Live and Let Die

International Nurses Day is observed around the world on 12 May (the anniversary of Florence Nightingale’s birth) of each year, to mark the contributions that nurses make to society. Go ahead – look it up – the International Council of Nurses set this up in 1965 and it’s real enough. And this year, as the pandemic rages on and nurses are the last line of defense in saving the day, or at least saving those who can be saved – or they’re on the front lines in this war – this day was a big day. Something special had to be done. And of course Donald Trump did something special:

President Donald Trump contradicted a nurse he was honoring in the Oval Office on Wednesday, insisting there are no personal protective equipment shortages in the US despite her account that availability could be “sporadic.”

This was embarrassing:

A reporter asked the nurses attending the National Nurse Day event if their PPE supplies are where they need to be amid the coronavirus pandemic, and many of them nodded in agreement or answered affirmatively.

“I think it’s sporadic,” answered Sophia L. Thomas, president of the American Association of Nurse Practitioners. “I mean, I talk to my colleagues around the country. Certainly there are pockets around the country where PPE is not ideal, but this is an unprecedented time.”

There’s always someone who ruins everything:

Thomas said she works at a community health center in New Orleans, and that her youngest Covid-19 patient was 4 days old.

“The infection control measures that we learned back when we went to school, one gown and one mask for one patient per day – this is a different time,” she said, adding that she has been reusing a single N95 mask for “a few weeks now.”

“PPE has been sporadic, but it’s been manageable. And we do what we have to do,” Thomas said. “We are nurses and we learn to adapt and do whatever we can do for our patients to get the job done and the care provided, and that’s what we will continue to do as Covid-19 continues.”

The message was clear. We nurses will never let you down, no matter what. Donald Trump heard an insult. She was calling him a liar. She had to be put in her place, so he did that:

“Sporadic for you but not sporadic for a lot of other people,” the President told her…

“Because I’ve heard the opposite,” Trump said. “I have heard that they are loaded up with gowns now. We had empty shelves and empty nothing because it wasn’t put there by the last administration.”

That was his rejoinder to her snarky insult – as he saw it. He knows his Fox News base. They would see it that way. Others might not. Was he right to slap her down and humiliate her? This is all too familiar. He is easily offended. He gets very angry very quickly, especially if the person who he thinks is trying to humiliate him is a woman, particularly an accomplished woman. He lashes out. And everyone should know better now. It’s best that everyone be careful and just shut up. Never even hint at contradicting him. You do NOT want to set him off.

Those are the rules. This nurse blew it. Now he’s REALLY pissed off. She made things worse for everyone. He was NOT going to be embarrassed! And it only gets stranger:

President Donald Trump on Wednesday defended his decision not to wear a mask during a tour of a mask production facility in Phoenix the day before, saying he had been told it wasn’t necessary.

“I didn’t need it, and I asked specifically the head of Honeywell, ‘Should I wear a mask?’ and he said, ‘Well, you don’t need one in this territory.’ And as you know, we were far away from people, from the people making the masks,” said Trump, who also didn’t wear a mask Wednesday as he spoke with reporters during a photo opportunity with nurses in the Oval Office.

First this nurse embarrasses him, or tries too, and then after he said people should wear masks, and he refuses to himself, the press is out to humiliate him. But of course they’re all liars who don’t ever pay attention to what’s really going on:

Trump said he did have a mask on “for a period of time,” and that he had at least four masks with him during the tour.

“I can’t help it if you didn’t see me, I mean, I had a mask on,” Trump told reporters.

When Trump was seen by reporters and photographers touring the Honeywell plant his face was uncovered, and he was less than 6 feet apart from the Honeywell officials giving him the tour, who were also without masks. Other workers throughout the plant were wearing masks; a sign posted in the building said, “Please wear your mask at all times.”

Reporters report things. They’re not out to get him. But there was this:

Vice President Mike Pence was also criticized for not wearing a mask when he toured the Mayo Clinic’s coronavirus testing labs last week despite hospital rules that all occupants wear masks. Pence later called the decision a mistake, and days later wore one during a tour of a General Motors plant in Indiana that is now making ventilators.

Trump may have to fire him. Mike Pence admitted he made a mistake. Donald Trump does not make mistakes. Everyone knows this. Pence must go, but really, if reporters wanted to be snarky, they’d report this:

During a pandemic that has seen more than 70,000 deaths in the US (almost a quarter of the global amount), there is probably no worse song the president could walk out to than Live and Let Die, a cover by the rock band Guns N’ Roses. But these are strange times, and so as Donald Trump walked around an N95 mask manufacturing plant in Phoenix, Arizona, that’s exactly what happened.

The president was, of course, not wearing a mask. He never does.

That’s from the Guardian, in London. They don’t fear his anger, but those of us on this side of the pond should worry:

President Trump has complained to advisers about the way coronavirus deaths are being calculated, suggesting the real numbers are actually lower – and a number of his senior aides share this view, according to sources with direct knowledge.

A senior administration official said he expects the president to begin publicly questioning the death toll as it closes in on his predictions for the final death count and damages him politically.

The official said Trump has vented that the numbers seem inflated and has brought up New York’s addition of more than 3,000 unconfirmed but suspected COVID-19 cases to its death toll.

And the obvious problem is that these doctors are no more than common thieves:

Some members of the president’s team believe the government has created a distorting financial incentive for hospitals to identify coronavirus cases, the official also said.

A second senior official said they shared this concern.

Medicare is giving hospitals a 20% bonus for their treatment of coronavirus patients as a way to help them make up for the money they’re losing because they’ve had to postpone a lot of non-coronavirus care.

So those greedy bastards are all lying about all this, with this implication:

Intentionally misdiagnosing patients with coronavirus would be fraud, and so far no one in the administration has publicly leveled such an accusation.

So, all of this is just idle talk, just threats that mean nothing, unless the plan is to accuse all the hospitals all across America of lying about the number of cases and the number of deaths – inflating the numbers when there are hardly any cases or deaths – to make him look bad and end his presidency. The doctors and hospitals of America were and are engaged in an actual coup attempt. This is treason!

No, they won’t go that far:

A senior White House official pushed back, saying this of the president’s thinking: “Skepticism isn’t the right way to frame it. The numbers have been revised up to include presumptive cases – meaning deaths that are believed to be related to COVID but not known for sure. So he’s expressed the need to properly convey that to American people so they’re not startled by why numbers ticked up.”

So that’s the new line. Things only look bad. But they’re not that bad. Numbers lie. Do not believe them, ever. But the odd thing is that many agree with him, but in the opposite direction, as NBC’s Josh Lederman reports here:

As President Donald Trump and his allies suggest that the number of deaths from COVID-19 may be overinflated, epidemiologists are warning that the U.S. death toll is actually far higher than official statistics show, almost surely missing many thousands of virus victims.

On paper, more than 72,000 people have died from the coronavirus, according to an NBC News tally from each state and U.S. territory. But that number is likely an incomplete picture because of a perfect storm of testing shortages, inconsistent death reporting practices across the country and a high concentration of nursing home deaths.

This means more investigative work:

Dr. Matt Heinz, a hospitalist who’s been treating COVID-19 patients in Arizona, said he’s seen cases, particularly early in the pandemic, in which patients still waiting for coronavirus testing died of unknown respiratory illness that in retrospect looked very much like the coronavirus.

“Is that COVID? Is that not? In some cases, we can’t even go back and test for that, because it’s been weeks and weeks,” he said.

But it would be useful to know what happened, and also what is happening now:

Researchers at the Yale School of Public Health found that in hard-hit areas of the country, the death toll may be off by 50 percent or more.

“Those numbers are only as good as the death certificates that they’re based on. And that depends upon the people who are filling them out,” said Dr. James Gill, Connecticut’s chief medical examiner, and vice president of the National Association of Medical Examiners.

Last month, he reviewed a death certificate for a woman who’d had a fever and shortness of breath but was never tested for the coronavirus. The cause of death was respiratory failure, but the state sent an investigator to the nursing home to take a sample post-mortem – and it was positive for the coronavirus. The certificate was changed.

“Without us doing that further investigation, that death would have been missed,” Gill said.

This item goes on to discuss the most and least useful statistical methodologies that are being used now, a technical matter. That’s fine, but the issue now is that Trump is white-hot angry that everyone is out to get him, so everything may be lies, lies to make him look bad.

There are those who believe that, and that is making a real mess now, as Ben Collins reports here:

At the end of another long shift treating coronavirus patients, Dr. Hadi Halazun opened his Facebook page to find a man insisting to him that “no one’s dying” and that the coronavirus is “fake news” drummed up by the news media.

Hadi tried to engage and explain his firsthand experience with the virus. In reply, another user insinuated that he wasn’t a real doctor, saying pictures from his profile showing him at concerts and music festivals proved it.

“I told them: ‘I am a real doctor. There are 200 people in my hospital’s ICU,'” said Halazun, a cardiologist in New York. “And they said, ‘Give me your credentials.’ I engaged with them, and they kicked me off their wall.”

So he’s stopped “engaging” these people:

Several other doctors shared similar experiences, saying that they regularly had to treat patients who had sought care too late because of conspiracy theories spread on social media…

Dr. Duncan Maru, a physician and epidemiologist in Queens, New York, said he had heard from colleagues that a young patient had come into the emergency room last week with damage to his intestinal tract after having ingested bleach. The incident occurred just days after President Donald Trump suggested that “injection” of disinfectants should be researched as a potential coronavirus treatment.

“Folks delaying seeking care or, taking the most extreme case, somebody drinking bleach as a result of structural factors just underlines the fact that we have not protected the public from disinformation,” Maru said.

The structural factors in this case include Facebook, YouTube and Twitter, which have struggled to contain the spread of misinformation, some of it coming from positions of authority.

That would be the president, so expect more of this:

Organized harassment campaigns, lies and urban legends targeting doctors are a real-life symptom of what the World Health Organization dubbed the “infodemic” as the coronavirus started to spread throughout the world earlier this year.

Halazun has since stopped engaging with the trolls on Facebook, some of whom claimed that “the hospitals are empty” and that the virus was part of a plot to vaccinate or microchip U.S. citizens – just two of the many conspiracy theories that have swirled around the coronavirus.

Well-organized, professional disinformation peddlers in the QAnon and anti-vaccination movements have gained new audiences during the coronavirus pandemic by coalescing around two primary boogeymen: Bill Gates and 5G towers.

Halazun heard it all firsthand. He didn’t know where it all began or how to stop it.

“These anti-vaccination people were telling me I’m a sheep,” Halazun said. “Dr. Fauci this, Bill Gates that. And I don’t really care what you think about Bill Gates. It doesn’t affect me. But it does affect me when they tell me what we’re doing is not real and that the hospitals are really empty. It hurts.”

And these theories are absurd:

In January, a well-known promoter of QAnon, the conspiracy theory that Trump is secretly dismantling a pedophile-cannibal cabal that runs the U.S. government, pushed a conspiracy theory that Gates “patented” the coronavirus based on a mischaracterized public patent search.

The patent was created by a Gates-aligned research institute to research a vaccine, a common practice among researchers, and it covered a previous coronavirus, not the one that causes COVID-19.

Still, the tweet helped spark a focus on Gates that has permeated the various conspiracy theory networks that have developed on the internet in recent years.

The same QAnon promoter later promoted a diluted form of bleach called “Miracle Mineral Solution” as a possible way to kill the coronavirus.

Similarly, the anti-vaccination movement has pushed a conspiracy theory that 5G towers are weakening immune systems throughout the world and that COVID-19 is a cover story for the colossal death tolls around the world.

The president has said that those giant windmills that generate electricity cause cancer, but he’s not gone this far, yet. He’s just defending himself. That’s what the New York Times’ Peter Baker reports here:

Confronted with America’s worst public health crisis in generations, President Trump declared himself a wartime president. Now he has begun doing what past commanders have done when a war goes badly: Declare victory and go home.

The war, however, does not seem over. Outside New York, the coronavirus pandemic in the United States is still growing, not receding. The latest death toll estimates have more than doubled from what Mr. Trump predicted just weeks ago. And polls show the public is not ready to restore normal life.

But Mr. Trump’s cure-can’t-be-worse-than-the-disease logic is clear: As bad as the virus may be, the cost of the virtual national lockdown has grown too high.

This then is simple. No one is out to get him. He’s making a choice:

With more than 30 million people out of work and businesses collapsing by the day, keeping the country at home seems unsustainable. With the virus still spreading and no vaccine available until next year at the earliest, though, the president has decided that for life to resume for many, some may have to die.

“Hopefully that won’t be the case,” Mr. Trump said on Wednesday when asked if deaths would rise as a result of reopening, but added, “It could very well be the case.”

And that’s that. People will be sacrificed to keep the rest of the country doing what it used to do, for the good life, but he’ll keep the television show going:

For a president who had staked his legacy on an economic record that was shredded by the crisis, moving on may seem like the best way to salvage his chances for re-election this fall. He tried to signal that this week by saying that his coronavirus task force would soon begin winding down.

By his own admission, Mr. Trump was surprised to discover that many others thought it was too soon to do that. By Wednesday he reversed course, vowing to keep the task force going “indefinitely” and promising that health experts like Dr. Anthony S. Fauci and Dr. Deborah L. Birx would remain part of the group even as he added other members.

Even then, the president tried to pivot by redefining the task force’s mission to figuring out how to reopen the country safely and soon.

“I thought we could wind it down sooner,” Mr. Trump told reporters as he hosted nurses in the Oval Office to sign a proclamation honoring National Nurses Day. “But I had no idea how popular the task force is until actually yesterday. When I started talking about winding it down, I got calls from very respected people saying, ‘I think it would be better to keep it going.'”

So let them have their little television show, but his work is done:

That partial retreat did not mean that Mr. Trump had changed his mind about the broader direction. At a news briefing later in the afternoon, Kayleigh McEnany, the White House press secretary, described the task force’s battle with the virus as if it were largely past.

“They’ve gotten our country through this,” she said. “There were supposed to be 2.2 million deaths, and we’re at a point where we’re far lower than that thanks to the great work of the task force and the leadership of President Trump.”

That is open to dispute:

The death toll on Wednesday passed 72,000, or roughly the equivalent of every man, woman and child in Evanston, Ill.; Canton, Ohio; or Wilmington, Del., and far beyond the low estimate of 50,000 advanced by Mr. Trump just a couple of weeks ago. The widely cited model of the Institute for Health Metrics and Evaluation at the University of Washington now predicts 134,475 deaths by Aug. 4, twice its previous estimate and about the population of Charleston, S.C.

The president shrugged:

The president has made little effort to reconcile his increasing pressure to reopen with the increasing death toll, instead boasting that the government is now in better shape to deal with new cases with more ventilators, masks and other equipment.

He may be wrong about that:

“I think he has given up on the hard stuff and as a consequence is writing off people’s lives,” said Andy Slavitt, the acting administrator of the Centers for Medicare and Medicaid Services under President Barack Obama and now a senior adviser at the Bipartisan Policy Center in Washington.

“Not, unfortunately, in exchange for a better economic outcome,” he added. “The economy – hiring, consumer spending, buying cars, getting on airplanes, signing leases – isn’t going to happen. It’s not going to happen until we have demonstrated we can navigate this global health crisis.”

Most Americans do not have confidence in that yet, preferring that the president and their states take a slower course in the name of public health. By a ratio of two to one, those surveyed by Monmouth University in a poll released this week were more concerned about lifting restrictions too quickly rather than too slowly. And 56 percent said the more important factor should be making sure as few people get sick as possible, while 33 percent said it was more important to prevent the economy from sinking into a profound downturn.

But the man is who he is:

Mr. Trump has long viewed the pandemic through the lens of his political prospects.

He openly admitted in March that he did not want to let infected patients from a cruise ship disembark because it would increase the number of cases counted in the United States. He essentially made the same calculation on Wednesday by saying that more testing only reveals more infections and therefore increases the numbers. “In a way, by doing all this testing we make ourselves look bad,” he said.

And he can’t look bad. Remember that nurse. He is easily offended. He gets very angry very quickly. He lashes out. And everyone should know better now. It’s best that everyone be careful and just shut up. Never even hint at contradicting him. You do NOT want to set him off. But you might want to vote for the other guy in November. Live and let die.