A short while ago I was on one of those e-conversations where folks were sharing notes on COVID-19.  E-conversations serve a vital role: they’re quicker and can reach more people than U.S. mail; and more amenable to actual conversation than text or twitter or similar.

In this particular conversation, one comment was tossed out, and another (myself) responded, as follows: “Meanwhile the hospitals are losing tons of money as they have cleared the decks for the epidemic that fails to happen here, many medical people of my acquaintance are suffering significant losses of income while twiddling their fingers [emphasis added], and local small businesses are decimated.  Welcome to life in the panicdemic [not a typo].”

A little later I replied (also emphasis added: “…re “the twiddling fingers” and lower incomes waiting for the crisis that hasn’t happened.  I hope it won’t happen.  And remember your local fire department, who is always ready for a crisis, but probably is rarely used for such.  In this one, we were caught with pants down, so to speak.”

It occurred to me that both comments, and many others no doubt, are relevant in this time of great uncertainty, and that neither of the two responders above have any direct connection to “public health” outside of what we know casually, experienced personally as a patient, or learn from others.  So I asked my sister, a retired Nurse Practitioner in New York State with lots of experience in public health in her long career in nursing, if she’d be willing to weigh in.  Her response follows.

Following her response is mine, which I wrote before I read her comments.

Mary:

Dick: I made an unrelated editorial comment on the above in my post Easter Sunday.  You can read that here.

My initial response, above, about emergency service in our society would remain my primary response.  Very rarely are there disastrous fires – they become front page news in their areas.  Because there are few fires does not mean we should cut back on what is, really, emergency preparedness.  You don’t develop and staff a fire department after the fire begins.  You have it available when it is needed.  In small communities this can be a real stretch, of course.  But even in the small towns there is some kind of rural fire department staffed by volunteers, and this has always been true.

I’d encourage thinking about other analogous services:  9-1-1 for emergencies comes to mind immediately.  It is a shared service, first used in the U.S. in 1968.  I could expand my list of rarely used, but important and even essential services for everyone that we take for granted, that are a public responsibility through taxes.

COVID-19 hi-lites an attitude problem.  We still have a tendency to think that we are an island in an inter-connected world – where we can close down something that originated somewhere else.  Very simply, we have porous and un-closable borders.  Period.  We are learning this the hard way in the United States, right now.

If we learn anything from this pandemic, it is that we need to increase our attention to the probability of some new and even more difficult pandemic that will most certainly strike sometime in the future – something which could originate here as easily as anywhere else on the planet.  This is an opportunity.  But it requires plenty of funding and a change in mindset: it has to become like the local fire department, a necessity not a luxury.  “Public Health” means everyone, not only those who can afford it.

In the Easter Sunday post I recalled visiting a hospital in Haiti in the spring of 2006.  After I published that post I got to thinking back to another trip, to the Philippines, in 1994.  I was traveling with a cousin and her group.  The cousin grew up in the Philippines, and was returning for a school reunion,

For two or three days we visited one of her friends, in an obviously wealthy family in Cebu City.  One day the husband took me around to see local sites; one evening they took us up to a high point overlooking the city.  My memory is of lots of people living in the ditches along the road.  Here they’d be called homeless; there, the ditch was home.

My host, later, in Cebu City, was showing me Magellan’s Cross in Cebu City.  My memory is that it was in a central square in the city.  Across the square was a hospital and/or a Cathedral.  I remember vividly, still, what my host said, matter-of-factly, while we stood looking across the way:  “here“, he said, “if you are rich you can afford to get the best medical care available to anyone in [the United States].  If you are poor, you die.”  Those with resources could easily go to Japan or the United States or anywhere else for the best care available.

There was no response asked or offered.  It was just a matter of fact.

This is our problem in this country on this day, at least in general.  If you are lucky, you don’t have to worry; if you aren’t, it’s your problem.  The problem with something like COVID-19, is that this virus, or something else, doesn’t recognize a persons wealth or where he or she lives or what her position might be.  It just goes to work.

We can learn from this – or just wait for the next crisis.

I open the floor to any and all comments!

POSTNOTE:

Kathy forwarded this received via a mutual friend, Howie.  I’ve seen this before, and it remains very relevant today.

There’s Something About Mary (unsure of source):

Between 1900 and 1907 a number of families living in New York City would mysteriously contract typhoid and fall ill. Typhoid is a bacteria that causes severe diarrhea, nausea, vomiting, and fever.  One by one New York families contracted the disease, seemingly at random with no explanation as to the cause. Finally, in 1907 one family  who had contracted typhoid hired a medical investigator to determine how they had become ill.  The investigator examined the household and discovered that the hired family cook, an Irish woman named Mary Mallon, had pretty disturbing habits, most atrocious of which was that she didn’t wash her hands after she pooped. Did I mention that typhoid is typically spread via contact with fecal matter? The investigator then examined her work history. All of her former clients happened to be the families that had contracted typhoid over the past 7 years.  She would cook for the family, they would get sick, and she would flee and sell her services to another family, who in turn would get sick.  It was no coincidence, as under medical examination it was discovered that Mary was an asymptomatic carrier, meaning she was infected with typhoid, but had no symptoms of the disease.

Mary was immediately quarantined at a clinic on North Brother Island. She denied she was a carrier and refused all medical treatment, including the removal of her gallbladder which was infested with the bacteria. Without her cooperation state medical authorities didn’t know what else to do except hold her in quarantine.  Finally in 1910 the NY State Health Commissioner ordered her release when she signed an affidavit to abide by certain sanitary conditions like washing her hands and to never work as a cook. After her release, the typhoid epidemics began again.

Over the next five years Mary Mallon worked as a cook for larger institutions such as schools, factories, orphanages, and hospitals.  As a result major typhoid outbreaks would occur all over the city. In 1915 a typhoid outbreak occurred at the Sloane Hospital for Women resulting in 25 sick and 2 dead.  When medical officials arrived to investigate, they found Mary Mallon cooking in the kitchen, having taken the alias “Mary Brown”. She still didn’t wash her hands after she pooped.

Mary Mallon was placed under arrest and once again placed in medical quarantine.  Once again she denied that she had typoid and refused all medical treatment.  This time, the authorities held her indefinitely, and as the years and decades went by Mary still refused to be treated or admitted that she had typhoid. Her story became a news sensation, with the media branding her with the nickname “Typhoid Mary”.  Mary Mallon would spend the rest of her life in medical quarantine until her death in 1938. During her culinary career she had sickened hundreds of people, resulting in 3 confirmed deaths with the possibility of many more unconfirmed deaths.

COMMENTS:

from Dick:  I’ve now read Mary’s thoughts.  Speaking personally, and as an individual, this has been a huge eye-opener for me in routine sorts of ways, such as ‘hand-washing’, and routine contacts with people.  I’m in a group where hand-shakes were common.  That will be a huge adjustment.  Etc. Etc.  We can’t solve all problems – every crisis will be different.  But we certainly can do better.

from Mary (her commentary above): Hi Dick….interesting!  Thyphoid Mary is a classic amongst professionals and I do not doubt its veracity.  Put in historical context…she is recent!  Major advances were made much earlier (1860’s) in infection control and awareness with the childbirth (puerperal) fevers contracted because health care workers did not wash their hands in obstetrical/gynecological work- see Ignaz Semmelwies.  Infection control and management is still pathetic in some of the cultures I have worked (Tunisia, 1968-a nursing job was to set the mouse traps in the wards each evening), (Malekula, 2014-a nursing job was to collect the wood, build the fire, and ‘sterilize’ instruments using an old pressure cooker).  Recently (October 2019) CMS mandated that there be at least one CDC trained infection preventionist in all accredited long term care facilities – primarily to increase awareness of contagion.  I have that certification and would restate the importance that the CDC (and WHO) puts on the infectious cycle….one thing this situation is doing is increasing awareness of transmission – this time it is airborne, next time, who knows.  Microbes are here to stay….and so is resistance.

from Joyce: Excellent; thank you for sharing this

from Flo: Thanks for sharing! Perhaps the most unforgiving aspect of covid-19 is that anyone can be a carrier, like Typhoid Mary, and not know it. I’ll keep wearing a mask in public, honor social distancing, and hope that I’m not a carrier nor become a victim. However, it won’t stop me from taking long walks with Carter, daily. I’ve also begun making masks, by request, and just received a very special thank-you from Mickey and her family and colleagues at her nursing home that appreciated my efforts! Same thing happened with Eric and Holly and her folks. It’s the very least I can do.

POSTNOTE April 8:   Today is Passover, Sunday is Easter, April 19 is Orthodox Easter.  Spring began March 19.  Whatever your tradition to recognize this season, this year is certainly without precedent in our era.  I saw a sign on my walking route this morning which speaks eloquently to all who see it.  The true test is how we as a society change as a result of this major test.

Related:  Fred sent this most interesting and informative link.  Take a look.

At entrance to Carver Park walking trail, Woodbury MN April 8, 2020.

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April 6: A month ago today I stopped by my daughters home, and she urged me to lay low for awhile because of COVID-19.  The concern seemed overblown, and my lifestyle is careful anyway, so I mostly continued life as usual for about a week.

Yesterday, the same daughter called, and says she’ll be making masks for us.  I fantasize what mine will look like….  Bank lobbies are not open, so they don’t have to worry about a masked man on premises!

We all have our own stories.  (Mine are basically in all of the March and April blogs, through the present.  See Archives).

Early on I had myself as 6 or 7 on a continuum (0 = hoax; 10 = hysteria).  I think I’m still there, but much more aware than I was.  We seem to. be faring okay so far, but this week, everywhere, apparently will be rough.  Getting sick with the virus is a lottery none of us want to ‘win’.  It is not to be trifled with.

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Observations from a single citizen (me):

Service:  First and foremost, thank you to those in the medical and other related professions in the front lines day to day dealing with the virus.  They are heroes, pure and simple.  Most true heroes never intended to be such, but when their time came they were ready.

Personally, I am most aware of the people who have been and will be the face of American business in my daily life.  Mostly these are younger people in low wage jobs – at the coffee shop, restaurants, grocery store, gas station….  These are largely people without financial reserves; the people who are at risk of exposure simply being at work; the people for whom financial recovery will be difficult and iffy.  I think constantly about how I/We can help these folks now and later.  They play a large role in the quality of life for this senior citizen, as they do for citizens in general.

Like most everyone, I know people personally who, while they, like me, have escaped the virus itself, have been damaged in various ways by its effects, directly and indirectly.  I could make a list, which lengthens…but this is NOT the time “to reopen”, or to “go back to work”….  As a nation, we need to figure the implications of this pandemic on a great many levels.

Community:  I think we all value community; the dilemma is where we individually set the borders of our ‘community’, from the most basic (“My home) to the broadest (“Our planet”) and all shades in between.  My general sense, just from brief forays out, is that we are more attentive to the idea of a greater community than we were before.  If I’m correct, what is critical is that we not stop where we are, rather continue to work for more improvement in the future, a future which will not be the same as our past, pre-COVID-19.

“Government” as essential:  ‘Government’ as a thing is very easy to kick around.  But we are daily learning how important a strong caring central government is; the very reason we became a United States, rather than a federation of independent states.  There is no way that I as an individual, or we as Minnesotans, can prepare for and anticipate everything.  We are in trouble now largely because key people diminished the value of a strong federal government “of, by and for the people”;  then diminished, for far too long, the notion that COVID-19 would be dangerous, even though all evidence available through intelligence was available several months before the alarm was sounded.  As we are finding, this was too late.

(Personally, my first awareness of a coming crisis was when I learned that some early flu victims were to be quarantined at Miramar, CA, where my grandson happens to be a Marine.  This would have been in very early February, and involved a group who had come in from Wuhan, China.  Lifecare in Kirkland WA came later.)

Planning and preparing for the long term is essential”: It should not have to be a political fight to invest in our future in all the ways that entails.  Rather than continuing campaigns to cut taxes, and hope that crises will not happen, we need more to think always in terms of the worst case, and plan accordingly.  This is neither cheap, nor a waste of money.  We were not prepared for this crisis in any sense of the word.  Bad things would have happened, regardless, but what we have experienced already and will continue to experience in large part is because of what our government, especially at the federal level, did not do to prepare for this.  (There will be plenty of time to do a fact-based debrief.  We will not look good.)

A month ago I could not have imagined this day.  I hope next month and those following will be a bit better, and that we all will have learned a very hard lesson.

Postword April 7 – An Opportunity: This, in my religious tradition, is Holy Week, culminating with Easter Sunday, April 12.  This, along with Christmas, is the day when everybody goes to Church – a busy day for ushers like myself.  This year the Basilica will be empty, as it was on Sunday – Palm Sunday – as it will be all week.  There will be a service, on line, each day of this week, Holy Week.  You can watch here, wherever you are in the world, if you’re on Facebook, whatever your tradition, whether a ‘believer’ or not.  They do an impressive job.

A suggestion: out of adversity often comes opportunity, and out of this adversity comes an opportunity to seriously reflect on what this all means to you, to all of us.  Sometimes adversity – a quick kick in the rear end, as my ancestors might say, and do, leads to insights one doesn’t normally have, and the interruption of our normal hubbub gives us the time to pay attention to things we may have overlooked in the franticness of contemporary daily life.

Give this week a chance for this activity.  You won’t regret it.

Postcard from the Busch farm in North Dakota app. 110 years old.  Here’s my article about the postcards at the farm, written 2006.

COMMENTS (More at end of page, from MN unless otherwise indicated.)

from JP in Manitoba: The following [including informative link to Winnipeg Free Press] will give you an idea on how we are faring in Manitoba.

My friend Suhail died in Pakistan a few days ago.  He was only 41, consequence of brain cancer.  We only worked together for a couple of months, and there is nothing I can add to what his fellow Pakistani, Ehtasham, wrote as an obituary a short while ago.  My life was immensely enriched knowing these two men, Fulbright scholars at the Human Rights Center of the University of Minnesota Law School.

The results of our labors together in 2014 can be seen here.  Suhail was the photographer.  It was Ehtasham’s project.  I’d specifically recommend the interview with Melvin Giles, if you wish to view only one.

Suhail is at Peace.

Suhail

Here is the link to Ehtasham’s obituary for his friend and colleague Suhail, presented exactly as I received it: Ehtasham Anwar- Suhail Apr 2, 2020.  (Click on the image to enlarge it).

As I write, I remember a long ago funeral I attended, honoring a teacher who had died at a young age, and was a very active contributor to his students and community.  The minister offered his eulogy, in part this memorable tribute.  “He lived before he died, he died before he was finished.”  If we all can be the same.

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If you wish further information please contact Dick Bernard.  e-address in upper left corner.

PRENOTE:  Have you filed your 2020 Census Data?  The website is here.  A mailer should have been received at your address earlier in March.  It is very easy to complete, and very important.

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Today was to be my annual tax appointment.  It was cancelled due to the Minnesota lockdown.  I submitted the paperwork on Friday in the event my tax preparer can do the preparation without my attendance.

I would venture that it is the rare person who likes the word ‘taxes’.  “Death and Taxes” are a common pair.

I think I have all but one of the tax returns filed since my first, which would have been about 1964.  One I misplaced.  56 years.  There is no reason to keep the others, but once the tradition started, it took root, and in the garage is a large box full of state and federal tax returns.  It will be something for my descendants to toss on my departure.  “Why did he keep these?” someone will ask….

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I truly don’t mind paying taxes.  I buy Justice Oliver Wendell Holmes Jr.’s declaration “Taxes are what we pay for civilized society.”

I don’t know for sure what my tax bill is for this year.  I am pretty sure that it will be similar to previous years: about 15% of our income for State and Federal taxes.  Has this broken us?  Hardly.

Yes, I know, there are those that aggregate any other conceivable tax to make it seem like half their hard-earned wages go to bureaucrats and other presumed loafers in that despised ‘government’, most of whom are expert in what they do, proven by their long experience doing it, regardless of the title of their position; whether in a cubicle or top floor corner office with windows on two sides.  Virtually every one of us are like these folks.  We have value.

What’s wrong with paying gas taxes to improve aging roads and bridges, or buy snow removal equipment for a city through municipal taxes?  Nothing, of course, unless you think you should get it for free, or for less, or later, when its already too late.

My favorite anti-tax guy was the old codger, during the most heated taxpayer revolution days, who slapped his wallet, as he exclaimed, loudly, “I want my money in my pocket, right here!”  It made for good drama, but not for good sense.  I was there, sitting near him at a community conversation the night he said it.  I wouldn’t be surprised if he’s still saying it, if he’s still alive…I used to see him at the copy machine at the local FedEx, running off his anti-tax flier for distribution somewhere or other.

One does not argue with someone so certain.  How about public schools?  Fire protection, roads, on and on.

Right now we’re dealing with the consequences of lack of foresight in dealing with a national crisis, COVID-19.  We ended up behind the eight-ball because the leadership of the Federal Government dismissed the potential need and all of us are suffering and will continue to suffer from this short-sightedness.

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If we are smart, we’ll use this episode in our history to take a good hard look at our priorities as a nation.  We need a strong central government, with strong United States, working together rather than being forced to compete with each other while the federal level tries to figure out what to do.

We will have plenty of months, this time, to reflect on how, or whether, we choose to work together for the greater good of everyone.

We are all wise in many ways.  We need to use our individual and collective wisdom to begin to right this collective train wreck in which we are living.

We can’t do this by our silence.

TOMORROW OR THE NEXT DAY: Breakdown in Communications.

More if you wish: Modified Happy Talk.

COMMENTS (More in the comments section):

from a good friend: I wouldn’t mind paying taxes if those taxes are spent on useful things, however, if you look at the budget of the Federal Government, one of the largest expenditures has to do with defense spending.  I may have told you that during my last few years at [a defense related industry], I worked with the Air Force and Navy to define defense systems that could improve their military effectiveness and could save each service several hundred billion dollars over the next system life span.  The Air Force showed some interest, but not so in the Navy.  The issue is that as you modernize and streamline, many of the positions that the officers were eyeing for their next promotion would disappear, hence there was strong objections to modernizing.  Just a fact of life, until we get a commander-in-chief that has the intellect to figure it all out.

NOTE: This is 10th in a series on Coronavirus, all in March 2020.  For the others, go to Archive, for March, 2020.  Check back for later commentaries on this and other topics.

Thursday’s Minneapolis Star Tribune had this front page graphic under a banner headline “Stay at Home”.  (I don’t feel guilty stealing the illustrations – I attribute the source.  Also, I’m (we are) a daily/Sunday subscriber to the STrib for many years.  I’ve paid my dues, or so I reason.)

Yesterday afternoon I stopped by the post office, and a young man preceded me in.  He was wearing gloves and a mask – not a crook.  Otherwise he appeared very healthy.  He’s been an unusual sight in my town.  I look at the graphic above: basically I’ve behaved consistent with the recommendations.  The only short term decision on the “what’s closed?” list will be a mutual one between myself and  barber – long retired who works out of his home for a few of us long-time customers.

In my opinion, the recommendations are very reasonable.  They have caused me no personal hardship, but they surely require a change in habit!  The financial and risk dimension for employees of closed businesses, etc. is another story, completely.  But these instructions are about health, and without health there is no consumption.

I’m about a month from 80, and thus too old to be constructively engaged in a physically active way, and in the prime at-risk group. frustrating realities.  I follow this crisis (and it is a crisis) carefully, and I offer a few personal observations in addition to the above.  My list is only a short list; mine could be much longer.

1.  The people on the front lines, particularly in the medical profession in any capacity are the heroes for all of us.   And, the victims are not only those who are exposed to the disease, but those who were people like the young people and others on the front line as the baristas at my now-empty coffee place, and all employees at our favorite restaurants, etc.  And yes, the businessmen and women, particularly small and local. These folks are the ‘face’ of business for lots of people like myself.  I keep thinking about how I can help them after a semblance of normal reappears, though that will have to be deferred.
2. This crisis points out once again that you cannot prepare for a crisis after it has begun – you have to do pre-planning, and then respond immediately.  We didn’t.  There was too much talk of ‘hoax’, and blaming someone else for starting the pandemic.  It wasn’t productive.  The old instruction applies: when the accident is happening, it is too late to fasten your seatbelt.
3. The federal government is always a favorite whipping post.  But a main purpose of States being United is the reasonable access to central coordination, as opposed to one state doing this, another doing that.  Pandemics don’t respect boundaries, we certainly are learning that again.  We had a bottleneck at the very beginning of this crisis, and we’re paying the price now for that.  Preparedness involves sacrifice before the crisis begins.
4. Shortly, we’re going to get a gigantic financial handout, or that is how it will be perceived and sold.  The federal government aid is essential and I support it completely, as I did in 2009 after our near national catastrophe.  But people need to look at this handout as each one of us taking out a loan for which the bill must be repaid, either in fact, or through future reductions in services we took for granted.  IN THIS COUNTRY, WE ARE THIS “GOVERNMENT”.  There is no free money, and while it is extremely convenient to offer it prior to an election, it can bite us all in the end.
5. We have an opportunity during and after this catastrophe to reprioritize our lives and the life of our country.  In too many ways we have been convinced to live our lives to facilitate profits for capitalism; where the well-being of our planet and our neighbors who live on it should be our focus.  Our country, with about 5% of the world’s population, has about 25% of the total money wealth of the planet.  Within our country there is a far worse inequity in wealth between the rich and the rest.  Within our own country, Paul Wellstone’s adage always has rung true: “We all do better when we all do better.” We have, and have had,  a collective responsibility much greater than a right.  “God” (or Capitalism) didn’t “bless America“.  That’s my ideological statement.

I could go on at much greater length.  Your thoughts?

POSTNOTE: Today’s Washington Post.  The U.S. is Still Exceptional by Fareed Zakaria