Precisely. When the data doesn't fit your narrative, take a smaller selection of the data - preferably the selection that fits the narrative.
Herd Immunity: Covid Deaths Devouring the South Are No Accident For Scott Atlas, as for Republican governors like Ron DeSantis, Greg Abbott, Tate Reeves, and Kay Ivey, the human cost of our shredded public health system is a feature, not a bug. https://www.thenation.com/article/society/atlas-covid-herd-immunity/ At the end of August, I wrote about the deficiencies in President Joe Biden’s initial response to the Covid-19 pandemic. At the beginning of September, the president announced a series of new initiatives that will tackle many, though not all, of these shortcomings. I am not positing a cause and effect here: I don’t think the president’s inner circle is reading my columns in The Nation to decide what to do. However, what is driving the Biden administration’s moves is reasonable scientific advice, and my comments here were largely framed within the existing scientific consensus of what we should be doing now. We can argue the specifics—and certainly still criticize—but by and large, “science is back” in 2021 (depending where you look, but more on that later). It’s hard to remember—perhaps because I am trying so hard to forget—the sheer lunacy of Trump’s science last year: second-rate economist Peter Navarro’s campaign to put hydroxychloroquine in the drinking water (with help from my own institution’s Harvey Risch); the president’s ravings about bleach and ultraviolet light; and then there was Scott Atlas, the Rasputin of 2020. Though an actual physician, his training was in neuroradiology, not infectious diseases; until 2012, Atlas was a professor in his field of expertise at Stanford. After 2012, his relationship with the university shifted, and he became a fellow at the Hoover Institution, the conservative think tank loosely affiliated with the university, where he was a vocal opponent of the Affordable Care Act and pushed for Medicaid to become a bridge to private insurance. But Scott Atlas’s claim to, well, infamy, was his embrace of the concept of herd immunity: the idea that Covid-19 was of negligible clinical significance for anyone but the elderly, and that—apart from sequestering the elderly from the rest of the population—public health restrictions were unnecessary. Rather than heed public health advice, Atlas claimed as many people needed to get infected as possible as quickly as possible to develop herd immunity and put the pandemic behind us. This was met with vociferous pushback from the medical and public health community, since “letting ’er rip”—letting the virus spread uncontrolled and thus allowing millions to get infected—also risked millions of deaths. Besides, actually sequestering the elderly and those with underlying conditions was nearly impossible given the sheer number of individuals in these categories. Atlas resigned his White House post on December 1, 2020. I started to think about Atlas again over the past few weeks. As the Covid-19 epidemic has torn through the American South, I’ve been trying to make sense of it all. It’s easy to criticize Southern governors as ignorant, uninformed actors in the sheer catastrophe unfolding in the ICUs in the region. But then I remembered a passage in a book I read a while ago, by economists Daron Acemoglu and James Robinson, called Why Nations Fail. In it they examine how poverty happens across the world throughout history, arguing that poor countries are poor because those who have power make choices that create poverty. They get it wrong not by mistake or ignorance but on purpose. To understand this, you have to go beyond economics and expert advice on the best thing to do and, instead, study how decisions actually get made, who gets to make them, and why those people decide to do what they do. What is happening in the American South is no accident. It is not born of ignorance or folly. It is a choice. Consider this comment in a New York Times article by Florida Governor Ron DeSantis: “Clearly the vaccines are keeping most of these people out of the hospital, but we’re not building the herd immunity that people hoped,” he said (emphasis mine). Herd immunity. We’re back to Scott Atlas, who would be a footnote in epidemic history—except for the thousands of deaths for which he is responsible. DeSantis was an early adherent of the notion of herd immunity espoused by Atlas and a group of scientists funded by the libertarian American Institute for Economic Research. Governor DeSantis and his colleagues in the South genuinely think they are doing the right thing. Their persistent, horrific quest for herd immunity confirms preexisting biases about the role of the state in our lives—the less the better. In the People’s Temple of the Sunshine State, this faith has led the people’s leader to hand out the Kool-Aid to his own citizens, leading them to their own deaths. Remember, before Covid-19 the South was already the least healthy region in the country: People there lived shorter lives, with much higher rates of chronic conditions. The South was the epicenter of the American AIDS epidemic—and rife with other infectious diseases. Yet, except for Louisiana and Arkansas, most of the states in the Deep South refuse to expand Medicaid—depriving many of their citizen of access to medical care that can make their lives better. While that, too, may be rooted in a libertarian, small-government impulse, writers like Jeneen Interlandi of The New York Times have made a compelling case that decisions to restrict access to health care in the United States have everything to do with race. This is where American libertarianism meets white supremacy. Conservatives have worked hard for decades to bring us to this very moment, always implying that the safety net they were shredding—the basic fundamentals of public health they’ve been chipping away at over the past year—were benefiting someone else. Someone darker. Someone less deserving. Before Atlas was pro-Covid, he was looking to roll -back the ACA and dismantle Medicaid. Lest there be any doubt, let’s take a detour to another aspect of American health care and public health: abortion and reproductive health. The new ban on abortion in Texas was crafted carefully to make it difficult to challenge. This was a considered, deliberate approach, which will deprive thousands of women of the care they need, but first and foremost women of color in the state. As Thomas Edsall wrote in the Times recently, abortion has never really been just about abortion but always tightly linked with racist ideologies. Edsall offered this quote from Richard Ballmer at Dartmouth: “Opposition to abortion became a convenient diversion—a godsend, really—to distract from what actually motivated their political activism: the defense of racial segregation in evangelical institutions.” This is our post-pandemic future—and it is bleak. When the next virus arrives here, we will be even weaker than we were before 2020. The trajectory of the pandemic in the United States has many drivers and we cannot lay all the regional variations at the feet of our politics. However, the toxic stew of Trumpism, white supremacy, and small-government-at-all-costs mania—the embrace of pseudoscience—has made things much worse. Watching developments over the past few weeks and months has, frankly, frightened me. Now Republican governors are going after vaccine mandates—though all their states have long had them for preventable childhood illnesses and for sectors of the workforce who interact with the sick and dying (e.g., health care workers). When Amy Coney Barrett assured us that the Supreme Court isn’t just a bunch of partisan hacks, what we heard was the Lady Macbeth of the judiciary trying to rub out the stain of the past few years’ judgments, even as she feels compelled to acknowledge it, in public, as real. With such partisanship now in place, might we see the striking down of long-held precedents on vaccine mandates and other public health measures? We’re already seeing state after state enact new laws to constrain public health authority. There has been a thread of the national conversation that blames public health for being its own worst enemy. The charge is that our failure to communicate clearly over the course of the pandemic has undermined public trust—and that much of what is happening now in terms of the attacks on public health is self-inflicted. Admittedly, there were significant failures in public health communications over the course of the pandemic, and there is huge room for improvement in this regard. However, separating the signal from the noise is harder in the context of state-sponsored misinformation and the deliberate manipulation of public sentiment for political gain. But let’s head south again. The recent attacks on public health, the willingness on the part of Ron DeSantis, Greg Abbott, Tate Reeves, Kay Ivey to defy standard public health practice—even as they see their constituents suffer—has its roots in a deep ideological commitment. This isn’t about the CDC’s shifting mask guidance, or about the belated acknowledgement of airborne transmission of the virus. This isn’t what matters to these leaders. And it’s simply willful ignorance to suggest that “bad communication” is at the root of what is happening now. As Naomi Klein notes, every catastrophe is an opportunity. The pandemic has enabled these leaders to pursue policies they have wanted to push way before SARS-COV-2 had entered the scene. As the poet Anne Sexton said of self-destruction in another context: “Suicides have a special language. Like carpenters they want to know which tools. They never ask why build.” The GOP is looking for ways to undermine access to health care, public health regulations and programs—the whole already-frayed safety net. Right now, we need a massive investment to revive public health in America. We were in dire shape before the pandemic; now we have one party that is hell-bent on destruction and the other party, for all its welcome departure from the Trump administration’s insanity, thinks it can McKinsey its way out of a crisis, ignoring the fundamental weaknesses in our public health system. Scott Atlas may be gone, but what he helped bring to pass must give him some measure of satisfaction. And as for the deaths of those who might still be alive if they had gotten vaccinated instead of being told they were defending freedom? In my mind’s eye, I see him shrugging it all off, telling us blithely that you can’t make an omelet without breaking some eggs. For Dr. Atlas and the politicians who share his views, the chilling fact may be that all of this has been worth it. ------------------------------------------------ Gregg GonsalvesTwitterNation public health correspondent Gregg Gonsalves is the codirector of the Global Health Justice Partnership and an assistant professor of epidemiology at the Yale School of Public Health.
Should there be any surprise that states with GOP governors had worse Covid outcomes when we see depravity like this... Idaho COVID Insanity Shows How Much Worse the GOP Can Get HUNGER GAMES The slightest hint of responsibility is enough to draw primary challenges in the party’s ever-accelerating race to the bottom. https://www.thedailybeast.com/idaho-covid-insanity-shows-how-much-worse-the-gop-can-get As the morgues and ICUs in Idaho overflow with COVID patients, Republican Governor Brad Little said he would fine businesses with over 100 employees if they enacted a mask mandate. It’s an insane stance rooted in his desire not to give his challenger, Lt. Gov. Janice McGeachin, any cause to attack him as she guns for his job. Dying people be damned, as Republicans turn against each other in contests up and down the ballot and across the country to see who can get farthest to the right to claim the Trumpian mantle. The Idaho governor has reason to be on guard. McGeachin pulled a power play when he was out of the state briefly in May, using her temporary status as acting governor to enact a mandate against mask mandates. Little overturned it as soon as he got back—not that he’s a big fan of mask mandates, but he was leaving it up to individual localities and that didn’t go far enough for the Trump base, so now he’ll be punishing companies for trying to keep their employees safe in a pandemic. “She does seem to be channeling Trump here and angling for Trump’s endorsement,” says Jessica Taylor, who follows governors’ races for The Cook Political Report. That dynamic is hardly confined to Idaho. In another red state, Alabama, where COVID cases have overwhelmed the health system, Governor Kay Ivey blamed the unvaccinated for the surge, a rare moment of truth-telling that has gotten her three primary challengers, with two more mulling the race. Even in Texas, where Governor Greg Abbott isn’t facing a super-serious challenge, says Taylor, he’s not taking any chances, ordering a recount at Trump’s request of four vote-rich counties that Trump won in 2020, adding to the craziness. At his rally in Georgia on Saturday, Trump bizarrely claimed that the months-long audit of the Arizona election found that he had won even though Cyber Ninjas, the company selected by the GOP that conducted the audit, found Biden had won—and by more votes than the original count. The Republican primaries are shaping up like the Hunger Games, dystopian battles among the Trumpian faithful. “What you’re seeing are incredible races to the bottom as they one up each other to be the craziest and the Trumpiest in whatever context presents itself,” says Matt Bennett, a co-founder of Third Way, a moderate Democratic group. The fights and the lies can be over mask mandates, or vaccines, or how we teach children about slavery, with all of them tying into the Big Lie that Trump somehow won the election and was cheated out of his supposedly rightful victory. Tomorrow the lies could be about Afghanistan refugees or what’s happening on the southern border or calls to defund the police, “the things that generate heat,” says Bennett, “and these politicians are fanning the flames as aggressively as possible.” That’s politics, you say, but this is different, says Robert Kagan, a neo-conservative foreign policy scholar whose essay in the Washington Post this weekend laid out loud and clear what many across the political spectrum have worried about for some time, namely the fascist tendencies of Trump and his followers as they put in place policies that could allow Republican legislatures to overturn elections when they don’t like the results. Kagan argues that we have never seen a U.S. political movement tied so passionately to one man and his lies as it is to Trump. The term fascist is associated with murderous genocide, and appropriately so because of its dark history. What we’re seeing on the populist right is rhetoric that leans into fascism and fuels primary challenges to see who can be the purest, the harshest, and the most extreme voice on the Trumpian right to win the Dear Leader’s endorsement. Another early test of whether this Trumpian, dystopian approach will work is Virginia, where Democrat Terry McAuliffe, once considered a shoo-in, is in a tight race with Republican Glenn Youngkin, a political neophyte who over the weekend refused to say whether he would have voted to confirm the 2020 election if he were a member of Congress. He’s running on “election integrity,” code for the Big Lie, and of course he’s skeptical of mask mandates even for nurses who treat immuno-compromised cancer patients. “The environment overall for Democrats is bad right now,” says Jessica Taylor with Cook Political, “and a lot hinges on what Congress is able to do” on infrastructure and the debt limit and the Biden agenda on transformational change now that the Democrats have unified power. “The fundamentals still favor McAuliffe,” she says, but it’s put-up or shut-up time for Democrats and the party’s disunity could cost him dearly if it’s not resolved. Before the 2020 election, says Matt Bennett, you could argue that the Republicans were simply trying to keep people from voting who weren’t their voters, odious behavior in a democracy but within bounds. “Since the election, it’s become super-clear that if they don’t like the outcome, they’ll change it.” Trump allies are pushing laws in Georgia, Arizona, Pennsylvania, and Wisconsin that would allow Republican legislatures to overturn the vote if it doesn’t go their way. “When we’re talking about abrogating or nullifying people’s votes, that is the end of the American experiment,” says Bennett, who is not otherwise an alarmist. “Our democracy, at least for now, will be over.” What’s happening in Idaho won’t change the national picture or power dynamics, but people will die unnecessarily because politicians who see a path to power are playing games with their lives. In Virginia, where early voting is underway for the gubernatorial election on Nov. 3, McAuliffe’s biggest enemy is lack of enthusiasm, but how can that be given all that’s at stake? “When democracies die, they no longer die in a coup, or with tanks rolling in,” says Bennett. “They die because people give over power or they aren’t paying attention.” Or they fade away when politicians act solely to preserve and extend their power, as Idaho’s governor and lieutenant governor are doing in a political slugfest that treats a population suffering from COVID as collateral damage in an undeclared and unnecessary war.
Nothing like killing your own voters to destroy your chances in upcoming elections... Republicans warned their self-destructive COVID behavior is 'killing off their voter base' https://www.alternet.org/2021/09/anti-vaxxers-2655186543/
Covid Is Killing Rural Americans at Twice the Rate of Urbanites https://khn.org/news/article/covid-death-rate-rural-america/ Rural Americans are dying of covid at more than twice the rate of their urban counterparts — a divide that health experts say is likely to widen as access to medical care shrinks for a population that tends to be older, sicker, heavier, poorer and less vaccinated. While the initial surge of covid-19 deaths skipped over much of rural America, where roughly 15% of Americans live, nonmetropolitan mortality rates quickly started to outpace those of metropolitan areas as the virus spread nationwide before vaccinations became available, according to data from the Rural Policy Research Institute. Since the pandemic began, about 1 in 434 rural Americans have died of covid, compared with roughly 1 in 513 urban Americans, the institute’s data shows. And though vaccines have reduced overall covid death rates since the winter peak, rural mortality rates are now more than double urban rates — and accelerating quickly. In rural northeastern Texas, Titus Regional Medical Center CEO Terry Scoggin is grappling with a 39% vaccination rate in his community. Eleven patients died of covid in the first half of September at his hospital in Mount Pleasant, population 16,000. Typically, three or four non-hospice patients die there in a whole month. “We don’t see death like that,” Scoggin said. “You usually don’t see your friends and neighbors die.” Part of the problem is that covid incidence rates in September were roughly 54% higher in rural areas than elsewhere, said Fred Ullrich, a University of Iowa College of Public Health research analyst who co-authored the institute’s report. He said the analysis compared the rates of nonmetropolitan, or rural, areas and metropolitan, or urban, areas. In 39 states, he added, rural counties had higher rates of covid than their urban counterparts. “There is a national disconnect between perception and reality when it comes to covid in rural America,” said Alan Morgan, head of the National Rural Health Association. “We’ve turned many rural communities into kill boxes. And there's no movement towards addressing what we're seeing in many of these communities, either among the public or among governing officials.” Still, the high incidence of cases and low vaccination rates don’t fully capture why mortality rates are so much higher in rural areas than elsewhere. Academics and officials alike describe rural Americans’ greater rates of poor health and their limited options for medical care as a deadly combination. The pressures of the pandemic have compounded the problem by deepening staffing shortages at hospitals, creating a cycle of worsening access to care. It's the latest example of the deadly coronavirus wreaking more havoc in some communities than others. Covid has also killed Native American, Black and Hispanic people at disproportionately high rates. Vaccinations are the most effective way to prevent covid infections from turning deadly. Roughly 41% of rural America was vaccinated as of Sept. 23, compared with about 53% of urban America, according to an analysis by The Daily Yonder, a newsroom covering rural America. Limited supplies and low access made shots hard to get in the far-flung regions at first, but officials and academics now blame vaccine hesitancy, misinformation and politics for the low vaccination rates. In hard-hit southwestern Missouri, for example, 26% of Newton County’s residents were fully vaccinated as of Sept. 27. The health department has held raffles and vaccine clinics, advertised in the local newspaper, and even driven the vaccine to those lacking transportation in remote areas, according to department administrator Larry Bergner. But he said interest in the shots typically increases only after someone dies or gets seriously ill within a hesitant person’s social circle. Additionally, the overload of covid patients in hospitals has undermined a basic tenet of rural health care infrastructure: the capability to transfer patients out of rural hospitals to higher levels of specialty care at regional or urban health centers. “We literally have email Listservs of rural chief nursing officers or rural CEOs sending up an SOS to the group, saying, ‘We’ve called 60 or 70 hospitals and can’t get this heart attack or stroke patient or surgical patient out and they’re going to get septic and die if it goes on much longer,’” said John Henderson, president and CEO of the Texas Organization of Rural & Community Hospitals. Morgan said he can’t count how many people have talked to him about the transfer problem. “It’s crazy, just crazy. It’s unacceptable,” Morgan said. “From what I’m seeing, that mortality gap is accelerating.” Access to medical care has long bedeviled swaths of rural America — since 2005, 181 rural hospitals have closed. A 2020 KHN analysis found that more than half of U.S. counties, many of them largely rural, don’t have a hospital with intensive care unit beds. Pre-pandemic, rural Americans had 20% higher overall death rates than those who live in urban areas, due to their lower rates of insurance, higher rates of poverty and more limited access to health care, according to 2019 data from the Centers for Disease Control and Prevention’s National Center for Health Statistics. In southeastern Missouri’s Ripley County, the local hospital closed in 2018. As of Sept. 27, only 24% of residents were fully vaccinated against covid. Due to a recent crush of cases, covid patients are getting sent home from emergency rooms in surrounding counties if they’re not “severely bad,” health department director Tammy Cosgrove said. The nursing shortage hitting the country is particularly dire in rural areas, which have less money than large hospitals to pay the exorbitant fees travel nursing agencies are demanding. And as nursing temp agencies offer hospital staffers more cash to join their teams, many rural nurses are jumping ship. One of Scoggin’s nurses told him she had to take a travel job — she could pay off all her debt in three months with that kind of money. And then there’s the burnout of working over a year and a half through the pandemic. Audrey Snyder, the immediate past president of the Rural Nurse Organization, said she’s lost count of how many nurses have told her they’re quitting. Those resignations feed into a relentless cycle: As travel nurse companies attract more nurses, the nurses left behind shouldering their work become more burned out — and eventually quit. While this is true at hospitals of all types, the effects in hard-to-staff rural hospitals can be especially dire. Rural health officials fear the staffing shortages could be exacerbated by health care vaccination mandates promised by President Joe Biden, which they say could cause a wave of resignations the hospitals cannot afford. About half of Scoggin’s staff, for example, is unvaccinated. Snyder warned that nursing shortages and their high associated costs will become unsustainable for rural hospitals operating on razor-thin margins. She predicted a new wave of rural hospital closures will further drive up the dire mortality numbers. Staffing shortages already limit how many beds hospitals can use, Scoggin said. He estimated most hospitals in Texas, including his own, are operating at roughly two-thirds of their bed capacity. His emergency room is so swamped, he’s had to send a few patients home to be monitored daily by an ambulance team.
A solution could be (half serious) to allow relatives of unvaccinated pre-ICU covid patients nurse their family members in offsite rooms. Knowing it would land on their own shoulders would make them wake the fuck up really quickly. An interesting feature of healthcare in Latin America is its expected that a family member is always present 24/7. There are sofa beds in private rooms and in wards, usually just a chair but often a lazy boy type. This takes a lot of strain off the nurses and patients get excellent attention, less stress, faster recovery I expect. Make the ICU into the I see you. (credit: Family Guy)
Should not be a surprise... the GOP governor of Montana and his staff used fake information to take a stand against masks. Staff scientists say health dept. used ‘misleading and false’ claims to justify school mask order The Sept. 17 letter was sent to Director Adam Meier via email by 18 staff epidemiologists. https://montanafreepress.org/2021/1...health-dept-used-misleading-and-false-claims/ In an internal letter delivered last month, scientific staff at the Montana Department of Public Health and Human Services criticized the evidence used by health department Director Adam Meier and Gov. Greg Gianforte to justify an August emergency rule discouraging school mask mandates, saying some claims made by the rule were “misleading and false.” The Sept. 17 letter was sent to Meier via email by Senior Epidemiologist Lisa Richidt and was co-signed by 17 additional staff epidemiologists. Their letter said the rule misrepresented the scientific literature by asserting that masks haven’t been proven effective at preventing the spread of COVID-19 and that prolonged mask wearing can harm children. The result, the scientists said, is a rule that undermines the health department’s credibility, “contributes to the spread of misinformation,” makes it harder for local public health officials to keep their communities safe and fosters divisiveness as school officials determine whether mask mandates are appropriate for their facilities. The emergency rule has previously been criticized by the Montana Nurses Association, which said it “promotes junk science” in a Sept. 8 memo. The letter from the epidemiologists, however, is the first public indication that discomfort about the evidence used to justify the rule extends into ranks of the state’s staff scientists. The letter, which Montana Free Press had sought via an unfulfilled public records request, was provided to MTFP this week by an anonymous source. One of its signatories independently verified that the document in MTFP’s possession is the document they signed. Gianforte spokesman Travis Hall declined to comment on the epidemiologists’ letter Tuesday, referring an inquiry to the health department.