Monday, October 12, 2020

Dr. Michael Fine, Author

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Justice Brett Kavanaugh

The full audiobook can be downloaded here.

"Boys and girls like beer"

-- Brett Kavanaugh, Associate Justice, US Supreme Court

Every morning at 5 AM, three or four white minivans leave from a parking lot on Cowden Street in Central Falls, Rhode Island for factories all across southern New England. Each minivan is densely packed with 10 to 15 mostly undocumented immigrants who live two or three or five people to a room in the ramshackle wooden frame triple-deckers that are crammed into every available square foot in this old mill city. The people in the minivans are from all over the world - from Guatemala, Honduras and El Salvador, from Cape Verde, the Dominican Republic, Colombia; and Puerto Rico refugees from Hurricanes Maria and Dorian who cant find other jobs here. The vans are run by labor contractors who find and supply unskilled labor to the low-wage employers who need bodies for the hot, dirty, smelly and dangerous jobs no one else wants, in the factories, construction sites, meat-packing plants and fish-houses of Southern New England. The vans charge each worker $5 to $10 a day. The work pays minimum wage - $10.50 an hour in Rhode Island, $12.00 an hour in Massachusetts, $11.00 an hour in Connecticut. Theres lots of wage theft on these jobs sometimes workers only get paid for eight hours when they work 12 or 14, or get told the labor contractors havent been paid yet and then never get paid, or are paid piece work using a scale that means they earn $5 or $6 dollars an hour, when they were promised $20 an hour but youd have to produce at an impossible pace to generate that much income.

Yes, we drank beer. My friends and I. Boys and girls. Yes, we drank beer. I liked beer. Still like beer. We drank beer, said Judge Brett Kavanaugh during his testimony to the US Senate Judiciary Committee confirmation hearing.

This testimony provided a unique lens on American culture and mores. A preening conservative President, pandering to his base, chose an undistinguished juror to sit on the U.S. Supreme Court. The opposition party, powerless to stop Kavanaughs confirmation, used accusations about the nominees behavior in high school as the bulwark of their objections to his nomination.

By the time Judge Kavanaugh testified, the process of Supreme Court nomination and confirmation had already been defiled. The nomination to the Supreme Court of Judge Merrick Garland two years earlier had been blocked by the Senate Majority leader, just because he had the power to do that. This occurred just six years after a President had forced through health care insurance reform, because he had the power to do that. Health care insurance reform was unanimously opposed by a minority party, even though the reform itself was based on the ideas of that minority party, which objected only because it was in their perceived political interest to resist the reform, the hell with what the country wanted and needed.

Any pretense of government of, by and for the people, and of governing for the good of the nation had fallen by the wayside years ago. The U.S. Government has long been controlled by special interests, the consequence of the over-centralization of capital, itself a consequence of changes in banking and securities regulations that had been sought by the banking and securities industries themselves. The notion of a common good, of Americans as one people with liberty and justice for all was replaced by narcissism, consumer capitalism, and greed. Brett Kavanaugh is a shallow self-satisfied man - the pure product of a culture without compass or meaning. He now sits on our highest court, appointed for life. I worked hard, he said. I played basketball. I got into Yale and Yale Law School. I got ahead. And yes, I like beer.

These are the values we brought with us into a pandemic.

The nomination and confirmation of Brett Kavanaugh posed a simple question. In the words of another time - have we no sense of decency or responsibility to ourselves as a people?

The story of SARS-CoV-2 and of Covid-19 makes the answer to that question clear. We let loose a pandemic in the US that will cost at least 250,000 lives because we have lost our sense of dignity, our discipline, our courage and our pride.

Almost all the deaths from Covid-19 were preventable. Any fingers to be pointed must be pointed directly at us at ourselves, our culture and our politics. No one did this to us. We did this to ourselves.

Sometime in September or October of 2019, a bat, a pangolin or some other wild animal in China coughed, sneezed, or cried out, perhaps in pain from being caught or slaughtered, or just breathed near a human being. Out of that animal came a virus or more likely a thousand or more viral particles from the family of viruses called Coronavirus - that hung in the air for a moment. Then a human being nearby inhaled. The virus entered the nasal passages and perhaps the lungs of that person, an event likely happens millions or even billions of times a day.

The transfer of viral particles from animals and other human beings is a common, even trivial, event in the human experience. Those particles are always in the air we breathe and they are what our nasal passages, our lungs, our respiratory secretions and our immune systems work to protect us against almost always effectively. Most of the billions of viral particles we inhale or introduce into the body by touching eyes, nose or mouth have no significant impact on the health of individuals. Many viral particles that infect other species plant viruses, insect viruses, frog and toad viruses and bird viruses - have cellular architecture that is slightly different from the cellular architecture of human cells, so most of those viruses are unable to attach to human cells or cause infection. Most of those viral particles are quickly destroyed by the immune system. Most are just dust.

But the virus that entered a human body in the fall of 2019 was different. That virus, which likely evolved in another mammal, had a mechanism that allowed it to attach to specific proteins in certain human cells, cells that line the nose, are present in the lungs and heart and in small numbers in the gastrointestinal system, proteins that are called ACE2 receptors. ACE2 receptors are the proteins that allow the attachment of a hormone called angiotensin converting enzyme, a hormone that helps regulate blood pressure, among other functions.

The virus attached to human cells. It entered those cells and inserted itself into the genetic material of those cells, which is what viruses do. The virus then caused those cells to make copies of itself. Those copies destroyed the cell and were released into the bloodstream where they found and attached themselves to the ACE2 receptors of other cells and entered those cells and their genetic material. Those cells began making still more copies of the virus billions and billions of copies.

That human being had become infected. And then that human began to cough, or sneeze, or breathe or speak, so that the virus entered the air and infected other people nearby. And those people coughed and sneezed and infected other people. The newly infected people infected others, over and over again, until at least sixteen million people who have been tested and counted, as I am writing this, but very likely many more than that likely a hundred to two hundred million people - people who have had the virus but havent been tested or counted have become infected. Which is not many, really, when you consider that none of us has seen this virus before so have no immunity to it. And that there are seven billion of us. Likely all seven billion human beings are susceptible to this new virus and will become infected with it before long since none of us were immune to it in the fall of 2019.

Seven billion humans. 200 million people is about three percent of seven billion, so many more people will become infected before this pandemic is over.

I thought Id sit out the Coronavirus outbreak in the US as an observer. Im a fiction writer turned doctor turned fiction writer again. I worked as a family physician and then started doing public health in my late fifties. I was Director of the Rhode Island Department of Health 2011-2015 a period that included the Ebola epidemic of 2014-2015. Along the way Ive had the privilege of knowing three CDC directors, three Surgeons General (one of whom I helped train to be a state health officer, in 2015) and about 100 city and state health directors, a number of whom are close and dear personal friends with whom I talk frequently. I know CDC and its culture. Many friends and colleagues work there. And I also know government and how it works at the federal, state and city levels. Or doesnt.

When reports began to come out of China of hospitals overwhelmed, of a doctor who had been silenced and then died of the disease, of health workers getting sick and dying in large numbers, of people dying in the streets of Wuhan, I was writing in the morning, and working in the afternoons seeing patients two half days a week, and trying to develop new programs to reduce cost and improve access to health services in Central Falls, Rhode Island, the smallest, poorest and most densely populated city in the state. I consulted a little with the mayors of Central Falls and Pawtucket, Rhode Island, a neighboring city, but had turned my attention to writing fiction, an old first love. I worried a little about this new virus but I assumed that the Chinese CDC and WHO would get in front of it and get it stopped before it spread too far.

I didnt expect to find myself in the middle of one of the worst outbreaks of Coronavirus in the nation.

I also didnt expect the public health apparatus of the world and nation to so dismally fail. Or that the failure would reveal again what my 2018 book Health Care Revolt was written to reveal originally that we have a medical services market, a pharmaceutical products market and a health care insurance market but that we dont have a health-care system in the United States, a system that provides the same set of essential services to all Americans. Our medical, pharmaceutical and health care insurance markets are focused on profit, as markets should be, and not public health. These markets, and the profit focus of American society, have produced a culture in which the rich get richer and the poor are kicked to the side of the road.

Again. The poor get kicked to the side of the road. We have decades of data showing how the market focus of American health care has made our population sicker and poorer, worsened income inequality in the US and has disadvantaged the poor and people of color. You would have thought wed learned something from all our studies, and used what we learned to do a better job with Covid-19. Instead, we failed again, and failed so profoundly that we locked up our society for at least a year, and perhaps for as long as half a generation.

Still, because of my role with a community health center and with the two cities, I paid close attention to the stories and the data coming out of China in late 2019 and by January of 2020 was able to brief the mayors and my colleagues about what we were learning: This new Coronavirus is in the family of viruses that cause the common cold. This one likely evolved in bats and crossed over to human beings in the fall of 2019 in Wuhan China. It was related to the coronaviruses that cause SARS and MERS but this virus appeared to be harder to contain. In most people this new Coronavirus causes mild disease runny nose, fever, cough, loss of taste and smell, and sometimes nausea, vomiting, and diarrhea. But the new Coronavirus spreads quickly and can cause a very serious lung infection in some people, something called Adult Respiratory Distress Syndrome, which is much worse than a simple pneumonia and can be fatal in about one-third of the people who get significantly ill. The case fatality rate - the ratio of the number of people who get the disease to the number of people who die of it - was reported to be 3 percent, so that of a hundred people who would get the disease likely three would die, which made this Coronavirus 30 times more lethal than influenza but 20 times less lethal than Ebola, a virus that kills 50-75 percent of the people who get it.

Eventually wed learn the case fatality rate is more likely 0.4 percent or less, or about four times that of seasonal influenza. Even so thats a scary number, because every human being, in theory is susceptible to the Coronavirus, which means all of us could get sick at about the same time. In theory, a city of 100,000 might have 10,000 people in the hospital in the span of a few weeks, about ten times the usual number. And 3000, we thought then, would likely die. By comparison, about 5 percent of us are susceptible to seasonal flu each year. Even so, it kills 30,000 to 60,000 Americans every year. This means in that city of 100,000 people, likely 5000 people get the flu, and 500 people are hospitalized for it, and 5 die.

See the rest here:
What Was That? Coronavirus, Chaos and Democracy By Michael Fine PART 1 - GoLocalProv

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