April 7, 2020 10:00 pm
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“Death is the sound of distant thunder at a picnic.” –W. H. Auden
It is growing increasingly difficult to report statistics about the pandemic without naturally wanting to cross over from just reporting facts to offering opinions about WHY things are happening as they are, and about WHAT is to be done. I’m going to do my damnedest, nonetheless.
However, one of my friends is a Registered Nurse in a sparsely populated rural state. We’ve been corresponding over the last several days. She understands this disease forward and back, and is treating victims in an emergency room. In relevant part, she writes:
“From my perspective, in healthcare, you have really, really helped me both in direct patient care and in practice by helping to educate patients and friends too…. What you’ve been doing is valuable and we need the information. I have expressed to you my concerns about the data being tremendously skewed. I want to emphasize this in terms of your calculations and margin of error. I spoke with an ER nurse today who straight-up told me our largest local hospital (city of @ 50,000 – 70,000 if we count the regional small farming communities) only have 100 test kits… AND they are NOT testing anyone. It’s so disturbing to me. I can’t wrap my brain around this. What they are doing are chest x-rays (which alone give little data other than “yes, you have pneumonia.” Of course, there are images that clearly demonstrate the virus; however, please note the x-rays are variable in presentation among patients who are positive – meaning they are NOT uniformly the same, meaning, diagnostically speaking, the exposure to radiation and a non-definitive diagnosis is totally inappropriate).
“They are also ordering a “respiratory panel” that does NOT include the Covid-19 antigen… We do know that almost 100% of patients with positive influenza tests have co-morbid Covid-19. I own a private practice, but I am affiliated with this hospital and sit on their quality assurance committee. I am terrified to address this, because I’m not sure how they will “handle” me, to be completely honest. It’s so unethical, suspect… I’m sort of coming apart. I feel like without accurate data we have little chance of finding a cure, vaccination, real treatment options. I feel like there is something larger going on and I’m not a crazy conspiracy person. But seriously… WHY can’t we have information?
“I went through the AIDS crisis, we had solid plans in place within about 10 days. Perfect? No. But there was testing and there were guidelines. All subsequent & similar crises were handled well. I’m SO confused about what the fuck is going on here. It’s keeping me up, I don’t trust anyone in the government. I’m truly on edge. To a large extent, I’m wondering if I should get out. But what I do is my passion…. I have a family too and I’m also a little concerned about the “squeaks” I’ve been making. I also don’t want my practice targeted. I am tremendously concerned about the numbers being completely underestimated, under-reported and virtually impossible to project. Do you feel, in your guts, this is on purpose? this whole not testing thing and skewed data is making me INSANE. The primary reason behind my telling you about what is happening – on a large scale – is to inform you the data is losing its impact. It has to without accurate reporting due to non-testing, which I believe is purposeful.
“I feel like the social chaos coming is their fucking fault for lying and keeping information from people. Even stupid people aren’t that stupid. Holy shit.
“The chaos is going to be outrageous. We are somewhat isolated from a regional perspective, but we’re not off grid… My husband is a senior accountant for a fiber communications company and feels strongly the internet won’t go down… Unless the gov. shuts it down.
“One more thing. There is an antibody finger stick test supposed to be available on Monday. Total BS. Antibodies only show if someone has been infected and/or carrying the virus symptoms or no symptoms. What ‘they’ are going to try to push out there is positive antibody = immunity and it does not. There is no empirical evidence for this, and very little theoretical evidence of immunity. If any at all. Just wait for the re-infection wave after the coming poop-residual from this move.
“I’m having a very hard time. I can’t even describe to you what is going on. It’s horrifying. Things are NOT Okay. I’m questioning giving up my life’s work and passion. It’s just over. I don’t see a way to go back.
I asked, “Are you already seeing cases where you are?”
She replied, “There are already cases here, but they aren’t testing. I’d say maybe 15% of patients with symptoms are being tested.
“They aren’t testing MULTIPLE DOAs arriving at the ER via ambulance (that’s not typical here other than drug overdoses & certainly not multiple/day) nor are they ordering autopsies. They aren’t testing patients arriving in respiratory distress or arrest. The illness itself is overwhelmingly and dramatically traumatic. I’ve seen a lot. A lot. South side of Chicago a lot. This is shaking my whole being. I’m scared to take my concerns to grand rounds. I’m scared to bring it up to the quality assurance committee I’m on. My private practice is falling apart. The SBA payroll assist won’t get us by. I don’t even care about the money. It’s just so awful. Awful. I would say [my state’s] confirmed cases are around 5-10,000 short.”
I said, “I just posted about how we’re like 41st in testing on a per capita basis. so what do you think this means as far as predictions and lethality? does the likely fact of a much larger denominator mean that actually the CFR is miniscule? And the issue is simply that it is novel? So if the whole world gets exposed, then yeah, some number of millions will die, but those millions are relatively insignificant, when viewed from the perspective of a denominator of 7 billion? the whole panic is just that it’s all happening at the same time instead of spread out over time. So is it something that just needs to be accepted? or is it really the existential crisis that it seems to be understood as?
She replied, “The latter. Re: your last comment. Millions aren’t insignificant. The mismanagement of this is profoundly concerning. Nothing is ever going to be the same. It can’t be. This is a fall. But maybe a chance to start anew. I’m processing. And seeing. And it’s breaking my heart.”
I replied, “Thank you. This is what I have been fearing. A former colleague and I, who worked on strategic analysis together for several years, have been in constant conversation over how things are going to play out, and we can’t come to any other conclusion than 2+2=FUCKED. I’m anticipating collapse of the banking system and social chaos soon. I can’t wrap my head around the fact that it seems like it will really happen, but right now all is calm. It’s like standing on the beach and seeing the huge tsunami 100 miles away and recognizing what that will mean, but it is still sunny and mild on the beach where I’m standing.”
“Exactly. Remember I see the illness in my face. It’s crazy traumatic.”
“I’m speechless. To hear it from you is frighteningly real.”
“It is the most real thing I have ever seen. More real than taking care of a 13-year-old girl on the south side of Chicago. Who had 3 babies by “uncles” in a crack house she’d never left in her life. Circa 1997. It’s more real than that. X 7 billion.”
Death is the sound of distant thunder at a picnic.
