Work, Love, Courage – in Abundance.

Posted on | March 27, 2020 | 2 Comments

Mike Magee

This morning I listened to an interview of the President of Mass. General Hospital, Dr. Peter Slavin, as he outlined the reality of Covid-19 and the challenges faced by his nurses, doctors and health professionals during this crisis. In his words, I found pride in having been part of the caring professions whose lives center around three critical themes: work, love, courage.

Forty-seven years have passed since I received my medical degree, but not one year has passed in which I was not proud to have chosen this life. My biases are strong and well known by now. Covix-19 has only reinforced them

The world is a better place today for having developed and supported strong, enduring patient-caregiver relationships. This is not simply a function of the nuts and bolts of health services that this relationship provides, in full vision and especially under duress. But also for those things it has reliably delivered over many decades around the world, quietly below the radar screen.

The first of these, as a collective, is the management and processing of a population’s fear and worry, which, absent the efforts of nurses, doctors and caring professionals, would accumulate in our society to destabilizing effect.

The second is a subtle and rational reinforcement of important societal bonds. The importance of this second contribution was best highlighted by the great Cardinal Bernardin, who shortly before he died said to several thousand AMA physicians, “There are four words in the English language that have common English roots. They are heal, health, whole and holy. I tell you this today to remind each of you that to heal in a modern world you must provide health; and to provide health you must keep the individual, the family, the community, and society whole. And if you can do all that, why that is a holy thing.”

The third mostly invisible contribution is hopefulness; a quiet confidence that most problems can be managed, most mysteries solved, and that, absent a cure today, there remains hope for a discovery tomorrow aralen. That deep-seated optimism, embodied in individuals whom you trust, have confidence in, and believe in, is transferable, and helps create a reservoir of good will, a belief that life is worth living, that risks are worth taking, that loving and being loved is possible, that dreaming, imagining, purchasing a home, getting married, having children are all worth the effort.

As these caring relationships have become threatened by Covid-19, stable civil societies are noticing the difference. This situation is made worse by predatory leaders, who leverage lies and fear as a currency to control a population in order to reinforce existing and past power silos, and who attempt to segregate us one from another to maintain the status quo. They not only draw down the reservoir of good will locally and globally, but compromise caring professionals medium and long term success.

I am older now, but still have a voice. I am not inside the hospital any longer, but I am inside the hearts and minds of every nurse and doctor and health professional who willingly place themselves in harms way for each of us. They have the courage to rise, the willingness to work, the hearts to love. They are honest and true.

The Trump Easter Celebration – Resurrecting The Economy?

Posted on | March 25, 2020 | 2 Comments

Mike Magee

New York Times columnist, Thomas Friedman, was sufficiently disturbed by President Trump’s suggestion that our nation needlessly sacrifice American lives to protect the American economy with a quick return to work by Easter, that he turned to his old friend, Michael Sandel, legendary political philosopher at Harvard for reassurance.

As many of us do, Sandel saw the problem as systemic. As he put it, “In a highly individualistic society like ours, we don’t do solidarity very well.”

Channeling my own messaging from CODE BLUE: Inside the Medical Industrial Complex, he continued, “Our lack of preparedness for the pandemic reveals the lack of solidarity in our social and political life, especially in our inadequate system of public health and lack of universal access to health care.”

Friedman is not the first columnist to be unnerved by American culture. Back in November of 2017, David Brooks wrote a column titled “Our Elites Still Don’t Get It.” In it, he states, “Trump is constantly making friend/enemy distinctions …creating toxic communities based on in-group/out-group rivalry.” Of course, back then, Brooks could not have imagined how far down that road we would travel.

Sandel sees a pathway back to sanity he calls the “common good.” What does that mean, asked Friedman. “The common good is about how we live together in community. It’s about the ethical ideals we strive for together, the benefits and burdens we share, the sacrifices we make for one another. It’s about the lessons we learn from one another about how to live a good and decent life.”

In Sandel’s eyes, the course Trump is suggesting amounts to an Easter celebration that allows the Economy rather than Christ to rise from the dead. He says, “The strategy of contending with the pandemic by allowing the virus to run its course as quickly as possible in hopes of hastening ‘herd immunity’ is a callous approach reminiscent of social Darwinism — the idea of the survival of the fittest. It allows the contagion to spike, intensive care units to be overrun, the most vulnerable to die, but with the goal of jump-starting the economy sooner rather than later.”

In 2017, David Brooks wrote, “The first step in launching our own revival is understanding that the problem is down in the roots.” Sandel believed that rot at the roots reflects markets out of control. “Markets are useful instruments for organizing productive activity. But unless we want to let the market rewrite the norms that govern social institutions, we need a public debate about the moral limits of markets.”

President Trump would do well to read Michael Sandel’s “Justice: What’s the Right Thing To Do?” In it, he says, “the Gross National Product does not allow for the health of our children, the quality of their education or the joy of their play. It does not include the beauty of our poetry or the strength of our marriages, the intelligence of our public debate or the integrity of our public officials. It measures neither our wit nor our courage, neither our wisdom nor our learning, neither our compassion nor our devotion to our country. It measures everything, in short, except that which makes life worthwhile. And it can tell us everything about America except why we are proud to be Americans.”

Confronting Presidential Out-ertia.

Posted on | March 23, 2020 | 6 Comments

Mike Magee

“All change of matter has an external cause. (Every body remains in its state of rest or motion in the same direction and with the same velocity, if not compelled by an external cause to forsake this state.) … This mechanical law can only be called the law of inertia (lex inertiæ) Immanuel Kant, 1786

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In the March 23, 2020 COVID-19 Washington Press Briefing, President Trump signaled his active intent to break through his self-imposed inertia and embrace opening markets while closing out American lives. In the process he has taken inertia and morphed its evil twin, out-ertia. What should medical leaders like Tony Fauci do now?

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Inertia describes the tendency for physical objects and human beings to resist change. If you want something to move, or to stop moving, or to shift direction, you must apply force whether through gravity, friction, or contact.

Isaac Newton defined inertia as his first law of his Laws of Motion in 1687 in his Philosophiae Naturalis Principia Mathematica. But the word “inertia” was first introduced in scholarly fashion 60 years earlier by Johannes Kepler in his Epitome Astronomiae Copernicanae, deriving the word from the Latin word for “idleness” or “laziness.”

The phrases “dig in your heels” or ‘denial and routine were her two best friends” reflect human tendency to embrace existing habits and ideas. Most of the time, this proves harmless and with some patience evolves with time. But in moments of great environmental change, whether by global warming or COVID-19, inertia can prove to be dangerous and fatal.

This truth is magnified by those in power. Indecision and poor judgement are a deadly combination. It matters little whether the man in control fails to recognize change or fails to react to it – the outcome is the same.

History tells us that failures of inertia are more commonly exhibited by those directly involved at the center of a crisis. They readily exhibit a bias toward the status quo, hanging by a thread to the old ways. Clarity often arrives first through witnesses on the periphery with greater perspective.

Breaking the rules requires mental courage. This is especially true at the beginning. After the first push, there is momentum. But it has to be a real push, not a feign, nor a wink and a nod. Gentle corrections of Presidential fabrications, false promises, and misdirections are not a course changing push. You’d have to say, “If you lie one more time in my presence, I will walk off the stage and quit.”

Dr. Fauci needs to insure his availability to the public to speak truth to power. That’s the only way to confront Presidential out-ertia. Trump has signaled his intent. There is no “hidden agenda.” It is present and clear, and there is no Presidential regret. Time for Medicine, Nursing, and all Health Professionals to rise to or fall from the challenge.

David Brooks on COVID-19 Response: Beware of Dread.

Posted on | March 17, 2020 | 5 Comments

Mike Magee

On March 12th, New York Times columnist David Brooks indulged in a moment of existential reflection when he wrote, “Frank Snowden, the Yale historian who wrote ‘Epidemics and Society,’ argues that pandemics hold up a mirror to society and force us to ask basic questions: What is possible imminent death trying to tell us? Where is God in all this? What’s our responsibility to one another?”

Three days later, he discarded metaphysics and just couldn’t take it anymore. On PBS News, he let loose with this:
“I feel a deep sense of anger that our government has responded so badly. Frankly, this is what happens when you elect a sociopath as president, who doesn’t care, (and) who’s treated this whole thing for the past month as if it’s about him.”

Likely Snowden’s book with its crushing insights put Brooks over the edge. Here are a few nuggets from a recent New Yorker interview of the author:

Historically, epidemics have “shaped politics, crushed revolutions, and entrenched racial and economic discrimination.”

“Epidemic diseases are not random events that afflict societies capriciously and without warning. On the contrary, every society produces its own specific vulnerabilities … it’s structure, its standard of living, and its political priorities.”

Epidemics are a category of disease that seem to hold up the mirror to human beings as to who we really are.”

“Epidemics also, as we’re seeing now, have tremendous effects on social and political stability. They’ve determined the outcomes of wars, and they also are likely to be part of the start of wars sometimes.”

“The way we respond very much depends on our values, our commitments, and our sense of being part of the human race.”

“The health of the most vulnerable people among us is a determining factor for the health of all of us.”

“To have officials in the White House saying, ‘Oh, its nothing more than a common cold, we’ve got it under control,’ when they have nothing under control, as far as I can see, and they’ve put people in charge who don’t even believe in science.”

Even as David Brooks awoke, Republican leaders have slept on, or offered weak bromides like Marco Rubio’s plea that we not “spend all our time taking political shots”, as if Susan Collins was right when she said President Trump had “learned his lesson.” No, he hasn’t.

His words – serious one day, flippant the next – mean nothing.  Actions – only verifiable actions – count now. They must be real, rational, and responsible. And so is David Brooks warning, “Dread overwhelms the normal bonds of human affection.”

A “CODE BLUE” Moment – Crisis In A Broken Health Care System.

Posted on | March 12, 2020 | 2 Comments

Mike Magee

In the opening pages of “CODE BLUE: Inside the Medical Industrial Complex”, I wrote:

 “When Donald Trump expressed his cluelessness—’nobody knew that health care could be so complicated’—before a meeting of state governors in February 2017, he was exposing a pattern of both arrogance and ignorance that is now on full display.

Most Americans awaken today forced to acknowledge the absurdity of our convoluted system of third-party payers, and the pretzel positions our politicians weave in and out of as they try to justify it, reform it, then un-reform it. Congressional loyalists continue to find solace in telling themselves, “Well, we still have the best health care in the world.”

In point of fact, we’re not even close to having the best health care in the world. As legendary Princeton health economist Uwe Reinhardt prophetically remarked two years prior to COVID-19, “At international health care conferences, arguing that a certain proposed policy would drive some country’s system closer to the U.S. model usually is the kiss of death.”

It is at times of crises like these that system weaknesses expose themselves. The inability to swiftly and efficiently test a population for COVID-19, share those results, and rationally plan a swift, coordinated, and effective response is a reflection of the gross inadequacies of our health care system. So is a leaky and disjointed supply system that can’t manage demand for cue tips, let alone ventilators.

In a review of CODE BLUE last year, John Rother, President and CEO of the National Coalition on Health Care wrote, “Code Blue will make you mad, but it will also make you better informed and better able to understand what we need to do as a country to fix it. I can’t think of a more persuasive book on the need for change.”

The need for change that John forecasted not only included matters of justice, planning, and equitable distribution of health care resources, but also the capacity to respond to a global public health event of the magnitude of COVID-19.

How broken must a system be when our nation can’t keep up with nations like South Korea and Italy in testing for the virus? What does our “patchwork response”, variable across states and communities, lacking any private-public planning and coordination, and absent clarity on pricing, access, eligibility and prioritization, and raft with confusion even on what protections are necessary for health care workers collecting samples, tell us about our need for a fundamental restructuring of our health care system?

God Bless Anthony Fauci, but is our system so fragile that the fate of Americans rests on a single individual having the temerity to speak truth to power in the face of executive incompetence? And how are we to reconcile a Presidential veto on testing kits months ago. And the solution now? The President turns to his son-in-law’s family for advise on what to do next.

A half-century of systematic underfunding of public health, planning and prevention in deference to entrepreneurial scientists in pursuit of profit and patents over patients and families, ends here – in crisis. We will survive this “Code Blue” calamity, but we need to assure through new leadership and deliberate action that it will never happen again.

For now:

1. Self-isolate the family.
2. Test if you can.
3. Trust and believe in each other.
4. Ignore Trump and Pence. Trust your state leaders for now.
5. Vote with your head, not your heart (or your gut), in the next cycle.

For All Health Professionals Now: “Connect the ‘DOTS’, Dump the ‘Hunch’ “

Posted on | March 9, 2020 | Comments Off on For All Health Professionals Now: “Connect the ‘DOTS’, Dump the ‘Hunch’ “

Mike Magee

There isn’t a health professional (or financial professional for that matter) out there who didn’t shake her head last week when Dr. Trump expressed his “hunch” about Covid-19. Crises and panic breed in an environment of ignorance, loose lips, and misshaped priorities. “Hunches” make all responsible leaders shutter.

Britain’s Adam Kucharski’s new book, “The Rules of Contagion”, recounting the mathematics of 1918 Pandemic, makes clear the critical roles of scholarship and leadership during a health crisis.

Rather than “a hunch”, he explains “DOTS.” As Joe Biden would say, “Here’s the deal.” The critical question we face today, as circuit breakers shut down our markets, and “South by Southwest” (a festival critical to the Austin, Texas livelihoods of thousands since 1987) is cancelled, is: “How worried should we be about infection from Covid-19?”

As Kucharski explains, the answer to that question is packaged in a number – R, for reproductive rate. But to calculate R,  you must know four other numbers signified by the acronym, “DOTS.”

“D” is for “duration”, that is, how long someone is infectious. It appears that with this virus, the answer is one to two weeks.

“O” is for “opportunity”, that is, the number of people an infected person comes in contact with during the period that they are actively infectious. “Social distancing”, self-isolation, eliminating hand shaking are all limits placed on opportunity.

“T” is for “transmission probability”, that is, the chance that the virus will pass from one human to the next during an interaction. For Covid-19, transmission seems most common in close-knit communities, and large gathering situations.

“S” is for “susceptibility”, that is the likelihood that the virus will find a welcoming environment in the contact individual. If and when we develop a vaccine, susceptibility would go way down. So far, children appear least susceptible to this virus. In contrast, the old and frail in some cases appear to have fatality rates in the range of 10%.

“D” x “O” x “T” x “S”  =  “R”

If  we are to bring this pandemic under control, we have to decrease “R” or the reproductive rate to less than one. What the means is that you can’t pass the virus on to more than one person, otherwise the numbers, and population vulnerability continue to explode exponentially.

For all health professionals listening: “No hunches now, just the facts – clear, calm, and consistent!”

The Mask – When Not To Cover Up and Why.

Posted on | March 5, 2020 | 1 Comment

Mike Magee

If you want to know what American consumers are obsessing on these days, just check out Amazon searches. There you will discover that the tag “N95 mask” has had more than a million hits over the past month.

It seems we have transferred all of our fears, and hopes of protecting ourselves and loved ones from COVID 19, to some form of this iconic, to the point that health professionals in hospitals and outpatient settings are nervous about their own dwindling supplies.

Obvious missteps and trust gaps related to our President and his administration haven’t been helpful. Health professionals in and out of government, through various communication work-arounds, have tried to settle things down – sometimes clumsily. For example, Surgeon General Jerome Adams tweet “Seriously people- STOP BUYING MASKS!” felt a bit like it had come out of the Mick Mulvaney “GET OVER IT!” school of crisis communication.

That said, masks can be a bit confusing, and that comes from someone who spent more than a few years wearing one as part of his daily stints in operating rooms. So here are the quick facts:

1. Two types of masks: There are a) surgical masks that fit loosely and prevent transmission through large droplets emitted by sneezing or coughing; and b) respirator masks that fit tightly, requiring sizing and adjusting, and can prevent transmission of smaller microorganisms like the ones that cause measles and chickenpox.

2. Who should make priority use of a mask?  Two types of people: a) Health care workers who are in frequent contact with infected individuals; and b) patients with symptoms of respiratory infection, and suspect or proven COVID 19 patients.

3. If not masks, than what? The basics are now essential:

a) Frequent hand washing. Soap and water for 20 seconds is very effective, more so than hand sanitizers.

b) Stop touching your face – that’s harder than it sounds, but quite essential.

c) Keep surfaces at home and at work clean and sanitary.

d) Avoid  close contact with sick individuals – challenging during the flu season.

e) Isolate yourself if you are sick. Stay put – close to home and limit non-essential travel.

Last piece of advice for doctors, nurses and other health professionals who are charged not only with caring for all of us, but also help all Americans process their fear and worry during these worrisome times. Deliver equal measures of knowledge and reassurance.

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