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theliberaltony · 4 years ago

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The first time Bob Duffy entered the world of epidemiology, he was an amateur scientist. It was 2003. He had retired from the New York City Fire Department and taken a sabbatical from his normal life in suburban Long Island to help his daughter Meghan earn her Ph.D. in Michigan. She was studying the ecology and evolution of infectious diseases, using tiny lake crustaceans as a model organism.

Together, Meghan and Bob would go out in a truck, towing a little, flat-bottomed rowboat. They were studying how epidemics begin and spread under a variety of conditions. They’d unhitch at one lake, and then another, working their way across the countryside as they collected and counted diseased crustaceans and the fish that preyed on them. “Over the course of a few months, you can go through a whole epidemic,” Meghan Duffy told me. Her father was her paid research assistant, and one of his jobs was to catch the fish. After 30 years of running into burning buildings, he couldn’t believe his luck, she said.

The last time Bob Duffy entered the world of epidemiology, he was a statistic.

Bob Duffy was a father, grandfather, retired firefighter, and longtime volunteer in his Long Island community. He died on March 29.

COURTESY OF MEGHAN DUFFY

He died, at home, on March 29, 2020. Officially, the cause of death was chronic lung disease. But there was more going on than just that. A sudden illness had left him too fatigued to leave the house, and he had had contact with multiple people who later tested positive for COVID-19. Yet Bob’s death certificate doesn’t list that disease as a cause or even a probable cause of his death. He never got tested — he didn’t want to enter a hospital and be separated from Fran, his wife of 48 years.

Instead, because he didn’t die at a hospital and because this was at the beginning of the pandemic, when guidelines were rapidly changing and testing was hard to come by, Bob Duffy became one of the people who fell through the statistical cracks. As of this writing,1 22,843 New Yorkers have officially died from COVID-19. Bob Duffy is not counted among them.

More than a month later, the question of who counts as a COVID-19 fatality has become political. In Florida, the Medical Examiners Commission accused state officials of suppressing their state death count. Pennsylvania’s death tally bounced up and down, enough to prompt the state senate to discuss giving coroners a bigger role in investigating COVID-19 deaths. And President Trump has questioned the official national death count of 90,340 as of May 19,2 reportedly wondering whether it was exaggerated.

The experts who are involved in counting novel coronavirus deaths at all levels — from local hospitals to the Centers for Disease Control and Prevention — disagree with the president. If anything, they say, these deaths are undercounted. And with a death like Bob Duffy’s, you can begin to see why.

Bob was a person, beloved by his family and his community. Ever since he died, Bob has also become a number — data entered into a spreadsheet, just like the tiny shellfish he and his daughter once pulled from cold Michigan lakes. His death might never end up being attributed to SARS-CoV-2, but his death matters to the way we understand it.

There was never a cough. Instead, the first sign of illness Fran Duffy remembers was when she and Bob tried to go for a walk and he couldn’t make it to the end of the block. “We got three houses down, and he said, ‘I can’t walk today. I’m too tired.’ I thought maybe he’s getting a bug. Maybe he’s just tired. So we came back. That was Wednesday,” she said.

He died four days later.

It was a very fast decline. But in other ways, Bob’s final illness was just part of a long string of sicknesses. Over the two decades since his retirement, he had had a stroke. He also had had cancer in his mouth, colon and liver. There was scarring — fibrosis — that had damaged his lungs and forced him onto supplemental oxygen. The radiation treatments that had cured his cancers years ago had also left him with nerve damage in his legs and a slowly eroding jawbone. Bob was not the picture of health. We are, after all, talking about a guy who worked for the NYFD during a time when firefighters did not routinely wear the ventilators and masks they had been issued. It was a macho thing, Fran said. You couldn’t be the one guy who put on the mask if nobody else did.

So when Bob got sick in late March this year, whatever it was was not the only thing he was sick with. He was also so sick of being sick that he wasn’t interested in going to the hospital. Even as his temperature soared to 103 degrees, Bob chose to do a video chat with his family doctor, Ihor Magun, rather than leave the house. Fran remembers the doctor suggesting they treat Bob as if he was positive for COVID-19, in terms of isolation from friends and family. He could have gotten a test — but the nearest testing center at Jones Beach was 30 minutes away, and then there were the long lines besides. Fran thought about driving him out there, but he was already sick enough that that option seemed worse for him than not knowing what it was that he had contracted.

All those small decisions, made in the moment because of what was best for Bob, ended up determining how his death was recorded.

The way deaths are counted, like so much else in the U.S., differs among (and even within) states. There’s a lot of variation in this process, even on a good day — a fact that stretches all the way back to the beginning of mortality records in this country. While the census began counting living people nationwide in 1790, recording deaths was left up to state and local governments. The first state to fully document its deaths was Massachusetts, in 1842. It wasn’t until 1933 that all states were turning in death counts to federal authorities.

Even today, now that the death certificate itself is fairly standardized, who first records your death and decides what you died of varies by where you live and where you die. And that variation is only likely to increase when people begin dying of a new disease that we still don’t understand. In Milwaukee County, Wisconsin, for example, medical examiners — medical doctors who investigate deaths and perform autopsies — must provide official certification for every COVID-19 or COVID-19-related death in the county, said Dr. Sally Aiken, president of the National Association of Medical Examiners. But that’s not true everywhere. In New York State, medical examiners get involved only in cases that seem strange or suspicious, like when an otherwise healthy young person dies with no prior warning, said Richard Sullivan, president of the New York State Funeral Directors Association. Otherwise, the decision is left up to health care workers.

Bob’s death certificate was filled out by his family doctor and did not mention COVID-19. The county medical examiner called Fran but asked only about Bob’s preexisting conditions. He had had enough of them that there was no reason to suspect foul play, and that was all the medical examiner needed to know.

If Bob had died in a nearby hospital, such as one of the ones in Nassau County owned by Northwell Health, he would have been tested for COVID-19, either before or after his death. Whether he’d been there for five minutes or a month, hospital staff would have been in charge of filling out the part of his electronic death record that pertains to cause of death, a representative from Northwell told me. This process can look deceptively simple — just write a cause of death on the line — but there’s more to it than you’d think.

A standard certificate of death provided by the National Center for Health Statistics leaves room for the chain of events that led to someone’s death.

The New York electronic death records form provides three lines for cause of death, which are supposed to be filled out in a way that tells a story. The idea is that nobody ever really dies of just one thing, Aiken told me. Even if you die in a traffic accident, the death record might read something like “Blunt force trauma … as a consequence of a car crash.” This is the information that helps people further up the data chain classify a death accurately. Leaving any part of the story out means a gap in the data later.

Not everyone fills out these records completely, though. And early on during the COVID-19 pandemic, there was a lot of confusion happening, said Shawna Webster, executive director of the National Association for Public Health Statistics and Information Systems, which represents vital registrars nationwide. “It might just say ‘coronavirus,’ which I’m sure you know is not as descriptive as it needs to be,” she said. There are, after all, multiple ways COVID-19 might kill a person. On the other end of the spectrum are people who fill out the forms completely wrong. “Please do not put ‘COVID-19 test negative,'” Webster said. “Do not do that. There were several.”

In the days after his first symptoms, Bob’s condition worsened. He’d become so tired he couldn’t leave the house — then so tired that walking anywhere by himself was impossible. He had a massively high fever. But even Saturday, the night before he died, he was still talking, Fran said, and so she asked him what he wanted for dinner. She expected something light. Bob said, “Corned beef hash.”

“I said, ‘Bob, corned beef hash?'” But he was sure. So Fran put it together for him, the man she loved. She had to move him to a wheelchair and bring him to the kitchen to eat. He could no longer walk without falling. “I bring him to the kitchen and I’m just turning to the sink to wash my hands and I hear plop,” she said. He had fallen asleep at the table. “His head went right down in the plate. And I just said, ‘Bob. What about the corned beef hash!’ So it just … he thought about it and he wanted it, but he just couldn’t get it, you know?”

Doctors say this kind of oxygen depletion and exhaustion — coupled with an ability to still communicate — is a common feature of COVID-19. Even after he collapsed at the table, Bob was lucid enough to talk to the priest who gave him his last rites later that night. He died the next day.

Over the next few weeks, it would become clear that Bob had been in contact with a number of potential sources of COVID-19 — or maybe he’d been a source that passed it to them. It’s impossible to know. His son-in-law was later diagnosed with the disease, and his wife — one of Bob’s three daughters — tested positive for COVID-19 antibodies. One day Fran would open the newspaper to find that the woman who had cut her and Bob’s hair for three decades — and who had come to their house just before Bob got sick — had died of COVID-19.

But Bob’s death certificate makes no mention of the novel coronavirus. Bob’s doctor did not return requests for an interview, so we don’t know why he made the choices he did when completing the certificate. But Bob’s immediate cause of death is listed as “cardiopulmonary arrest” — his heart stopped — as a consequence of “chronic obstructive lung disease,” as a consequence of “fibrosis.”

Bob is a prime example of why doctors and other experts think that COVID-19 deaths are probably being undercounted — not overcounted, as some COVID-19 skeptics have alleged. In fact, if Bob had died today, there’s a decent chance that he’d have been labeled a “probable” COVID death, based on current CDC guidelines, which, among other things, advise doctors to include “probable COVID-19” on death certificates when a patient has had symptoms of the disease and been in contact with people who tested positive. Originally, only people who themselves had tested positive for the virus were being counted. Like Bob, a lot of people were probably left out. But even as the guidelines were revised and the national death count — which includes probable as well as confirmed cases — shot upward, experts said that undercounting was still more likely than overcounting.

COVID-19’s death toll has been so overwhelming that officials have had to resort to makeshift morgues in trailers.

TAYFUN COSKUN / ANADOLU AGENCY VIA GETTY IMAGES

Some of this reasoning is based on logic. We know that we had a widespread shortage of tests when people were already dying of COVID-19, so it makes sense that these two problems would overlap at times.

Other reasoning is based on data. In a lot of states the number of pneumonia deaths in March was higher than what you’d expect for that time of year, or for the level of influenza active during that time — an important detail, given that pneumonia can often be a complication of that disease as well. These increases were particularly noticeable in New Jersey, Georgia, Illinois, Washington and New York, according to research led by Dan Weinberger, a professor of epidemiology at Yale School of Medicine. But pneumonia isn’t the only way COVID-19 kills. All deaths in the state of New York went up in March, and these excess deaths — deaths above the usual rate for that place and time of year — outstrip diagnosed COVID-19 cases statewide by nearly three times. Data collected by The New York Times suggests that the high number of “excess” deaths in New York continued through April.

Yet another reason why experts say we’re not overcounting COVID-19 deaths is that we’re now counting them in much the same way as we have always counted deaths from infectious disease. The methodology is longstanding and is used for all sorts of diseases — and there’s never been cause to think that the methodology made us overcount the deaths from those other diseases.

In the bureaucracy of death everything happens fast, fast, fast, and then, after a while, things just grind on.

If you look at the CDC’s annual report of flu deaths, for example, you’ll see that it’s “estimated,” modeled on official flu deaths reported, deaths from flu-like causes reported, and what we know about flu epidemiology. The calculation is done this way precisely because public health officials know that a straight count of formally diagnosed flu deaths would be an undercount of actual flu deaths.

While flu tests aren’t in short supply and essentially anyone who wants to be tested for the flu can be, not everyone who catches it gets tested. Plenty of people get sick with the flu and never go to a doctor, said Alberto Marino, a research officer at the London School of Economics who has studied disease case and death counts for both LSE and the Organization for Economic Cooperation and Development. If they die — especially if they are also old or have some underlying condition — the role the flu played in their deaths can easily go unnoticed and unrecorded. We don’t record “probable” flu deaths (again, the tests aren’t rationed), but we do record deaths due to “flu-like illnesses” — and plenty of people who die from the flu don’t have that listed as the cause on their death certificates.

Likewise, when a doctor lists COVID-19 as a condition that led to someone’s death — even if it was just the last in a series of illnesses — they’re not doing anything different from what’s been done with the flu for years, Aiken told me.

Basically, if you think COVID-19 deaths are being inflated, then you shouldn’t trust annual flu death counts, either. Or a whole host of other death counts. The only reason to really think that COVID-19 death counts are less trustworthy at this point is that the flu is politically neutral while the new coronavirus is not.

If there’s any major difference between the way we count flu deaths and the way we count COVID-19 deaths, it’s that nobody is trying to publish flu deaths daily, in real time. And that’s where death counting for COVID-19 gets complicated.

When Bob Duffy died, his community responded immediately. Fran found her mailbox filled with cards; flowers and baked goods piled up on the porch. At one point, there were so many tulips, hydrangeas and pansies that the Amazon delivery guy started to make comments, so Fran decided to plant the flowers around the yard. “There’s not one card that doesn’t have a separate letter in it,” she said. And many were from people she didn’t even know.

Besides being a firefighter and Ph.D. assistant, Bob spent many years working with the local Catholic parish’s social ministry. Essentially, he was a volunteer social worker. He made sure people who were hungry found meals. He helped strangers pay their utility bills, and he coordinated a Long Island-wide food bank. “Most people volunteer one day a week. Bob officially volunteered five days a week,” Fran told me. “He ended up with the keys to the parish. He was up there seven days a week, and he couldn’t be stopped.”

So when he did stop, people cared. And they cared for his widow.

Bob Duffy’s family will never know for sure whether he died of COVID-19.

COURTESY OF MEGHAN DUFFY

Death happens suddenly, abruptly. At first, family, friends and, sometimes, if we’re lucky, strangers burst into action like Roman candles, sending out showers of casseroles and condolences like sparks. For a short period of time, there is a lot to do, decisions to be made, love to be accepted. But then there is quiet. And then there is the rest of your life. The absence that death leaves behind lasts far longer than the initial flurry of condolences.

The bureaucracy of death has a similar dynamic — first, everything happens fast, fast, fast, and then, after a while, things just grind on.

In New York, in the heady first day or two after a person dies, the doctor or hospital enters the cause of death on an electronic death record, the funeral home fills out demographic data on the same form, and the state registrar of vital statistics logs the data. But from there things slow down considerably.

Usually, that’s fine — death statistics aren’t so volatile that we need them to be updated as quickly as, say, election returns or live sports scores. But the pandemic has changed our relationship with these stats. Now they’re how we know whether we’re stopping the spread of COVID-19, and just how big that spread is. The problem is that the system isn’t designed to do that work.

Normally, if a death is uncomplicated and requires no investigation or autopsy or debate, death records are transferred to the National Center for Health Statistics, an arm of the CDC that organizes and analyzes the data of life and death in this country. It’s here that a death is categorized and tabulated. And this process is happening now, with COVID-19 deaths as well.

It takes time to investigate some of the deaths and get them to NCHS — the frequency of investigations varies widely, but state-level emergency operations teams work with medical personnel and state epidemiology surveillance to review COVID-19 deaths and possible COVID-19 deaths, Webster said. So the records can be in the state databases for a while before they’re solid enough that they go to NCHS. Then, someone at the NCHS is reading each of these death records to make sure that, say, a car crash victim who happened to have a COVID-19 diagnosis is logged in a database differently from a COVID-19-positive patient who died on a ventilator. The result of all this is that, even though public counts include confirmed COVID-19 deaths and probable ones, the deaths aren’t just being recorded willy-nilly. And it will be possible, in the future, to go back and look at the records and see which cases were confirmed by testing and which weren’t.

But these are slow stats. And they’re slowed down even further by the confusion caused by a novel virus pandemic. Currently, the count of COVID-19 deaths produced this way is at least two weeks behind, said Robert Anderson, chief of the mortality statistics branch of the NCHS. The counts in some states, including New York, might be lagging even more. This system is the gold standard, Webster said, but it’s designed to produce accurate statistics — not monitor a pandemic in real time.

Death is hard — hard to count, hard to experience.

And so the CDC also has fast stats on COVID-19 deaths. Besides going to the NCHS, the data from the New York State vital records office is also gathered directly from that agency’s database and into one maintained by USAFacts, a nonpartisan nonprofit organization charged with collecting daily death reports from the state and county registrars that first record them. The CDC’s COVID Data Tracker comes directly from the USAFacts count.

That means there are two distinct death counts being published by the CDC — one slow, one fast. (That’s in addition to counts being kept by Johns Hopkins University, The New York Times, and other entities.) As of May 19, the CDC’s slow count was 67,008, and its fast count was 90,340. You’ll find both counts in various sections of the CDC’s website, and when you look at those pages, it’s not always clear what these separate counts do and don’t represent. It’s easy to get confused and assume that the death count you’ve just seen in the newspaper has suddenly been cut in half. On May 2, conservative firebrand Dinesh D’Souza falsely claimed exactly that, linking his followers to the CDC’s slow count.

The smaller, slow count is more accurate, but it doesn’t reflect how many people have died as of today. It’s weeks behind. The fast count does a better job of portraying the real-time situation, but the exact number will shift as state and local counts fluctuate. Some of that change is due to confusion between state and local entities. New York City, for example, has its own vital records office — almost as though it’s an independent state — and the fast-count numbers it produces for itself don’t usually match the fast-count numbers produced for it by the State of New York, said Tanveer Ali, a data visualization analyst for USAFacts.

And while Bob Duffy will not be counted in either the slow or the fast counts happening now, he will likely end up included in the data — if only by algorithmic proxy. Eventually, experts said, the CDC will come back and do an estimated burden of death counts for COVID-19, just as it does for the flu every year.

All of this is why we won’t know the exact number of people who died of COVID-19 for years, Aiken said. Again, that’s nothing new. Final estimates for the number of people who died in the 2009 H1N1 pandemic weren’t published until 2011. Getting the slow count right, sorting through differences between disparate and nonstandardized state reporting systems, correcting errors and categorizing probable cases, finding ways to understand how many Bob Duffys we’re missing — it all takes time. This is, experts emphasized again and again, something nobody has ever done before. But the precedent that does exist suggests we shouldn’t expect to get a “right” answer soon. “If you look at opioid mortality, they’re two and a half years behind on compiling that,” Aiken said.

Death is hard — hard to count, hard to experience. The personal and the statistical both reside in a space where the question of “what happened” can be answered as an absolute — as certain as we can ever be about a thing — while simultaneously remaining painfully inexact and mysterious.

We will almost certainly never know exactly how many Americans died of COVID-19. But any count we get by leaving out deaths probably related to the virus — and, ultimately, leaving out Bob and a lot of people like him — will be less accurate than a count that includes them.

“We like to have answers. We like to have a yes, a no, a definite answer,” Fran said. Bob had been dead for about a month when Fran spoke to me from her kitchen. Just that day, someone she didn’t know had sympathetically left a loaf of banana bread in her mailbox. He was still so close. He was so far away. “But we certainly don’t always get what we like,” she said. “That’s really the truth, you know?”

Additional reporting by Kaleigh Rogers.

#IFTTT #Politics – FiveThirtyEight #politics #538 #Maggie Koerth

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drakus79 · 5 years ago

Text

We’ve reached the climax

I know it’s been a long time since I updated. I don’t update often and sometimes forget I have this blog, but I had to follow up on my earlier Fourth Turning predictions. I believe we are now, thanks to COVID-19 and our reaction to it, in the climax of the Fourth Turning (4T). Please read up on Strauss and Howe Generational Theory if you haven’t heard of it before.

https://en.wikipedia.org/wiki/Strauss%E2%80%93Howe_generational_theory

Trump is, whether you like it or not, the Gray (orange) Champion of this cycle. His approval keeps going up despite this crisis and it doesn’t seem likely that he will lose to Biden in the next election. But that could change, especially considering the long term economic effects of this crisis. Biden’s choice of VP is very important as whoever he picks is likely going to be the real president if Biden does manage to win. I'm guessing he's going to pick Kamala Harris, but I could be wrong. It's interesting to note that a presidential nominee has never died before the election, but that actually may happen this time considering the ages of the candidates and COVID19. And even if Biden does manage to survive to the election, he's already in his late 70s so he may not last two terms.

But it's interesting to note how unimportant these politics seem at this time. Issues that were huge only a month ago (impeachment, FISA abuses, even climate change) just seem trivial by comparison. This pandemic is a real crisis unlike anything we've been through. You would have to go all the way back to WWII to find a crisis that required such a level of sacrifice by the whole population and put us against so common an enemy. That being said, the hardships they went through is nowhere's near the same as what we're going through. Our lives have become undeniably a lot easier since then. But because we've become so accustomed to an easy life, even a mild crisis, like this, seems difficult. So compared to what we've become accustomed to, this is our version of the WWII climax of the last 4T.

And like the great depression and WWII changed the world permanently, so will this crisis. The last 4T saw the permanent addition of social safety nets, ie Social Security, unemployment insurance and Medicare. As a result of this pandemic, we will very likely see additional permanent changes to healthcare and the introduction of something like a Universal Basic Income (UBI) due to the massive damage this crisis has done to an economy that was booming just a month ago. Even Republicans are supporting UBI now, and it may replace Social Security and unemployment insurance entirely. And I don't see us putting the UBI genie back in the bottle once this crisis ends either. Politicians that run on a platform to end UBI will very quickly lose support. UBI will become the new "third rail" in politics like Social Security has been for so long.

But UBI, by itself, will not be sustainable. For those of you who are familiar with my posts, you'll know that I was always in favor of UBI, but preferred the Gary Johnson model over the Andrew Yang model. The Gary Johnson "Fairtax" model involved switching away from a federal income tax system to a consumption tax system, and using a percentage of the consumption tax to fund a monthly UBI prebate or "tax refund". The reason being that if UBI was funded by income tax, the incentive to work will collapse. If the checks were big enough, most people would prefer to collect free government money rather than work, and there wouldn't be enough income tax revenue to fund UBI. Plus the resentment between the workers funding UBI, and the non-workers collecting UBI will become unsustainable after a point. At least, if it were funded by a consumption tax, everyone would be paying into it, not just the people with jobs. Gary Johnson's UBI model could stand the test of time. Andrew Yang’s could not. So it's likely that we will see something like the Fairtax being instituted to keep UBI sustainable.

As more and more schools and companies adopt a work from home model, I have a feeling this is another genie that we will not be able to put back in the bottle. Work from home will become the norm, except for jobs that can't physically support a remote work option. School will also adopt more of a remote desktop model, and I see homeschooling becoming way more prevalent after this.

Looking at the big picture, I see this crisis as the death knell for globalization. The trend towards globalization had already been losing ground with Brexit and Trump's election, but this just killed it. Borders are more secure than ever, and although it will ease up a bit, I don't see the "open borders" argument regaining ground any time soon. Yet, despite how socially isolated we've become, we're becoming more connected than ever online. But I see us ultimately becoming more domestically focused. Economically we're already seeing a major push to rely less on other countries (especially China) for manufactured goods. There’s already been a movement away from over-centralized economies and this trend is likely to continue as we'd want to be more prepared for another crisis like this. It's interesting to note that WWII ultimately resulted in increasing globalization. This crisis is resulting in the opposite.

So let’s re-examine Strauss and Howe Generational Theory and see how things line up. S&H Theory is generally based on US history, but can be applied to other countries as well if you adjust the dates and major events. Keep in mind I don’t view S&H Theory as a science. It’s really just a framing device. It’s an interesting way to organize history. It is highly subjective (and that’s what makes it so much fun to study).

Strauss and Howe identify four turnings in each Generational Cycle:

The First Turning is a high or recovery. (Spring). ie Reconstruction (1865-1886).

The Second Turning is an awakening. (Summer). ie The Gilded Age (1886-1908).

The Third Turning is an unraveling (Autumn). ie WWI and The Roaring Twenties (1908-1929).

The Fourth Turning is a Crisis (Winter). ie The Great Depression and WWII (1929-1945).

Strauss and Howe broke the Fourth Turning up into four phases: 1. Catalyst - Event that sparks the crisis. (ie Stock Market Crash of 1929) 2. Regeneracy - Call to Action and unity in response to the crisis. (FDR's New Deal in the mid 1930s) 3. Climax - Darkest point of the crisis. (Attack on Pearl Harbor 1941) 4. Resolution - Winners and losers are decided, and new institutions rise as the country is put on a new trajectory. But every solution creates a new problem, and the next cycle is all about addressing that new problem. I generally agree with the dates and analysis Strauss and Howe gave for the above Great Power Cycle (1865-1945), however, I disagree with the way they divided up the Civil War Cycle, and I’ve discussed that at length in an earlier post, but here’s a summary: First Turning - 1789-1807 - The Constitution is ratified and the states come to a compromise on how to deal with slavery. George Washington becomes the first President. A new country is established and party lines are drawn between John Adams' more classically conservative "Federalist Party" and Thomas Jefferson's more classically liberal "Democratic-Republican Party". The US gains the midwestern territories and the issue of slavery in these new territories reopens the divide between the pro-slave and anti-slave states. Second Turning - 1807-1828 - The Atlantic Slave Trade is banned and slavery ends in the North. The War of 1812 results in the collapse of the Federalist Party and the "Era of Good Feelings" begins. Only one party, Jefferson's Democratic-Republican Party, is dominant for the rest of the turning. The expanding cotton industry makes the southern states a lot more reliant on slavery. Third Turning - 1828-1848 - The Election of Andrew Jackson ends the "Era of Good Feelings". The Democratic-Republican Party splits into a more populist left wing Democrat Party and the more classically conservative Whig Party. The Democratic Party dominates this turning and slavery becomes more entrenched in the Southern States. The abolitionist “Free Soil Party” splits away from the Democratic Party. Manifest Destiny, The Gold Rush and westward expansion results in The Mexican War and Sectionalism. And I would break up the Fourth Turning into these phases: 1. Catalyst - 1848. The Mexican War ends and the issue over whether new territories should be free states or slave states becomes an even more controversial and divisive issue than before when the midwestern territories were gained. 2. Regeneracy - 1850. The Compromise of 1850 at first unites the country, but ultimately results in more division. The Whig Party splits in 1852 over disagreements with The Compromise. The pro-compromise faction joins the Democratic Party or joins up with third party coalitions. The Whigs that were against the Compromise and were more fervently anti-slavery forms a coalition with the Free Soil Party. The Republican Party is born. The country is divided between southern pro-slave, and northern anti-slave lines even more than before. 3. Climax - 1860. Lincoln is elected and the Confederacy breaks away, resulting in the Civil War. 4. Resolution - 1865. The North wins the Civil War, Lincoln is assassinated and Reconstruction begins in the next 1st Turning.

But most of you are probably more interested in my thoughts on this current “Cold War Cycle” (1945-Present). Well, I agree with the first half of Strauss and Howe’s analysis. But would make some changes to the second half:

First Turning - 1945 - the USA and USSR emerge from WWII as the two dominant world powers. The Cold War begins. The Korean War breaks out and ends in an armistice. Keynesian Neoliberalism replaces Classical Liberalism and Progressivism in the Democratic Party. The UN, NATO and the IMF world bank is established as the world becomes more globally centralized. The Civil Rights Acts of the 50s and early 60s to end Jim Crowe and Segregation are put into effect and the Federal Government gains more power over the states.

Second Turning - 1964 - JFK is assassinated and the Cold War heats up with the Vietnam War. The peace movements quickly make the war unpopular. Neoconservatism (a more conservative, supply side flavor of Neoliberalism) begins to emerge and dominate in the Republican Party. The gold standard is officially abandoned and the classically liberal Libertarian Party forms to challenge the more dominant and interventionist Neoliberalism of both parties. Nixon resigns in shame as a result of Watergate. Rapid stagflation ensues and the election of Jimmy Carter in 1976 is the last time The Democrats are able to win the southern states. A poor economy, his pessimistic malaise speech and mishandling of the Iran situation results in his loss to Reagan in 1980.

Third Turning - 1980 - Strauss and Howe start this turning with Reagan’s optimistic “Morning in America” campaign in 1984 that resulted in his sweeping electoral victory. But I chose to move it back earlier to 1980 when he won his first term, since that’s when things really started to change. The economy soared for most of the 80s and 90s and the USSR collapsed in 1989. The other major communist power, China, adopted a more free market friendly economy, but never completely abandoned communism and totalitarianism. The Culture War heated up as the more traditional values of the right clashed with the more progressive values of the left. Universities, schools and the press became more left leaning. Immigration and Globalism increased as America became more reliant on other countries (especially China) for manufacturing.

Fourth Turning - 2001 - Neil Howe believes the current 4T started with the 2008 Financial Crisis, and I used to agree with him. But as time has passed it seems clear to me that it started on September 11th 2001. Here are the phases of this current Fourth Turning:

1. Catalyst - 2001 - The terrorist attacks on September 11th 2001 shocked the world and showed us that, just because the we “won” the cold war, we weren’t yet at peace.

2. Regeneracy - 2001 - The regeneracy for this catalyst was immediate as volunteers rushed in to save lives. Despite the growing culture war, the country came together with a new sense of patriotism. But over time, the unity collapsed as the war on Terror spread to Iraq and the Patriot Act was passed. Anti-war leftists and libertarians turned against the hyper-interventionist surveillance state. Events like Katrina in 2005, the financial meltdown of 2008, The Great Recession, And reactionary movements like The Tea Party, Occupy Wall Street, Black Lives Matter, Gamergate and the Alt Right only served to further divide the country and exacerbated the crisis as the culture war raged worse than ever before. Mass Shootings became a regular occurrence as hatred levels rose, and the resulting gun debates only worsened the divide. Like it did during the Civil War 4T, the regeneracy failed. We hated each other more than ever. And it looked like the 2016 election was going to lead to another Civil War. The establishment and pro-war Neo-liberal and Neo-conservative factions of both parties became increasingly discredited in favor of an anti-war populism on both the left and right. Brexit and Trump’s election saw a rejection of globalism and a desire to secure borders and bring manufacturing back home. The economy made a massive recovery after 2016 and was booming during the first few years of Trump’s presidency. But Trump was a divisive figure who was hated by the Democrats and he was impeached in late 2019.

3. Climax - 2019 - The first case of COVID-19 was discovered in Wuhan China in late November 2019. The disease spread rapidly and resulted in thousands of deaths. In the US, the politicians and press were distracted by the impeachment trial and were late to react. China was unable to contain the disease and it spread all over the world. By March 2020 governments all over the world mandated self quarantine, business lockdowns and social distancing. The economy, which was booming only a month earlier, collapsed and drastic measures were needed to be taken to save people from falling into poverty while still protecting the public from infection. Congress is now attempting to come to an agreement on a massive and unprecedented two trillion dollar stimulus bill, funded primarily by the Fed’s magic creation of money. But unlike the quantitative easing of the past, this time the money’s not just going to banks and major corporations, it’s going to businesses big and small and even individuals. The increased demand that will result from so much money injected to the economy combined with a shortage of supplies will very likely result in rising prices like we’ve never seen before. There will be attempts to price fix but as more and more businesses shut down the resulting shortages will force the government to allow price gouging. The stagflation will likely be worse than it was in the 70s and could lead to a monetary crisis. We may be heading into the worst worldwide depression we’ve ever seen. To top it off, many countries are succumbing to the temptation of full on totalitarianism to manage this crisis. A world war is looking increasingly inevitable. But hey, let’s try to stay optimistic and hopeful.

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gordonwilliamsweb · 4 years ago

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Public Health Officials Face Wave Of Threats, Pressure Amid Coronavirus Response

Emily Brown was stretched thin.

As the director of the Rio Grande County Public Health Department in rural Colorado, she was working 12- and 14-hour days, struggling to respond to the pandemic with only five full-time employees for more than 11,000 residents. Case counts were rising.

She was already at odds with county commissioners, who were pushing to loosen public health restrictions in late May, against her advice. She had previously clashed with them over data releases and had haggled over a variance regarding reopening businesses.

But she reasoned that standing up for public health principles was worth it, even if she risked losing the job that allowed her to live close to her hometown and help her parents with their farm.

Then came the Facebook post: a photo of her and other health officials with comments about their weight and references to “armed citizens” and “bodies swinging from trees.”

The commissioners had asked her to meet with them the next day. She intended to ask them for more support. Instead, she was fired.

“They finally were tired of me not going along the line they wanted me to go along,” she said.

In the battle against COVID-19, public health workers spread across states, cities and small towns make up an invisible army on the front lines.  But that army, which has suffered neglect for decades, is under assault when it’s needed most.

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Officials who usually work behind the scenes managing everything from immunizations to water quality inspections have found themselves center stage. Elected officials and members of the public who are frustrated with the lockdowns and safety restrictions have at times turned public health workers into politicized punching bags, battering them with countless angry calls and even physical threats.

On Thursday, Ohio’s state health director, who had armed protesters come to her house, resigned. The health officer for Orange County, California, quit Monday after weeks of criticism and personal threats from residents and other public officials over an order requiring face coverings in public.

As the pressure and scrutiny rise, many more health officials have chosen to leave or been pushed out of their jobs. A review by KHN and The Associated Press finds at least 27 state and local health leaders have resigned, retired or been fired since April across 13 states.

From North Carolina to California, they have left their posts due to a mix of backlash and stressful, nonstop working conditions, all while dealing with chronic staffing and funding shortages.

Some health officials have not been up to the job during the biggest health crisis in a century. Others previously had plans to leave or cited their own health issues.

But Lori Tremmel Freeman, CEO of the National Association of County and City Health Officials, said the majority of what she calls an “alarming” exodus resulted from increasing pressure as states reopen. Three of those 27 were members of her board and well known in the public health community — Rio Grande County’s Brown; Detroit’s senior public health adviser, Dr. Kanzoni Asabigi; and the head of North Carolina’s Gaston County Department of Health and Human Services, Chris Dobbins.

Asabigi’s sudden retirement, considering his stature in the public health community, shocked Freeman. She also was upset to hear about the departure of Dobbins, who was chosen as health director of the year for North Carolina in 2017. Asabigi and Dobbins did not reply to requests for comment.

“They just don’t leave like that,” Freeman said.

Public health officials are “really getting tired of the ongoing pressures and the blame game,” Freeman said. She warned that more departures could be expected in the coming days and weeks as political pressure trickles down from the federal to the state to the local level.

From the beginning of the coronavirus pandemic, federal public health officials have complained of being sidelined or politicized. The Centers for Disease Control and Prevention has been marginalized; a government whistleblower said he faced retaliation because he opposed a White House directive to allow widespread access to the malaria drug hydroxychloroquine as a COVID-19 treatment.

In Hawaii, U.S. Rep. Tulsi Gabbard called on the governor to fire his top public health officials, saying she believed they were too slow on testing, contact tracing and travel restrictions. In Wisconsin, several Republican lawmakers have repeatedly demanded that the state’s health services secretary resign, and the state’s conservative Supreme Court ruled 4-3 that she had exceeded her authority by extending a stay-at-home order.

With the increased public scrutiny, security details — like those seen on a federal level for Dr. Anthony Fauci, the top infectious disease expert — have been assigned to state health leaders, including Georgia’s Dr. Kathleen Toomey after she was threatened. Ohio’s Dr. Amy Acton, who also had a security detail assigned after armed protesters showed up at her home, resigned Thursday.

In Orange County, in late May, nearly a hundred people attended a county supervisors meeting, waiting hours to speak against an order requiring face coverings. One person suggested that the order might make it necessary to invoke Second Amendment rights to bear arms, while another read aloud the home address of the order’s author — the county’s chief health officer, Dr. Nichole Quick — as well as the name of her boyfriend.

Quick, attending by phone, left the meeting. In a statement, the sheriff’s office later said Quick had expressed concern for her safety following “several threatening statements both in public comment and online.” She was given personal protection by the sheriff.

But Monday, after yet another public meeting that included criticism from members of the board of supervisors, Quick resigned. She could not be reached for comment. Earlier, the county’s deputy director of public health services, David Souleles, retired abruptly.

An official in another California county also has been given a security detail, said Kat DeBurgh, the executive director of the Health Officers Association of California, declining to name the county or official because the threats have not been made public.

Many local health leaders, accustomed to relative anonymity as they work to protect the public’s health, have been shocked by the growing threats, said Theresa Anselmo, the executive director of the Colorado Association of Local Public Health Officials.

After polling local health directors across the state at a meeting last month, Anselmo found about 80% said they or their personal property had been threatened since the pandemic began. About 80% also said they’d encountered threats to pull funding from their department or other forms of political pressure.

To Anselmo, the ugly politics and threats are a result of the politicization of the pandemic from the start. So far in Colorado, six top local health officials have retired, resigned or been fired. A handful of state and local health department staff members have left as well, she said.

“It’s just appalling that in this country that spends as much as we do on health care that we’re facing these really difficult ethical dilemmas: Do I stay in my job and risk threats, or do I leave because it’s not worth it?” Anselmo asked.

In California, senior health officials from seven counties, including Quick and Souleles, have resigned or retired since March 15. Dr. Charity Dean, the second in command at the state Department of Public Health, submitted her resignation June 4. Burnout seems to be contributing to many of those decisions, DeBurgh said.

In addition to the harm to current officers, DeBurgh is worried about the impact these events will have on recruiting people into public health leadership.

“It’s disheartening to see people who disagree with the order go from attacking the order to attacking the officer to questioning their motivation, expertise and patriotism,” said DeBurgh. “That’s not something that should ever happen.”

Some of the online abuse has been going on for years, said Bill Snook, a spokesperson for the health department in Kansas City, Missouri. He has seen instances in which people took a health inspector’s name and made a meme out of it, or said a health worker should be strung up or killed. He said opponents of vaccinations, known as anti-vaxxers, have called staffers “baby killers.”

The pandemic, though, has brought such behavior to another level.

In Ohio, the Delaware General Health District has had two lockdowns since the pandemic began — one after an angry individual came to the health department. Fortunately, the doors were locked, said Dustin Kent, program manager for the department’s residential services unit.

Angry calls over contact tracing continue to pour in, Kent said.

In Colorado, the Tri-County Health Department, which serves Adams, Arapahoe and Douglas counties near Denver, has also been getting hundreds of calls and emails from frustrated citizens, deputy director Jennifer Ludwig said.

Some have been angry their businesses could not open and blamed the health department for depriving them of their livelihood. Others were furious with neighbors who were not wearing masks outside. It’s a constant wave of “confusion and angst and anxiety and anger,” she said.

Then in April and May, rocks were thrown at one of their office’s windows — three separate times. The office was tagged with obscene graffiti. The department also received an email calling members of the department “tyrants,” adding “you’re about to start a hot-shooting … civil war.” Health department workers decamped to another office.

Although the police determined there was no imminent threat, Ludwig stressed how proud she was of her staff, who weathered the pressure while working round-the-clock.

“It does wear on you, but at the same time we know what we need to do to keep moving to keep our community safe,” she said. “Despite the complaints, the grievances, the threats, the vandalism — the staff have really excelled and stood up.”

The threats didn’t end there, however: Someone asked on the health department’s Facebook page how many people would like to know the home addresses of the Tri-County Health Department leadership. “You want to make this a war??? No problem,” the poster wrote.

Back in Colorado’s Rio Grande County, some members of the community have rallied in support of Brown with public comments and a letter to the editor of a local paper. Meanwhile, COVID-19 case counts have jumped from 14 to 49 as of Wednesday.

Brown is grappling with what she should do next: dive back into another strenuous public health job in a pandemic, or take a moment to recoup?

When she told her 6-year-old son she no longer had a job, he responded: “Good — now you can spend more time with us.”

This story is a collaboration between The Associated Press and Kaiser Health News.

AP writer Audrey McAvoy in Honolulu and KHN correspondent Angela Hart in Sacramento contributed to this report.

Public Health Officials Face Wave Of Threats, Pressure Amid Coronavirus Response published first on https://nootropicspowdersupplier.tumblr.com/

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stephenmccull · 4 years ago