WW3: How to Win the War (And How AZ is Failing)

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How do we re-open our economy safely and sustainably while containing the epidemic and preserving as many lives as possible?

If you agree with the premise that the Coronavirus pandemic is World War 3, what must we do to ensure victory against the epidemic, and save our economy? First, we must resist and thwart those calling for a surrender to the virus. Second, we need to build a public health infrastructure capable of containing and controlling the epidemic. I’ve written about this before, but these matters certainly bear repeating.

The Democrats have now released the draft of the next proposed $3T relief package, which they are calling the HEROES Act (HR 6800). Here’s a summary of the main points. Part of it deals with Testing, Tracing, and Treatment, budgeting an additional $75B to these programs. That is an excellent start and recognizes the importance of rebuilding our public health functions. I will discuss the HEROES Act more in the following sections.

Meanwhile, Arizona’s Gov. Ducey has announced we are in Phase 1 of reopening and the shelter-in-place order expires this Friday, so many businesses that could be problematic for mass infection events, such as bars and dine-in restaurants are re-opening. This is a poor idea. Epidemiology suggests that shopping venues where an average customer spends only a short time (less than an hour) inside a building with a limited number of other patrons are relatively safe (especially while wearing masks) longer periods of exposure in such enclosed settings is still too conducive to infection.

Testing

America’s diagnostic testing capacity per capita is still middling, at best, and far from the range per capita that epidemiologists say is required to diagnose all the cases still undiscovered, let alone do continuous preventive testing of our most vulnerable populations, who are most ripe for new outbreaks. Yet there is still no coordinated national testing strategy; Trump says it’s all the responsibility of Governors. The real reason? He doesn’t want to look bad. Do you want to re-open? Make your government fix that.

The HEROES Act is a positive step in the right direction. Tell your legislators to support this aspect of the bill, at least.

Here in Arizona, We are still in the back of the pack for testing capacity, despite recent gains. We have “blitzed” from the very back of the pack, to somewhere a little further up the back of the pack.

Gov. Ducey and Dr. Christ have announced a program to systematically test the residents of congregate-care facilities, such as nursing homes, prisons, and jails. This is a step in the right direction and I have nothing but praise for the initiative. [discussion of the testing program runs until time 16:45]

Well, maybe a little something more than nothing but praise… My only question is, “Why have you waited so long?” All our testing capacity not used for diagnosis and preventive testing of staff in hospitals should have been devoted to these facilities already. Where was this program a month ago? The testing capacity that has been rolled out during the “Testing Blitz” of the past week also could have been much more effectively used to initiate the congregate care facility initiative sooner.

Dr. Christ claims that the protection of congregate-care facilities has been their “top priority” since day one, but that is simply not borne out by their executive order on the subject. Halting visitation was wise, but we’ve long known that temperature checks are not effective at containing viral spread among staff and residents, given asymptomatic infections. Requiring PPE use by staff is great, but without ensuring access, supply, and compliance, it is really nearly meaningless. Only now are DHS ensuring PPE access and replacement staff for those out sick. And, of course, DHS did not institute a systematic testing program of any sort, until now. Our most vulnerable populations across so many axes of risk are in these facilities. They can’t wait. And they have been waiting for over 6 weeks now.

Finally, I would note that they are NOT implementing a universal testing program for inmates. They are merely giving epidemiological advice to jails on how to contain the contagion, and doing serological testing of staff, not inmates. So, still, no systematic testing of inmates, even though we know that COVID19 is ravaging prison facilities around the country.

We are making testing progress in Arizona, but nearly enough to meet the gating protocol that Ducey is relying on to begin re-opening the very kinds of businesses that tend to be infection opportunities.

Treatment

If you contract the virus and get serious complications as a result, you may well be on your own when it comes to paying for treatment. As millions are out of work, their private healthcare, if they ever had it as a benefit, is expiring just when they need it. The cost of maintaining insurance coverage will explode under COBRA extensions, making coverage unaffordable for those lucky enough to have it in the first place, and even luckier if their insurer will cover COVID-19 expenses.

Millions are still priced out of the ACA or ineligible for public coverage like Medicaid. We have no national strategy beyond empty promises that your treatment will be covered, somehow, if you get seriously ill as a result of an infection. and worker’s compensation is unlikely to be of any help, there being no way to definitively link one’s exposure to one’s employment and no presumption in the law to ensure coverage.

So how are we going to pay to treat everyone who gets seriously ill with COVID-19? We really have no idea. The financing of our health care system is a fucking mess. The cost of treating a seriously ill COVID-19 patient is not cheap: a median of nearly $100K per person. And we often simply don’t know how, or who is going to pay for that treatment. Until we do, hospitals are just having to eat the costs, and many hospitals will simply collapse under the pressure.

That’s what the emergency funding for hospitals in the CARES Act was all about. But it’s not nearly enough. Not for now, and certainly not for the long-term. We don’t really know how long the epidemic will last, but we know it’s not going to disappear on its own like the moron in the White House hopes.

Even as we social distance to flatten the curve, that doesn’t actually decrease the number of cases we’ll eventually have, it just brings down the rate of infections so our healthcare system won’t be swamped by everyone getting sick at once. We have no long-term plan of how to pay for all those medical services that handling this epidemic will entail.

Well, Bernie Sanders had a pretty good one: give everyone Medicare and pay for it with new taxes. It’s still a good plan, and it’s financially viable. So blame your government and your political system for being unable to create a sensible system of financing and insurance that covers everyone in this country. We’ve only been trying for a century: maybe this crisis is the breakthrough we need.

The newly introduced HEROES Act is not a great solution to the Treatment aspect of the solution. While it does include $75B of new funding, part of which may be devoted to ensuring that COVID19 treatment remains free, it not clear how much of that allocation is for treatment per se.

The main method by which the HEROES Act proposes to ensure newly uninsured people are covered by health insurance is to subsidize their COBRA coverage, which is a terrible way to ensure continued access. It is going to be hellishly expensive for people to make their prior employer’s insurance programs portable through COBRA, and we will end up spending a lot, for very little coverage. But it also presumes that many who have become unemployed actually had insurance to begin with :: spoiler alert :: which most didn’t.

The HEROES Act does a little better by opening a new enrollment period for the ACA (Obamacare), which the Trump Administration refused to do on its own. This is great, as far as it goes, but many cannot afford even the subsidized premium rates, being out of work, and forget the deductibles and co-pays.

A better way is HR 6674, the Medicare Crisis Program of 2020. Instead of throwing money at subsidizing those few people who will qualify for a COBRA program, spend that money on enrolling newly unemployed people into Medicare, for much lower cost, regardless of whether they had health insurance through their prior employer. It’s more cost-effective, doesn’t subsidize health insurance companies for no good reason, and covers a lot more people who need coverage now.

Strangely, no Democrats from Arizona have signed on as co-sponsors of HR 6674. That needs to change. We have five perfectly good Democratic Members who should be co-sponsors, but are not. Call and write to them and demand that they support HR 6674 and not the COBRA provisions of the HEROES Act.

Tracing

Our ability to do contact tracing still relies on small local teams of county and state legacy teams that are far from adequate to pursue the millions of cases required to chase down the virus, and are chronically underfunded by governments falling into deficits and so unable to hire the personnel needed, though they are doing their best. Yet there is no national effort to recruit, pay, and train the squads of virus detectives to hunt down and contain outbreaks. Worse, the GOP nationally is dead-set against providing aid to state and local governments whose revenues are plunging due to the epidemic. You want to get mad that we can’t re-open? Do something about the lack of contact tracing and the inability to pay for it. The HEROES Act does provide substantial additional funding for tracing.

Dr. Christ announced a plan to “enhance” contact tracing at the last press conference on Tuesday [discussion of contact tracing ends at time 19:45] :

Dr. Christ also announced an “enhanced” contact tracing program but gave very little detail as to what the “enhanced” part might entail. She says the State will provide “additional resources” to the county health departments, with few details available that I can find, which doesn’t mean much.

In fact, I would assert it means next to nothing. Prove me wrong, Dr. Christ.

Isolation

Our capacity to effectively isolate infected people so that they don’t infect yet more people is virtually non-existent – the best we can do is tell them to stay home, where they can and will infect their family members. Millions of Americans simply lack the means or facilities to effectively self-isolate, let alone the financial means to survive weeks in isolation without work. Yet there is no national effort to build and/or convert the facilities needed to isolate the infected nor to keep those people alive and fed. You want to re-open? Fix that.

The HEROES Act does include additional funding for isolation facilities with the $75B in new funding for public health initiatives.

There is nothing in Ducey and Christ’s plans regarding isolation facilities other than hospitals and staying at home if sick. Not adequate.

Prevent.

Millions of businesses, small and large, lack the means, the will, or the proper incentives to provide safe workplaces and business facilities to their employees and customers needed to re-open safely. Yet there is no national program to address this problem, other than the crass and evil effort to merely indemnify business against any liability arising from any negligence in protecting their employees and the public from infection. I’m sure that will work out well for everyone. The business sector has no incentive at all to help protect you or their employees from infection.

The HEROES Act, does require OSHA to develop an enforceable standard for the protection of employees on the job from infections. But it does nothing to fix the market incentives for employers to cheat and cut costs in the area of protecting their employees and customers. Worse, there are plenty of bills in the hopper from Republicans to indemnify employers from liability for COVID19 exposures. We have to do better at ensuring the access to and use of proper protective measures to prevent workers and the public from infections at businesses.

Given that we are not nearly ready to ensure that those who inevitably fall ill as we being to re-open the economy will be taken care of, or that new infections will be monitored and outbreaks contained, or that the infected can safely self-isolate, or that the public will be protected from infection to best of our ability, what does that make those pushing to “re-open now”, and damn the consequences?

Damned fools.

2 COMMENTS

  1. The Ducey Admin seems to have no concept that “custody” entails a duty of care, not just the right to take someone’s freedom.

  2. Monday when I went to have my COVID 19 test, the nurse told me she used to work at a hospital and they never tested their employees. I forgot to ask which one. Tuesday doing political phone calls I happened to talk to a person who worked at Eyman Unit at the prison in Florence who told me that in the last month, 9 inmates were quarantined for COVID and 4 died.

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