Kids raising Kids

I read today that one in four Parents lied about their Children’s Covid infection which likely lead to more spread and in turn more deaths. Again, this is not shocking as this is the same cohort that take their children to the ER for behavioral issues.

I finally lost it yesterday after falling apart on Thursday by Friday I was in full blown melt down mode. The shooting in Denver ended with the young man taking his own life. I am still trying to process how a child on a “watch list” was allowed to go to school as long as he was subject to a search before entering. The same supposed program that a six year old was on before he shot his Teacher. Neither do anything to resolve, explain or work on the issue that a Child was such a discipline problem that the school felt it was necessary to go through the Child’s personal belongings. And with that this was in turn all that is needed in which to allow him to return to school does what exactly?

There comes a tilting point, a point in which you will finally snap. It appears that in Denver that happened but the only one dead in that case is the Child. Meanwhile Parents are banning books, halting Drag Queen story hours, demanding curriculum changing and now art that is perceived damaging. Hey the problems begin and end at home.

When the pandemic upended the world, the world changed and the response was to universally lock down. This was the worst idea and utterly done without any concept of what that would do to people financially, emotionally, personally or professionally. It was especially oblivious on how it would affect Children and that will not be known for at least a decade or more as we follow the Pandemic Generation, those born during that time, now age 3 to those aged 22. It appears that it is already showing itself to be a major life altering event as evidenced by the violence and mental health struggles that have been brought to the forefront of what is now the new normal.

Several factors fall into place here – economic as many children took on full time work or caregiver rolls to fill in for family members who became ill, may have died or in turn did so to take pressure off the family whose personal finances were already precarious. Then we have the children who were in school full time and now put into online schools that were ill prepared to take on the challenge and especially for those without broadband access and a quiet place into which they could work and concentrate. All while Parents/Caregivers tried to do the same or in turn monitor their children and all while a massive pandemic with political chaos and confusion reigned. We are seeing the after affects now play out at School Board Meetings, Protests and of course additional forms of Violence that seems to be the only outlet in which to sublimate and misdirect anger. And the children are watching, be they yours or someone else’s.

We wind down Women’s Month and with that of late I am not sure about the state of Women in general. I saw a new revival of a Doll’s House with Jessica Chastain who was riveting in the role of the oppressed wife Nora. She brought a new sense of purpose and edge to a character who at the time Ibsen wrote the play, was considered blaspheme. Women were and to some extent considered the “better half” the better of two evils and the fairer sex, a word that has many meanings. I have never really “got” Women, and I am one. I have largely worked for and around women who were Mid Mangers, Supervisors and never really Bosses. They were hideous to work for and I suspect little has changed. I work in the Pink Collar profession of Education which again has zero to few Superintendents, irony Jersey City is one of the few I have worked for, the other in Seattle was there and gone after two years in a cloud of corruption. So much for fair. To be frank the reality is that the last Superintendent in Nashville, the first Black Male did so as well. Both were Black, I use the past tense as the Woman in Seattle went to I believe Detroit Schools and died prior to making any mark of any kind, as for the male I have no idea where he is or what he is doing. I believe the Superintendent of Nashville is a Black Woman and has been there now going on three years and the schools are the same as they ever were – a hot mess. So at least consistency there is not a Race or Gender issue. The schools were designed that way and little imperative is done to change that. And that is all about Race and all about Money.

Public Education is perhaps even more political than Congress which says a great deal. To get anything done is overwhelming through the Bureaucratic hurdles to the immense amount of money that passes through its doors is is always about one thing – Money. Kids and their achievements less so. It is why there are Magnet Schools and Special schools and the reality is that it is the only way to divert money to a school that has the highly academic to the special needs, for without them then the schools are on a level playing field that has a sinkhole in the middle. The Motto for Public Education: We do less with less. So when the Schools closed the new Astro Turf Group, Mom’s for Liberty came into fruition. This is the new Tea Party down to funding by the Kochs just now it is under the umbrella of a Mother’s coalition and with that who knows better than a Woman when it comes to educating their children. Well pretty much anyone as just because you went to school doesn’t mean you understand its working parts. You drive a car, can you build one or repair it?

I wondered what my life would be like had I gone into Law or another profession and to be again frankly honest, the same. I truly have never worked for many individuals either intelligent or decent enough human beings to both mentor and inspire. The reality is that few in Education as in K-12 or higher learning have worked in jobs for long periods doing what they are Teaching. Teachers in Business schools are Academics, Teachers in Ed Schools, FAILED Teachers. So this is what you pay for, do as I say not as I have never done. What a waste of money. I see why Colleges are closing doors and selling art off, the point to learn is to learn by doing. We have failed that on every level. And with that the groups most in need are not getting what they need. We need course work on Civics, Basic Finance, Business Writing, Basic Programming, a Foreign Language and Nutrition. With that Phys Ed, Sex Education (yes folks that) Art and Music so we don’t have this! What is going on here?

I rarely meet any young person with a sense of intellectual curiosity and most of them are grinning idiots who are sure they understand me not one whit but think I am weird. I truly hate their walking guts and why I have such loathing for my job. I know what is being pushed out there and it is not good. Stories like this make me laugh as this is America, raging morons and label whores. But also word police, social media justice warriors and all around bores. Last book you read that was not told to you by a stranger on Tik Tok? Wow they are removing books from Libraries that none goes to, so not a loss there! Irony much?

And now we want to ensure that the little Education we provided them, particularly with regards to Sex Education we want to limit if not eliminate health care for the young. We have systemically underfunded public health and that is evident by the pandemic. We fail to upgrade infrastructure and deny homes, clean water and safe travel to and from homes to work and all of that we blame the same Government we refuse to fund, to actually become engaged in and instead shout at each other with no listening intended. The reality is that you get what you pay for. We don’t pay.

So when I read this story in the Washington Post it was dated 2022 right after Roe was overturned. The Post put it back up on their front online page with no updates nor additional information regarding this situation, instead leaving it in tact as if it was written recently. I doubt many checked the date and as comments are closed the ones stand in tact as ghost writers in the sand. It is inflammatory, it is distressing and mostly it is just sad. The reality is that this a child with not one child but two. No real Adult influence and a Man/Boy as a Father. Where are they now? Fuck if I know but the same people screaming STOP ABORTION and the Government intervention on my body when it comes to masks and vaccines are the same ones funding this idiots enlistment in the Military. A division of Government that is bloated, corrupt and largely more bullshit on top of bullshit. That they are likely living hand to mouth if they are together and with that these Infants are a year old. Their families should have been active participants in Family Counseling, as it appears her Mother had real problems on many levels; shocking? No, not really. Proper pre and post Natal care and with that ability for her to get a GED let alone a Real Estate License. I am sorry but really she was going to sell and negotiate Real Estate? Are you fucking kidding me? The Boy can barely manage a skateboard but hey let’s give him a gun.

I am not discussing the Anti Abortion dump that counseled her. I have written about these fraudulent and again paid for through Government funds (aka TANF) that do nothing to help young women in these situations and largely religious in nature and origin. They are not even Medical facilities subject to the same laws such as HIPPA so that makes it even more horrific. And they used this child as a fund raising tool. Wow this is America. Welcome.

This Texas teen wanted an abortion. She now has twins

Brooke Alexander found out she was pregnant 48 hours before the Texas abortion ban took effect

By Caroline Kitchener

The Washington Post June 20, 2022

CORPUS CHRISTI, Tex. — Brooke Alexander turned off her breast pump at 6:04 p.m. and brought two fresh bottles of milk over to the bed, where her 3-month-old twins lay flat on their backs, red-faced and crying.

Running on four hours of sleep, the 18-year-old tried to feed both babies at once, holding Kendall in her arms while she tried to get Olivia to feed herself, her bottle propped up by a pillow. But the bottle kept slipping and the baby kept wailing. And Brooke’s boyfriend, Billy High, wouldn’t be home for another five hours.

“Please, fussy girl,” Brooke whispered.

She peeked outside the room, just big enough for a full-size mattress, and realized she had barely seen the sun all day.The windows were covered by blankets, pinned up with thumbtacks to keep the room cool. Brooke rarely ventured into the rest of the house.Billy’s dad had taken them in when her mom kicked them out, andshe didn’t want to get in his way.

The hours without Billy were always the hardest. She knew he had to go, as they relied entirely on the $9.75 an hour he made working the line at Freebirds World Burrito, but she tortured herself imagining all the girls he might be meeting. And she wished she had somewhere to go, too.

Brooke found out she was pregnant late on the night of Aug. 29, two days before the Texas Heartbeat Act banned abortions once an ultrasound can detect cardiac activity, around six weeks of pregnancy. It was the most restrictive abortion law to take effectin the United States in nearly 50 years.

For many Texans who have needed abortions since September, the law has been a major inconvenience, forcing them to drive hundreds of miles, and pay hundreds of dollars, for a legal procedure they once could have had at home. But not everyone has been able to leave the state. Some people couldn’t take time away from workor affordgas, while others, faced with a long journey, decided to stay pregnant. Nearly 10 months into the Texas law, they have started having the babies they never planned to carry to term.

She wanted an abortion. Now, she has twins.

Texas offers a glimpse of what much of the country would face if the Supreme Court overturns Roe v. Wade this summer, as has been widely expected since a leaked draft opinion circulated last month. If the landmark precedent falls, roughly half the states in the country are expected to dramatically restrict abortion or ban it altogether, creating vast abortion deserts that will push many into parenthood.

Sometimes Brooke imagined her life if she hadn’t gotten pregnant, and if Texas hadn’t banned abortion just days after she decided that she wanted one. She would have been in school, rushing from class to her shift at Texas Roadhouse, eyes on a real estate license that would finally get her out of Corpus Christi. She pictured an apartment in Austin and enough money for a trip to Hawaii, where she would swim with dolphins in water so clear she could see her toes.

When both babies finally started eating, Brooke took out her phone and restarted the timer that had been running almost continuously since the day they were born.

She had two and a half hours until they’d have to eat again.

Brooke and Billy first met at the downtown skatepark with a big group of friends, one clear night in May of last year. They didn’t talk that first day, but Brooke noticed how effortlessly Billy dropped into the quarter-pipe, the way his blond hair flipped out from underneath his red beanie. She followed him on Instagram, and her stomach did a little dance when she saw that he followed her back.

Soon, they were spending almost every day together, throwing themselves into the Gulf of Mexico waves on Padre Island and watching the sun setoverthe pier. At the skatepark, he’d help her do the tricks she’d been scared to try alone.

“Pinkie promise me you’ll do it,” he’d say, all blue eyes and dimples, as she peeked over the edge of the ramp.

Once he hooked her little finger, there was no backing down.

Billy was different from the other guys Brooke knew. He held her hand in public and introduced her to his dad. When she took him to the mall, he grinned each time she stepped out of the dressing room, telling her how good she looked in each new crop top she tried on. He made her feel pretty.

“I wasn’t used to feeling like that,” Brooke said.

Brooke took the pregnancy test at 11 o’clock on a hot night at the tail end of the summer. When the two pink lines appeared, she looked over at Billy, then slid onto the bathroom floor, finally connecting the signs she’d ignored for weeks.

The nausea she’d chalked up to food poisoning. The two missed periods. That moment a few weeks back, when Billy put a hand on her stomach and asked if she was sure she wasn’t pregnant.

Leaving Billy in her bedroom with the pregnancy test, Brooke grabbed her keys and drove to her best friend’s house, where they sat on his bed and examined her options.

She could always get an abortion, she told him. Then he reminded her of something she vaguely remembered seeing on Twitter: A new law was scheduled to take effect Sept. 1.

Brooke had 48 hours.

The abortion clinic in South Texas, two and a half hours from Corpus Christi, had no open slots in the next two days, with patients across the state racing to get into clinics before the law came down. When Brooke called, the woman on the end of the line offered the names and addresses of clinics in New Mexico, a 13-hour drive from Corpus Christi.

In the meantime, the woman said, Brooke could get an ultrasound somewhere nearby: If she was under six weeks, they could still see her.

“We’re gonna see how far along it is,” Brooke texted her dad, Jeremy Alexander, later that night. “See if abortion is an option.”

“What’s the cut off date,” he asked.

“They just passed a law today!!” she responded in the early hours of Sept. 1, referring to the ban that had just taken effect. “What are the f—ing odds I believe it’s 6 weeks.”

“Fingers crossed????” her dad said.

Brooke found a place that would perform an ultrasound on short notice and scheduled an appointment for 9 a.m.

Whenever a new client walks into the Pregnancy Center of the Coastal Bend, they are asked to fill out a form. After all the usual questions of name, date of birth and marital status comes the one that most interests the staff: “If you are pregnant, what are your intentions?”

From there, the team sorts each client into one of three groups:

If they’re planning to have the baby: “LTC,” likely to carry.

If they’re on the fence: “AV,” abortion vulnerable.

If they’re planning to get an abortion: “AM,” abortion minded.

The Pregnancy Center of the Coastal Bend, which advertises itself as the “#1 Source of Abortion Information” in the region, is one of thousands of crisis pregnancy centers across the United States, antiabortion organizations that are often religiously affiliated.

When Brooke showed up with her mom for her appointment, she had no idea she’d walked into a facility designed to dissuade people from getting abortions. She also didn’t know how much significance her form held for the staff: By signaling that she wanted an abortion,she became their first “AM” of the Texas Heartbeat Act.

Brooke heard about the centerfrom her mom’s friend, who knew she needed an ultrasound. This place offered them free. Brooke felt a sense of calm, sitting in the waiting room, lulled by its decorative throw pillows and soft watercolors of ocean scenes.

The advocate assigned to her case, Angie Arnholt, had been counseling abortion-minded clients at the pregnancy center for a year. While many of the center volunteers signed up only to talk to “LTCs” to have happy conversations about babies their clients couldn’t wait to have, Arnholt, a 61-year-old who wears a gold cross around her neck, felt called to do what she could to help women “make a good decision,” she later told The Washington Post.

Back in a consultation room, Brooke told Arnholt all the reasons she wanted to get an abortion. She had just enrolled in real estate classes at community college, which would be her first time back in a classroom since she dropped out of high school three years earlier at 15. She and Billy had been dating only three months.

Sitting across from Brooke and her mom, Arnholt opened “A Woman’s Right to Know,” an antiabortion booklet distributed by the state of Texas, flipping to a page titled “Abortion risks.” The first risk listed was “death.”

As Brooke listened to Arnholt’s warnings of depression, nausea, cramping, breast cancer and infertility, she tried to stay calm, reminding herself that women get abortions all the time. Still, Brooke couldn’t help fixating on some of the words Arnholt used: Vacuum suction. Heavy bleeding. Punctured uterus.

(Serious complications from abortion are rare. Abortion does not increase the risk of mental illness, breast cancer or infertility, according to leading medical organizations.)

Starting to panic, Brooke looked over at her mom. When she found out Brooke was pregnant, Terri Thomas told her daughter to get an abortion. While she was a devout Christian, going to church a few times a week and twice on Sundays, she had her own views on this particular issue.

Thomas had her first kid at 20, she said, just as she was transferring out of community collegewith hopes of starting law school. If the timing had been different, she said, she might have been a prosecutor. Instead, she hopped from one retail job to another: Bath & Body Works to Walgreens to Home Depot.

Growing up, Brooke said, she bounced back and forth between her mom’s house and her dad’s, depending on who was the more stable parent at the time. Her happiest years as a kid were spent with her dad, she said, on a tree-lined street with a ping-pong table in the garage and a trampoline in the backyard. But then Brooke’s dad started using cocaine.

While Alexander has been sober for a few years now, he said, back then he couldn’t kick the habit. Around the time he stopped paying all the rent, and sewage started backing up in their toilets, Brooke moved back in with her mom.

With her mom, Brooke always felt like she was tiptoeing. If Brooke forgot to turn off the lights or do the dishes, Thomas would start yelling. Thomas felt she had every right to respond that way, she said, because she was the “hen” in her henhouse.

Arnholt ushered Brooke into the ultrasound room, where Brooke undressed from the waist down and lay back onto an examination table, looking up at a large flat-screen TV.

As the ultrasound technician pressed the probe into her stomach, slathered with gel, Brooke willed the screen to show a fetus without a heartbeat.

The technician gasped.

It was twins. And they were 12 weeks along.

“Are you sure?” Brooke said.

“Oh, my God, oh, my God,”Thomas recalled saying as she jumped up and down. “This is a miracle from the Lord. We are having these babies.”

Brooke felt like she was floating above herself, watching the scene below. Her mom was calling the twins “my babies,” promising Brooke she would take care of everything, as the ultrasound technician told her how much she loved being a twin.

If she really tried, Brooke thought she could make it to New Mexico. Her older brother would probably lend her the money to get there. But she couldn’t stop staring at the pulsing yellow line on the ultrasound screen.

She wondered: If her babies had heartbeats, as these women said they did, was aborting them murder? Eventually, Arnholt turned to Brooke and asked whether she’d be keeping them.

Brooke heard herself saying “yes.”

Brooke walked out of the pregnancy center that day with an ultrasound photo and a handful of lollipops that Arnholt promised would help with her morning sickness.

Arnholt and the ultrasound technician each followed up with Brooke a few times over text. Brooke scheduled what the pregnancy center called a “prenatal appointment,” where she sat through another ultrasound, then dropped by for a parenting class, earning “points” she redeemed for a package of diapers.

After that, Brooke didn’t go back to the pregnancy center. She said the class felt like a waste of time.

Instead, she turned to Billy.

Within a few weeks, Brooke and Billy had a plan. He would join the Air Force as soon as he graduated from high school. Brooke would wait for him to finish basic training, then follow him wherever he got assigned.

Soon they were debating baby names. Surrounded by their friends and families one afternoon in October, Brooke and Billy fired gender-reveal cannons into Thomas’s backyard, unleashing two giant puffs of pink smoke.

“I’m so happy I met you billy,” Brooke wrote in an Instagram post announcing her pregnancy. “Starting a family with you is gonna be one of the hardest things I’m ever gonna experience, but I’m glad I get to do it with you.”

Brooke started her real estate classes in early November, and she loved everything about going to school. When she showed up the first day in her favorite crop top and jeans, the cinder-block building “felt like an opportunity,” she said. Most days, she’d buy a Frappuccino from the vending machine and sit down in the chair she’d claimed as her own, opening her textbook to a page she’d already covered in yellow highlighter.

Brooke got an 83 on the final exam, the highest grade in the class.

She texted everyone she could think of who might want to hear the news: Billy, her brother, her mom, her dad, her grandpa. After threeyears out of school, she couldn’t believe she’d done so well.

“I felt like, man, I must be really smart,” she said.

Throughout the fall, Billy was her biggest worry. He’d stayed pretty quiet back when she was deciding what to do about the babies. Just once, he told her he’d prefer to get an abortion, but would support her completely in whatever she chose. He’d thought about adoption, but Brooke wouldn’t even consider it.

“I don’t think I’m ready for this,” he’d told her.

Billy was scared to lose what he described as “the freedom of being a teenager.” After he graduated, he’d planned to keep working at Freebirds, just enough hours to get by, so he could maximize his skate time and “just chill.” People respected Billy at the skate park. Whenever he geared up to film some tricks, everyone else cleared out of the bowl.

By November, Billy was paying all of Brooke’s bills. She’d stopped working at Texas Roadhouse after the smell of the meat and grease had been making her sick to her stomach. To swing Brooke’s $330 car payment, they applied for a WIC card and ate ramen or pancakes for dinner. When they overdrafted Brooke’s credit card, Billy worked double shifts until he could pay it off.

Brooke wanted to work, but she couldn’t hack a waitressing job. At seven months pregnant, she struggled to stay on her feet for too longand felt utterly exhausted by even the simplest tasks. She started falling asleep while doing her homework. Then she missed a class. Then another.

When she decided to drop out of real estate school, she couldn’t bring herself to tell her teacher. She convinced herself it wasn’t that big of a deal. They’d be moving away soon anyway, and the Air Force would pay Billy enough to support them both.

Brooke wedged her real estate textbook in a line of books on her dresser, between “What to Expect When You’re Expecting” and the fourth Harry Potter. Maybe she’d come back to it one day.

Anytime Brooke went out with the babies in public, she knew that people were staring. She was 18 and she looked 18, with rosy cheeks and curly blond ringlets tied together with a ribbon. As she struggled to maneuver her double stroller through the doors at Freebirds, she imagined everyone was judging her, writing her off as a clueless kid and a bad mom.

She was determined to prove them wrong.

Somehow, mothering came naturally to Brooke. Whenever one of the babies started crying, Brooke would tick through her mental checklist: Was her daughter hungry? Tired? Did she need to be changed?

If it was none of those things, Brooke would pick up her daughter and hold her close, swaying from side to side, kissing the silky brown strands on the top of her head. Almost always, her baby would stop crying.

“I think they can smell me,” she said. “And that makes me feel so special.”

Brooke knew the little things about her daughters that no one else would notice. Olivia had a higher-pitched cry. Kendall was harder to soothe. You could always tell when they were about to wake up, because they’d start to smile.

Looking at her daughters, Brooke struggled to articulate her feelings on abortion. On one hand, she said, she absolutely believed that women should have the right to choosewhat’s best for their own lives. On the other, she knew that, without the Texas law, her babies might not be here.

“Who’s to say what I would have done if the law wasn’t in effect?” she said. “I don’t want to think about it.”

Brooke considered all that she’d lost: long nights at the skate park, trips to the mall, dropping $30 on a crab dinner just because she felt like it.

“I can’t just really be free,” she said. “I guess that really sums it up. That’s a big thing that I really miss.” She sat silently for a while, Olivia’s hand wrapped around her finger. “It’s really scary thinking that I wouldn’t have them,” she said.

There was only one way she could make sense of it, she said. Losing them now, as fully formed human beings, would be different from losing them back then.

All through the pregnancy, Brooke had planned to bring the babies home to her mom’s house, where they’d all live together until Billy made enough money to pay for a home. Brooke’s mom had promised to be there for them, back in the ultrasound room, and Brooke had believed her. But after a couple of weeks, Brooke started to feel like her mom could turn on her at any moment.

Thomas would remind Brooke that she was staying in her house rent-free, running the TV and AC all night without paying for electric. After Brooke left dirty dishes in the sink one night in May, she woke up to her mom yelling at her from the kitchen.

“You don’t get a prize for getting yourself knocked up and pregnant,” Thomas remembered saying. “I don’t know what you think I owe you, but you don’t get a prize for that.”

Brooke told her, “You treat me like some random chick off the street. I’m your daughter.”

Thomas said she told her to find another place to live.

Brooke packed up a few things and drove the babies toBilly’s dad’s house. Billy’s room wasn’t exactly where she’d imagined raising her daughters, with its stash of skateboard magazines and a giant Freebirds billboard behind the bed, advertising fountain drinks for 95 cents. But it was a place she was welcome.

The next morning, Brooke woke up to a text fromher mother. “I am by no means a perfect human or a perfect mom, but I love you no matter what,” she wrote. “You don’t have to stay over there.”

Brooke would rather rely on Billy than her mom, she decided, though in her most anxious moments, she worried he might kick her out, too.

She often relived an argument they’d had one Saturday night in April, when they got a little too drunk and Billy finally talked about all the things he’d been avoiding. He didn’t really like the way his life was turning out, he told her. He didn’t want to join the Air Force. He just wanted to skate.

“That’s not my fault,” she’d told him. “I didn’t get myself pregnant.”

At one point, she recalled, he suggested they try living apart.

They were over that now, Brooke reminded herself as she hung up her clothes in Billy’s closet. She placed a bouquet of flowers on his desk and lit a candle, filling the room with a scent called “Forever Love.” Bit by bit, she would make Billy’s room a home.

Across town, a woman Brooke had never met would soon be sharing her story, holding up the twins as an antiabortion triumph, just two weeks after the leaked draft decision revealed a Supreme Court on the brink of overturning Roe.

The Coastal Bend Republican Coalition gathered on May 19 for its weekly meeting at a local barbecue joint. Over brisket and coleslaw, members listened to the speaker they’d invited for the evening: Jana Pinson, the executive director of the Pregnancy Center of the Coastal Bend.

To explain the center’s work, Pinson told a story about a girl who showed up with her mom on the morning the Heartbeat Act took effect, asking for an abortion. The mother and daughter “were so furious with us,” Pinson said, “so angry.” But as soon as they saw the ultrasound, she said, everything changed.

“The moment we put that wand on her sweet belly and two babies popped up … it absolutely melted them.”

Last year, Pinson said, 583 abortion-minded and abortion-vulnerable women chose to continue their pregnancies after visiting their facility. At their banquet in March, with over 2,800 attendees from across the region, Pinson and her staff lit 583 candles.

One of those was for Brooke.

Three weeks later, the babies stayed home while Brooke and Billy drove to the courthouse. Billy was about to leave for a five-month stint in basic training and technical school. For Brooke to qualify for military benefits, they had to get married.

At 11 o’clock on a Monday morning, they walked into a courtroom with an American flag behind the bench, Brooke in a flowery sundress, Billy in jeans. She’d looked around for white dresses on Amazon but couldn’t justify the $30: She was terrified she’d run out of money while Billy was away.

The loneliness scared her, too. She kept imagining the long nights alone in Billy’s house, trying to calm two crying babies without him. He wouldn’t have his phone at basic training, and she would hear from him mostly through letters. She knew she’d have to manage that little voice in the back of her head: What if he changed his mind about their life together?

Standing with Billy in front of the justice of the peace, Brooke told herself that, one day, they would have their “love story moment.” She would walk down the aisle in a wedding gown. Their friends and family would cry and cheer as she and Billy publicly declared how much they meant to each other.

“I, Brooke Alexander, take thee, Billy High, to be my wedded husband,” she repeated.

If it wasn’t for the Texas law, Brooke knew shemight not be standing here. She’d probablybe studying for her next exam, while Billy mastered some new trick on the quarter-pipe. She liked to think they’d still be together, spending their money on movie tickets and Whataburger, instead of diapers and baby wipes.

She told herself that alternate life didn’t matter anymore. She had two babies she loved more than anything else in the world.

“I do,” she said, tears in her eyes.

Brooke pulled out her phone once they finished the ceremony: 1 hour, 15minutes.

Time to grab some lunch and head home. The babies would be hungry.

Public Health

If you rely on the CDC for information regarding Covid that is your first mistake, the second is not wearing K95 masks indoors after a 15-30 minute time frame exposure. Did I get that from the CDC, no, I got that from a study done by the Wall Street Journal and from numerous other Biology and Science sites that cover virus exposure. That was the presumption in 2020 and that has not changed. The spread has it was believed 1:3 but now it is presumed 1:4 which is equivalent to Whooping Cough. Will you find that on the CDC website? No. What you find is an ever changing time frame and info guide that has since I contracted Covid on Sept 9, has said that from time of contracting Covid and getting a booster should be six months or four months or now three months. Okay which months? The guide should be have an antibody test at 3 then from there until there are none present to act as a natural immunity factor, for which it appears there is none. Or is depending upon the variant and if you are a breakthrough case. What.ever. At some point they are sure to have some consistency and with that it explains Fauci doesn’t it and his ever changing barometer of precautions. But in the nascent days of Covid he seemed “wise.” Yeah okay. A Bureaucrat with an MD is not someone who is reliable as we have turned our back on Birks and Redfield who were marginalized early on and with that Birks did more than Fauci ever did, going on a road trip state to state to meet local Health Directors to discuss the Covid protocol, which at that time was just hide. It clearly failed. Today we are averaging 400 deaths a day so no the pandemic is not over and we are in the same dark we were three years ago when it comes to understanding Covid. My God the shear stupidity of some of the bizarre decisions still rankle me – Curfews, only outdoors for limited time, closing parks, schools and failure to test anyone showing any symptom of Covid unless they met a certain set of parameters. What a joke. I need to go wash my door handle. Remember that? And masks not needed? Yeah that is the first and most simple defense today that would work and yet it is the most political. So let’s keep blaming Trump shall we?

The reality is that we have no funding, no central authority, a piecemeal of laws and regulations and a reality that we are shitty at public health. We can put that down to systemic institutional racism as we have always believed that hard working boot strap folks have jobs with insurance, good medical leave plans and of course access to affordable health care. Yeah right.

A few days ago I received a text from the State saying this number was tied to a positive Covid result. I deleted it. The reality is that they needed data to track and trace all my contacts that I had prior to confirmation to ensure they are tested. Well that is a four day late time frame. The time frame from exposure to symptoms has always been 72 hours but you will not find that anywhere on the CDC site as no one seems sure of that data. Really I knew instantly by my behavior and where I was three days prior, it fit perfectly. I immediately knew on Thursday I was not feeling well but I chalked that up to travel but by that night I knew for certain without a test as I had a fever and cough. Friday an at home test confirmed it and with that I immediately went for a PCR test. Those days I was masked the time I went to the store, the drugstore and my storage unit, limiting my contacts and already beginning to isolate with the plan it was coming. On Saturday morning when the confirm results came in I immediately went on Paxaloid and went to the drug store alone, with a mask and quickly returned home. I made no stops and with that I informed my front desk that yes I was POS and anyone who did get near me the next few days when I went to get my paper or mail to wear a mask in my company. I was responsible so anything the State was going to do I knew was not, they were going to harvest my data to find something to do nothing. I contracted it out of state and my contacts were limited to one and one alone that I could have transmitted Covid, the massage spa. The Masseuse was a bitch and she really harmed me, and I left a 20 buck tip knowing I would never be back. With that I have no idea if she contracted Covid or if in fact she was the only other one who could have transmitted it to me so with that we are done. The State got nothing as there was nothing to give. But you can see why reading the article below how and why they do need the data. We are fucked folks without monkeypox.

‘Very Harmful’ Lack of Data Blunts U.S. Response to Outbreaks

Major data gaps, the result of decades of underinvestment in public health, have undercut the government response to the coronavirus and now to monkeypox.

By Sharon LaFraniere The New York Times Sept. 20, 2022

ANCHORAGE — After a middle-aged woman tested positive for Covid-19 in January at her workplace in Fairbanks, public health workers sought answers to questions vital to understanding how the virus was spreading in Alaska’s rugged interior.

The woman, they learned, had underlying conditions and had not been vaccinated. She had been hospitalized but had recovered. Alaska and many other states have routinely collected that kind of information about people who test positive for the virus. Part of the goal is to paint a detailed picture of how one of the worst scourges in American history evolves and continues to kill hundreds of people daily, despite determined efforts to stop it.

But most of the information about the Fairbanks woman — and tens of millions more infected Americans — remains effectively lost to state and federal epidemiologists. Decades of underinvestment in public health information systems has crippled efforts to understand the pandemic, stranding crucial data in incompatible data systems so outmoded that information often must be repeatedly typed in by hand. The data failure, a salient lesson of a pandemic that has killed more than one million Americans, will be expensive and time-consuming to fix.

The precise cost in needless illness and death cannot be quantified. The nation’s comparatively low vaccination rate is clearly a major factor in why the United States has recorded the highest Covid death rate among large, wealthy nations. But federal experts are certain that the lack of comprehensive, timely data has also exacted a heavy toll.

“It has been very harmful to our response,” said Dr. Ashish K. Jha, who leads the White House effort to control the pandemic. “It’s made it much harder to respond quickly.”

Details of the Fairbanks woman’s case were scattered among multiple state databases, none of which connect easily to the others, much less to the Centers for Disease Control and Prevention, the federal agency in charge of tracking the virus. Nine months after she fell ill, her information was largely useless to epidemiologists because it was impossible to synthesize most of it with data on the roughly 300,000 other Alaskans and the 95 million-plus other Americans who have gotten Covid.

Those same antiquated data systems are now hampering the response to the monkeypox outbreak. Once again, state and federal officials are losing time trying to retrieve information from a digital pipeline riddled with huge holes and obstacles.

“We can’t be in a position where we have to do this for every disease and every outbreak,” Dr. Rochelle P. Walensky, the C.D.C. director, said in an interview. “If we have to reinvent the wheel every time we have an outbreak, we will always be months behind.”

A Covid Data Pipeline Riddled With Holes and Obstacles

State and local health departments have struggled to combine data from disparate sources and pass it along to the C.D.C. This flow chart shows how Covid case reports are typically handled in Alaska.

Test results provide the basic case count, but to better track the pandemic, they must be combined with information from other data sources.

Staff members attempt to use other sources to add more details to each case, but with high volume, missing information and systems that inhibit data sharing, records are mostly incomplete.

Though missing fields in many cases, the data is used to power a public dashboard and is sent to the C.D.C. Frequently, little beyond age, sex and county of residence is sent.

The federal government invested heavily over the past decade to modernize the data systems of private hospitals and health care providers, doling out more than $38 billion in incentives to shift to electronic health records. That has enabled doctors and health care systems to share information about patients much more efficiently.

But while the private sector was modernizing its data operations, state and local health departments were largely left with the same fax machines, spreadsheets, emails and phone calls to communicate.

States and localities need $7.84 billion for data modernization over the next five years, according to an estimate by the Council of State and Territorial Epidemiologists and other nonprofit groups. Another organization, the Healthcare Information and Management Systems Society, estimates those agencies need nearly $37 billion over the next decade.

The pandemic has laid bare the consequences of neglect. Countries with national health systems like Israel and, to a lesser extent, Britain were able to get solid, timely answers to questions such as who is being hospitalized with Covid and how well vaccines are working. American health officials, in contrast, have been forced to make do with extrapolations and educated guesses based on a mishmash of data.

Facing the wildfire-like spread of the highly contagious Omicron variant last December, for example, federal officials urgently needed to know whether Omicron was more deadly than the Delta variant that had preceded it, and whether hospitals would soon be flooded with patients. But they could not get the answer from testing, hospitalization or death data, Dr. Walensky said, because it failed to sufficiently distinguish cases by variant.

Instead, the C.D.C. asked Kaiser Permanente of Southern California, a large private health system, to analyze its Covid patients. A preliminary study of nearly 70,000 infections from December showed patients hospitalized with Omicron were less likely to be hospitalized, need intensive care or die than those infected with Delta.

But that was only a snapshot, and the agency only got it by going hat in hand to a private system. “Why is that the path?” Dr. Walensky asked.

The drought of reliable data has also repeatedly left regulators high and dry in deciding whether, when and for whom additional shots of coronavirus vaccine should be authorized. Such decisions turn on how well the vaccines perform over time and against new versions of the virus. And that requires knowing how many vaccinated people are getting so-called breakthrough infections, and when.

But almost two years after the first Covid shots were administered, the C.D.C. still has no national data on breakthrough cases. A major reason is that many states and localities, citing privacy concerns, strip out names and other identifying information from much of the data they share with the C.D.C., making it impossible for the agency to figure out whether any given Covid patient was vaccinated.

“The C.D.C. data is useless for actually finding out vaccine efficacy,” said Dr. Peter Marks, the top vaccine regulator at the Food and Drug Administration. Instead, regulators had to turn to reports from various regional hospital systems, knowing that picture might be skewed, and marry them with data from other countries like Israel.

The jumble of studies confused even vaccine experts and sowed public doubt about the government’s booster decisions. Some experts partly blame the disappointing uptake of booster doses on squishy data.

The F.D.A. now spends tens of millions of dollars annually for access to detailed Covid-related health care data from private companies, Dr. Marks said. About 30 states now also report cases and deaths by vaccination status, showing that the unvaccinated are far more likely to die of Covid than those who got shots.

But those reports are incomplete, too: The state data, for instance, does not reflect prior infections, an important factor in trying to assess vaccine effectiveness.

And it took years to get this far. “We started working on this in April of 2020, before we even had a vaccine authorized,” Dr. Marks said.

Now, as the government rolls out reformulated booster shots ahead of a possible winter virus surge, the need for up-to-date data is as pressing as ever. The new boosters target the version of a fast-evolving virus that is currently dominant. Pharmaceutical companies are expected to deliver evidence from human clinical trials showing how well they work later this year.

“But how will we know if that’s the reality on the ground?” Dr. Jha asked. Detailed clinical data that includes past infections, history of shots and brand of vaccine “is absolutely essential for policymaking,” he said.

“It is going to be incredibly hard to get,” Dr. Jha added.

New Outbreak, Same Data Problems

When the first U.S. monkeypox case was confirmed on May 18, federal health officials prepared to confront another information vacuum. Federal authorities cannot generally demand public health data from states and localities, which have legal authority over that realm and zealously protect it. That has made it harder to organize a federal response to a new disease that has now spread to nearly 24,000 people nationwide.

Three months into the outbreak, more than half of the people reported to have been infected were not identified by race or ethnicity, clouding the disparate impact of the disease on Black and Hispanic men.

To find out how many people were being vaccinated against monkeypox, the C.D.C. was forced to negotiate data-sharing agreements with individual jurisdictions, just as it had to do for Covid. That process took until early September, even though the information was important to assess whether the taxpayer-funded doses were going to the right places.

The government’s declaration in early August that the monkeypox outbreak constituted a national emergency helped ease some of the legal barriers to information sharing, health officials said. But even now, the C.D.C.’s vaccine data is based on only 38 states, plus New York City.

Some critics say the C.D.C. could compensate for its lack of legal clout by exercising its financial muscle, since its grants help keep state and local health departments afloat. But others say such arm-twisting could end up harming public health if departments then decide to forgo funding and not cooperate with the agency.

Nor would that address the outmoded technologies and dearth of scientists and information analysts at state and local health departments, failings that many experts say are the biggest impediment to getting timely data.

Alaska is a prime example.

Early in the pandemic, many of the state’s Covid case reports arrived by fax on the fifth floor of the state health department’s office in Anchorage. National Guard members had to be called in to serve as data-entry clerks.

The health department’s highly trained specialists “didn’t have the capacity to be the epidemiologists that we needed them to be because all they could do was enter data,” said Dr. Anne Zink, Alaska’s chief medical officer, who also heads the Association of State and Territorial Health Officials.

All too often, she said, the data that was painstakingly entered was too patchy to guide decisions.

A year ago, for instance, Dr. Zink asked her team whether racial and ethnic minorities were being tested less frequently than whites to assess whether testing sites were equitably located.

But epidemiologists could not tell her because for 60 percent of those tested, the person’s race and ethnicity were not identified, said Megan Tompkins, a data scientist and epidemiologist who until this month managed the state’s Covid data operation.

Long after mass testing sites were shuttered, Ms. Tompkins’s team was culling birth records to identify people’s race, hoping to manually update tens of thousands of old case reports in the state’s disease surveillance database. State officials still think that the racial breakdown will prove useful.

“We’ve started from really broken systems,” Ms. Tompkins said. “That meant we lost a lot of the data and the ability to analyze it, produce it or do something with it.”

Boom and Bust Funding

State and local public health agencies have been shriveling, losing an estimated 15 percent of their staffs between 2008 and 2019, according to a study by the de Beaumont Foundation, a public-health-focused philanthropy. In 2019, public health accounted for 3 percent of the $3.8 trillion spent on health care in the United States.

The pandemic has prompted Congress to loosen its purse strings. The C.D.C.’s $50 million annual budget for data modernization was doubled for the current fiscal year, and key senators seem optimistic it will double again next year. Two pandemic relief bills provided an additional $1 billion, including funds for a new center to analyze outbreaks.

But public health funding has traced a long boom-and-bust pattern, rising during crises and shrinking once they end. Although Covid still kills about 400 Americans each day, Congress’s appetite for public health spending has waned.

While $1 billion-plus for data modernization sounds impressive, it is roughly the cost of shifting a single major hospital system to electronic health records, Dr. Walensky said.

For the first two years of the pandemic, the C.D.C.’s disease surveillance database was supposed to track not just every confirmed Covid infection, but whether infected individuals were symptomatic, had recently traveled or attended a mass gathering, had underlying medical conditions, had been hospitalized, had required intensive care and had survived. State and local health departments reported data on 86 million cases.

But a vast majority of data fields are usually left blank, an analysis by The New York Times found. Even race and ethnicity, factors essential to understanding the pandemic’s unequal impact, are missing in about one-third of the cases. Only the patient’s sex, age group and geographic location are routinely recorded.

Data Is Missing for Many Virus Cases

Share of C.D.C. coronavirus case surveillance records containing each type of data.

Note: Data is as of Sept. 9, 2022.

Source: Centers for Disease Control and Prevention case surveillance data

By Albert Sun

While the C.D.C. says the basic demographic data remains broadly useful, swamped health departments were too overwhelmed or too ill-equipped to provide more. In February, the agency recommended that they stop trying and focus on high-risk groups and settings instead.

The C.D.C. has patched together other, disparate sources of data, each imperfect in its own way. A second database tracks how many Covid patients turn up in about 70 percent of the nation’s emergency departments and urgent care centers. It is an early warning signal of rising infections. But it is spotty: Many departments in California, Minnesota, Oklahoma and elsewhere do not participate.

Another database tracks how many hospital inpatients have Covid. It, too, is not comprehensive, and it is arguably inflated because totals include patients admitted for reasons other than Covid, but who tested positive during their stay. The C.D.C. nevertheless relies partly on those hospital numbers for its rolling, county-by-county assessment of the virus’s threat.

There are bright spots. Wastewater monitoring, a new tool that helps spot incipient coronavirus surges, is now conducted at 1,182 sites around the country. The government now tests enough viral specimens to detect whether a new version of the virus has begun to circulate.

In the long run, officials hope to leverage electronic health records to modernize the disease surveillance system that all but collapsed under the weight of the pandemic. Under the new system, if a doctor diagnoses a disease that is supposed to be flagged to public health authorities, the patient’s electronic health record would automatically generate a case report to local or state health departments.

Hospitals and clinicians are under pressure to deliver: The federal government is requiring them to show progress toward automated case reports by year’s end or face possible financial penalties. So far, though, only 15 percent of the nearly 5,300 hospitals certified by the Centers for Medicare and Medicaid Services are actually generating electronic case reports.

And many experts say automated case reports from the private sector are only half the solution. Unless public health departments also modernize their data operations, they will be unable to process the reports that hospitals and providers will be required to send them.

“People often say, ‘That’s great, you put the pitchers on steroids, but you didn’t give the catchers a mask or a good mitt,’” said Micky Tripathi, the national coordinator for health information technology at the Department of Health and Human Services.

One Case, Many Data Systems

The effort to document the Fairbanks woman’s Covid case shows just how far many health departments have yet to go.

After the woman was tested, her workplace transferred her nasal swab to the Fairbanks state laboratory. There, workers manually entered basic information into an electronic lab report, searching a state database for the woman’s address and telephone number.

The state lab then forwarded her case report to the state health department’s epidemiology section, where the same information had to be retyped into a database that feeds the C.D.C.’s national disease surveillance database. A worker logged in and clicked through multiple screens in yet another state database to learn that the woman had not been vaccinated, then manually updated her file.

The epidemiology section then added the woman’s case to a spreadsheet with more than 1,500 others recorded that day. That was forwarded to a different team of contact tracers, who gathered other important details about the woman by telephone, then plugged those details into yet another database.

The result was a rich stew of information, but because the contact tracers’ database is incompatible with the epidemiologists’ database, their information could not be easily shared at either the state or the federal level.

For example, when the contact tracers learned a few days later that the woman had been hospitalized with Covid, they had to inform the epidemiology section by email, and the epidemiologists got the hospital’s confirmation by fax.

Ms. Tompkins said Alaska’s problem was not so much that it was short of information, but that it was unable to meld the data it had into usable form. Alaska’s health officials reached the same conclusion as many of their state and federal counterparts: The disease surveillance system “did not work,” Ms. Tompkins said, “and we need to start rethinking it from the ground up.”

The C.D.C. awarded Alaska a $3.3 million grant for data modernization last year. State officials considered that a start, but anticipated much more when a second five-year public health grant for personnel and infrastructure was awarded this summer.

They hoped not only to improve their digital systems, but to beef up their tiny work force, including by hiring a data modernization director.

Carrie Paykoc, the health department’s data coordinator, texted Dr. Zink at 8 p.m. on June 22, after news of the grant arrived.

The award was $1.8 million a year, including just $213,000 for data modernization. “Pretty dire,” she wrote.

“We were hoping for moonshot funding,” Ms. Paykoc said. “We learned it was a nice camper van.”

Last and Ditch

Effective immediately I have ditched any further efforts to persuade, inform, educate or beg anyone who has not gotten one variation of the Covid vaccine, as at this point there is no point. I tried to explain to a Doorman today why I am going out of my way to walk through the Lobby, get packages in the middle of the night or just be polite with distance as the two other Doormen who refuse to vaccinate are not worth my time. One I have NEVER bothered as she is point blank stupid and a bitch, the other a boy who to say confabulates is one thing, another if you say he lives in a fantasy world that seems to be full of dragons and demons which makes sense as he is a Gamer. And we all know that crew, they escalated into full on Q this past year so who the fuck is dealing with them? You have to be a raging moron.

And with that I have decided to ask politely of any business I frequent what their vaxx status is. if there is a preponderance of anti vaxxers, as one coffee shop has, I say: Thanks but no thanks. Again these are all kids who are to say the least ill-educated, people of color and have very fractured lives. They are not people who need in the least a dose of Covid and they are just lucky that for them it has been an issue they have avoided. But with the new variants I suspect it won’t last. And while I have my protection via my own vaccine, why would I push my luck? We don’t know for certain the efficacy of the vaccine against the variant and with that I don’t want to be the one who has found that .05% failure rate. And with that I find it hypocritical that I know this and yet somehow enable it with tacit participation. If I don’t know I don’t but frankly I do ask and I have the right to know as for the last 424 days we have been asked a multitude of questions, signed numerous waivers and been on high alert to ensure that we STOP THE SPREAD. Many people lost their jobs, their businesses and over 500K their lives. We have heard stories of those who have had to have lungs replaced, limbs amputated and financial ruin thanks to Covid costs, despite the supposed reimbursement by the Government, there are many who have found that another hurdle to recovery. So now those who choose not are asking me to carry them to the finish line. Sorry, not sorry.

I did my part and went out of my way to not risk my health and anyone whom I did business with and now these same individuals are asking me to further do more. Here is my statement of that: GO FUCK YOURSELF. I am done but for those who still wish to try this is an excellent piece from the New York Times on why you should. Good luck with that.

The Importance of Getting Fully Vaccinated

Covid remains a mortal threat not just for people like me in the upper decades of life but for almost anyone, no matter how young and healthy.

Credit…Gracia Lam

By Jane E. Brody The New York Times Personal Health May 10, 2021

Too many Americans don’t seem to realize just how easily the novel coronavirus spreads and how awful Covid-19 can be. It is prompting far too many either to a) avoid getting any vaccine, b) skip the second dose if their first was Pfizer or Moderna or c) assume that the vaccine they got means they are now free to gather in any way they choose without taking any public health precautions.

Covid remains a mortal threat not just for people like me in the upper decades of life but also for almost anyone, no matter how young and healthy. Like the 37-year-old pregnant woman in Illinois who was put on life support after her baby was delivered by emergency C-section. Or the 26-year-old man in Maryland who was hospitalized on oxygen for five days and now tells everyone “how bad it was and how scary it is.” Although infections, hospitalizations and deaths are down from their dreadful peaks in 2020, we are still a long way from herd immunity — if we ever get there.

Sixty-one percent of people live in counties where the risk of infection right now is very high or extremely high, and whenever someone gets infected with the coronavirus, a mutation to an even more dangerous variant could arise.

After months of uncertainty about whether any vaccine that emerged from Operation Warp Speed would be safe and effective, the final highly reassuring results from the vaccine trials late last year were almost beyond belief. The members of the vaccine advisory committee who endorsed the Food and Drug Administration’s emergency use authorization of the vaccines are nongovernment experts with integrity and independent judgment. Had the government delayed the vaccine release until fully licensed, both the population and the economy likely would have been irreparably devastated.

I waited with bated breath for my turn to get immunized last winter and then for my two sons and daughters-in-law and four grandsons to become eligible this spring. All will be fully vaccinated by the end of the month when we gather for the first time in nearly two years to celebrate my 80th birthday. And all of us will continue to wear masks and maintain appropriate distance from others when we’re outdoors in close settings or indoors in public venues with people we don’t know.

In its advisory issued April 27, the Centers for Disease Control and Prevention said that fully vaccinated people can visit indoors with others who are fully vaccinated without wearing a mask or physically distancing and can travel domestically without getting tested or self-quarantining. They can also now “gather or conduct activities outdoors without wearing a mask, except in certain crowded settings or venues” like a live performance, parade or sporting event.

But the agency warned unvaccinated people that they are least safe — and should remain masked — when going to an indoor movie, eating in an indoor restaurant or bar, participating in a high-intensity indoor exercise class or singing in an indoor chorus. Dr. Rochelle Walensky, the C.D.C.’s director, said that there’s an almost 20-fold increased risk of transmitting the virus indoors.

Even for vaccinated people, she said, “until more people are vaccinated and while we still have more than 50,000 cases a day, mask use indoors will provide extra protection.”

There are good reasons for continued precautions. More than half the population, including young children, are not yet immunized. It is not known whether immunized people can acquire the virus and remain symptom-free, then unwittingly spread it to others who are vulnerable. Not everyone who wants the vaccine is able to get it for logistical or health reasons, and the vaccines may not fully protect people with immune deficiencies.

Furthermore, even though the authorized vaccines result in a stronger immune response than natural infection, we don’t yet know how long their protection will last. The Excelsior Pass I got in New York State attests to my vaccination status, but it expires mid-August, six months after my second dose, at which time a booster shot may be needed to maintain my immunity.T

Speaking of which, that second shot of the Pfizer or Moderna vaccine should not be skipped. Although a delay of a few weeks in getting it is likely not critical, the immune response after one dose is relatively weak and may leave people vulnerable, especially to the more virulent variants now circulating.

Two doses are 90 percent effective in preventing infection, and that protection is expected to last much longer. You should be given an appointment for the second dose when you sign up for the first dose or when you receive it.

Some people hesitate to get the second shot because they’ve heard the side effects can be nasty. But no matter how nasty, the vaccine side effects are short-lived and not nearly as severe or persistent as the disease the vaccine protects against. After recovery from even a mild case of Covid-19, a distressing legacy like a foggy brain or chronic fatigue can persist.

And, of course, the virus can also kill, even people who are relatively young and free of underlying health risks. The fatality rate from Covid-19 based on more than 32 million confirmed cases in the United States is 1.8 percent. Over 245 million doses of Covid vaccines were administered by May 3, and a federal review of adverse events found that no deaths resulted from the vaccine.

Nearly everyone gets a temporary sore arm from the shot, but at worst people may have flulike symptoms that last a day or two. If you have the option, consider planning a day off after the second shot in case you need to take it easy. Half my family had no reaction other than the expected arm pain. One daughter-in-law developed a fever of 102 degrees and one son was unusually tired, but I was like the Energizer Bunny the next day and accomplished twice as much as usual. Go figure!

If you have a smartphone, I urge you to sign up for the side effects monitoring system established by the C.D.C. I did and was asked repeatedly how I was faring after each vaccine dose. The system, called v-safe, can alert government health authorities to the frequency of side effects and to any previously unknown complications. It will also remind you to get your second dose of the Pfizer or Moderna vaccine.

And a final word: If you know people still struggling to get a vaccine appointment, please try to help them if you can

Get Sacked

The term often refers to someone who is about to be fired. I cannot think of a more expressive way to discuss the Sackler family of Perdue Pharmacy who make the drug cartels in Latin America and Mexico seem benign in comparison. Next on Narcos, meet Dr. Raymond Sackler who makes Pablo Escobar the equivalent of a low life street dealer.

No family has contributed such an impact on the drug addictions and deaths of Americans than the Sacklers. Hell the notorious Genovese Crime Family seem pale in comparison as they did not seek public acclaim and acknowledgement through funding the Art World as they have. Might have paid some attention to that if you did not want to be held in the eye of the storm. When the drug wars were launched the United States targeted ordinary citizens, largely Black, as the source of the problem. No they were the victims and only when the drug changed to ones legally prescribed did then they pay attention and promptly as always turned their back on those who enabled it – the moneyed class. That is your White Privilege for you.

The Crack Epidemic began in the 80s and targeted/affected largely the Black Community. And that debate has maintained today as to its origins and purpose but understand that drugs have always been a part of our culture to maintain order. We like our drugs in America and we like them legal and if they evolve into a sub culture that is not our fault. This blame the victim is why we have Drug Wars as they allow a second culture to evolve, for Black folks that became the Criminal Justice one for White people the treatment culture. But it has always been that way as we have long associated drugs with two kinds of people and we market and sell them that way, be it the drugstore or the street. My first recollection of a two tier drug market began in my home when I was a kid. My Cousin died of street drugs and my Mother was addicted to Valium.

In the 70s Valium was the drug, aka “Mother’s Little Helper.” This was a paean to Valium. Anyone who recalls the era, as I do this was a wildly popular drug and given to my Mother, who literally fell into almost a coma taking this shit. She had no idea how powerful it was and it left her out of her mind, what she could remember of it. Ah yes, women are so stressed out and must be managed, so pop a tranq and call it a day. And when you cannot remember it even better.

What a drag it is getting old
‘Kids are different today,’ I hear ev’ry mother say
Mother needs something today to calm her down
And though she’s not really ill
There’s a little yellow pill
She goes running for the shelter of a mother’s little helper.

– The Rolling Stones 

This was a paean to Valium, a Benzodiazpine that today has many uses. Perhaps you have heard of GHB, aka “date rape drug”. From sleeping pills to Xanax, or Diazepam, Benzos are in many drugs and highly addictive and this is is one such a story from Britain about Valium addiction.

.Benzodiazepines at one point became the worlds most prescribed drug in a decade, but it was devised in the 50s, so when you hear about how long it takes to develop and test a drug, that is what they mean. It means finding an audience and a way to market and use it. Initially, benzodiazepines were hailed as a medical miracle, and they soon became the most widely prescribed class of drugs in the world. Even though the drugs’ addictive properties have now become clear, they remain widely available and are often prescribed for longer than the recommended 2–4 weeks.And in the 90s that torch paseed to a new a better helper – OxyContin. And while Valium is still around, Xanax or Diazepam are the current counterparts and this is is one such a story from Britain about Valium addiction.

So how drugs are created and in turn imagined often become secondary to what ends up when thousands of people are prescribed a drug that has properties less associated with healing and more about money and long term growth. Hence that is why vaccines and cures for long term diseases are back burnered as who needs a drug that will be used and not reused. Finding a drug that has a never ending lifespan is the wet dream of all big pharma. And with Valium they had a money maker. How does that work exactly?

Tolerance to the drugs is thought to develop because benzodiazepines weaken the response of receptors in the brain. That means a benzodiazepine user needs to keep ramping up the drug’s dosage to trigger the same calming effect of GABA. The drugs are also non-specific: they act on multiple subunits of GABA, which govern different actions, such as anxiety, restfulness, motor control and cognition. So even if a person goes on the drugs to alleviate social anxiety, they are invariably altering how they think, sleep and even move. That, in turn, explains why a person coming off benzodiazepines may experience wholly new symptoms, such as panic attacks and seizures.

Malcolm Lader, a psychologist and pharmacologist at King’s College London in the UK, began looking at the benzodiazepine craze as a young scientist in the 1970s. He initially assumed that most people on the drugs had ramped up their dose to such a degree that they had become hooked; instead, he found that users had largely remained on the prescribed dosage. “People couldn’t believe that you could still be on your original dose…and still have problems when you try to come off,” he recalls.

In the 1980s, Lader and a team of researchers issued one of the earliest warnings against long-term benzodiazepine use. Since that time, decades of evidence have made clear that taking benzodiazepines comes with serious risks, yet they remain hugely popular. Antidepressants (e.g. Prozac) and cognitive behaviour therapy are effective anxiety treatments, but neither act immediately; antidepressants can also initially worsen symptoms. For many people, benzodiazepines always seem like the better option.

Most patients in receipt of tranquillisers or sleeping pills do not consider themselves to be addicts until they attempt to reduce their dosage and, like Pat Edwards, find complete withdrawal impossible. It is not hard to find people who have suffered from benzodiazepine use, or people who are happy to talk of their experiences as a warning to others. The several men and women I spoke to tell stories unique only in their early details; their tales of involuntary dependence on their medication all end with a common catalogue of suffering and distress. They all find it hard to understand why this state of affairs has been allowed to exist for so long, and why we ever thought that these drugs would be the answer to our ills

So as you can see that getting on is easy, getting off not so much. And this becomes the case with regards to OxyContin.

The Sackler Family have been the subject of several lawsuits by States regarding their drug company, Perdue Pharmacy and the growth of OxyContin addiction that have led to a public health crisis in their community. With those lawsuits finally attention was paid to the nefarious way the family pushed the company to do more, sell more and up the dose across the country while they reaped billions and to assuage their guilt, divested their interests into the philanthropy of art and class. Nothing says class more than have a Symphony Hall, Museum wing or College building named after you – its a legacy baby. Just one built on a new kind of slavery.

This week HBO began the Alex Gibney Documentary, Crime of the Century, which covers the Sackler family and their push to have Oxy become the number one pain relieving medication prescribed in the world. His work coincides with the research of Patrick Raden Keefe and his book about the Sackler Family, The Family that Built an Empire of Pain.

The Sacker family are ones of medical science but their goals in changing how medicine is used and more importantly misused is the true story behind Perdue Pharma. They went to great lengths to push the drug while simultaneously enriching themselves as it truly contributed to the bottom line of profits for the company, despite the evidence that the drug was addictive and contributing to a significant crisis across the country.

Their efforts to obscure the addictive qualities were quite imaginative, including the phrase, pseudo addiction, to convince hesitant Doctors that while the patient appears to be addicted that is simply the bodies response to be under treated.

I found this explanation: Pseudoaddiction is a term coined in 1989 to describe the phenomenon of patients with pain being under-treated. The idea is that patients with legitimate pain that could be alleviated with opioid painkillers exhibit drug-seeking behavior that is misinterpreted as addiction.

My mother used to say, “Take it from the source.” In this case the source was well Perdue and their team of Doctors, former FDA medical staff who had approved the drug’s use and other con artists devised to pimp more pills. To say pill mill would be an understatement. As small communities one after the other were flooded with the drugs that led to higher crime, increased violence and of course overdoses and death. The hero of this story is a West Virginian Doctor in a small town, Art Van Zee, who took this to Congress and was shut down by Senator Chris Dodd, of Connecticut where Perude is located. He concluded this from his research: Opioid prescribing has had significant geographical variations. In some areas, such as Maine, West Virginia, eastern Kentucky, southwestern Virginia, and Alabama, from 1998 through 2000, hydrocodone and (non-OxyContin) oxycodone were being prescribed 2.5 to 5.0 times more than the national average. And it was Kentucky that managed to be the state that finally brought the Sackler’s down. And their current Bankruptcy is still being settled in the Courts.

What was tragic is how they managed to hire numerous Doctors, pay them through third parties, to pimp the product, use their own sales persons to bribe or excahnge sex for orders with Doctors. And host large parties and conferences feuling them with gifts and perks, while these same individuals were over prescribing and managing care of people to the point where they were full on addicts and some died as a result. The images of these individuals as they lay dead show a life not in pain but death in shame. Families who were lied to, manipulated and blamed for their family member’s death. And this is why I believe many today are resistant to vaccines as they see the same manipulation and promise that may be false. I get it, I really do. I loathe the Medical Industrial Complex and this does little to change my mind but I am intelligent enough to discern the truth when it comes to the role of what a drug is to do. We can look back on time to see how little changes in health have been the result of simply changing a few elements in society, pasteurizing milk, chlorine in water, the use of penicillin (which is mold folks) to extending the lifespan of us all. It is also done with resistance, as the Physician, Dr. Semmelwiess , who recommended washing hands before touching patients was ridiculed for it.

Life is a crapshoot. We idolize false idols all the time. We elected one to the highest office in the land so we are not perfect, we too are flawed individuals. But when the wealthy take advantage of our stupidity and unwillingness to say no, to not ask questions then the first time is shame on them but then to allow it then shame on you. We have failed to truly inform and educate our citizenry, our education system is so damaged, so segregated and so badly managed that it can explain much of. this. It is why I have a soft spot for Kentucky and their people. They are not the hideous Racists or Trash bag idiots, they are neglected and ignored and in turn manipulated by the likes of Mitch McConnell and Rand Paul. They deserve better and they can and will but it is heavy lifting and that is not easy given that the minority rule the majority there and they do so by FEAR and that is the co-dependence I found throughout the area. FEAR but not HATE.

The Mandate

I cannot stress enough that there will have to be a mandate for those American’s eligible to get a vaccine to do so. Yes we get it we really do but the reality is that this bullshit will go on for years if we don’t. There are some Covid hangovers I would like, such as Masks on Transit, working offsite, and of course better medical care and free! But the reality is that the anti-vaxx idiots are making everyone else do the heavy lifting at this point. Sorry you fucks we carried you through a pandemic and now you want us to continue to do so. You want to prepare and deliver my food and packages. You want to serve me in Bars and Restaurants and sit next to me in public forums such as Theaters and Stadiums. You want me to travel with you and you want me to teach your children, to acknowledge your presence. You actually are in the medical field and expect me to pay money for health care and you knowingly refuse to vaccinate. What the flying fuck! We should take those pots we were clanging for you and smack them upside your head.

I just passed the Covid denier/exposer standing with his kids up the street, and as I have truly mastered the Covid dodge and I boogied away before he noticed me. Then I returned home to the two Desk Agents who are anti vaxxers and I hooded up and boogied past them. Earlier going out to run errands the elevator stopped and a woman with a dog was waiting, I said, “I am fully vaxxed.” She said no thanks and turned her back. As the doors closed I go, “Oh so you just hate me then.” This is where we are folks.

We have largely faces of color and weird ass white trash refusing to vaccinate. I can assure you the Proud Nation of White Supremacy have all been vaxxed with every single one of them, and they are busy lying and hiding it while busy spreading misinformation as a way of getting that genocide plan they have long hoped for going. The big chief of the camp of hate, The Donald, has and that he continues to manipulate these white trash morons is for reasons I am unclear. If they are dead how can they Vote? As for the faces of color who refuse, I spoke with a woman who is working with an activist to get all the undocumented workers vaccinated with leftovers which requires no paperwork and there is no shortage of those who do want it. As for any of the rest well again the Proud Nation of White Supremacy have members who are of numerous races and sexual identities and self-hating is something we have all experienced at a time in our lives which may explain that. Or they figure that better to join them then get beaten by them. Who knows?

The issue about workplaces mandating their employees to get vaccines is about fear of lawsuits. Okay here we go. I don’t want to work next to a maniac with a gun so do they ban those? What other legal bullshit you sign to work. I don’t think anyone should have to sign a non-compete clause or and NDA but they do. Those don’t hurt anyone but a fucking contagious disease that can kill? Sure fuck that come on in! I would rather work with Scott Rudin and Harvey Weinstein as I can dodge a flying potato and avoid getting raped by never going to a hotel room, so hey what about a job?

I want you to read the story of a young man who grew up in an anti-vaxx household. He is now telling you that it is more dangerous than you think, as this is akin to a cult. And this is before Covid. Folks talk about serendipity. The sangfroid this kid displays is what we need right now. Seriously we have really failed ourselves as a nation with this bullshit.

There is no excuse. Anti-vaxxers put us all at risk

| March 12, 2019 By Gracie Bonds Staples, The Atlanta Journal-Constitution

Ethan Lindenberger

Let that name sink in a bit because something tells me we will be hearing from him again. Soon.

Lindenberger is the 18-year-old from Ohio who shared his story last week about growing up in an anti-vaccine household. He spoke at a U.S. Senate hearing on vaccines and the outbreak of preventable diseases.

His mother, however well-meaning, never took him to get the standard vaccines that protect against measles, mumps, chickenpox, rubella and other diseases

Her love, affection and care were used to push an agenda to create a false distress, Lindenberger told the committee.

He believes his mother’s misinformation and fear put children at risk.

Reasonable people will agree with him. For proof, look no further than the recent measles outbreak.

The culprit? Low vaccination rates.

According to the Centers for Disease Control and Prevention, on average one person with measles will infect 12 to 18 people in a susceptible population, which is a population without prior exposure to the measles virus either through vaccination or natural infection.

The disease is highly contagious; infectious droplets can remain in the air for two hours, meaning that one can become infected during that time period even without skin-to-skin contact. Some 90 percent of susceptible individuals exposed to the airborne droplets will become infected.

Lindenberger grew up debating these points with his mother but to no avail.

You can lead a horse to water, as the saying goes, but you can’t make him drink it.

Dr. Austin Chan, an assistant professor of infectious disease at the Morehouse School of Medicine, believes vaccines are one of the greatest preventive tools that have ever been developed against disease.

Many people, however, still point to a 1998 study by Andrew Wakefield that showed vaccinated children had increased rates of autism, Chan said. Even though that fact was later retracted because Wakefield altered the facts to support his claim, Chan said, the idea stuck.

“I think the anti-vaccination movement is incredibly dangerous, but for some reason, they’ve managed to convince some very high-profile celebrities, who then sway public opinion,” he said.

That’s baffling beyond words. Why would anyone trust a celebrity when it comes to their health? There’s a big difference between an entertainer and a doctor, and it’s not just between the ears.

Heck, they don’t buy half the stuff they’re allowed to sell. It’s given to them. But I digress.

What’s important to remember here is the notion that vaccines might cause autism was refuted nine years ago, when a British medical panel concluded in 2010 that Wakefield had acted with “callous disregard” in conducting his research.

More recently, researchers examined data for more than half a million Danish children born between 1999 and the end of 2010 that show the MMR vaccine not only does not increase the risk of autism but is not likely to trigger the developmental disorder in susceptible populations. Their findings were published in the Annals of Internal Medicine the day before the Senate hearing.

Like the rest of you, I’ve been watching these outbreaks pop up across the country for months now. By last count, six outbreaks are ongoing in the United States, according to the CDC. Georgia health officials have confirmed three cases of measles, all within the same metro Atlanta family.

That isn’t just scary. It’s as preventable as the disease itself. All one has to do is get vaccinated.

The moment Lindenberger became an adult, he was done with the back and forth with his parents. He did his research and, armed with the facts, not the hysteria you find on the internet, he decided to get vaccinated on his own.

Not only is he smart, he’s a great role model.

One news story I read said that after the hearing, he told reporters he’d done his best to “address misinformation without demonizing people,” and that he and his parents are still working through their differences.

His advice to other youths experiencing debates about vaccines within their families? “Just maintain respect and continue presenting evidence.”

The Senate also heard from Saad Omer, a professor of epidemiology and pediatrics at Emory University; John Boyle, president and CEO of the Immune Deficiency Foundation; and John Wiesman, secretary of health at the Washington State Department of Health.

Washington has had three measles outbreaks over the past 10 years. As of March 4, the state Department of Health had confirmed 70 cases of measles in Washington’s Clark County.

Sen. Rand Paul, R-Ky., expressed his opposition to mandatory vaccines during the hearing even though he said he vaccinated himself and his kids.

“For myself and my children, I believe that the benefits of vaccines greatly outweigh the risks, but I still do not favor giving up on liberty for a false sense of security,” he said.

I wish I could say I understand his line of thinking but I don’t.

People certainly have the right to choose, but do they also have the right to jeopardize the health of others? Please, you tell me.

Mother’s Day

I am not a Mother and in Christian dogma I am a worthless slut. Yay for me! I have spent the better part of the last two weeks searching the varying Facebook and YouTube pastors who seemingly manage to avoid any of the filters and screening that is in place to avoid riling up the white supremacist crew. The free speech mantra of hate has a special place in many of the ramshackle churches that turned to the social medium forums when the pandemic hit thanks to to restrictions in attendance numbers in public/private settings. All that is coming to an end as we our in the tri-state area, day 418 of quarantine. I am not sure which is my favorite supressive speech about women. There is of course my dear former friend Ethan explaining the role of women in the Church, (Feminism is not about equality its about power) or this assholes idea of how men must work with women in the home to not dress or act like a worthless slut. There are many others with similar tones which tells me that Christianity is not something I will take a pass on, like Covid vaccines for some of the more ill informed.

As we now have our final day of reckoning on May 19th, it brings us to 432 days spent in fear. That aspect doesn’t end that day it just means for us folks vaccinated we can fully rejoin the living with some risk but far less than it was when this officially began which was 2019.

So this will be for many a Sunday of brunches and family gatherings for some it will be better than last year and for others not any better as Grandmother may have been one of the dead, or she may be an anti vaxxer or has not been able to access it due to health or physical restrictions have prohibited her from getting the vaccine. Here is where a modified version of meals on wheels is becoming a proactive way of getting this to homes and hoping to also reduce the additional confusion and fear associated with vaccine resistance. And no folks I am not letting up as long as we have anti vaxxers in a our midst we are at risk for variants and continued spread in the community which will require us to be endlessly on guard when put into a confined space. Who wants to be the one who managed to be the .05 percent that bypasses vaccine resilience? And frankly I don’t want to deal with any of these assholes and it is why I am boycotting any business or individual who professes to think that my shot is their cover for their ignorance. Go fuck yourself.

As we know Women and Faces of Color will be the most harmed if not physically from Covid but the fallout economically due to the shutdown. Jobs will not just “come back” and everyone is back at their old gig with better pay and health care in place to secure that this bullshit doesn’t happen again. Companies have found that the last 418 days of remote work may be worth investigating more fully as a way of reducing costs and enhancing profit. The most effective way a business does this is by staff reductions or RIFF’s as that is quick and easy. Cutting operational costs, such as physical space and logistics is rarely done and certainly not CEO or Managerial pay is ever done. Well on the logistical demands this fell into the laps of their CFO and I am sure that it will be a factor in re-opening businesses in the months ahead.

Americans are a different breed than say 50 years ago when faced with another type of flu epidemic. There was no closing of schools, no hysterical pronouncements daily by leaders, no shutting of borders and closing businesses. There was little to no economic fallout and hospitals were not sites of massive Black Friday rushes. Well that is because the amount of hospital beds in 1957 when the Asian Flu arrived (yes it was called the Asian flu as that is where it originated from). Now the transmission rate was lower, it was 1.65 to Covid’s 2.5 to 3. That means likely about the same as normal flu 1 to 1 with a likelihood of a 1 to 2 spread (which again factors the rate of spread by how new the contagion was contracted and of course the health of the exposure of those to whom close contact was made). So in the case of Covid I like the use the former acquaintance of mine: His wife had Covid, a mild case, she transmitted it to both him and their daughter (she is 8, so yes kids get it). And this child transmitted it to her Grandfather. Spread with children is smaller and they don’t have the true high virus load required to further transmission and get very sick. And with Covid the random way it did sicken people we know killed more with pre-exisisting conditions, or just old as the immune system is weaker. Of the original 3 that contracted Covid all of their symptoms were mild. The Grandfather admitted to the hospital. Now we don’t know who else contracted the disease from the two adults, as he is also a Covid denier and in turn did not cooperate let alone tell me within in a reasonable time frame from the original date of exposure that he had it. I knew when I saw him in the car with the family half masked, him half masked picking up takeout and going to get tested. To this day I still laugh at what a fucking piece of garbage he is and then the family went to Hawaiil within 14 days of their original contraction, with the explanation that they had to quarantine there anyway and could not leave the house they rented. I did not ask if they had tested negative prior to going as I knew he would lie or come up with a convoluted justification for his assholeness.

But it was then I knew air and circulation, outdoors and distance matter. Close contact, longer contact were factors as I nor the Barista inside (but doors open and he wearing a mask) did not contract Covid. But as we look back as to now almost two years there were so many lies, so many contradictions and confusion I can see why we were not the beach goers dancing to the summer hit, Rockin’ Pneumonia and the Boogie Woogie Flu, by the Huey Smith and the Clowns.

The number of deaths in 1957-58 were approximately 116,000 versus the current 550K we have faced in Covid and again we know that these numbers can never be accurate in either case but this is a fair comparison. The death rate of Covid has been 80% in the ages 65+ and of that again we know like Cop violence the death rate among faces of color hovers around 40%. But that was not how the rollout began to focus on the most vunerable and getting them into qurantine and tested, isolated if positive right away, it largely affected the youngest, the wealthiest who were least affected by both Covid and the economic restraints the lockdown caused. Once again we demonstrated institutional racism at its finest. Had we rolled out testing and closed borders earlier, sped up a tracking and tracing program to meet those needs the same way we did vaccines we may not have had these deaths and collapse of economy. Again the rich have been doing just fine; however walk through towns and see the businesses and doors shut, the small employers holding on without customers that used to come from the offices next door. Their story is not yet told, along with the owners of rental properties who are not wealthy landowners and have not been able to meet obligations in the same way larger businesses (like Kushner) who have. That fallback has yet to happen, but it is coming.

But what is more distressing and explains much of the reasoning behind the lockdown, was hospitals being overwhelmed. Again we know that some did not have the Black Friday crush and others were devastated with patients to the point many were sent home, which in 1957 was the preferred course of action and treatment despite the fact that hospital beds per 1,000 were at a high of 9.18 and today they are 2.77. So in other words we don’t have the access and availability to provide care and that is where economics and race came into factor and why public facilities were simply unable to provide care to the level needed and may have inadvertantly contributed to more deaths than needed. Lack of coordinated efforts, lack of equipment and simply just a lack of funding for public health overall are all factors involved in the failures of the pandemic.

Looking at Eisenhower Administration at the time they shifted money to public health services requesting 2.5 million (23 million in today’s dollars) to do the equivalent of Operation Warp Speed and the father of vaccines, Dr. Maurice Hilleman. As for closures and demands on public lockdowns, it did not happen. As for the sick, the public messaging was that Americans were to do what we do best; pull ourselves up by our bootstraps and stay home and drink fluids. Wow Dr. Fauci was very much alive during that time I wonder what he did? Man I hate that dude.

And lastly the issues of the schools which has become the most divisive issue over all of those made during the lockdown. Schools were not closed in 1957 and there was the attitude that the earlier diseases of Mumps, Rubella, Chicken Pox and Measles (the most virulent of contagions) had swept through towns and schools in the late 1940’s led people to take the Asian Flu in stride. That is the up by the bootstraps mentality I have met among many older folks who are the anti-mask, vaccine resistant folks that Trump embodies. Again even Biden who is actually older than Trump would be; however, that is why he gets the need for better public health and education as that is a real issue for us to go forward. Trump’s world view is myopic and narcissistic and that is the one reason we truly failed in response to new Asian Flu.

Jack Kerouac summed up the decade the best in “Off the Road” – “I just gotten over a serious illnesss that I won’t talk about.” And that marks the Beat Generation, they beat a virus and hit the road to study the way America had changed. I am not sure we have that kind of self reflection or stamina. And we owe it all to our Mothers. So happy Mother’s Day, this wanton slut will spend the day doing what she does best – telling anyone who crosses her path to go fuck themselves, this pussy is out of business.

Bloodlust

Americans are thirsty for violence, from film to sports, the bloodier the better. Our obsession with guns only perpetuates that notion as we seem to think the more the better and of course we love this notion of them being used for hunting and self protection as if we are living in the movie Out of Africa, where we can combine the two. The photos of the Trump children standing over dead animals following a ‘big game’ hunt reminds me of the late Prince Phillip and his standing before a dead Tiger as if it proved what a man he was, how big his dick must of been pursuing an animal in a vehicle along a well marked trail with a long range rife and trackers who were there to ensure that he took the kill shot and saved all the Natives from impending death. How fabulous! Tea anyone?

They look thrilled no?

As we look to the past month we have had an inordinate amount of mass shootings, 45 if you have been keeping track. And we focus on the one or two that have the media captured in the same way we do with regards to Police shootings. But there are always more than the media portrays as there were 985 in 2020 and yet I am sure people might mention the top 3 or 4 that captured their attention and in turn that doesn’t change the reality that every year near to 1000 people are killed by Police and in what is designated a mass shooting the hundreds, the dozens, the few that are injured and/or killed. The GSA archive notes all victims of shootings be they killed or injured. Regardless it is a larger mental and public health crisis than Covid could ever be. And then here comes the hate about this issue and in reality, Covid is a serious health disorder with the reality that while over half a million died in America we have no idea how many actually had Covid, recovered and in turn what was done that contributed to the spread, that added to the number dead and what ultimately contributed to their reaction to Covid that over 95% of the victims did not have. Again, less than 5% of Covid patients are hospitalized and yet it appears that this is not true by the media’s hyperventilation over the subject. In the meantime, no one has ever held anyone’s feet to the fire about how this occurred and what could have been done earlier to ensure that the deaths, the lockdowns, and the overwhelming of medical emergencies that resulted.

Imagine a year ago if the United States rolled out testing on the level they did with vaccines? Imagine all those with pre-existing conditions were immediately quarantined and that we had tested anyone living in communities that are dense and overcrowded homes and found ways to isolate, track and trace each case. To ask businesses to limit numbers, wear masks, alter schedules to have less of a rush-hour flow, including work at home, and kept schools open but fell to a shelter-in-place mode, with mandatory testing, nurses on site, and isolation areas for those who test positive as they await going home in safe manners to locations that allowed recovery or observation without rushing to a hospital. Building strong testing methods and provide them to anyone and everyone, in the same way, we have choices in vaccines. What about that with regards to tests. And build large sites in the same way they have done with vaccines, educating, informing, and establishing locations for people to handle their inquiries and in turn find assistance without effort in which to prevent transmission. We have botched this from day one and now only now are we seeing that we have learned NOTHING. The endless paranoia is still being peddled, the fear factor is rising faster than temperatures and the reality no one knows what they are to do or should do to stop the spread, flatten the curve, to build herd immunity. The reality is that no one has a clue so it is all in or all out. Try the truth it is very freeing.

And with that try that with gun violence. Show the carnage, show the after-effects of what happens after a mass shooting. We seem to love the endless showings of the assaults on Black individuals by Police. I have seen the videos, the photos, the endless loops of news footage that seem to less show the horror but to build another kind of immunity. Today on CNN I watched a story with the caption “Mass shootings are on the rise” but the footage was all from the Police shootings and violence at the Black Lives Matter protests, so no you have that wrong. If anything the Police are on the track to maintain the same numbers they have annually for the last five years that a press organization has been keeping track of. As for mass shootings, they have increased but not by a significant number. Since the GSA has been formed they found 40K incidents in gun violence in 2014 rising to 49K in 2015. Of those mass shootings were 269 and 335 respectively in the same years. Police actually killed by a gun has been consistent, 222 and 278 respectively. The numbers of Police shootings have risen from 1856 to 2055 in the same two years. So some guns are doing a great deal of damage and the Police are not the ones who are on the receiving end.

As I was listening to a podcast with a photo-journalist she spoke about the challenges of her work when it came to actually release the photos she was taking and shared her experience of being embedded with the Military in Iraq. She was frequently told that she could not take nor use the photos she had as in order to allow her to remain on board, she was to agree to certain parameters with regards to the type of photos she took. She feels that is why Afghanistan went on so long as few saw the true photos of damage and carnage that war causes. And why Vietnam ended with such political social outcry as there were no restrictions on the photos and those images being sent home and shown on the daily news led to the push to end America’s role in that conflict. This could be applied to the sites of mass shootings as the former Editor of the local paper in Denver when Columbine occurred received copies of many of the crime scene photos taken that day that showed just how severe the damage was done. In fact, the one photo he did run was one taken outside the school of a young man dead, a Mountain Dew just outside of his hand which his Mother recognized by the shirt and the drink as her son and which she carried with her for years to remind herself of that day. She vacillated on her anger over the release of this photo and then over time changed her mind as she realized that people needed to see what guns do to those who are on the targets of those who have a plan in mind to use them. And if we are so keen to see the death of George Floyd on auto replay and from that a major international movement and outrage were the result, why not see the blood, the visage, and the damage wrought from a concert in Las Vegas or a Grocery store in Boulder. If that is what it will take to see innocent people dead in a pile of blood to get people to realize how dangerous this endless obsession with guns brings, then I am all for it.

We will go to endless bloody violent films, watch horror films in which the antagonist is largely male who is deranged and goes to great ends to stalk and prey mostly young women, Halloween anyone, and we will applaud films that take violent crime and create heroic figures to resolve the situation as a type of well costumed Militia. And then we have the actual Police portrayed as diligent competent figures that have no limit to the resources needed to do their job which further confuses the reality with the fantasy. Again we hear the bad apple analogy but there were three Police that day George Floyd died and any of the other two could have stopped the process, they did not. There are often many members of the force standing by, riding along or adjacent and I have yet to see or hear of any intervention. The same way I have never heard of that ubiquitous “good guy with a gun” will stop and save a “bad guy with a gun”. Who is that? Where are they?

We accept the same sources of information without question which may be why we turn to social media to somehow validate our outrage, confirm our beliefs or simply provide support or balm that we are not receiving from the conventional means that are in place to provide it. I do believe we need to seek blame, point fingers, and demand retribution when we fail to hold those accountable for their failures. The Police knew of the boys in Columbine prior to that day. The Police have gone numerous times to numerous homes under the guise of a tip or in pursuit of a comment or query by a family member. They have yet to prevent that from going forward that I am aware but I am aware that when they go on “wellness checks” on individuals who have demonstrated at-risk behavior and are clearly disturbed and they go guns drawn. We cannot even distinguish the difference between what it means to be at risk to yourself and others, the basic question asked by any Mental Health professional when an individual is seeking care. And we are in need of care, a lot of it.

Add to this Doctors and Nurses on the frontline who handle these victims. The damage is done, the likelihood of actually saving someone from that kind of gun, the kind of bullets use, show the tissue damages, the recovery process, and of course the costs associated with all of it. Show an itemized bill, explain how it is paid and who pays it. They were never-ending with the hero worship and grief suffering during Covid and the endless shots of ER’s and patient trauma and yet what happens when a mass shooting occurs in the local ER? Does the Governor get on the TV and share the numbers of those who were shot, who recovered, the type of injuries, the costs, and the long-term issues that will result? Does he demand change and punish everyone for the failures or acts of a few? Where are the photos of coffins, funerals, and mourners as they bury their dead as they did with Covid? How about a Funeral Director and his/her challenge to handle the dead like they did with Covid. Covid is horrible but again this could have been handled better and it wasn’t. And no one actually did do anything to improve it, the States were like the Cops standing next to Chauvin, immobile.

We have an unrequited love of blood and a lust for pain. We mask it with drugs, alcohol and we pretend that we are healthy and well and we ignore that it only takes one gun and one bullet to bring it all down. So we want more as we want more blood and more pain and that will make us feel better. So let’s show everyone how good you feel, I want the media to start showing the carnage and without apology. If they can show us the last moments of the hundreds of victims as the hands of Cops let’s show the other victims that were largely due to failure by cops to stop them. Where are those good guys with guns when you need them? Well not anywhere where a bad guy is, clearly.

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Flood at the Gates

I was not one to join the chorus of applause, pot banging, horn honking or any other expression of gratitude or hero acknowledgement to any health care professional; however, I do feel that UPS, USPS, Transit professionals, Grocery clerks and others such as dry cleaners, laundry’s and the Amazon warehouse workers do. None of the non-professional blue collar individuals who stayed working during the lockdown signed up for a pandemic, had no idea that they would be at a significant risk as they commuted to work and employers failed to provide necessary PPE, health care, paid time leave or had an established protocol for safety and well being for both staff and customers. I shopped at Whole Foods during it all, prior to mask mandates, prior to any screens erected and sheer confusion as to what, where and how we were to get through this. I traveled on public ferries going out of my way to avoid subways and paths but did so with masks, gloves, and other clothing to obscure my face to prevent virus transmission. I stripped down immediately after coming home, showered, did laundry and not one single food item went into the frig or cupboards without wiping them down, transferring them into my own containers if possible. I kept physically distant the entire time and still do, getting off PATH if the train is too crowded and just one single person is unmasked. I have limited the subways to 15 minutes or less and I move again if necessary to quickly limit exposure. Where is my applause? 

The reality is that we somehow did a Jesus complex on these people and in reality their employers, the owners and investors in many hosptials (some they closed before Covid which led to further problems), that the lack of centralized communication and transport, the failure of private medical care to open the doors, leaving public hospitals overwhelmed after years of under-funding and in turn the simple lack of again a coordinated and comprehensive effort by the Trump Administration to ensure all facilities had what they needed to effectively treat the virus and the patients appropriately. And in turn this lead to many deaths that need not be and also contributed to the spread as over 7% (the last estimate I read) of the infections were health care professionals. Most deaths were in facilites that housed and treated the elderly and in turn most of the infections again were attributed to warehouses that process food. So while you sit home ordering your sofas online the persons putting that in boxes, the dudes cutting up your chicken for your Seamless delivery were getting infected, taking it into the community and dying. They were unable to access health care nor was it made available to them with proper testing, time off and of course insurance to pay for it all. So where is their applause? As for the deaths and infection rates among health care workers has a lot to do with the failure of the boards, the directors and of course the local and state agencies for not funding them, maintaining and managing the faciliites to run on a daily basis well let alone in a situation of emergency that Covid wrought. Some did as they looked to major events from natural disasters to terrorists attacks or mass shootings to change their protocol in crisis but few to none were ready for a highly infectioous virus to arrive on the shores with little warning and little direction from the Federal Government. Again we have learned that all this no to low government thing doesn’t actually work, does it? And when you put the national care of eduacation, health and justice in the hands of private enterprise you get what we got, shitty health care, workers getting sicker and of course failure to handle a crisis.

  Hospitals for Years Banked on Lean Staffing. The Pandemic Overwhelmed Them. 

Russell Gold, Melanie Evans| The Wall Street Journal. June 18 2020

Banner Health had figured out how to get ahead in the modern health-care industry. The Phoenix-based nonprofit hospital system relentlessly focused on costs. It trimmed labor, the largest expense for any hospital. Last year, it carried 2.1% fewer employees for every bed filled, compared with the year before. It also moved away from pricey hospital settings. Visits at free-standing clinics and surgery centers grew 12% in 2019, while its hospital emergency rooms were flat. The result was a financial powerhouse with $6.2 billion in cash and investments and a bond rating that is the envy of corporate financial officers. But when the pandemic hit, the strategies that had helped it become a model for other hospital systems suddenly became weaknesses. In early June, as Arizona’s count of Covid-19 cases began to rise by 1,000 a day, Banner’s hospitals filled with very sick patients needing one-on-one help from critical-care nurses. There weren’t enough. Banner and other well-funded hospitals muddled through, but in doing so they overtaxed existing nurses, had to train others on the fly and relied heavily on rapidly hiring temporary staff, including more than 1,000 nurses and respiratory therapists on expensive short-term contracts. Those moves helped drive up prices for traveling nurses, putting them out of the reach of neighboring hospitals. Nurse pay for contracts signed by the state, which eventually did much of the hiring, rose to $145 an hour from $85 for intensive-care specialists. Draining that limited pool meant that poorer hospitals were unable to find help when they needed it. Medical research concludes that being short-staffed at any time leads to worse outcomes and higher hospital death rates. 

The staffing pain in Arizona is emblematic of what took place in hospitals across the country during the pandemic, according to dozens of interviews with hospital executives and workers, public-health officials and industry experts. Hospitals by design were supposed to be lean and efficient, pushed that way by the market and government policies. But that left the U.S. dangerously unprepared. 

 “You’re looking at a private-sector entity that suddenly has to take on the world’s largest public-sector response,” said John Hick, medical director of emergency preparedness for Hennepin Healthcare, a public hospital system in Minneapolis. “They’re not prepared for it because there’s no incentive to do that.” 

 Banner Health said it acted prudently in keeping its pre-pandemic nursing staff lean. It said it had a cross-trained staff and that the system successfully expanded capacity during the worst of the pandemic, in part because of its financial strength. “You’re never going to sit there with 500 more nurses if they don’t have the patients,” said Peter Fine, the longtime CEO of Banner. “It’s this balancing act that literally goes on in every health-care organization around the country, all the time, in projecting what their business activity is [and] what staffing they need to support that business activity.” The health-care system has faced pressure over decades to improve financial performance, even as per capita spending has soared.

 Hospitals are pushed by Medicare and insurance companies to trim waste, and by bondholders and shareholders to boost income. Health-care systems have spent the past decade tightly managing staff and pursuing scale through acquisitions to better negotiate terms with health-insurance companies. Deal making across the hospital sector picked up with passage of the Affordable Care Act and has largely remained strong in the past decade, with an average of 84 combinations a year among general, surgical, specialty and long-term care hospitals, according to Irving Levin Associates, a research firm. Labor is typically the largest expense at any hospital, and nurses make up 42.7% of hospital payrolls, according to federal labor department data.

 In 2016, as an improving economy drove higher wages and signing bonuses for nurses, labor expenses grew faster than the median hospital’s overall operating expense, according to Moody’s Investors Service. Median operating expenses overtook hospital revenue that year and the next, squeezing margins and forcing hospitals to take a tighter grip on labor costs. In recent years, hospitals have shifted resources to outpatient settings for a growing number of lucrative, high-volume procedures such as knee replacements, bolstering staff outside hospitals where the sickest patients get care. For the past decade, the amount Medicare has spent per beneficiary on inpatient hospital services has grown 0.4% a year, compared with an average 7.9% growth in spending on outpatients, according to federal data. 

The upshot is fewer hospitals, with less capacity for intensive services. There has been a 12% decrease in the number of hospitals between 1975 and 2018, American Hospital Association data show—even as the U.S. population has grown about 50%. Even large nonprofit hospitals, which receive federal and local tax breaks and treat two of every three patients in the U.S., according to federal data, have adopted similar financial models. 

 “They are not the ‘Little Sisters of the Poor’ charitable institutions that hospitals once were back in the 19th century,” said Martin Gaynor, an economics professor at Carnegie Mellon University who studies the health industry. “These are big businesses.” 

 The global crisis exposed weaknesses in the “just-in-time inventory” of nursing staff in the same way it did for personal protective equipment, ventilators and other vital supplies. More than 5,300 Arizonans died of Covid-19, more than half in Maricopa County, where Phoenix is located. Strapped hospitals in the state’s smaller cities tried to move patients into Tucson and Phoenix. 

Arizona created a statewide transfer system and moved 2,451 patients, sometimes hundreds of miles. But some hospitals rejected transfer requests, despite reporting open beds. It “wasn’t due to lack of space or stuff, it was staff,” said state health official Lisa Villarroel. No hospital could fully prepare for a surge on the scale of the coronavirus pandemic, said disaster experts, but boosting nurse staffing outside a pandemic and routinely training staff to swap roles would better prepare them for sudden waves of patients. The goal is to avoid a having to deploy a “crisis standard of care,” a method of triaging who gets medical care when a system runs out of critical resources—including health-care practitioners. Arizona activated its crisis standard in late June. 

Banner postponed certain needed surgeries as it redeployed operating room nurses and technicians to help elsewhere in the hospital. Other Phoenix hospitals did the same. Banner said the state’s crisis standards didn’t influence its decision. Banner, Arizona’s largest private employer, was formed in 1999 in a merger and has a 43.5% market share of Phoenix’s inpatient hospitalization, more than the next two largest chains combined. Mr. Fine, the CEO, is one of the highest paid executives in the industry. His 2018 compensation was $10.3 million; a year earlier, his $25.5 million compensation was the highest of any nonprofit health executive that year, according to a Wall Street Journal analysis of filings.

A Banner spokeswoman said he received several years of deferred compensation, inflating his annual salary figure. Over the past five years, Banner Health has reported a combined $941 million in operating income and another $1.09 billion from its investments, according to Banner financial disclosures. Banner expanded into urgent care, building and buying 51 locations since 2016, and has a joint venture to expand from nine to 34 ambulatory surgery centers over the next three years, continuing its goal of shifting patients away from hospitals. It also plowed income back into existing facilities. It recently spent $857 million expanding and modernizing its two largest hospitals, in Phoenix and Tucson. To attract bond buyers and maintain high ratings, Banner expanded its cash reserve, which helps keep its cost of capital low. 

Banner Health finances about one-third of its investment in technology, property and equipment with debt, which now totals about $4.1 billion, said Dennis Laraway, chief financial officer for the system. “The stronger the credit, the cheaper the capital, the better the price,” Mr. Laraway said. Early in the pandemic, Arizona wasn’t as hard hit as some parts of the country. But the state’s new daily cases soared 10-fold between late April and late June. The state’s governor in late March ordered hospitals to be ready within a month to increase their available beds by as much as 50%, which Banner and other hospitals did. But they didn’t also ensure there would be enough skilled nurses to handle the possible crush of sick patients. “They needed to come up with a staffing plan,” Arizona Department of Health Services Director Cara Christ said. 

“They didn’t have to staff those plans.” Banner said it employs 11 full-time emergency-preparedness staff and first drafted its pandemic response plan a decade ago, which it activated in March. In June, as patients poured in from Northern Arizona, Banner halted transfers to Banner-University Medical Center Phoenix, one of its premier facilities, according to a spokeswoman. It shifted patients to Banner’s other area hospitals to manage the strain on its hospitals, including its staff. Brittany Schilling, a 27-year-old ICU nurse at Banner-University Medical Center Phoenix, said her hospital reached capacity several times in June. She recalls hearing several “Code Purple” announcements, an indication that her unit was at its capacity. Nurses at some of Banner’s Phoenix hospitals went from working three shifts a week to five. “I do feel like it has taken a toll, for sure. Physically. Mentally. Emotionally,” said Ms. Schilling. 

 

 Banner pulled staff from its ambulatory centers to help its ICUs. Lacking needed qualification, they were often paired with ICU-certified nurses. “We put them through very quick training programs to upskill their capabilities,” Mr. Fine said. It eventually trained and reassigned 700 employees. It also hired 898 nurses and 113 respiratory therapists on short-term contracts. By shuffling patients across its hospitals and hiring more staff, Banner ultimately denied only 13 transfer requests from the state and accepted 870 patients through the state-coordinated transfer center, a spokeswoman said. Less financially strong hospitals, which tend to be public or rural, were more vulnerable. Well-funded hospitals across the country soaked up much of the available supply of traveling nurses, leaving the rest priced out of the market. “Demand is through the roof,” said Alan Braynin, chief executive of Aya Healthcare Inc., a health-care staffing agency. Aya had 506 requests for ICU-registered nurses in June. By mid-July, the number of job requests was up to 2,870. In the early summer, Maya Jones’s phone began to buzz several times a day with recruiters. 

An ICU nurse on a three-month assignment at Johns Hopkins Hospital, she said the offers kept rising. “I don’t know how they got my number, but once these people have your number, they don’t lose it,” she said. The 26-year-old Virginia native signed a two-month contract beginning in August at the Chandler Regional Medical Center in the Phoenix area. It pays nearly three times what a contract she signed in January pays. By mid-June, the staff at Valleywise Health, a large public hospital in Phoenix, was worn down from pulling extra shifts. Sherry Stotler, the chief nursing officer, tried to hire 20 to 30 traveling nurses. “We needed to let people take time off,” she said. She was able to hire only six. “We weren’t getting a lot of bites because everyone was competing for the travelers,” she said. Valleywise, usually the hospital of last resort in the Phoenix region, began to turn down transfer requests from rural hospitals that wanted to send their sick patients to a better-equipped urban hospital.

 The situation was also chaotic at Yuma Regional Medical Center, a three-hour drive southwest of Phoenix on the Mexican border. The hospital had struggled to recruit to its remote location even before the pandemic, said Diane Poirot, the hospital’s chief human resources officer. During the crisis, the hospital paid top prices for temporary staff, only to have them recruited for better-paying jobs, Ms. Poirot said. 

Yuma Regional pulled nurses from its operating rooms, canceling surgery to free up staff. But on peak days in June, it was transferring as many as 11 or 12 patients a day on helicopters and airplanes, because it didn’t have enough nurses. Normally patients would be moved to Phoenix hospitals, but as that city strained under the surge, Yuma patients were moved elsewhere, said Glenn Kasprzyk, regional chief operating officer for Global Medical Response Inc., which handles about 60% of the state’s ambulance traffic. 

As Covid-19 cases climbed, nurse Yasmin Salazar said she was overwhelmed as the Yuma Regional emergency room flooded with patients gasping for air. “We weren’t used to how fast they were crashing,” said Ms. Salazar, who has worked in the emergency room for six years. Staff from other parts of the hospital were brought in to care for less-critical patients, but despite the reinforcements, nurses in the emergency room were stretched too thin for the number of critically ill who needed their help, Ms. Salazar said. She couldn’t leave one dangerously sick patient to help when an emergency code sounded in the room next door. “I couldn’t go,” she said. “We all had a critical patient.”

 Yuma Regional’s ICU also filled up. Typically, an intensive-care nurse is assigned to one or two patients. That increased to three to four patients for each nurse as the surge took off, said Gail Galate, one of Yuma Regional’s intensive-care nurses who works overnight in the hospital. “You spend all night figuring out, ‘What am I going to do for the next emergency?’ ” she said. “ ‘What am I going to do for the next person that crashes?’ It’s just nonstop.” Even though Banner was able to increase staffing, nurses at its hospitals were still stretched at the peak of Arizona’s surge. 

Charles Krebbs was taken by ambulance to Banner Thunderbird Medical Center on July 11, less than a week after his 75th birthday and after experiencing a fever and shortness of breath. It could be hard to get nurses on the phone, his daughter, Tara Swanigan, said. When Mr. Krebbs’s breathing worsened, he was moved to the ICU and placed on a ventilator. By Aug. 7, Mr. Krebbs’s health had declined and his daughter was allowed to visit for one hour to say her goodbyes. A night nurse with whom Ms. Swanigan had bonded on the phone switched shifts to be there to comfort her. Afterward, she watched through a window as they removed his ventilator. He died a few minutes later.

“They were overwhelmed, but we know that they did everything they could to treat my father.” she said. In early July, the state health department’s Dr. Christ took the uncommon step of saying the state would hire traveling nurses on behalf of hospitals who could not, even with bonus offers. 

 It contracted with Vizient Inc. to recruit nearly 600 intensive-care and medical-surgical nurses, all of whom had to come from outside Arizona to prevent intrastate poaching. By the time the contract was signed and nurses began to be placed in smaller cities such as Yuma and Flagstaff, it was the end of July, according to Vizient. 

By Aug. 7, half of the contracted nurses were on the job. But Arizona’s patient count was half its July peak and falling. The cavalry arrived, but after the battle was over.

Lockdown Showdown

I have suspected we are moving toward a national lock down right after Labor Day as there is no way to contain Covid and open the schools without a large scale program to force down the virus numbers and slow down positive cases and of course increasing death numbers.

I read this in the Washington Post and once that idea is floated with the Chamber of Commerce no less demanding Congressional intervention (a notoriously conservative leaning group) means that the heat is on to resolve the current issues being debated in Congress and that seems centered on the additional UI benefits that the GOP want to reduce to 70% of the unemployed workers last wages.  Again that would be fine if it was possible but in reality our States have very antiquated systems that cannot simply upgrade, alter or even calculate the equation correctly.  If no one recalls the fiasco about even simply getting benefits to people in a timely basis and in fact some are just receiving them so we have 99 problems when it comes to nationalized systems and policies regarding well fuck all anything.

But here we are with the fuckwits in the White House, the economy is in the shithole,  and Covid is not going away as this first wave is now a Tsunami.  

Coronavirus threat rises across U.S.: ‘We just have to assume the monster is everywhere’

The Washington Post

By Joel Achenbach,  Rachel Weiner and Chelsea Janes

August 1, 2020 a

The coronavirus is spreading at dangerous levels across much of the United States, and public health experts are demanding a dramatic reset in the national response, one that recognizes that the crisis is intensifying and that current piecemeal strategies aren’t working.

This is a new phase of the pandemic, one no longer built around local or regional clusters and hot spots. It comes at an unnerving moment in which the economy suffered its worst collapse since the Great Depression, schools are rapidly canceling plans for in-person instruction and Congress has failed to pass a new emergency relief package. President Trump continues to promote fringe science, the daily death toll keeps climbing and the human cost of the virus in America has just passed 150,000 lives.

“Unlike many countries in the world, the United States is not currently on course to get control of this epidemic. It’s time to reset,” declared a report released last week by Johns Hopkins University.

Another report from the Association of American Medical Colleges offered a similarly blunt message: “If the nation does not change its course — and soon — deaths in the United States could be well into the multiple hundreds of thousands.”

The country is exhausted, but the virus is not. It has shown a consistent pattern: It spreads opportunistically wherever people let down their guard and return to more familiar patterns of mobility and socializing. When communities tighten up, by closing bars or requiring masks in public, transmission drops.

That has happened in some Sun Belt states, including Arizona, Florida and Texas, which are still dealing with a surge of hospitalizations and deaths but are finally turning around the rate of new infections.

There are signs, however, that the virus is spreading freely in much of the country. Experts are focused on upticks in the percentage of positive coronavirus tests in the upper South and Midwest. It is a sign that the virus could soon surge anew in the heartland. Infectious-disease experts also see warning signs in East Coast cities hammered in the spring.

“There are fewer and fewer places where anybody can assume the virus is not there,” Gov. Mike DeWine (R) of Ohio said Wednesday. “It’s in our most rural counties. It’s in our smallest communities. And we just have to assume the monster is everywhere. It’s everywhere.”

Dire data

A briefing document released Friday by the Federal Emergency Management Agency counted 453,659 new infections in the past week.

Alaska is in trouble. And Hawaii, Missouri, Montana and Oklahoma. Those are the five states, as of Friday, with the highest percentage increase in the seven-day average of new cases, according to a Washington Post analysis of nationwide health data.

“The dominoes are falling now,” said David Rubin, director of the PolicyLab at Children’s Hospital of Philadelphia, which has produced a model showing where the virus is likely to spread over the next four weeks.

His team sees ominous trends in big cities, including Baltimore, Chicago, Detroit, Indianapolis, Kansas City, Louisville, Philadelphia, St. Louis and Washington, with Boston and New York not far behind. And Rubin warns that the expected influx of students into college towns at the end of this month will be another epidemiological shock.

“I suspect we’re going to see big outbreaks in college towns,” he said.

Young people are less likely to have a severe outcome from the coronavirus, but they are adept at propelling the virus through the broader population, including among people at elevated risk. Daily coronavirus-related hospitalizations in the United States went from 36,158 on July 1 to 52,767 on July 31, according to The Post’s data. FEMA reports a sharp increase in the number of patients on ventilators.

The crisis has highlighted the deep disparities in health outcomes among racial and ethnic groups, and data from the Centers for Disease Control and Prevention last week showed that Black, Hispanic and Native American coronavirus hospitalization rates are roughly five times that of Whites.

Thirty-seven states and Puerto Rico will probably see rising daily death tolls during the next two weeks compared with the previous two weeks, according to the latest ensemble forecast from the University of Massachusetts Amherst that combines more than 30 coronavirus models.

There are glimmers of progress. The FEMA report showed 237 U.S. counties with at least two weeks of steady declines in numbers of new coronavirus cases.

But there are more than 3,100 counties in America.

“This is not a natural disaster that happens to one or two or three communities and then you rebuild,” said Beth Cameron, vice president for global biological policy and programs at the Nuclear Threat Initiative and a former White House National Security Council staffer focused on pandemics. “This is a spreading disaster that moves from one place to another, and until it’s suppressed and until we ultimately have a safe and effective and distributed vaccine, every community is at risk.”

A national strategy, whether advanced by the federal government or by the states working in tandem, will more effectively control viral spread than the current patchwork of state and local policies, according to a study from researchers at the Massachusetts Institute of Technology published Thursday in the Proceedings of the National Academy of Sciences.

The coordination is necessary because one state’s policies affect other states. Sometimes, that influence is at a distance, because states that are geographically far apart can have cultural and social ties, as is the case with the “peer states” of New York and Florida, the report found.

“The cost of our uncoordinated national response to covid-19, it’s dramatic,” said MIT economist Sinan Aral, lead author of the paper.

Some experts argue for a full six-to-eight-week national shutdown, something even more sweeping than what was instituted in the spring. There appears to be no political support for such a move.

Neil Bradley, executive vice president of the U.S. Chamber of Commerce, said fresh federal intervention is necessary in this second wave of closures. Enhanced federal unemployment benefits expired at the end of July, with no agreement on a new stimulus package in sight.

“Congress, on a bipartisan basis, was trying to create a bridge to help individuals and businesses navigate the period of a shutdown,” Bradley said. “Absent an extension of that bridge, in light of a second shutdown, that bridge becomes a pier. And then that’s a real problem.”

With the economy in shambles, hospitals filling up and the public frustrated, anxious and angry, the challenge for national leadership is finding a plausible sea-to-sea strategy that can win widespread support and simultaneously limit sickness and death from the virus.

Many Americans may simply feel discouraged and overtaxed, unable to maintain precautions such as social distancing and mask-wearing. Others remain resistant, for cultural or ideological reasons, to public health guidance and buy into conspiracy theories and pseudoscience.

DeWine is struggling to get Ohio citizens to take seriously the need to wear masks. A sheriff in rural western Ohio told the governor Wednesday that people didn’t think the virus was a big problem. DeWine informed the sheriff that the numbers in his county were higher per capita than in Toledo.

“The way I’ve explained to people, if we want to have Friday night football in the fall, if we want our kids back in school, what we do in the next two weeks will determine if that happens,” DeWine said.

The crucial metric

The coronavirus has always been several steps ahead of the U.S. government, the scientific community, the news media and the general public. By the time a community notices a surge in patients to hospital emergency rooms, the virus has seeded itself widely.

The virus officially known as SARS-CoV-2 can be transmitted by people who are infectious but not symptomatic. The incubation period is typically about six days, according to the CDC. When symptoms flare, they can be ambiguous. A person may not seek a test right away. Then, the test results may not come back for days, a week, even longer.

That delay makes contact tracing nearly futile. It also means government data on virus transmission is invariably out of date to some degree — it’s a snapshot of what was happening a week or two weeks before. And different jurisdictions use different metrics to track the virus, further fogging the picture.

The top doctors on the White House coronavirus task force, Deborah Birx and Anthony S. Fauci, are newly focused on the early warning signs of a virus outbreak. Last week, they warned that the kind of runaway outbreaks seen in the Sun Belt could potentially happen elsewhere. Among the states of greatest concern: Indiana, Kentucky, Ohio and Tennessee.

Fauci and Birx have pointed to a critical metric: the percentage of positive test results. When that figure starts to tick upward, it is a sign of increasing community spread of the virus.

“That is kind of the predictor that if you don’t do something — namely, do something different — if you’re opening up at a certain pace, slow down, maybe even backtrack a little,” Fauci said in an interview Wednesday.

Without a vaccine, the primary tools for combating the spread of the virus remain the common-sense “non-pharmaceutical interventions,” including mask-wearing, hand-washing, staying out of bars and other confined spaces, maintaining social distancing of at least six feet and avoiding crowds, Fauci said.

“Seemingly simple maneuvers have been very effective in preventing or even turning around the kind of surges we’ve seen,” he said.

Thirty-three U.S. states have positivity rates above 5 percent. The World Health Organization has cited that percentage as a crucial benchmark for governments deciding whether to reopen their economy. Above 5 percent, stay closed. Below, open with caution.

Of states with positivity rates below 5 percent, nine have seen those rates rise during the last two weeks.

“You may not fully realize that when you think things are okay, you actually are seeing a subtle, insidious increase that is usually reflected in the percent of your tests that are positive,” Fauci said.

The shutdown blues

Some governors immediately took the White House warnings to heart. On Monday, Kentucky Gov. Andy Beshear (D) said at a news conference that he had met with Birx the previous day and was told he was getting the same warning Texas and Florida received “weeks before the worst of the worst happened.”

To prevent that outcome in his state, Beshear said, he was closing bars for two weeks and cutting seating in restaurants.

But as Beshear pleaded that “we all need to be singing from the same sheet of music,” discord and confusion prevailed.

Iowa Gov. Kim Reynolds (R) said Thursday she wasn’t convinced a mask mandate is effective: “No one knows particularly the best strategy.”

Earlier in the week, Tennessee Gov. Bill Lee (R) demurred on masks and bar closures even as he stood next to Birx and spoke to reporters.

“That’s not a plan for us now,” he said. He added emphatically, “We are not going to close the economy back down.”

The virus is spreading throughout his state, and not just in the big cities. Vacationers took the virus home from the honky-tonks of Nashville and blues clubs of Memphis to where they live in more rural areas, said John Graves, a professor at Vanderbilt University studying the pandemic.

“The geographical footprint of the virus has reached all corners of the state at this point,” Graves said.

In Missouri, Gov. Michael L. Parson (R) was dismissive of New York’s imposition of a quarantine on residents from his state as a sign of a worsening pandemic. “I’m not going to put much stock in what New York says — they’re a disaster,” he said at a news conference Monday.

Missouri has no mask mandate, leaving it to local officials to act — often in the face of hostility and threats. In the town of Branson, angry opponents testified Tuesday that there was no reason for a mask order when deaths in the county have been few and far between.

“It hasn’t hit us here yet, that’s what I’m scared of,” Branson Alderman Bill Skains said before voting with a majority in favor of the mandate. “It is coming, and it’s coming like a freight train.”

Democratic mayors in Missouri’s two biggest cities, Kansas City and St. Louis, said that with so many people needing jobs, they are reluctant to follow Birx’s recommendation to close bars.

“The whole-blanket approach to shut everybody down feels a little harsh for the people who are doing it right,” said Jacob Long, spokesman for St. Louis Mayor Lyda Krewson. “We’re trying to take care of some bad actors first.”

Minneapolis Mayor Jacob Frey also got a warning from Birx. On Wednesday, he said all bar drinking must move outside.

“We don’t want to be heading in the direction of everybody else,” said Kristen Ehresmann, director of the infectious-disease epidemiology division at the Minnesota Department of Health. She acknowledged that some options “are really pretty draconian.”

The problem is that less-painful measures have proven insufficient.

“The disease transmission we’re seeing is more than what would have been expected if people were following the guidance as it is laid out. It’s a reflection of the fact that they’re not,” she said.

‘A tremendous disappointment’

Wisconsin Gov. Tony Evers (D) tried to implement broad statewide measures early in the pandemic, only to have his “Safer at Home” order struck down by the state’s Supreme Court.

With cases in his state rising anew, he tried again Thursday, declaring a public health emergency and issuing a statewide mask mandate.

“While our local health departments have been doing a heck of a job responding to this pandemic in our communities, the fact of the matter is, this virus doesn’t care about any town, city or county boundary, and we need a statewide approach to get Wisconsin back on track,” Evers said.

Ryan Westergaard, Wisconsin’s chief medical officer, said he is dismayed by the failures of the national pandemic response.

“I really thought we had a chance to keep this suppressed,” Westergaard said. “The model is a good one: testing, tracing, isolation, supportive quarantine. Those things work. We saw this coming. We knew we had to build robust, flexible systems to do this in all of our communities. It feels like a tremendous disappointment that we weren’t able to build a system in time that could handle this.”

There is one benefit to the way the virus has spread so broadly, he noted: “We no longer have to keep track of people traveling to a hot spot if hot spots are everywhere.”

As it Was, Ever and Will Be

The daily Covid Chronicles continue with two more significant points: Data Not Complete and Costs and Coordination for Medical Facilities

Here in the hot bed of Covid, the Three Stooges ran around commandeering Naval ships, public parks, conference centers and other facilities to house the thousands of Covid patients expected to arrive on the shores.  They failed to provide adequate testing, tracking and tracing and more importantly do adequate coverage and protections for those in more confined situations that are petri dishes for the virus – the old folks homes, prisons, public housing and veteran facilities. Well that takes time and we are at war with Trump so off with their heads!

By the time you are now tested a week or longer has passed and you have passed on the virus to your two friends and family and they have passed it on and finally when the results are back or quarantine for  you have ended you are onto the next.

Again the mysterious Covid parties are apparently another urban myth with little substantiation, the other, “we never left the house” is actually another myth, as someone did at sometime and they brought back with the essentials a little something extra.

The states have always had odd numbers and data collection from those who test positive to deaths as we have counties and cities not complying nor compiling in any consistent manner.  The reality is that those who have died from “covid related” symptoms are still charted on death certificates as cause of death the primary reason so again not Covid.

Then of course the private Physicians who have tests and in turn do not release the data nor are required to thanks to HIPAA or that again we have everything from false positives to false negatives gumming up the numbers so the real count is just that an anathema.   Shocking, I know. Not really.

We will never know the full numbers and we have a President and his administration that simply refuse to actually take responsibility and accountability for the failures that have continued now well into the year when this all began.  But the question remains: Would this have been any different regardless? And given what we are seeing world wide with regards to stockpiles, surpluses, inventories of needed PPE to even drugs just a basic crisis would have exposed the system as a piece of shit.   Then we have the horrific red tape, lack of communication and coordination systems that have been repeatedly tested and repeatedly failed and never once dealt with. This includes the deluge of Unemployment claims that States across the country demonstrated our outdated systems.  The curtain pulled back, the rock is now overturned and the soft underbelly exposed. And I have not seen or heard anyone discuss this with meaning, intent and a plan. Same as it ever was, is and will be.

Former CDC chief: Most states fail to report data key to controlling the coronavirus pandemic
Not a single state reports on the turnaround time of diagnostic covid-19 tests.

The Washington Post
By Lena H. Sun
July 21, 2020
Six months after the first coronavirus case appeared in the United States, most states are failing to report critical information needed to track and control the resurgence of covid-19, the disease caused by the virus, according to an analysis released Tuesday by a former top Obama administration health official.

The analysis is the first comprehensive review of covid-19 data that all 50 states and Washington, D.C., are using to make decisions about policies on mask-wearing and opening schools and businesses. In the absence of a national strategy to fight the pandemic, states have had to develop their own metrics for tracking and controlling covid-19. But with few common standards, the data are inconsistent and incomplete, according to the report released by Resolve to Save Lives, a New York nonprofit led by former Centers for Disease Control and Prevention director Tom Frieden and part of the global health organization Vital Strategies.

Some essential information that would show response effectiveness is not being reported at all. Only two states report data on how quickly contact tracers were able to interview people who test positive to learn about their potential contacts. Not a single state reports on the turnaround time of diagnostic tests, the analysis found. Week-long waits for results hobble efforts to track real-time virus spread and make contact tracing almost irrelevant.

“Despite good work done in many states on the challenging task of collecting, analyzing, and presenting crucial information, because of the failure of national leadership, the United States is flying blind in our effort to curb the spread of COVID-19,” Frieden said in a statement. “If we don’t get the virus under control now, it will get much, much worse in the coming months.”

Publicly available, standard dashboards with information on life-or-death metrics can make more of a difference than anything else U.S. officials can do in the weeks and months ahead, he said. Of the hundreds of projects the team has done since January, Frieden said Tuesday’s report was the most important.

His team and other public health leaders are recommending that states and counties report 15 indicators they say are essential for an effective response. The metrics were drafted with input from states and public health organizations and modeled after practices from around the world, Frieden said. States should be able to report on nine of the metrics now and the other six within several weeks.

The nine include information about confirmed and probable cases, rates of hospitalization per capita, and emergency department trends showing people who have symptoms of influenza-like illness and covid-19-like illness.

While almost all states report cases, 20 percent of state dashboards did not report same-day data by 5 p.m. local time. Kansas updates data only three times a week.

The CDC, in a statement, said it has been working since the beginning of the outbreak with states and other partners “to collect, analyze and report out data critical to formulate the nation’s response to this unprecedented public health crisis.”

The CDC is already tracking, or has plans with the states to track, 14 of the 15 indicators, the agency statement said. The CDC said the data is posted on its website and many states are also tracking some indicators on their state websites. The statement added: “CDC is always looking at best practices for ways to enhance, consolidate and report data, to make it easier for states and the public to access.”

The CDC said it has no plan to calculate data on the percentage of people wearing masks correctly in public, one of the metrics included in the report.

Without a national coordinated strategy, public health experts say consensus from governors will be vital to suppress and eventually recover from covid-19. That includes agreement on common metrics, a regular system for reporting data, and triggers for implementing social distancing policies and stay-at-home orders.

Most states are not collecting most of these measures, or if they are, reporting on only a small fraction, said Tom Inglesby, an infectious-disease physician and director of the Johns Hopkins Center for Health Security.

“The more we agree on the targets for response that states should achieve, the better the public will understand what it’s going to take to bring this epidemic under control,” Inglesby said in an email. If the target benchmark for a state’s diagnostic test positivity rate should be below 5 percent, for example, but if the state is reporting a positivity rate of 20 percent, that’s a sign that “things are going quite badly.”

Similarly, if a state is reporting that only a small fraction of new covid-19 cases can be linked to prior cases, “things are not going well no matter what a national or local leader might say.”

The D.C. health department published that key metric for the first time Monday. It said the percentage of new coronavirus cases linked to already known cases is just 2.8 percent — meaning most people contracting the virus aren’t aware of who might have exposed them. The city’s goal is 60 percent.

Groups representing state public health officials support the measures.

“Having some standard metrics to compare across the country will make a big difference in identifying where things are going well and where there is need for additional resources and improvements,” said Michael Fraser, chief executive of the Association of State and Territorial Health Officials.

Janet Hamilton, executive director of the Council of State and Territorial Epidemiologists, said the organization supports using consistent indicators to give people information that will help them change behavior and understand the threat of the pandemic.

It’s also important, she said, that Frieden’s team recognized the relative importance of each metric and that “the optimal target may change based on the local status of the pandemic.”

While they praise the effort, public health experts are also concerned that overwhelmed state and local health departments don’t have the resources to report some of these measures at a time when the pandemic is surging and states are experiencing record numbers of infections and hospitalizations.

“Some of these data are going to be very very hard to get without a workforce dedicated to just charting these metrics week by week,” said Jeanne Marrazzo, director of the Division of Infectious Diseases at the University of Alabama at Birmingham School of Medicine.

“If we had this as a road map at the start in confronting the pandemic, that would have been the bomb,” she said.

And across the country today, cities are looking to shut down in States from Los Angeles to Atlanta, the outbreaks are not following the protocol established by the varying Governors, Medical Advice and of course the Millennials who are the largest cohort simply not giving a shit.   Meanwhile we are paying the price for this, in more ways than one.  When it comes to hospital bills this one is a whopper.

This Hospital Cost $52 Million. It Treated 79 Virus Patients.

Red tape and turf battles marked the race to create temporary hospitals for the coronavirus onslaught in New York.

By Brian M. Rosenthal
The New York Times
July 21, 2020

The Queens Hospital Center emergency department has a capacity of 60, but on its worst night of the coronavirus pandemic, more than 180 patients lay on stretchers in the observation bays and hallways. Alarms rang incessantly as exhausted doctors rushed from crisis to crisis.

Less than four miles away, a temporary hospital opened the next morning, on April 10. The facility, which was built at the U.S.T.A. Billie Jean King National Tennis Center to relieve the city’s overwhelmed hospitals, had hundreds of beds and scores of medical professionals trained to treat virus patients.

But in the entire month that the site remained open, it treated just three patients from the Queens Hospital Center emergency department, records show. Over all, the field hospital cost more than $52 million and served only 79 patients.

The pandemic has presented unique challenges for officials grappling with a fast-moving and largely unpredictable foe. But the story of the Billie Jean King facility illustrates the missteps made at every level of government in the race to create more hospital capacity in New York. It is a cautionary tale for other states now facing surges in cases and for New Yorkers bracing for a possible second wave.

Doctors at the Queens Hospital Center, a public hospital in Jamaica, and at other medical centers wanted to transfer patients to Billie Jean King. But they were blocked by bureaucracy, turf battles and communication failures, according to internal documents and interviews with workers.

New York paid as much as $732 an hour for some doctors at Billie Jean King, but the city made them spend hours on paperwork. They were supposed to treat coronavirus patients, but they did not accept people with fevers, a hallmark symptom of the virus. Officials said the site would serve critically ill patients, but workers said it opened with only one or two ventilators.

“I basically got paid $2,000 a day to sit on my phone and look at Facebook,” said Katie Capano, a nurse practitioner from Baltimore who worked at Billie Jean King. “We all felt guilty. I felt really ashamed, to be honest.”

As the coronavirus spread in March, the federal government, state leaders, city officials and hospital executives all began creating their own temporary medical facilities, at times competing against each other. Gov. Andrew M. Cuomo’s office oversaw most transfers to the centers, but city officials say the state did not closely coordinate with other players.

The federal government’s biggest contribution, the Navy hospital ship U.S.N.S. Comfort, arrived in New York with great fanfare but initially did not accept coronavirus patients at all, prompting one hospital executive to call it “a joke.”

Even once the Comfort began treating people with Covid-19, the illness caused by the coronavirus, the hospital ship and another overflow facility run by the state, located at the Jacob K. Javits Convention Center, mostly accepted patients transferred from private medical centers, not from the public hospitals that were the most besieged, according to government data.

Billie Jean King, the only emergency hospital built by the city, should have been a success story: It opened at the height of the pandemic, with a full staff eager to treat virus patients.

An aide to Mayor Bill de Blasio who helped oversee the site, Jackie Bray, said the city acted quickly to open it but ultimately concluded patients were best treated at existing hospitals, even if they were crowded. She added that she expected the federal government to reimburse the city for the cost of the facility.

Officials with the city and the state said Billie Jean King and other temporary sites treated so few patients because New York’s statewide shutdown curtailed the virus and hospitals expanded their own capacity, reducing the need for extra beds.

“The alternative space was less used than we expected it to be because we broke the curve, thank goodness,” Ms. Bray said.

Doctors disagreed.

“The conditions in the emergency room during this crisis were unacceptable and dangerous,” said Dr. Timothy Tan, the director of clinical operations at the Queens Hospital Center emergency department. “Knowing what our patients had to endure in an overcrowded emergency department, it’s frustrating how few patients were treated at facilities such as Billie Jean King.”

In past disasters, such as during Hurricane Sandy in 2012, the state created a unified system across multiple agencies to transfer patients between hospitals. That did not happen during the coronavirus pandemic, leaving hospitals in low-income areas overwhelmed, while some wealthy private medical centers had open beds.

Instead, with projections forecasting a severe shortage of beds, officials focused on building field hospitals.

The largest facilities opened in Manhattan in late March — the Comfort and the Javits Center. They treated about 1,400 patients, although only about 300 came from public hospitals, data shows.

Hospitals also opened overflow locations, including a Central Park tent hospital that treated 300 patients from Mount Sinai Hospital. The city’s public hospital system created a wing at a nursing home on Roosevelt Island.

Facing a projected shortage of 50,000 beds, federal officials spent more than $320 million to build facilities at two state colleges and the Westchester County Center, and the city spent about $20 million on a center at the Brooklyn Cruise Terminal, records show. In the end, reality never neared the dire projections, and none of those facilities opened.

The only makeshift hospital the city opened was at Billie Jean King.

The complex, home of the U.S. Open, is at the site of the 1964 World’s Fair in Flushing Meadows and is one of the largest tennis centers in the world.

Officials put out a call on March 18, saying they needed a contractor that could open a hospital in seven days and run it. Only one vendor said it could do it: SLSCO, a company from Galveston, Texas, best known for helping build part of President Trump’s border wall.

SLSCO had spent $90,000 annually to lobby New York in recent years and received contracts after Hurricane Sandy, records show. The company referred questions to city officials.

The contract paid SLSCO whatever costs it incurred for creating and operating 470 beds for “Covid-positive patients of medium and high acuity” — plus an additional 18 percent for profit and overhead, the deal said. The final bill is still being tallied; it could top $100 million.

“This is a war effort,” Mr. de Blasio said in a news conference at the tennis center in late March, announcing it would open April 7. “This facility will be crucial.”

The site opened on April 10, during the grimmest week of the pandemic, with records in statewide hospitalizations and deaths.

The night before, the patients in the Queens Hospital Center emergency department included 66 who were so sick that they had already been admitted and were waiting for beds, according to a hospital log.

City officials said emergency department patients were inappropriate for Billie Jean King. The site did not have all of the equipment, drugs and services available at a permanent hospital, so it was not the best place for unstable patients, they said.

Dani Lever, communications director for Mr. Cuomo, said the Queens Hospital Center transferred 11 patients to the Javits Center that night, and could have sent more. The state accommodated every transfer request from hospitals, Ms. Lever said.

Other nearby hospitals were also in crisis, including Elmhurst Hospital Center and several small private hospitals.

SLSCO had recruited hundreds of workers from across the country. It paid most doctors about $600 an hour, or $900 for overtime, according to the contract — far more than the typical rates at hospitals. Registered nurses made more than $250 an hour, as did pharmacists and physician assistants.

But in the early days, they spent hours in orientation to learn computer systems, waiting to get fitted for masks and looking for equipment, workers said. They also said they had to complete repetitive paperwork.

“Extreme dysfunction,” Dr. Kim Sue said about working there. “Bureaucracy and dysfunction, and all kinds of barriers to serving patients.”

But the biggest barrier was simple: Hospitals did not send many patients to Billie Jean King.

The city did not allow ambulances to take 911 calls to Billie Jean King because health officials said they did not trust the facility to triage patients. The site had its own ambulances, but they could not pick up transfers because, according to some workers at the site, hospitals had exclusive agreements with ambulance companies. So doctors had to wait for transfers. Few came.

In interviews, doctors at overwhelmed private hospitals said they were told they could not transfer to Billie Jean King because it was only for patients from public hospitals.

Several doctors at public hospitals said they believed their bosses did not want to transfer because the hospitals in the public system each had their own budgets, and they did not receive revenue from patients they sent away. Some said they were told Billie Jean King could treat only people with extremely mild symptoms.

There were at least 25 medical conditions that disqualified patients from being transferred to Billie Jean King, including “spiking” fevers, a city spokesman acknowledged. The Javits Center had similar rules.

At Billie Jean King, seven workers said in interviews that even with limited ventilators, they could treat most severely ill patients. They said they grew increasingly frustrated to report every day to a sea of empty beds. Several mentioned that three men with mild symptoms died while quarantining at a Manhattan hotel.

“We were sitting on all of these beds with hundreds of people trained to watch over patients exactly like that, and these people died,” said Elizabeth Ianelli, a social worker at the site. “That was preventable.”

City officials said the men were not sick enough for Billie Jean King’s level of care. They said all hospitals could transfer to the site, which had enough ventilators, and said the ambulances did not pick up because they needed to be available in case patients at Billie Jean King deteriorated and needed to be transferred. Nobody was thinking about patient revenue, they said.

“The thing that saved the most lives was to treat them in expanded capacity in the hospitals, and bring staff into the hospitals, and that’s what we were focused on,” said Matt Siegler, a senior vice president at the city’s public hospital system, which oversaw the site.

Mr. Siegler said he could not think of anything the city should have done differently.

On April 27, the city amended the contract to pay SLSCO for only a 100-bed facility for patients with “low to moderate” needs, records show. The site became a quarantine location for homeless people, and some staffers left to work in other hospitals.

Billie Jean King closed on May 13, and workers returned home.