Despite having watched Outbreak and Contagion, I remain no expert in epidemiology, and so I leave it to more knowledgeable people to make predictions about what COVID-19 will bring to our life and how we should address it. My general view is to hope for the best but prepare for the worst, but that’s unhelpful platitudinous nonsense when there are hard choices to be made. Some counsel panic while others argue denial. Neither helps.
Should things deteriorate as some anticipate, there will be hard choices to be made. This isn’t a new concept. When Obamacare was on the docket in the halcyon days of 2009, its opponents created the phrase “death panels*” to manipulate people’s fears, that people’s lives would be left in the hands of bureaucrats to decide if their lives were “worthy of saving.” Much as the phrase was intended as a rhetorical device to create fear, it wasn’t entirely wrong. The allocation of scarce resources will always require decisions to be made to provide, or withhold, the resource.
Since then, there has come to be a large group of people who contend that healthcare is a right, which means that people are entitled to it without regard to whether they can afford it. To some, this means a safety net for the poor. To others, this means an entitlement to whatever care they desire, no questions asked and no limits imposed. In other times, this could be some procedure of extreme expense and dubious efficacy if it promises to extend a life for a month.
But if this pandemic pans out as some expect, it will have a very different meaning. Putting aside the lack of coronavirus test kits, despite our having months to prepare in anticipation of it flying into Los Angeles, exponential growth will overwhelm hospital bed capacity and ventilator capacity, just as it’s cleared the shelves of hand sanitizer and N95-9 masks. If this happens, and I’m neither suggesting it will or won’t, but “if,” we will be constrained to engage in triage.
Triage is the process of determining the priority of patients’ treatments based on the severity of their condition. This rations patient treatment efficiently when resources are insufficient for all to be treated immediately; influencing the order and priority of emergency treatment.
This definition is at best inadequate and at worst misleading. There’s a reason the word begins with the word “tri,” as it separates people into three classes: Those who can be saved and are in the most extreme need of care. Those who can be saved and who are not in as extreme need. Those who cannot be saved. The last group will be left to die.
The rationale for this is sound, logical and cold as ice.
In these extreme situations, any medical care given to people who will die anyway can be considered to be care withdrawn from others who might have survived (or perhaps suffered less severe disability from their injuries) had they been treated instead. It becomes the task of the disaster medical authorities to set aside some victims as hopeless, to avoid trying to save one life at the expense of several others.
In some cases, the imminence of death is beyond dispute, as painful as that may be for others, family, friends, to accept. In other instances, it is a probability but not a certainty. With COVID-19, there stands a good chance that there will be far more uncertain cases at issue, where the limited availability of ventilators means grandpa, who has a 30% chance of survival, is denied one so it can be given to a younger person with a 70% chance of survival. From a detached perspective, and the expected complaints about why we don’t have enough ventilators for everyone who needs one aside, this is the only rational way to address the situation.
But if that’s your grandpa, and you neither know nor care about the younger person, you don’t care. All you know is that grandpa could live but was killed for lack of a ventilator. You will be outraged because you’ve been convinced that grandpa is entitled to care. It’s his right. It’s a human right. You believe this with all your heart. There will be a thousand stories of wonderful people dying needlessly afterward, followed by the demand of healthcare for all that wouldn’t have saved grandpa anyway because that was never the problem.
Some have suggested that I tend to be cold and harsh when it comes to employing unpleasant logic that would deny a desired outcome, insisting that if one wishes hard enough, fantasies can be real. There is much that could have, and should have, been done in anticipation of this pandemic, and perhaps it would have created a very different situation today. Perhaps not. Pathogens will happen despite the best plans.
But since we’re faced with the situation that exists, a condition well-known to criminal defense lawyers who take on cases where the defendant comes to him only after doing everything we would advise against, we don’t squander our energies on things we can’t fix and focus instead on dealing with the case as it exists.
The situation we face with the coronavirus will be whatever it will be. Hopefully, actions will be taken on every level to reduce its impact, to lighten the pain. But if there is pain coming, as appears to be likely, then we need to come to grips with the concept of triage, a reality too many have spent the last few years denying.
Not everyone can or will be saved. There is no right to be saved at the expense of saving someone else. Cold, hard choices will have to be made. There is no other choice, and even when it’s your grandpa, or your younger person, or your most passionate belief that both are entitled to survive, we must have a rational way to make the choice. This is why we have triage, as we must.
*The phrase is specifically attributed to Sarah Palin.
Discover more from Simple Justice
Subscribe to get the latest posts sent to your email.
Robert Heinlein.
“All societies are based on rules to protect pregnant women and young children. All else is surplusage, excrescence, adornment, luxury, or folly which can – and must – be dumped in emergency to preserve this prime function. As racial survival is the only universal morality, no other basic is possible. Attempts to formulate a “perfect society” on any foundation other than “Women and children first!” is not only witless, it is automatically genocidal. Nevertheless, starry-eyed idealists (all of them male) have tried endlessly – and no doubt will keep trying.”
In time, those lifeboats will get lonely.
“women and Children First”, for the reasons Heinlein gave in the quote, has not made sense for many generations. In fact, it never really made that much sense except on a family/tribal/village level. Your ethnic group is not going to die out if some women and children who are part of it do. There are many thousands more. In the past, your family/village/tribe might have been damaged, or even destroyed, if that principle was not followed, but modern society will not be harmed, it will continue. In fact, pretty much every scientist agrees we need fewer people, not more. We follow women and children first because that is what men do by instinct, but the instinct evolved under far different conditions than those existing now. “Childen first” still seems fair, if nothing else, we’ve lived a lot longer than them – “mother’s and children first” makes sense, someone needs to take care of the kids – but in terms of what Heinlein is saying, “racial survival”, a grandmother should not take a place on the lifeboat that could be given to a healthy young man. To be clear, we should keep doing “women and children first” – only excluding the extremist feminists who say they want perfect equality.
Was it only about survival of the species, or was there a chivalry component in there as well?
Rudyard Kipling.
“To stand and be still
to the Birken’ead Drill
is a damn tough bullet to chew.”
For those unfamiliar with the origin of “Women and children first.”, look up Birkenhead Drill. No link per rules.
The History Guy episode on it is…
Moving.
The math and logic here are indeed cold and inescapable: if millions are infected then not only will tens of thousands at a minimum die from the virus, but more will die from not receiving medical care for other issues due to lack of resources.
This isn’t Captain Trips, it’s not the end of the world, but it is a serious situation, and it’s maddening to see otherwise intelligent people acting as if preparing for this is stupid and the threat overblown.
I see Trump supporters denying that any problems exists in order to prove Trump’s failures to not be failures. I see SJWs going to bars because they are young and healthy, and so what if catch it because they won’t die and don’t care if they infect olds because they don’t deserve to live anyway for destroying their world.
Stupid knows no ideology.
The threat is overblown in the sense of misdirection. The guidance from the CDC is the bug affects a distinct subset of the population–a subset always at risk. Now, that group has a heightened risk. The risk is not to the entire population, and people under 70 should stop sucking up all the toilet paper. That “preparation” is stupid. Grandpas, many, will die. That includes me.
The early goal is to slow the spread of the infection until treatment protocols are in place for those that get sickest. Sure, they should have been in place before, but they weren’t. ERs were overwhelmed before this happened, with patients spending a week or more because no beds were available in the ICU. The situation will get worse.
But freaking out isn’t the appropriate response, especially by those not threatened.
At the risk of being called bat shit crazy by a man i truly respect ( that’s you my dear host ) i recommend taking the time to listen to this vid. Clif is one of those guys that treads the line of genius and BSC. Planing for a worst case scenario won’t hurt anyone if it don’t happen. Us ‘creatives’ can come up with some good ones, ya know. 🙂
Mr. High is convinced its a biological weapon, as there are additions in the genome that are not possible naturally. If that is the case, there will be no vaccine that will work, as each new ‘bloom’ will have new mutations…if your paying attention, you know that virologists are already seeing this, and adding a number or letter to the name of the virus to denote the “strain”. I could go on, and on….but the most important thing you can do is have your immune sys. as tough as possible. Vitamin C seems to be THE major key in self-protection…Chinese Dr.’s are having good results with massive I.V. doses. ( Also vit’s D3, all the B’s and Chaga mushroom tea or tincture, for protection)
Personally, I’ve had no ‘healthcare’, or Dr., or any illnesses for 40+ years…I take 2g’s a day since the early 80’s( ascorbic acid caps or powder,[ plus a bunch of other supplements])….note: taking plain AA vit C only gets about 20% absorbed by the body, if you go overboard, 4g’s+, you’ll get the runs, or as they say ‘past your bowel tolerance’. Way better is, Liposomal Vit. C..due to it being encapsulated in a fat that gets it past the gut tolerance problem…it has an 80% absorption rate!
I.V. AA Vit. C has about 75% absorption rate, but skips the gut, so its the most effective when someone is in a critical condition…..but if you feel yourself getting sick, you can get a possibly life saving “massive dose” (12g-25g) of C with the Liposomal version, that would be impossible, and even unhealthy, with regular AA Vit C. ( Google Linus Pauling…pioneer in C research)
The Liposomal kind is lot more expensive than AA Vit. C, but the good news is, if your poor like me, you can make your own Liposomal C almost as cheap as plain ascorbic acid…I’d like to drop the link, but just put https://qualityliposomalc with a dot com at the end for a good recipe to make your own….I’ve been using it for a few weeks now, and I’ve done over 8g’s at one shot with no sign of the runs ( yes, i am a 6’3″-220lb lab rat ) (note: i used sunflower lecithin instead of the soy based kind he used in the recipe, with no problems)
A new world is upon us. If you wanna see what its gonna be like you better get on board with DIY health care if things get bad. ( and for Christ sake, learn to clean your ass with a washcloth) Lets all say a little prayer now and hope that none of what i said here will be necessary.
PS: I AM NOT A DOCTOR, AND THE ABOVE IS NOT MEDICAL ADVICE. Just an “anecdotal” experience…
Because I love you, I posted this. Further, your affiant sayeth naught.
I have a spare tinfoil hat if anyone needs it.
I like to poke fun, but I stopped going to the office weeks ago, and started taking more C than usual, and I just ordered some Chaga. What’s the old saying… It’s better to wear a tinfoil hat than to die from coronavirus?
OK…I was feeling a bit butt-hurt, but not enough to fill out the form mind you..
I really don’t believe much of any thing these days, be it MSM lies, or deep wu-wu guys.
I do find the wu-wu guys, like Clif, are good as a way to stimulate the far reaches of “what if” thinking. Its a form of exercise for ones imagination.
Since i don’t watch anything from the tar pit called Hollywood, where the imagining is all done for you, i get my crazy ideas from actual crazy guys. Its a lot more fun than Star Wars… and if anything of really ‘high strangeness’ ever shows up in this reality, i may be a bit more prepared to deal with it than your average tube zombie.
While your stocking up on natural remedies that can be useful for these type illnesses, don’t forget Elderberry extract/syrup, and Usnea extract or caps.
The Usnea is more of a med than a supplement…it makes the bronchial tubes slippery, and stimulates the cilia to get the spooge outa your lungs.
(I got the last bottle of Elderberry at the big supplement store in town the other day…the Usnea was already sold out from the online supplier i usually use, so good luck)
I hoarded Sambucol weeks ago. I hadn’t heard about Usnea; googling now.
Did they throw that in for free when you bought the pallet of toilet paper, and the 55 gallon drum of hand sanitizer?
In our enlightened age, the patients that are hopeless still get palliative care, so that they feel better while they are dying.
If you want to know what could happen, I suggest looking back to the Spanish Flu pandemic of 1918. My folks often spoke of it, and there is a fairly complete historic record of what happened. Highlights included the failure of the medical system and mortuary facilities. Even healthy young people could be dead within 48 hours of the onset of symptoms. People died in numbers, in their homes and in the streets, and there were not enough caskets. Consequently burials, when they could be managed, became ad hoc affairs with whatever kind of shipping crate or box might be obtainable. Even here in the flats, if you go to any old cemetery, the number of headstones from the time of that pandemic continue to tell the story of its impact.
Maybe today, our communications and supply networks are a little better, but we are dealing with a “novel” virus for which there is no specific treatment and as to which nobody will have specific immunity. Some people did have fortuitous immunity to the Spanish Flu, so I think it could be a toss-up whether the problem we have now is going to be more or less severe.
Is it dark and moist down there?
Only when the power goes out.
Everyone keeps going back to the Spanish Flu epidemic.
That’s like comparing the Spanish Inquisition to a modern trial. The aren’t the same, at least in first world countries.
Public sanitation, clean water, medical advances and supplies, better nutrition, etc. make the environment totally different.
We are about to have a crisis of liability, sparked by the need to triage. All of the people who expect care to meet a certain legal standard are going to realize that the higher the standard, the more the triage.
At heart the main risk of coronavirus seems to be a distinct lack of ventilators. And what is a ventilator, really, but a device to push a set volume of air at defined intervals? It’s quite literally an air pump.
That is not an inherently-difficult thing to build with even 19th century technology, much less 21st century technology and manufacturing. Give me a compressible “bag” to base off of (cheap, plastic, easy to mass produce) and a one way valve (same) or better yer a manual one designed to work w/ a squeeze, and I can build a foot-powered one out of construction timbers fairly fast. Give me a couple of extra days, and I could power it on 110V electricity. Give me two weeks and a few widely-available relays and sensors, and a friend and I could figure out how to run it through an Arduino.
And I’m not even good with my hands. Give that same task to my engineer grandfather-in-law, together with a free weekend, and he would walk into his garage machine shop and come out with a version that would work 10x better than mine.
What *IS* difficult is making it “perfect”, so that you have computer control; alarms; fancy dial settings, easier setup; years of longevity; and so on.
And what is REALLY difficult is making it liability proof. That is going to need to change.