Sex, Drugs, and Public Health

February 1, 2022


Filed under: Uncategorized — cbmosher @ 8:10 am

            Sometimes, whether writing on paper or two-fingering on the ‘puter, an issue reduces me to a hopeless tangle of glitching neurons. Shaking the Magic 8 Ball for the hundredth time, hoping for different answers, I asked people what the Covid pandemic had taught us about ourselves. Our list includes many lessons – some painful, some hopeful. You may have your own list. 

            Americans thought that our Health Care system was resilient – the best in the world. To be more accurate, most of those who believed this did not work in health care. To hold this belief, you’d need to ignore the two most basic facts about U S “Health Care.” First, that it’s been the most expensive system in the world for decades. Currently costing $10,500 per person each year. Second, that the Health RESULTS from our system have been among the worst in the industrialized world. And I’ve seen “Third World” countries with better health outcomes than we get for our massive investment.

            (Stops typing to face-palm himself about this yet again).

            OK. I’m back.

            How could so many people ignore these realities for so long?

            Answer: the “Sunk Cost Fallacy,” a Cognitive Bias which states that we invest more in things that have already cost us something, even if that results in a negative outcome. “Investment” can be money or emotional commitment.

            What Covid did was rip the bandage of denial from this Sunk Cost fallacy with wave after wave of variants overwhelming every aspect from ambulances to ICU’s. Nurses and physicians have been stressed, exhausted, heart broken and have been attacked by hostile families. Patients in need of non-Covid care (planned surgeries, heart attacks, cancer treatment) have been triaged to the back of the line, to their detriment.

            One of the most eloquent synopses of this situation was written by an E R doctor and dean of the School of Public Health at Brown University (Rhode Island). Some out-takes:

  • many beds are closed in the emergency department and across the rest of the hospital (including ICU) because of a lack of staffing.
  • patients have been waiting on emergency department stretchers for hours, until an intensive care unit, medical or surgical bed becomes available.
  • Health Care Workers suffer emotional exhaustion from caring for horribly sick Covid patients — especially now that the disease is so preventable. Said one, “I feel like we’re rats on a sinking ship. Do I jump off now or hope that someone saves us?”

            Added to this, a friend who is a cancer specialist in SoCal reports that blood donations have fallen off so drastically that there is no longer enuf for leukemia patients who need blood regularly to survive. 

            An E.R. nurse recently wrote about why she (like many others) is quitting. “A patient in critical condition who was waiting outside, coded in the ambulance bay, I learned that the patient had an active bleed and was given two units of blood at the previous facility where he was being treated. They ran out of blood there. ‘Would you like me to run and get STAT blood, doctor?’ I asked as I looked down at the pale, motionless body in front of me. ‘No,’ he replied. ‘We only have two units left, and we are saving it for any emergency pregnancy complications.’ I am watching my country’s health care system crumble in front of me.” 

            “I feel like we’re rats on a sinking ship.” (E R physician)

            So it took getting to this point, where our Health Care system is being held together with fraying twine and chewing gum to realize that it’s been run like a profit-making business, and is so lean that anything more than the short-term crush of several trauma victims at once or of sick folks during Flu season is too much for it. What we need, what you deserve for all that $10,500 per person, is a system that stresses Prevention. Keep as many people healthy and out of the E R and hospital as possible. Take the stress off Health Care Workers. And put together a system that serves the Public (not just those with good insurance), eliminating the profit motive which thrives on admitting as many “heads-in-beds” as possible. Meanwhile – – –

         Topless Urgent Care Centers !

            This satirical line from, “Don’t Look Up” is not as far from reality as I’d like. As politicians early on in the pandemic undermined Public Health professionals and the virus ran thru us as gleefully as an 8 year-old in Disneyland, Quacks and Scammers moved in for the kill. These are the descendants of the Old West’s Dr. Feelgood, who, from his covered wagon hawked magical elixirs (chief ingredient in “elixir” is alcohol) and snake oil.

            Exhibit 1: in Florida and Texas, they set up Covid testing sites which take your money and Social Security number, give you a swab, then disappear. 

            Exhibits 2 thru 5:  bleach, U-V light, Ivermectin, drinking pee.

            Exhibit 6: people that demand hospitals perform malpractice on critically ill family members by administering some of these fake cures.

            How can people BELIEVE this stuff?

            This question keeps popping up when people get together outdoors to drink and eat. Comes from both sides of the political chasm and is, apparently, applicable to most any human behavior these days.

            Answer is found in two more Biases – the “Dunning-Kruger Effect” wherein the less knowledge one has, the more confident he / she is. And the “Bandwagon Effect” where beliefs grow as more people adopt them.

            Ask not what your Society can do for you – – –

            Thought we’d learned that (paraphrased) lesson back when our skin was smooth and our hair wasn’t gray. But :

            Exhibit 7– flight # AAL38, one hour into its journey to London, had to turn around and return to L A because of one person acting out her distorted concept of “freedom” by repeatedly refusing to wear a mask. 

            Exhibit 8 – recently, another person in Virginia threatened to shoot local school board members who were discussing following State law about masks to protect the children.

            Exhibit 9 – people who study the genes of viruses and others who study the virus’ behavior (“epidemiology”) have found that the un-vaccinated population has become the breeding grounds for Covid variants. So we’re not waking up anytime soon from this nightmare. There are places in the world where people are begging for the vaccine but there’s not enuf available. Here, it’s the opposite. We are begging folks to take the (free) vaccine to protect, not only themselves, but everyone around them. But – – – nope.

            My Flabber is exceedingly Gasted at what Covid has revealed – the depth to which America’s concept of Rugged Individualism seems to have degenerated into flat-out self-centeredness. What Public Health does to protect people in a situation of a highly contagious virus  can only be successful if everyone (or some large majority) of Society co-operates. Society is people who do things for you (road repair crews, flight attendants, Health Care Workers, waiters, store clerks, teachers) AND you doing things for them (not running them over with your car, paying a living wage, getting vaccinated, wearing a mask or – failing that – staying away from them).

            A sizable segment of people has basically abandoned Society, endangering others with their behavior and justifying it with words. “Personal Choice.” “Pure Blood.” “Freedom.” There’s a Bias working here, too, “Reactance,” wherein we do the opposite of what we’re told. (Kind of thing we were supposed to out-grow around age 16).  

            We’re seeing the damage this is causing as the unchecked spread of Covid, but an even more profound damage to our Society comes from what underlies that: the subversion and rejection of our Public expertise and government service, which is dragging our Society off a cliff.

O.T.O.H. – – –

            Got a friend here in Mariposa and another off in Texas who had simultaneous epiphanies, not too long into the closure of schools in an effort to protect the kids and to control the outbreak.

            “Have a renewed appreciation of teachers,” they wiped their sweaty brows.

            Teachers’ jobs got even harder with Covid, what with re-working their curricula to fit the Zoom app. But family members had to keep the kids at the computer, urge them thru lessons, drill-sergeant their assignments. Teachers (along with the citizen-volunteers who make up School Boards,     nurses, restaurant servers, flight attendants, store clerks) are the previously underappreciated heroes, revealed to us by this pandemic. 

            We saw restaurants and other businesses struggling, failing. And we responded by supporting them with take-out orders, outdoor dining (in the snow, some places) and ordering for curb-side pick-up.

            Neighbors helped those who were afraid to go shopping because of their age or medical conditions.

            We reconnected more intensely with family and friends.

            Flip side of that coin: we came to see ourselves as Citizens of the World. Now a virus from an animal half the world away can hitchhike in someone’s pharynx and de-plane into a virgin population in mere hours. We’re all in this together. 

            We learned what Public Health does to keep all of us safe.

            Covid revealed how valuable Public Education is. With a constant whirlwind of mis-information and outright lies bombarding us and confusing us (not only about Covid), it reminded us that teaching young people to know how to find accurate facts and how to detect flawed information is crucial to a Free Society.

Punchline: as a physician friend said: “Life is short, sweet, precious and highly fragile.”

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