loons will head to the coast of Maine. By December the lake will freeze. It will thaw in mid April. The loons will come back. Eggs will be laid in May, and with luck there will be another baby next June. 

 

As I watch the loons and think about the cycle of life before me, I sometimes find myself humming Pete Seeger’s song which he lifted from Ecclesiastes. The song is really about taking comfort from Mother Nature and her cycle of life. It says:

 

To everything (turn, turn, turn)

There is a season (turn, turn, turn)

And a time to every purpose, under heaven

 

A time to be born, a time to die

A time to plant, a time to reap

A time to kill, a time to heal

A time to laugh, a time to weep

 

To everything (turn, turn, turn)

There is a season (turn, turn, turn)

And a time to every purpose, under heaven

 

A time to build up, a time to break down

A time to dance, a time to mourn

A time to cast away stones, a time to gather stones together

 

To everything (turn, turn, turn)

There is a season (turn, turn, turn)

And a time to every purpose, under heaven

 

A time of love, a time of hate

A time of war, a time of peace

A time you may embrace, a time to refrain from embracing

 

To everything (turn, turn, turn)

There is a season (turn, turn, turn)

And a time to every purpose, under heaven

 

A time to gain, a time to lose

A time to rend, a time to sew

A time for love, a time for hate

A time for peace, I swear it’s not too late

 

There is some comfort in the loons, and much comfort in the seasonal cycle when something like the pandemic leaves us lost in a sea of uncertainty on a ship without a captain. It’s good to know that there is a natural order of things to which we can look for hope. 

 

Be well! Still stay home if you can. Remember that there are self interested souls with little concern for others almost everywhere you go. Wear your mask and practice social distancing as best you can if you must go out. Think about the America you want for yourself and others. Think about how a better America might evolve with a genuine respect for all people as one of its foundational pillars. If that were true, we would see that the Triple Aim is a given. Demand leadership that is empathetic, thoughtful, truthful, capable, and inclusive.  Look for opportunities to be a good neighbor. Let me hear from you because I would love to know how you are experiencing these very unusual times!

Gene