Category Archives: Health

The boy is home.

Posted on by
5

It a remarkable turn of events my son is home 8 days after surgery. The contrast with his September surgical and post-operation experience is stark: what too 5-7 days in September (removal of most IVs and draining tubes, catheter, getting up to walk and use the loo, diminishing of painkillers on demand) now happened in just 2-3 days. His final drain was removed on Sunday and his final IV yesterday. His last chest X-ray was clear. He was then discharged last night. I am truly staggered at the contrast in recoveries and it is only now that we realise how close we came to a disaster last spring.

So four surgeries (two open chest) in 5.5. months later, we now have a basis for hope. Although his energy levels are still low–he feel asleep in the car during the hour+ drive from the city to our homestead, something that he has not done since he was five–the colour is back in his skin and he is already talking about going back to school. We will ease him into that with a visit on Friday, but it looks like the worst is over. He has a few tears in his left lung where it adhered to his inner chest wall when deflated, and his phrenic nerve may have been nicked during the procedure to remove the cystic mass enveloping it, but his diaphragm is working, his lung is inflating and both the tears and nerve should heal in time. Again, the whole process has been a study in contrasts.

It was interesting to see people from all walks of life in the wards. Some clearly have had a rough go of it. I found it refreshing that even though the rules specified just two visitors per patient at a time, the nurses were relaxed about extended family visitors circulating through. The general ward has a steel drum and xylophone available for anyone to use, and because the weekend was brilliant the instruments were moved out to a big veranda overlooking the helicopter pad. The kid in the next room had abut 25 members of his whanau out there lounging under makeshift tents made from bedsheets (the sun was blazing), playing music on the instruments and basically offering not only support to the child patient but also to his parents. In that sense it reminded me of Irish or Italian (my heritage) wakes–attendees are not only there for the departed, but for those that they leave behind. In this case the child is the priority and alive, but the family support extends well beyond the bedridden. When it comes to family values, let’s just say that some folk know how to walk the walk.

Needless to say we owe a deep debt of gratitude to the Starship staff. During the seven day stay my son was in the heart ward, the general surgery ward, the paediatric ICU as well as the cardiac operating theatre and recovery room. Every step along the way the doctors, nurses, counsellors, psychologists and ward orderlies were there to help. That even extended to a multidisciplinary effort to help the kid deal with his fear of the very painful removal of the deep drains at the bottom of his mainline scar and in between his left side ribs. Between the anaesthetists, surgeons and play specialists, he had a much better experience this time around and emerged as a free boy unencumbered by his tubes or the drip trolley.

As a bonus my son spent the last three days in a single room opening onto that wide veranda overlooking the helicopter pad. He not only got to watch the choppers come and go, which allowed us to discuss the various models involved and to speculate on the patients and how crews worked in difficult circumstances for the betterment of others. But he also got to play the xylophone and make friends with some resident pigeons on the veranda, two of which he named “Bob” and “Uncle.” I am a bird fancier and the kid has followed in my footsteps in that regard, plus we have birds at home, so he quickly became buddies with the feathered residents, to the point that he was feeding them out of hand and they were perching on his arm by the time he left. To be honest, the best use of hospital food turned out to be when taming the resident birds.

We have all come out the experience much wiser in many regards, and completely thankful for the skills and compassion of others. I extend that thanks to all of you who offered your support as well. Now back to normalcy!

An atheist finds his God.

Posted on by
14

Given the intensity of the last few days I thought that I would share what I wrote on a personal page because of the kindness displayed by family and friends, including KP readers. It basically summarises the core of the experience. Here it is:

When it comes to my son, for this atheist there is a god and it is plural. God is two teams of human surgeons working in tandem to save his life from a slow death. The saints are a staff of nurses and clinicians who do the before and after surgery work. It is very early days yet–it is less than 48 hours since he entered the operating theater–but if not a full miracle it has been a revelation of sorts.

The surgery took 6 hours, and then it took 2 hours to slowly wake him up given what transpired. The surgery was a mix of keyhole and open chest (sternotomy, for those into the lexicon). They drained him first using the keyholes while looking at the mass in real time through the telescopic micro-camera before opening him up. They went through the original scar, which was tough because there was scar tissue and metal to work through. They excised the bulk of the mass via resection (“debulking” is the term), then focused on the phrenic nerve. The cystic mass came off the nerve and they do not believe that it is damaged, although it will take time to tell whether it is intact or will regain function. But he is breathing from his diaphragm so the outlook is positive even if it takes a few months to confirm.They also found that the mass was moving to the upper right side of his chest so that was removed as well.

They then proceeded to the carotid artery. They found that it was easier to remove the enveloping mass than they expected. Think of an arm warmer being slowly unwrapped. As before (after the first surgery), his heart was not compromised by the mass. The overall outcome is to my mind astounding–complete removal of the cystic mass with only the possibility of microscopic bits left. This is way beyond our hopes.

The down side is that they scraped and cut more extensively than during the first surgery, so the kid is in agonising pain when the painkillers are wearing off. They have him on a cocktail of things normally associated with junkies because he is allergic to morphine (the cheapest and crudest painkiller), which causes him an excruciating full body itch (it turns out the entire class of opioids that morphine is part of is allergic to him). So they are working on mixes that also have a sedative effect, as he has developed a full-on phobia about tubes and drains regardless of whether they are being placed or pulled. Since we can see the vital signs monitor readings on screens connected to the cables attached to his six monitor points (electrodes connected via adhesive plastics), we can see that his heart rate, blood pressure and breathing spike at the very thought that someone is going to “mess” (his words) with the tubes.

Worse than that is hearing his cries of pain when they actually do it. The experience of hearing his cries is both blood curdling and agonising because although his phobia is mental the pain is real, even if it is just the pulling of a tape holding one of his tubes. He now has 3 big ones to go. And to be clear: this is a boy who has a very high tolerance for pain and who is steadfast and resolute when dealing with adversity. He is not a snowflake of any sort. But we also have a sense of perspective, because his are not the only cries we hear in the ward, and they are not just from children.

The best news is that when compared to his first big surgery he is in far better shape and recovering much faster. They have removed 3 tubes including the catheter (a major negative event) and he has now gotten off the bed and sat in chair twice as well as used the bathroom in a normal way. Those are major milestones that he did not achieve until a week after the first surgery and now it is just a day and a half since he got out of theater. All of his vitals are good except when he freaks out, so he has been moved from ICU to an observation room and should be sent to the general heart ward if things continue along the same trajectory. If that is the case he may, in fact, be discharged earlier than expected.

They are working on a protocol to sedate him when they take out the last big drains, which should happen in 2 days. The psychologists and pain relief people are very much involved at this point, even as the surgical teams take a step back now that the most their work is done.

The boy has a few lacerations on his left lung where it adhered to his inner chest wall when deflated, and it is leaking air, but the consensus is that the leaks will seal in the next days and weeks. The lung deflated before the first surgery and did so again before this one, so it was good that they got in before further damage was done. They cannot be sure how much it will re-inflate but the fact that he was doing deep breathing right out of the operating room is a very good sign the the phrenic nerve is working and the leaks are not major.

Anyway, we are much relieved and thankful for the surgical skills displayed by the cardio-thorax and internal medicine teams working together. It is amazing what people can do when working towards a common goal, especially at a global moment when all appears to be just the opposite.

Thanks to all of you who have offered support and empathy for what we are going through. He is not out of the woods yet and there’s a long road ahead to being whole again, but to completely jump the shark on this mix of metaphors, there is light at the end of the tunnel that leads to my son’s future.

Another forced break.

Posted on by
12

Well, the time has come yet again for my son to go back into Starship for another major surgery (the fourth in five months). The mass in his chest is growing and has enveloped his left carotid artery as well as his phrenic nerve and assorted other blood-carrying vessels and nerve linkages. His left chest cavity has filled with fluid, putting pressure on his left lung and causing him pain. After many consultations the surgeons feel there is no other option but to try and excise the mass. That will involve a cardiac team as well as an internal medicine team, both led by senior surgeons. The surgery is scheduled for this upcoming Monday and will last a long time as it is a full open chest affair. Needless to say, my wife and I are anxious and, to be perfectly honest, scared. I have a sense of hope but also of foreboding.

We have not told our son about what is about to happen because he is already anxious and stressed out after hearing the bad news (that of needing another surgery) in early Feb. We have consulted with a senior Starship child psychologist and she agrees that waiting until Saturday morning is the best way to break the news. That way he will only have one sleepless night before we head to the hospital on Sunday afternoon (they need to do a lot of prep on him so we head to Starship the day before the surgery).

Basically this is a repeat of what the boy went through late last Sept., when the hard mass on his sternum was removed. But the more fibrous/gelatinous “tendrils” that have branched out along his upper left rib cage have continued to grow rather than ceased growing, much to the surgeon’s dismay. Again, this is a very rare and aggressive type of benign cyst–some of you may remember that it is a congenital multilocular thymic cyst that should have naturally atrophied when he was a toddler–so the surgeons are discovering things on the go, and so far they have not been good. The remaining mass must come out if my kid has any chance of a normal life.

There are all sort of side effects in play, but for the moment the plan is to try and resect the mass without damaging what it is clinging to. It is a complicated and risky process.

The irony is that my son is actually doing quite well at the moment, acting like a normal kid, running around and doing his best to be active. We believe that this is more a case of him trying to be tough in the hope that exercise and pain management will make the fluid pressure on his left lung go away (as was initially hoped last year). Alas that is not what has happened and his brave front notwithstanding, only surgery can help him. We admire his resolve and, to use that much abused term, resilience in the face of this adversity. He is strong and in some respects wise beyond his years, but it is the strength and wisdom of the battle scarred at a very young age.

Assuming that he makes it through the surgery and recovers, we are concerned about the psychological impact this will have on him. Let’s just say that, from being a kid who could get vaccinated and undergo blood tests without a whimper, he now does not like hospitals and is afraid of needles and drains (which are very painful when removed from his torso). I just hope that we can offer the support he needs to get his head right if and once this is over.

I have had some bad moments in my life but looking at the boy’s face when he was told the news that he would need another big surgery is one of the worst things that I have experienced. It was compounded by the lead surgeon’s look when he told us because it had a sense of hopelessness written all over it. He is a good and honest man, and he simply said that because of its rarity and complicated presentation, they are very much in the dark about how to proceed and are just doing what they think is best after extensive consultations with colleagues in NZ and abroad. Apparently this is a case that no-one wants.

All of which is to say that my mind is not on political blogging at the moment, or much anything else for that matter. So I will take a break from KP, focus my attention on my wife and child, and put my faith and trust in the staff at Starship. They have been excellent so far and understand what we are going through.

Please keep my boy in your thoughts. I will check back in when I can.

Shoutout to Starship.

Posted on by
7

My son returned home this week after spending two weeks at Starship undergoing major surgery. It was dicey for a while, as he had a lemon-sized tumor removed from his anterior sternum that was putting pressure on his heart and lungs and which had extended out onto his upper left rib cage. It turns out that he had a mediastinal multilocular thymic cyst, most likely congenital and therefore present since his birth. Normally they atrophy and are absorbed by the age of three, but in his case it apparently kept growing. He was asymptomatic until this past May, when he developed shoulder pain and shortness of breath. After several misdiagnoses and a change of GPs he was referred to Starship in late September, where chest X-rays showed a large mass. Things accelerated from there. It turns out that the shoulder pain was referred pain and common with chest tumors–but one has to know what to look for and the original GPs did not.

Multilocular thymic cysts are extremely rare but fortunately most often benign. There are more tests to be done and even the possibility of further surgery to remove remnants of the mass from his ribs, but the hope is that now that the large hard mass has been removed the rest will stop growing and wither or can respond to drug therapy or some other form of non-surgical intervention. What is amazing is that my son’s left lung had collapsed at some point in the past–maybe even a year ago–but he had continued to play soccer, ride his bike and run cross-country until his symptoms appeared in May. He finally had to stop sports in July while we looked for an answer.

In any event, he is on the mend even if not entirely out of the woods yet. The prognosis is good for the long-term. He is now pleased at his ability to breath and move about pain-free (other than from the chest and drain wounds), He thought that the shoulder pain was just from over-doing it on the monkey bars and that it was normal to be short of breath after exertion. And well one would be on both counts when operating on one lung and a compressed heart.

I wanted to use this post to publicly thanks the medical staff at Starship for saving his life and for the world-class quality of the attention that my son received, both during the surgeries (he had two), during four days in paediatric cardiac ICU and during the remainder of his time on the cardiac paediatric ward (he was there because of the open chest surgery, not his heart per se, because cardiac surgical teams are the best versed in matters of chest surgery recovery). Everything about Starship was first rate, especially the surgical care from the moment the mass was detected to the ongoing post-operative recovery here at home, where the team has called us to check on him and outline a schedule for follow-ups. Above their skills as surgeons, anaesthetists and paediatric nurses, what sets the Starship staff apart if their incredible level of compassion and empathy for their patients as well as their patient’s whanau. My son was on the upper end of the paediatric age group (ten) but the way in which the staff interacted with toddlers and newborns was, from my family and I could see, absolutely wonderful.

If there is an institution to which a charitable contribution can be made, I recommend Starship Hospital simply because it provides world class care and, among all the other worthy causes that can be supported, it is uniquely able to provide an actual physical future for those who otherwise would have none.

Random Retweets: Pandemic mitigation.

Posted on by
14

Introduction.

I have recently seen a trend whereby people turn their twitter ruminations into op eds and even semi-scholarly essays such as those featured on Spinoff, Patreon or The Conversation. It makes sense to develop ideas from threads and maximise publication opportunities in the process, especially for academics operating in a clickbait environment that has now crept into scholarly journals. I am not immune from the thread-to-essay temptation, although I have tended to do that on my work page and stick to subjects more pertinent to my work because the twitter account I use is a business rather than personal one.

With that in mind and because I have not posted here for a while, I thought it opportune to edit and repurpose some twitter thoughts that I have shared on the subject of what might be called the security politics of Covid mitigation in New Zealand. Below I have selected, cut and pasted some salient edited tweets along that analytic line.

Security aspects of pandemic politics.

There are traditional national security threats like armed physical attack by external/internal enemies. There are non-traditional national security threats like rising sea levels and disasters. Anti-vaxxers are a non-traditional national security threat that must be confronted.

Social media is where state and non-state actors (criminal organisations, extremist groups) link with local agitators in order to combine resources for common purpose. Viral dis-/misinformation and influence campaigns designed to socially destabilise and politically undermine public faith in and support for liberal democracies like NZ are an example of such hand-in-glove collaboration. If left unchecked it can lead to mass public disorder even when seemingly disorganised (e.g. by using “leaderless resistance” tactics). This growing “intermestic” or “glocal” threat needs to be prioritised by the NZ intel community because otherwise social cohesion is at risk. On-line seditious saboteurs must be identified, uncovered and confronted ASAP. That includes “outing” the foreign-local nexus, to include state and non-state actor connections.

If people are going to complain about Chinese influence operations in NZ, then they would do good to complain about US alt-Right/QAnon influence operations in NZ as well. Especially when the latter is manifested in the streets as anti-vac/anti-mask protests. The difference between them? PRC influence operations attempt to alter the NZ political system from within. US alt-Right/QAnon influence operations seek to subvert it from without. Both are authoritarian threats to NZ’s liberal democracy.

In the war against a mutating virus initially of foreign origin NZ has a 5th column: anti-vax/maskers, religious charlatans, Deep State and other conspiracy theorists, economic maximisers, venal/opportunistic politicians, disinformation peddlers and various selfish/stupid jerks. Their subversion of a remarkably effective pandemic mitigation effort should be repudiated and sanctioned as strongly as the law permits. Zero tolerance of what are basically traitors to the community is now a practical necessity (along with a 90% vaccination rate). Plus, as a US-NZ dual citizen who had his NZ citizenship application opposed by some hater, I would like to know who let in the rightwing Yank nutters now fomenting unrest over masks/vaxes/lockdowns/mandates etc. They clearly do not meet the good character test.

A counter-terrorism axiom is that the more remote the chances of achieving an ideological goal, the more heinous will be the terrorist act. Anti-vax and conspiracy theorists using Nazi/holocaust analogies to subvert democratic pandemic mitigation strategies are akin to that.

Long-term community well-being requires commitment to collective responsibility and acceptance of individual inconvenience in the face of a serious public health threat. It is part of the democratic social contract and should not be usurped for partisan or personal gain. Elephant in the room: when cultural mores contradict and undermine public health scientific advice but for political reasons cannot be identified as such. If true, partisan-focused approaches to Covid is not just an Opposition sin. The virus does not see culture or tradition. Anti-vax/mask views are no excuse to violate public health orders. Likewise economic interest, leisure pursuits, religious or secular beliefs no matter how deeply held. Ergo, cultural practice cannot override the public good. Collective responsibility is a democratic obligation.

Those that set the terms of debate tend to win the debate. In politics, those that frame the narrative on a subject, tend to win the debates about it. By announcing a “Freedom Day” the govt has conceded the debate about pandemic mitigation. The issue is not about human freedom. It is about managing public health risk in pursuit of the common good. Using “freedom” rhetoric injects ideology into what should be an objective debate about prudent lockdown levels given uneven vaccination rates, compliance concerns, mental health and economic issues. Bad move.

Church, State and the weight of capitalism.

Posted on by
27

Arguments by religious folk that they are being discriminated against under the Level 2 pandemic restrictions in NZ, which limit church services to ten people or less when schools, restaurants, malls and other service outlets are allowed to host many more people under voluntary self-distancing protocols, got me to think about whether people understand the rationale behind the government approach as well as the role of religion in society and particularly in a liberal democracy such as NZ. I wrote a tweet outlining my general view and it elicited some contrary responses from people who are either religious and/or dislike the current government. I will not dwell on their responses but I will below string together in fuller scope my side of the discussion.

I began with the first tweet:

“Liberal democracies are secular regimes where church and state are separate and the state treats all religions neutrally and equally while having superordinate authority over material (as opposed to spiritual) issues, including public health. Churches need to respect that.” That began a back and forth with the contrary minded readers, which elicited the following responses from me:

“Stage (sic) 2 is based on opening up commerce, with some social restrictions still in place. Education is critical for commerce in several ways. Services are critical to economic well-being. Religion is a social construct based on belief that is not economically essential. Big diff.

In medicine, the environment, engineering, economics, threat assessment, even political forecasting, among so many other material things, science must and will trump belief. With CV-19 science must prevail over belief. There is nothing “illiberal” about the govt response.”

The last sentence came in response to a commentator’s remark that NZ is an illiberal democracy because of the restriction on religious gatherings, among other things. The author went on to speak of a difference in values between the government and people like him when it comes to family and society. I replied:

“A secular democratic regime can, should and most often does value families and society, and its social policies demonstrate this. The level 2 re-opening is business driven because NZ is a capitalist country, and everyone’s welfare depends on capitalist survival, not churches.

So long as the economic imperatives of a capitalist society remain a paramount concern of govt, then commercial concerns will supersede (much variegated) spiritual ones. Hence the pro-business incrementalism of the govt approach. They respond to structural necessity, not values.”

And that is the bottom line. NZ is a capitalist society. It is a capitalist society because the means of production are mostly in private hands and subject to market-oriented logics, because the relations in and of production reproduce the material hierarchy on which the economic system rests, because it is inserted in a global capitalist system of production, consumption and exchange, and because the social division of labour that emerges out of it reinforces the hierarchical relations between the ultimate producers of wealth and the owners of productive assets in NZ and elsewhere. Most of all, NZ is a capitalist society because the welfare of everyone directly or indirectly depends on the welfare and investment of capitalists–if they do not prosper, no one does.

Regular readers know the I am not a fan of laissez fare capitalism or the various market-driven experiments of the last forty years. Nor am I entirely pleased with how the current government defers to capitalist logics rather than fully embrace the entire policy spectrum involved in well-being budgeting. I am just saying: when it comes to the economic motor of NZ society, it is what it is.

NZ has just faced and continues to be threatened by a deadly global pandemic. The initial government response was a public health campaign marshalled on scientific grounds that was mitigated by an unprecedented economic relief package designed to help people weather the financial storm caused by the disruption of economic activity. Capitalists and workers were included in the relief measures. This response was vetted by a pandemic emergency response committee chaired by the Leader of the Opposition and communicated in daily press conferences by the Prime Minister and Director General of Health, along with other officials. That is far from being the makings of a totalitarian police state that a fair few believe it to be.

Once the lockdown/quarantine phase of the restrictions was lifted (after six weeks), the government announced that its level 3 and 2 approaches were designed to get businesses back to work. This employed a type of pragmatic incrementalism where restrictions on commercial activity were slowly lifted in piecemeal, sectorial and graduated fashion over what is now going on 3 weeks. The government explicitly stated that this was not a social opening and that pre-pandemic social activities that do not have a commercial orientation were very consciously excluded from the stage 3 and 2 re-opening measures.

That is why churches are not allowed to resume pre-pandemic activities, indulging religious services, in the measure that they did before March 23. Note that they can still host church services and other activities but that they must adhere to the “fewer than 10” rule when doing so. No one has restricted their freedom of worship. Only group size when worshipping has been limited, and that is because churches are not considered to be businesses.

If churches want to claim that they are a type of commercial enterprise, then they have reason to feel discriminated against and by all means should air their grievances along those lines. But that might open questions about their tax-free status, real estate holdings, tithing practices and other non-spiritual aspects of their mission. So it is unlikely that we will hear this argument aired in public or as a defence of a church’s right to host large gatherings for religious purposes.

In any case, the “blame” for not including churches in the Level 3 and 2 re-openings is not the fault of government values when it comes to family and society. If anything, blame comes simply from the fact that NZ is a capitalist nation and the bottom line is, well, the bottom line. Spirituality is fine but it does not pay the bills, unless of course it is of the “prosperity doctrine” persuasion where the Lord commands that we should enrich ourselves before all others.

Speaking of which: why the heck was that charlatan fraudster Brian Tamaki and his Destiny Church minions allowed to defy the level 2 restrictions without punitive sanction? Were the police worried about a confrontation with a large crowd? Even if that was the case, if the letter of the public health order cannot be enforced even with enabling legislation conferring extraordinary enforcement powers on the police, what is the point of having them? Or are exceptions to the rule made for bully-boy bigoted loudmouth xenophobic lumpenproletarians posing as preachers?

We might call that a type of reverse discrimination.

A matter of definition.

Posted on by
8

Recent reports have surfaced that hospital officials in some US localities are inflating the CV-19 death count by classifying anyone who dies in their care who is not the victim of an accident or other obvious non-viral cause as a CV-19 victim. Apparently this is because the US public health scheme, Medicaid, pays hospitals USD$5000 per non CV-19 death versus USD$13,000 for CV-19 related deaths. Most hospitals in the US are private, for profit entities so the hospital administrators (not doctors) who do the paperwork submissions to the federal government for Medicaid death reimbursements have financial incentive to falsify the real causes of death.

There is no independent body above hospital administrations regularly overseeing how cause of death in hospitals is classified unless some gross error comes to the attention of local and state authorities, and there is no way for the federal government to unilaterally challenge the legitimacy of CV-19 death claims. Moreover, since local coroners are swamped by an influx of CV-19 dead and Medicaid is stretched to the breaking point by the upsurge in (legitimate) CV-19 claims, there is little way to hold the dishonest hospital administrators to account unless a whistleblower from within a hospital provides concrete proof of institutional malfeasance.

In contrast, official Russian statistics show that there are over 263,000 cases in the country, with nearly 2.500 deaths and new cases exceeding 10,000 per day. That death count has raised eyebrows outside of Russia, as it is remarkably low when compared to other countries given the number of cases and rate of infection.

Russian officials counter the skeptics by claiming that their definition of a CV-19 death refers only to those that can be directly attributed to the pathogen. They deliberately exclude other causes that are exacerbated by CV-19 contagion, such as heart failures and smoking-related pulmonary embolisms, liver failures etc. Because of this the Russian CV-19 mortality rate is not only very low but also does not disproportionately affect the elderly, whose deaths are most often attributed to the underlying condition rather than to CV-19.

These differences in reporting remind me of an incident that happened to me when conducting research in Brazil in 1987. I had an interest in national health administration because I had worked on that subject when conducting Ph.D. dissertation research in Argentina earlier in the decade, I lived in Rio at the time and had experienced Carnaval in February, when thousands of sex tourists of every persuasion descended on the city in the middle of what was clearly an AIDS epidemic (in a cultural context where men refused to use condoms because that was considered “unmanly” and in which many (usually) straight men used Carnaval as an excuse to enjoy gay sex). Around that time I had to donate blood for my then-wife to use in a blood transfusion after she picked up a water-carried blood infection while cleaning vegetables and because we were told that most of the blood supplies in Rio were infected with both AIDS and syphilis, so I was acutely interested in how health authorities dealt with the convergence of viral calamities.

I managed to arrange an interview with a senior official in the Health Ministry in Brasilia, one who just happened to be involved in infectious disease mitigation. As part of our conversation I asked him how many AIDS cases there were in Brazil. He said “100.” I laughed and said “no, seriously, how many cases are there because I just came from Rio during Carnaval and it was a 24/7 bacchanal of unprotected sex, drug use, drinking, dancing and other assorted debauchery, plus I am told than the blood banks are unreliable because the supplies are infected with AIDS and syphilis.”

He smiled and leaned back in his chair for a moment, and then said “you see, that is where my country and your country are different. In this country a person gets the AIDS virus, loses immune system efficiency, and eventually succumbs to an infectious tropical disease such as malaria or dengue fever. We put the cause of death as the tropical disease, not AIDS. In your country a person gets AIDS and eventually dies of a degenerative disease such as a rare thyroid or other soft tissue cancer. Since they otherwise would not have likely had that cancer, your health authorities list the cause of death as AIDS. For us, the methodology for defining cause of death is not only a means of keeping the official AIDS count low. It also keeps the foreign tourist numbers up because visitors are not fearful of contracting AIDS and have much less fear of malaria or dengue because those are preventable.” I asked him what he thought about those tourists who did contract AIDS while in Brazil on holiday. He replied “that is a problem for their home authorities and how those authorities define their cause of death.”

I recount this story because it seems that we have entered a phase in the CV-19 pandemic where definition of what is and what is not has become a bit of a hair-splitting exercise that has increasing levels of political spin attached to it. It opens a Pandora’s box of questions: Is the lockdown approach overkill? Is the re-opening too soon? Are the overall US CV-19 death figures inflated because of the structural imperatives layered into their health system? Are the Russian figures underestimated because of their politics or because of their accounting methods? Has the PRC lied all along about the extent of the disease before and after it left its borders (in part by assigning different causes of death than CV-19)? At what point do honest medical professionals assign primary cause of death to CV-19 rather than an underlying condition?

There is one thing that I am fairly certain about. In Bolsonaro’s Brazil, I have little doubt that the rationale I heard in 1987 is still the rationale being used today, except that now it is CV-19 rather than AIDS that is the scourge that cannot be named.

Between push and shove.

Posted on by
38

The NZ government’s handling of the CV-19 pandemic has won international praise for its decisiveness and effectiveness. It is hard to argue with a response that has reduced the number of daily reported transmissions to near zero and the death toll to less than two dozen out of 1500 total cases. Not bad.

But as could have been expected, there are those who are not happy with how the government has comported itself on the matter. There has been much whinging about restrictions on movement during the stage 4 lockdown, and now there is much moaning about ambiguous rules governing shopping, “bubble” expansion and easing of travel restrictions. It seems that some people will simply never be satisfied even if the international community stands in awe of what NZ has accomplished.

There appear to be three types of complainants. The first are the serial whiners. These sorry folk just like to bitch and moan about anything. They do so more as trolls rather than out of partisan spite or informed concern and are best seen as losers. They shall be ignored in this discussion.

The second group are the public health advocates. These include medical professionals, educators, some service sector providers and others who feel the government is moving a little too quickly when lifting the quarantine restrictions on commerce. They believe that the disease must be eradicated or at least its transmission reduced completely before the lockdown is lifted. For them, the current Level 3 restrictions are an invitation to transgression and indeed, that is what has happened in many instances. Some people simply ignore the fact that Level 3 is not about social movement but about gradually getting businesses going again in a limited way. Hence beaches and parks, trails etc. swelled in the days after the move to Level 3 with mindless or selfish opportunists who either ignored or did not understand that Level 3 was not supposed to be an invitation to resume the party.

Public health advocates push for the continuation of restrictions and hence are dissatisfied with the government’s liberal easing of the lockdown after just a month. They want a longer and more complete quarantine as per Levels 3-4, with no imminent move to Level 2. For them, the matter is a public health issue first and foremost, with all economic considerations secondary to that fact.

On the other side are what can be called the profit over people crowd. They are those who demand that the restrictions be lifted yesterday and that the country get back to business as usual as soon as possible. Level 2 cannot come too fast for them and the sooner that NZ gets back to Level 1 normality the better as far as they are concerned, no matter how many get sick or die. They whine about jack-booted government intrusion on their liberties and rights and, while happy to take emergency funds from the government when it suits them, also decry its meddling and interference in their economic affairs. These type of complainants include most of the political opposition and assorted commentators who have been provided media platforms well above their intellectual station. Among this crowd utilitarian logics and lifeboat ethics 101 abound, but the selfish is also strong, as is the self-servingly stupid.

Whatever the specific reason, here economic security comes before public health concerns.

It is understandable that small businesses fear that a prolonged suspension of trade will destroy their livelihoods, and I do not include them in this dichotomy. But the hypocrisy of big corporate players and their political and media acolytes is shameful. Of course there are exceptions to the rule, but the overall attitude of many NZ capitalists appears borne of self-interest rather than solidarity. And unlike the public health advocates, who span a range of political persuasions, the profit over people folk are clearly of the rightwing persuasion. That is not surprising.

I admit that these are very crude categorisations and that I have painted things in broad strokes. That was done as a preface to my larger point, which is to note that, because it is unable to satisfy either the public health advocates or the profit over people crowd in the measure that each wants, the government is actually doing the right thing. It is striking a pretty fine balance between the two sides, and its pragmatic incrementalism demonstrates a good understanding of the scientific, economic and political realities in which it operates.

In the end, NZ’s response has been quintessentially democratic. Not because the pandemic emergency response committee is chaired, at the government’s behest, by the Leader of the Opposition. Not because it has allowed for full throated criticism of its actions and used its emergency (coercive) powers very selectively and discretely. Not because it put science above partisanship and politics when addressing the threat. Not because the Prime Minister and Director General of Health fronted daily press briefings for over a month and answered in clear, honest and humane fashion everything that was pitched their way, including inane questions with little relevance to the NZ situation (such as whether it was advisable to ingest disinfectant as a cure). Mostly, because its balancing approach encapsulates the essence of democracy as a social contract: it is not about everyone getting everything they want all of the time, but about everyone getting some of what they want some of the time. In other words, it is about settling for mutual second-best options.

That may not be always the case in NZ and democracies elsewhere. But it is what has been done in this instance. Beyond the positive statistics of the policy response itself, that is the most significant and enduring achievement to come out of this crisis: a reaffirmation of democracy as a contingent sectorial compromise on a grand scale.

A tipping point for the dotard?

Posted on by
30

I guess that we should see the silver lining in the CV-19 pandemic. It has finally done what no political opponent could do. It has fundamentally undermined Trump’s credibility and that of the science-denying elements within the GOP and rightwing media. The important aspect of this is that the loss of credibility is evident in a private sector that otherwise was willing to cast a blind eye on the Trump/GOP corruption and buffoonery so long as the latter advanced business interests via deregulation, tax cuts etc.

Now that Trump’s incompetence has been fully exposed, as has that of his immediate advisors and sycophants in and around the White House, private businesses, state and local governments are taking action in defiance of his original bluster and denials. Led by their owners, elected officials and high level managers, entire sports have cancelled or postponed seasons, universities and school districts have closed, cities and states have ordered mandatory quarantines and numerous mass events have been abandoned. Even the military has acted against his original commands, instead opting to listen to military doctors and other experts about the effects of CV-19 on troop concentrations (such as cancelling military exercises and forbidding all domestic travel for service personnel). This, in response to what Trump initially called a politically inspired hoax and to which the GOP/media science deniers decried as the product of partisan hysteria and media manipulation. The fact that private businesses have led the defiant response is especially telling. No lefties among them.

The ineptitude and incompetence of the Trump administration is not only shown in its delayed response and original denials and deflections. The order to institute a ban on all travellers from Europe–done by the same people who crafted the Muslim ban attempted shortly after Trump was inaugurated–was done without forewarning to airlines, airport authorities and local law enforcement, much less the traveling public, American as well as foreign. No contingency plan was crafted, much less enacted, leaving federal border control agencies such as Customs, Immigration, Border Patrol and TSA short-staffed and undermanned in the face of a surge of last minute mass arrivals before the ban commencement date. Additional CV-19 health screenings deployed at the same time has resulted in chaos at airports of entry, with thousands of passengers stuck for hours in baggage returns and lined outside passport control stations (again, manned by federal employees). The result has been a clusterf**k of epic proportions.

Although he has been tested and cleared after being exposed to the virus, Trump may still fall ill because the test only measures one’s status on the test date. If that happens, he becomes a candidate for Article 25 removal from office since he is physically unable to perform the functions of president (which was the original intent of the framers. I shall leave aside jokes about his mental competence but let’s just say that his addled blathering about the pandemic does not inspire confidence). I have a feeling that if he gets sick, those in the GOP who secretly loathe him will have their knives out, because his gross negligence and inaction in handling the response will have election consequences for the party as a whole later this year. Seriously, if the predicted thousands of deaths and job losses and billions in productivity losses resultant from the botched initial response and the chaotic catch-ups since then actually happen, given the now open news that the Trump administration eliminated key public health agencies and replaced public servant scientists with lackeys, then the makings of an election disaster are looming large over the GOP’s political future.

Until now, the GOP’s 2020 election strategy was to ride Trump’s coattails as hard as possible. In the wake of CV-19 that seems politically suicidal. And if GOP politicians start to distance themselves from Trump in their campaigns, the possibility of intra-GOP fratricide becomes more likely. In fact, it is likely that factions are sharpening their knives as I write, with the pro-Trump crowd developing plans to delay the elections or smear anti-Trump politicians as traitorous during a national emergency. For their part, the anti-Trump faction will attempt to convince the public that they did all that they could to prevent him from doing more harm to the Union. That will be a tough sell, but so to will be any argument in support of Trump’s handling of the crisis.

The real trouble for the GOP starts if the pandemic lasts in the US for months, well into the post-convention campaign season (which starts in July). If the death and sick toll mounts to anything close to what is being predicted and job losses increase while businesses shut down, then perhaps even hardened MAGA morons will re-consider their support for the imbecile-in-chief. Even if they do not, undecided and independent voters could well draw the conclusion that enough is enough while the previously apathetic who did not vote in 2016 may finally realise that their votes do in fact count when it comes to national leadership selection. None of this bodes well for the GOP in November.

Perhaps there is a goddess after all. Her name is Mother Nature, and in this instance all she had to do is to let human folly advance her work. That may wind up being a painful but necessary political blessing for the US regardless of who wins the Democratic presidential nomination.

Inviting trouble?

Posted on by
5

Over the next few weeks New Zealand will host two major international sporting events involving hundreds of athletes and spectators gathered together in iconic settings. The gun goes off on Ironman NZ this upcoming weekend in Taupo, and then a week later the World Surf League (WSL) hosts the inaugural Piha Pro surfing competition in the namesake West Auckland seaside town. Ironman NZ will have 1500 competitors at the starting line, and the Piha Pro is said to attract, along with a highly competitive international field of surfers, up to 25,000 spectators during finals weekend (the competition runs for one week). The events are considered to be economic boons for the local communities as well as excellent ways of popularising the Kiwi “brand” around the world.

As a former surf lifeguard who lives near Piha and who spent nearly twenty years doing triathlons (including Ironman NZ), I can attest to the fact that events such as these are very important to those who engage in such sports. I have seen the energy generated by mass competition events and well understand why people are enthusiastic about supporting them. But this year there is something else added into the equation, one that has forced me to put on my day job hat as a someone involved in the risk management business: coronavirus.

Both Ironman NZ and the Piha Pro will bring athletes from all over the world, including countries with coronavirus outbreaks. They will by flying in on what are essentially long metal cigar tubes with recycled air, often on flights of 8 hours or more. Many of these athletes will bring family, friends and other support crews. Likewise, the organisers of these events–both Ironman and the WSL are international firms headquartered abroad,–basically act as a traveling circus, bringing in equipment, machines and staff and hiring local providers to do the same as part of the set-up process. All of these people mingle in close quarters in the days leading up to, through and after the event, and when not at the venues themselves populate the restaurants, bars, hotels, motels and rental accommodations near them.

What makes this issue a bit trickey is that the virus is not only spread by human-to-human contact but via contact with contaminated surfaces, be they plastic, metal, glass or wood. The incubation period is two days to two weeks in humans, but the surface contamination longevity is thought to be much longer. Infrared disinfection is considered the best way of treating contaminated surfaces but that requires resources and knowing which surfaces to treat.

Interestingly, the fitter one is nearing a long-distance triathlon, the more an individual’s immune system becomes depressed. This has to do with rigours imposed on the body by long-distance swimming, cycling and running for months at a time before the race, which is why a so-called “taper” is used whereby athletes gradually back off on training starting two weeks before race day. Surfers do not have quite the same problem, but for many in the WSL time is spent as much traveling as on the water, which also wears on the body.

And now they all get on those flying Petri dishes and head to Auckland.

Out of curiosity I have looked into the specific coronavirus contingency planning around these events. The bottom line is this: there appears to be none. It seems that neither the organisers or the district councils involved have drawn up plans for what happens in the event that someone involved in the competitions comes down sick with the virus. General guidance is provided by the Ministry of Health, to which councils can refer. Auckland Council offered this:

“At this stage Auckland Council is monitoring advice from the Ministry of Health and Auckland Regional Public Health. There is guidance for event organisers and attendees on their website below: https://www.health.govt.nz/our-work/diseases-and-conditions/covid-19-novel-coronavirus/covid-19-novel-coronavirus-information-specific-audiences/covid-19-advice-public-events-and-mass-gatherings. We’re aware that some community-led events are being cancelled by their organisers – they have their own reasons for making that decision and is entirely up to them. The current advice we’re relaying is for Aucklanders to take care of themselves and their families and follow health experts’ advice. Organisers and attendees should keep an eye on the health authorities’ websites for any new/changed information.”

That is the general advice given throughout the country. I was unable to find anything by the Ironman Corporation or WSL on coronavirus contingency planning for the New Zealand events, even though some Ironman-branded races have been cancelled or postponed in Asia because of the pandemic. The WSL has been silent on the subject in general even though there have been questions in the surfing community about whether the Olympics to be held in Japan at the end of July will go on if the pandemic deepens in Japan and/or spreads further (with surfing making its debut as an Olympic sport). Ironman New Zealand makes no mention of the disease in media announcements or on its website.

I assume that the insurance underwriters for these events have taken stock of the odds and given the green light for them to go ahead. That is certainly good news for everyone involved. But I also fear that the unique circumstances particular to these competitions might be inviting trouble, and that if it is left to participants, spectators, organisers and local communities to sort things out as per the general guidelines should the coronavirus arrive in their midst, then a public health emergency might occur.

Then again, having just become a naturalised Kiwi, rather than contingency planning and preparation for the possibility of trouble, I can always fall back on the belief that at the end of the day, “she’ll be right.”