Healthcare Charlie Foxtrot by Scarlett Doc

Posted on by accordingtohoyt

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Healthcare Charlie Foxtrot  by Scarlett Doc

Since social distancing interventions have been implemented to limit the spread of COVID-19, many industries have faced significant changes in the way they function.  Some businesses have been temporarily shuttered.  Others continue to function with work-from-home initiatives.  Still others remain open with significant operational changes.  While these changes have been implemented with the goal of ‘flattening the curve’ to limit impacts of the virus on our healthcare system, blanket expansion of these interventions into the healthcare system may be causing more harm than good.

Much like the rest of society, the healthcare system has been modified to shift emphasis to essential services, while limiting services deemed nonessential.  Many outpatient offices have closed or switched to tele-health visits exclusively, lab and imaging centers have stopped taking non-urgent appointments, and non-emergent surgeries have been cancelled or postponed.  As a healthcare worker whose social circle is dominated by other healthcare workers I have been privy to the impacts of these changes on a variety of patients, and the potential downstream effects are concerning.

For example, multiple cancer patients have had their post-chemotherapy tumor resections postponed until after the various ‘shut-down’ directives are lifted.  Prompt tumor resection following chemotherapy reduces chance of tumor recurrence and improves long term outcomes.  Delaying resection could prolong chemotherapy treatments – which result in immunosuppression in addition to multiple other side effects – and ultimately lead to increased risk of infection, worse outcomes, increased healthcare burden, and increased morbidity and mortality.  Patients presenting with lumps and bumps that may be cancer have had diagnostic biopsies postponed – early identification and treatment of cancer is vital to prevent spread of tumors to other organs.  For patients being discharged from the hospital after surgery, treatment for life-threatening illness, or psychiatric stabilization, locating appropriate follow up is more complicated now.  Many offices are not taking new patients, and those who are often offer only tele-health visits.  Close follow-up with monitoring of vital signs and at least a targeted physical exam is important to prevent complications and readmissions.

The patients falling in the uncertain land between routine follow up and emergent care are also encountering difficulty accessing appropriate care.  Uncomplicated injuries such as a broken arm or torn ligament can often be managed in person at an outpatient orthopedic or primary care office, and imaging can be done at an outpatient imaging center.  In states and counties with stay-at-home orders in place, these outpatient services can only be accessed in person with an order from an emergency physician.  As a result, other-wise healthy patients are being diverted to the emergency room, where they are more likely to be exposed to infections such as COVID-19.

If the emergency physician doesn’t place a referral for an orthopedist and imaging, patients are often left in the lurch of delayed care.  Non-life-threatening acute injuries, without appropriate and timely follow up can become chronic injuries that require more significant intervention when finally addressed, take longer to heal or heal incompletely, or can become complicated by infection.  This translates to increased morbidity, increased mortality, preventable complications and increased healthcare utilization.

For patients who can get in to see a provider for an orthopedic injury, many will require occupational or physical therapy to help restore function and prevent muscle atrophy.  Occupational and physical therapists are important not only for patients recovering from broken bones – their interventions can reduce pain and improve function for patients with chronic and soft tissue injuries, stroke and other neurological injuries, and patients recovering from surgery.  These types of therapy often require hands-on assessments and use of various tools (weights, resistance bands, balance balls, etc.) that are shared between patients.  Due to the high risk of infection and the non-emergent nature of the care, these therapy offices have almost entirely closed across the country.  While not immediately apparent, patients who don’t receive timely access to this follow up intervention can suffer from delayed restoration of function, increased morbidity, decline in quality of life, and an overall increased burden on the healthcare system.

While many patients receiving routine follow-up care may find themselves mildly inconvenienced by closed outpatient offices, there is a minority who are disproportionately affected.  Many effective medications require regular monitoring of labs to prevent adverse outcomes and help attain and maintain therapeutic levels of medications.  Clozaril, for example, requires lab draws as often as once a week.  It is an antipsychotic that, while very effective, can cause significant damage to the immune system.  Regular lab monitoring and strict reporting requirements have produced a system that closely monitors patients for this severe outcome and forces intervention if it develops.  Restrictions have been temporarily lifted to allow patients to fill their scripts without labs, but the system is there for a reason, just like monitoring guidelines for other drugs and illnesses exist for a reason – to prevent negative outcomes and catch problems before they land a patient in the emergency room.

In closing down healthcare indiscriminately, we have created delays in care that is known to reduce negative outcomes down the road.  Delays in non-emergent care place patients at risk for increased complications that can result in more office visits, more emergency room visits, decline in quality of life, and increased morbidity and mortality.  The appointments and surgeries that are being postponed will still be there when stay-at-home restrictions are lifted, in addition to the routine burden on the system.  These delays will catch up to us. The healthcare system moves at a constant, rapid pace, and we just stopped the factory for over a month.  A month of follow up appointments. A month of surgeries. A month of therapy appointments. A month of new but non-emergent injuries. A month of labs and imaging. A month of acute complications of chronic illnesses. A month trying to avoid overwhelming our system with one illness. I think we will find when things open again that instead of being overwhelmed with one illness, we will be overwhelmed with all of them.

In addition to delaying care, we are putting healthcare staff out of work.  Hospitals and offices can’t afford staff they aren’t using and therefore have been implementing furloughs, mandatory PTO, and letting staff go.  Hopefully those nurses, techs, CNAs, doctors, ARNPs, PAs, CRNAs, etc., will still be around when we need them, otherwise facilities will be even less equipped to accommodate the increased demand that will develop when we open again.

In sum, the effects of halting care for over a month will reverberate for years – first in the surge of appointments that will likely exceed non-emergent capacity, then more chronically, with the illnesses that worsened or the increased complications from surgeries, supportive treatments, and diagnostics withheld. I don’t know that the chronic effects will be as marked as the acute, but the longer this shut-down goes on, the worse it will be.

These outcomes could be mitigated if we opened up healthcare prudently.  Sure, keep the at-the-door screenings.  Continue to limit the number of visitors in the hospital and companions at appointments.  But also, take a page from grocery stores and reserve early morning appointments for elderly and immunocompromised patients who are most at risk for infection.  Transform our waiting rooms to resemble pediatric waiting rooms with separate areas for patients with possible communicable infections as opposed to patients coming in for routine follow-up care or orthopedic injuries.  Where this can’t be done effectively, modify outpatient schedules with specific times for ‘sick’ and ‘well’ visits.  Educate patients about appropriate use of masks, gloves, hand-washing, and hand-sanitizer, and make these available in the waiting area and throughout offices.  Continue to utilize tele-health visits for appointments that don’t require a physical exam, and employ medical device companies to outfit our patients who require regular monitoring of blood pressure for example with the appropriate equipment to monitor from home and communicate these values with their providers.  Put our physical therapists, occupational therapists, lab technicians and imaging technicians back to work, with extra time between appointments to clean equipment properly.

Shutting everything down comes at a future cost, but we also can’t resume business as usual.  Many of these operational changes will benefit patients not only in limiting transmission of COVID-19, but also influenza and other communicable diseases that are omnipresent.  We should have been doing these things before COVID-19, but we can’t go back, only forward.

 

 

292 thoughts on “Healthcare Charlie Foxtrot by Scarlett Doc”

  1. It’s Back!

    My dad has had two surgeries delayed due to this, but both were put off pre-lockdown (and scheduled for before his state locked down. Though it was VA surgery, and they were not as serious as other surgeries that are also “Unnecessary” like biopsies, or cancer scans.
    Only super-omg-gotta-dire-need surgeries like abortion can be done at a time like this, after all.
    But in his case he doesn’t overly mind, one eye is fine and clear (that eye was better than the first one operated on) and his hip hurts still, but they also decided to bug out to Atlanta and hole up with my Sis and Bro-in-law who are also best well isolated (sis has some issues, and bro can work from home just as well)

  2. We saved grandma/grandpa for the upcoming famine and/or civil unrest. I don’t want to live in “interesting times,” I want to live like a comfortable king (without the political headaches of state) again.

    1. We saved grandma/grandpa for the upcoming famine and/or civil unrest.

      Uh, phrasing?

      Though there is something to be said for the idea of keeping a mobile protein source that in a pinch can serve as ablative armor…..

  3. I was wondering about this recently. I have a check-up with a “systems specialist” in July. That was the soonest I could get – when I had my last appointment in January 2019. Am I going to get bumped because of all the people who need to be seen but who have been locked out since mid-March? I hope not, because I’m at a point where I need some tests to see “Is it age or is it something potentially serious?” But I suspect I will get a phone call asking to move to September or October or later.

    1. My mom got through breast cancer, has some additional issues but nothing that requires constant up keep–I’m afraid her monitoring stuff is going to be seriously jacked up, too.

  4. All of which brings me back to a question I would love to see someone ask the fans of government health care, “Why do you want those f*ck-ups to run something that important? They can’t even keep the roads in decent shape!”

    1. I know a fool who in the same argument will tell you all politicians are lying so-and-sos and gov’t worker incompetent, and he’ll gladly pay more taxes for “free healthcare”.
      Then again, my now dead aunt and uncle wanted single payer health care because they didn’t like dealing with the gov’t run healthcare they hated (her the free clinic system in Louisiana, him the VA).

      1. They figure it’ll be no different from having topline bcbs and just waltzing into hospital and getting no bill. They don’t realize that even without outright murder of unpersons it will be corrupt and less capable

        1. lost one online friend for pointing out her mother had survived a cancer that at the time was not considered treatable in Canada because the treatment was too expensive by the NHS.
          That was in response to her silly “If Ronpaul doesn’t get the nomination, then I’m voting dem so at least we will get free health care like in Canada”

      2. Then again, my now dead aunt and uncle wanted single payer health care because they didn’t like dealing with the gov’t run healthcare they hated (her the free clinic system in Louisiana, him the VA).

        –
        Uh? Misery loves company?
        –

        1. thick as a brick
          it was automagically gonna make topline care free, and not make all care exactly like what state run care devolves to.

    2. Because then the media wont make all the scary noises when hospitals overload on the flu (iirc the Italian system and nyc hospitals that overloaded do so in plenty of “normal” conditions.)

      The reason we’re gonna get Biden, or rather whichever fascist is his elected successor, is because people remember the calm of the obamedia. No crisis exists if none is touted, right?

      1. The definition of a scandal is “something that everyone is talking about.” If nobody’s talking about it, it’s not a scandal. There were no scandals in the Obama administration. By definition.

  5. And the infuriating bit is that none of these knock-on results – none of them – will come home to roost with the people who ordered “OMG close everything now”. Who probably have their own healthcare, because politicians. Bah.

        1. This, with randomized pseudonyms to ensure they get exactly identical treatment as others at least in timeliness.
          Let them sit for 10 hours with chest pains, popping nitro pills like tic tacs

  6. Here, it already took two to three weeks for a regular doctor’s appointment and four to six weeks to get a cardiology appointment. And I had a consult with a specialist last week; the appointment was made in the first week of February.

    The gap between “sick enough to see the doctor” and “two weeks” was already big enough to be a problem. If the delays become much longer, we effectively won’t *have* any medical care other than what can be DIY.

    “Welcome to the real world.”

    1. No, “Welcome to Socialized Health Care.” They’re just trying to get us used to the lines, the delays, the rationing, when they finally institute the U.S. National Health Service and prohibit private health care for anybody except The Right People.
      ———————————
      Do you really want hospitals run by the same people that run the post office, schools, and prisons?

      1. “Do you really want hospitals run by the same people that run the post office, schools, and prisons?”

        Expect all the compassion of the IRS combined with the awesome efficiency of the US Postal Service or the CA DMV.

        Still interested in that single-payer gov’t-run system?

          1. Military dependent here; USAF healthcare through pre-teen years.

            Even as a child, I could tell it sucked. No mas, por favor.

        2. The second sentence requires editing. Just the IRS, and DMV is all that is needed for an accurate description of of the horror. I plan to share this with others as a compact description.

          1. You’re right, I should have used the DMV. Although that’s state, not federal.

            That could actually be worse. Fifty different state governments all created similar pits of despair.

          2. The Development Services Department, where you have to go for building permits — except, most people are fortunate enough not to have to deal with them. Permits can take longer, and cost more, than the actual construction work.

            1. Case in point:

              North Los Angeles County, ca. 2005::
              Neighbor’s metal barn: $14k
              Permits: $18k

              LACo Building Codes/Assessor office makes the DMV look like a model agency.

              [Model: a small copy of the real thing.]

            2. My degree is in urban planning. For 30 years I did not work for government, but helped people cope with urban planners. I translated from planner to English. Solving problems, acting as an advocate for the small guy trying to navigate the system. The big guys had people who worked full time doing what I did.

              I told people there were 2 invisible warning signs at all planning departments.
              First: “We are not out to get you. We treat everyone this way”.
              Second: “Abandon hope, all yea who enter here”.

              People strangely found it comforting to learn the planning department was not out to get them. To understand it was nothing they had done, this was just the way the system worked.

              For a long time I was a guide to the urban planning jungle. I no longer can do it. It is no longer what you know, but who you know. Now people hire “lobbyists”, who “know” people.

          3. Curiously enough, the Oregon DMV is nowhere as rage-inducing as the CA variant. I’ve even seen the worker bees crack a smile (without the sadistic variant found in CA.) OTOH, all but 6 in the entire freaking state were declared “nonessential”.

            1. Pretty good in Montana too.. DMV personnel are actually helpful. They must be doing something wrong!

            2. Curiously enough, the Oregon DMV is nowhere as rage-inducing as the CA variant. I’ve even seen the worker bees crack a smile (without the sadistic variant found in CA.) OTOH, all but 6 in the entire freaking state were declared “nonessential”.

              –
              Yes. When son went for his Oregon driver’s license at 16, one of the requirements was a driving log noting when he’d driven with an approved co-pilot, length of time. Totaled. So he gets to that point & hand it off. DVM person barely glances at it … me (mom) goes “Oh, no. It is a requirement. Someone is going to actually Look At It.” DMV Person looks at me “This is legit?”. Me “Yes”. DMV person to other staff “Someone actually followed the rules!” Of coarse there is a fine distinction between surprise, irony, and sarcasm, so, you know … Granted it wasn’t so much of him doing the work, it was mom & dad harping on him to write down when he drove so that he’d have the totaled required 100 hours. Because we weren’t signing a WAG.

              Did not know they closed most the DMV’s in Oregon. Haven’t been to a DMV since last license renewal; I have a few years. Vehicles have been registered through dealerships. Have been doing tags renewals online …

              1. Here in CA you can do license renewal online. They issue drivers licenses to illegal aliens — so they’ll be better drivers. Huh? Since when did drivers licenses make American citizens better drivers? You wouldn’t believe the idiots I’ve seen…

                AND NOW…voter registration is by driver’s license. The illegal alien licenses have a little note on them somewhere, but if they register online and vote by mail nobody will ever have to see that.

                There is no vote fraud, according to the Democrats. That’s just a white supremacist paranoid conspiracy theory!
                ———————————
                My grandpa voted Republican until the day he died — but he’s been voting Democrat ever since.

                1. Whole point of getting a renewed Driver’s License in person is to get a current official photo. Next renewal I have to go through the “real Id” process. Already did in the brief period they required it & didn’t back off the need documents to prove your last name change. Required for original post 9/11 passport too. You know: Birth Certificate, certified marriage license causing name change (not the pretty one you keep after everyone signs it, nor the one you sent to the county you were actually married in, but the one returned to county issuing the license).

                  I understand why Oregon backed off the name change proof requirement. PIA, but they didn’t do anyone any favors.

                  1. I (well, my parents) had to show my birth certificate when I got my driver’s license in 1972. But I have to show it *again* next time I renew, as “Real ID” becomes non-optional. For the same state license, kept current since 1972.

                    Except I don’t *have* that document; my parents kept it, and it was part of the “trash” the Spawn threw out when they passed away. So I have to sent off a payment to a records office in another state to get a copy…

                    My driver’s license is good for another three years, and it’s $40 for a renewal. Or I can get a “Real ID” compliant “state ID card”, $5 for four years. It’s the same card, except it says “not a driver’s license.”

                    I have no intention of ever boarding a commercial aircraft again; any ATF or IRS officials are welcome to come down to the parking lot if they need my physical presence for something, and I don’t have any plans to leave the country, so the only reason I will ever need the stupid “Real ID” is when they blackmail me by refusing to renew my driver’s license.

                  2. I renewed my driver’s license before the Real ID stuff, but the current CCW permit process involved the same documents as for Real ID. I did mine before Winnie The Flu made it’s presence known in town, but $SPOUSE had to renew by mail. Boatload of documents for her because reasons.

                    Still, it was a lot less nervous making than the first time we did her permit. Same wad of important documents. We did some grocery shopping, and when I hit the bathroom, one of the gang members was scoping her out for a grab&run. I saw him when I came out, and the little creep didn’t like my smile. Just because I was reviewing the “2 at center of mass, one at the head”, and just maybe the 1911 in my shoulder rig was printing through…

                    She called the K-Falls PD the next day, and they made the town too hot for that gang. Constant and/or frequent police presence at that grocery store will do that.

                    When I did my permit renewal with the extra paperwork, it was “drive to the Sheriff’s office, do the stuff, and go straight home.” Easier on the nerves.

                  3. Hmmm… We don’t have a marriage license. California has (or had) this neat little law where you could go to a priest, minister, rabbi, or shaman, whatever, state that you’ve been living together, and presto chango, you sign the papers, a little ceremony is performed- if you want it, and- you’re married! My better half drove all the way across country to San Diego, and the next day we went to one of the chapels advertising this service in the classifieds,declared we had been living together (there was no time period specified….) and were suddenly married. Took the paperwork to the yeoman’s shack, the YNC filled out his part. I walked it up to PSD with my new wife, and got her her brand new official Navy dependent ID card. The Navy had no problem with it.

                2. Not sure of the current situation in Cali, but when I was there, you renewed every 4 years, but you only had to go in to get a fresh mugshot every 12. IIRC, there was a written test, too. (This held true when I moved there in ’74 and until I left in ’03. Mileage may vary. Slippery when wet. Remove windshield shade before driving. Buckle up, dammit!)

                  Oregon has the DL last 12 years, and you need a new pic then. I was 67 for the last one; don’t know what the renewal process is as I get older.

                  1. Oregon has the DL last 12 years, and you need a new pic then. I was 67 for the last one; don’t know what the renewal process is as I get older.

                    12 years must be new? My Oregon DL is good for 8 years, last renewed ’16 at 59, due in ’24 at 67.

                    1. Ah, looks like I goofed. 8 years seems to be right. I renewed last year and back in ’11.

            3. Good in Texas, too – organized, polite, professional and helpful. I had to get my drivers’ license renewed last year. Set up an appointment at the local office, was in and out in about fifteen minutes.
              Through an accident with the previous car and insurance inssues, I had to de-register it as salvage, repair, and then re-register. The supervisor at the local office walked me through the right things to put on the paperwork, to make it all square, Above and beyond, in my book.

              But, yes – I also had military health care for 20 years active service, and another two decades as a retiree. My primary care is the family clinic at Fort Sam … I had the sense that the showplace of Army medicine would not do a retiree wrong, I’ve yet to be disappointed in the care I have gotten. My last two primary care doctors have actually remembered me from year to year, which is nice.

        3. Surely states come not much woker, compassionate and supportive than New York?

          So:

          NY Death Rate from COVID-19: 140K+ recorded cases, 14K+ deaths attributed = approximately 10%

          News Items, OpEd:

          What the ‘Let them die’ order tells you about New York’s health chief
          [SNIP]
          Until the order went out April 17 with special rules for the duration of the pandemic, EMTs were expected to spend up to 20 minutes trying to revive someone found in cardiac arrest.

          To their credit, the FDNY and other first responders rejected the state order and kept to the 20-minute policy.

          [SNIP]

          Earlier in the crisis, when it looked like virus cases might overwhelm hospital ICUs, Zucker’s department issued guidance on ventilator allocation to consider a patient’s past do-not-resuscitate status and relative chances of survival to ration access to the life-saving machine.

          Hard decisions may be needed in a crisis. But it’s hard to miss the pattern here.
          nypost[DOT]com/2020/04/22/what-the-let-them-die-order-tells-you-about-new-yorks-health-chief/

          Forcing nursing homes to take coronavirus patients is just insane — and evil
          Of all the missteps in the early days of the coronavirus crisis, New York state’s Health Department may have committed the worst: ordering nursing homes to accept residents who tested positive for COVID-19.

          Instead of quarantining the folks most vulnerable to the disease, the state encouraged its spread: 85 percent of the state’s confirmed deaths from the bug are people over 60, with nearly a quarter of all corona fatalities coming in nursing or adult-care facilities — and at least 2,210 such deaths tallied in the city.

          And when asked why these residents and workers weren’t better protected, Gov. Andrew Cuo­mo answered Wednesday, it “wasn’t our job.” It was up to privately run homes to keep infected people isolated; if they needed help, the governor magnanimously offered, they should’ve asked.

          [SNIP]

          As best we can tell, Dr. Howard Zucker, the state’s health commissioner, made his order so these patients could be released from stressed hospitals — but that doesn’t make it any less callous.

          [SNIP]

          Despite all evidence to the contrary, Zucker claims the nursing homes are equipped to protect and segregate the corona-stricken. But critics such as Assemblyman Ron Kim (D-Queens) report that many lack the equipment, trained staff and/or protocols to control it. He explains: “The staff, the families, everyone is telling me there’s completely a lack of support and they don’t have the necessary PPE [personal protective equipment] to be safe.”

          Mayor Bill de Blasio, meanwhile, has been sending coronavirus patients to the city’s public nursing home on Roosevelt Island — where staff and local officials say the virus is spreading to its vulnerable, high-risk residents. Many are wheelchair-bound and/or chronically ill. Wrong place to be in tune with the governor, Mr. Mayor. …
          nypost[DOT]com/2020/04/22/forcing-nursing-homes-to-take-coronavirus-patients-is-just-insane-and-evil/
          –

      2. If I thought for one fat instant that the Fascist Lefties could run healthcare as well as the Post Office is run, I would be willing to give it a shot. The schools and prisons, not so much.

        1. Having seen some of the USPS from the inside, it works in spite of rather than because of. Medicine needs to work because of – it’s not as simple as “Put $ITEM where the code on the label says to put it.”

          1. Maybe, but I still think the “would you want health care run by the people who run the Post Office” bit is unfair to the Post Office. Now, “would you want health care run by the people who run the DMV?”, THAT’S legit. Almost every DMV I’ve ever dealt with has been staffed by nice folk…who can’t do their jobs because of bad equipment, disintegrating office space, and insane regulations.

              1. Whenever the government gets into health care, you wind up with doctors filling out paperwork while paper-pushers play doctor.

                1. 25 years ago I worked for a large healthcare provider. I was assigned to write a program to run on a Windows laptop, that would replace all the – _ think it was 30 – forms that had to be filled out with patient information, primarily their meds and cardiac symptoms.

                  At one of the early meetings I asked who was going to be filling all this out. The doctor, of course. I pointed out that doctors cost money, and playing laptop-jockey wasn’t a good use of their time. They already had PAs following them around with clipboards, it would be faster for the PA to be entering information while the doctor did his thing.

                  It eventually became apparent that eliminating the PA was the whole point; laptops were still fairly new then, and they wanted a glitzy user interface so the docs wouldn’t realize they were now doing two jobs…

                  I’ve seen the successor to the system I wrote; it works much the same. The doc still has his five minutes, but he walks in, looks down at the laptop – they haven’t forced them to tablets yet – fires off questions, and leaves. Without ever once making eye contact, much less doing anything remotely like an exam. (that’s done by a nurse or tech beforehand, and presumably their comments are on the laptop)

                  So the PA position was eliminated, and the only ones seeing a downside are the patients… the docs are still the profit bottleneck, but in some demented accounting system it’s cheaper to pay an MD to do minimum-wage work.

    2. I went through that a year ago, trying to get my hypothyroidism diagnosed. I was pretty sure of what was wrong with me in late December, but working my way through the medical mouse maze with attendant three-week waits meant I didn’t get to someone who could put me on thyroid pills until late March. It meant I lost almost all my strength, which took most of last year to get built back up. It also meant that I had to force my way through doing a convention while untreated and so weak and lethargic that I could barely put one foot in front of the other, and I still think I may have done some permanent damage to my joints and ligaments.

      1. “hypothyroidism”

        I think that may be where I’m at. Or what Sarah deals with with blood panels look good, but the thyroid not being processed by the body correctly. But I’m not sure what to do about it.

        1. Yeah. Mine is the second. It’s a b*tch to find a doctor (mine is retiring) because it’s …. controversial? As in some people think it’s all “new age.” I mean, there is solid research, but it hasn’t been integrated into practice, so older practitioners say “nuh, uh. we don’t know it, doesn’t exist.”
          BUT in my case the improvement was MAJOR including reversal of brain damage, so….

          1. It’s a b*tch to find a doctor (mine is retiring) because it’s …. controversial? As in some people think it’s all “new age.”

            so older practitioners say “nuh, uh. we don’t know it, doesn’t exist.”

            –
            My GP isn’t exactly an “older practitioner” but he’s old enough. Run into the same with Service Dogs, although that can be as much as the clinic as your doctor. You can run into “I want to but …”. My GP did a reversal on me at the last visit stating that RH wasn’t a problem if you were overweight. That I was diagnosed previously when I was underweight … Wait? What? I was underweight at 165? I’m 5’4″. Since when? Granted it is a lot less than now. RH isn’t about whether you have built in fat for your system to process into sugar. But I digress. Luckily I already have that letter (not that is required, legally … but …).

            Now with all the other symptoms I’m not 100% that the RH isn’t wrapped up into what is really wrong …

            (RH – Reactive Hypoglycemia … Not the same as Diabetic. Not the same as Hypoglycemic. For all that all 3 have to do with low blood sugar and insulin.)
            –

        2. Make sure they look at ReverseT3. If too much of your T4 is being converted to RT3 instead of T3, you can sometimes fix that by going on straight T3 (no T4). Some failing-to-uptake cases are actually too-much-RT3.

          Tho a lot of endos still don’t believe RT3 is a real thing, and will only prescribe T4 no matter what.

  7. I’m in disease management and all I can say is yep.

    Well that, and my dad is one of the thousands having their chemo deferred right, so it’s now a personal as well as professional concern, to put it mildly.

  8. The tin-foil hat wearing part of me wonders if, perhaps, this isn’t a semi-organized plan to really get more people behind and pushing single-payor health care in the US. After all, if the healthcare system gets clobbered when the lock downs end and people are stuck (still) waiting weeks / months just for a checkup, they could point to it and cry “see how broken our current system is?”

    As though a Dr who specializes in reconstructing broken bones could just be slotted in to also handle a heart surgery or general practice medicine, avoiding such “shortfalls.”

      1. Sounds like pattern recognition to me.

        “Break a thing that’s working, then declare that since it’s broken we need to buy the thing that doesn’t work but the breaker likes.”

        1. “Destroy what we’ve got because it’s not perfect, and replace it with something far, far worse.”

        2. Right overload something so people scream for Government is a known strategy on the left that was proposed by two social “scientists” Cloward and Piven. This seems like the left see a convenient chance for them to try it for health care. Hopefully no one will buy it, although the old saw is no one lost money betting on the stupidity of the American populace.

        4. One of the theories is that was the point of ACA. i.e. break US healthcare enough that the public runs to embrace single-payer.

          1. Not a theory; a number of people involved in drafting the ACA (i.e. Obamacare) expressly stated that they did not expect it to work and simply viewed it as stepping stone to a British style NHS national healthcare system-including Biden advisor Ezekial Emmanuel (brother of Rahm “never let a crisis go to waste” Emmanuel). Note the large number of Democrats claiming that the virus “has been so harmful” because the US does not have socialized medicine. They really don’t care that people get sick and die; they simply care about gaining and keeping power so they can “fundamentally transform America”.

            1. Zeke is the death panel, don’t live past 75 Biden Advisor who’s on cnn every night saying we’re all gonna have to get used to staying home forever. he’s a creep who’s be a killer if he could get away with it. He makes Rahm look like mother Theresa. What a vile family.

              1. There’s a third brother, Ari (short for Airel) who’s a big Hollywood macher, founder of one of the major talent agencies, described at Wikipedia as “as a ’21st century Hollywood mogul’ and ‘the pre-eminent power player in Hollywood*.”

                Yeah, it really says something when a Hollywood agent is the white sheep of the family.

                The Donald was a client and friend of Ari, who produced a film (eventually not used) on Trump for the 2016 RNC convention. Must make for interesting family get-togethers.

                *per the New York Times
                –

            2. It was so obvious a consequence that you prayed they were simply evil rather than dumb enough to believe their Rude Goldberg System would actually work.
              –

        5. This is more like “shoot people in the knees then demand praise for providing crutches” territory.

          The crutches, of course, being the wrong length.

          Is there anyone who can draw willing to do a “What the politicians promised,” “What the healthcare administrators provided” and “What the patient received” cartoon? The first panel being a glistening, efficient picture of patient care, the second a DMV-like office. The last panel would be a grave, of course, or an obviously neglected patient.

          Memes have power.
          –

          1. The irony, of course, is that the politicians promised something like the VA… right before it came out that the VA had been moving patients off of waiting lists by putting them on other waiting lists.

      1. Outside of chemical supply houses, is tin foil even available? And who uses it, and for what? Tin has this little problem with low temperatures… slowly turning to powder.

        1. BBQ aluminum foil is .004″ thick, vs. .002″ for normal home foil or .001″ for restaurant foil. When crinkled, folded, and layered, you get a nice corner-reflector effect to ward off the Valis signals.

          Just theorizing of course… [ignore the crackly noise when donning hat]

        1. For those ratfinks, yeah they’d see it as a feature. The bug would be having people point it out in advance. Then, it might not matter – the various obvious failings of 0bamacare were pointed out out, ignore, and then “unexpectedly…” the obvious and predicted came to pass.

          1. They just didn’t expect it to implode before Saint O was safely out of office, and could blame it all on somebody else.

            2. Shoot enough current through, and they’re all fast fuses.

              Got some gubernatorial idiots going “Hold my beer and watch this!”

                1. Perhaps as I’ve never been… professionally* involved.. with pyrotechnic and explosive devices, I’ve used (and seen used) ‘fuse’ for ‘metal melt’, ‘electrical safety device’, and ‘flammable string going to a charge’. ‘Fuze’ was a bit of a puzzlement and for a while I presumed it was simply some alternate spelling such as how that extra ‘u’ gets put in ‘color’ and how ‘-er’ is ‘-re’ in various locales.

                  * I will neither confirm nor deny amateur involvement. I will state, however, that I have ALL my limbs and extremities, can hear with both ears, and have sight in both eyes. This indicates one of these things: (a) I’ve never actually dealt anything that goes boom. (b) I’m really damn lucky (c) I’m that good. I will not claim (c), for that way lies disaster should one be (when one is) called upon. Though I am aware that is a case (much like dealing with true High Voltage**) that respect to the point of paranoia is not insane, but a survival trait.

                  ** If you get it seriously wrong (no details will be forthcoming) I suspect/fear it is quite possible to have a fatal incident with a 9V ‘transistor’ battery – but it would likely take homicidally/suicidally serious effort.

      2. As in Soviet system, all get same free health care. Some (officials who must be restored to health for to serve the nation) will get their Physical Therapy from Nurse Bambi, others (low-ranking workers who do not make such great contribution to national good) will get their PT from Nurse Ratchett.

        But ALL will get same treatment.

        Or as in Army: Generals get health care equal to PFCs, but some soldiers more equal than others.
        –

    4. every issue is a reason to call for gov’t running an NHS or nationalizing an industry to these types. Especially an issue caused by their poor running of things

      1. Yes. If healthcare was going well, they would be calling for it to be nationalized so “everyone has access” and touting how cheep it will be because the free market kept prices down and access up.

        Remember, these people are the same ones who think if the price of oil is crashing, that that’s the sign that we must absolutely go pure corn fuel immediately.

          1. There’s not a lot we can do right now– the corn that’s good for ethanol isn’t that good for people. *looks out the window* It’s also if not already in the ground, halfway through set up for it. Not sure there IS seed corn of the table-bound variety around to fill the demand gap.

            Could use it to shift animal food supply some, and might be able to get better-than-starving type supplies out of it, but it’d still have a lot of waste.

            Of course, animal forage is much less likely to be stolen, and hard to guard, but would still help places where there’s serious issues, and subsistence folks are likely already going “we can barely feed ourselves, make sure we have that and deal with the animals later.”

            1. the corn for ethanol is fine for feed (and booze!), and better than nothing for food (parched, polenta, flour, it works). It is a bit late for maize changes to the crop but other grains could fill in some. not that it will be easy, or fast, or possibly enough.
              I saw something somewhere, some fools are pushing for an “Africa going wholly organic only” via the U.N. funding, in this crisis.
              Needless to say we need the mandate dropped, and the suppliers working on next year’s crop seeds now.
              Can we maybe get the haters of humanity out of positions of power, please?

              2. *snerks* I do know about the booze part, that’s why denatured alcohol exists…..

                *******

                I know you can eat it, but harvesting it? I know they select species for mechanical harvest at the same time they select for taste and human nutrition.

                Do you know if the starve-Africa-with-neo-pagan-pseudo-morality is part of the banning GMO thing, or just the same endpoint?

                1. The farmer I knew who grew it said it was basically a field corn variant, and he sold it to wherever the highest return came from. Sometimes it went for food when a market hiccup caused the food price to surpass the refiners. At least the strain he grew was that way. Farmers hedge. He wouldn’t grow something he had to sell in one place only. I doubt he is the only one. They harvest, dry it, and then decide which place to deliver it.

                  Well, the No GMO and Must Be Organic lot are a Venn with a massive overlap
                  Pointing out that regular rice, lettuce etc are GMO, but over a very very long time gets all sort of random silliness.

                  1. I’ve gotten blocked a lot by explaining how genetic modification is done…and explaining, with links, that we came up with it by watching what happened naturally and then trying to do it on purpose.

    5. If it is tin foil, it must be going around. Considering how they spent the last thirty years of my life and more saying “we don’t want to take your guns, we just want sensible gun control,” to this last bit “h*ll yes we want to take your guns! (and the clapping and cheering that followed, why yes I did pay attention).

      Also considering how the progression from “raising awareness” to tolerance to the jump to “you *will* be made to conform!” in the whole gay rights thing. And I know gay folks that got progressively more alarmed as it got worse- I’m talking about old school democrats from the seventies and eighties that wanted government out of their bedroom- they supported *none* of this cancel culture cake fiasco bullcrap with gender neutral bathroom sprinkles on top.

      Any one of us could go on with examples, but Sarah might need a bigger blog for that, and the linkage would probably break something.

      Even if it isn’t the plan, consider the “no crisis left to waste!” mentality. It *would* be used. But the pattern is clear. Businesses roll left and die, saying “we weren’t progressive *enough,*” and the charge to the left that 2008 on brought, these things follow the long march through education, the gun control cake, the massive growth of election fraud, the Clintion presidency (let me count the instances corruption), 2008-2016 (not a whiff of scandal, except Fast & Furious, pen and phone, more felxible after election, 0bamacare, regulation abuse, IRS, etc, etc, AYFKM?!), the 2016 election, the sham-peachment, the deep state, and ALL the other things I didn’t mention including the ones we don’t even *know* about…

      Yeah. Color me suspicious.

    6. It’s the same as king cuomos statement yesterday that the 25 m people that lost jobs should just go get an “essential” one. Individuals are not fungible. Hell,they are reports that hospitals in hot zones are turning away hcps from other states because by the time they are spun up itll be past.

  9. Jerry Pournelle used to say that despair is a sin. Some days, it’s harder than usual to keep that in mind.

    1. Agreed. I had enough trouble fighting the black dog before this mess. Now… well, one day at a time. Sometimes one minute at a time. And make sure you know when to keep away from scissors and cliff edges.

      (Dratted uncooperative brain. Keeps flitting through ideas and not putting words to paper because “augh it’ll never work!” Grump, grump, grump….)

      1. If it makes you feel any better, I’m in the same boat. Spent all of last week plotting out a new story idea, haven’t actually written anything this week because “GAH! That is so stupid and unrealistic! Nobody’ll be able to suspend disbelief enough to make it through this!”

        2. “GAH! That is so stupid and unrealistic! Nobody’ll be able to suspend disbelief enough to make it through this!”

          so,
          is it based in reality, or based in Slow Joe’s addled mind?

            2. Low bar. Closer to reality than *any* politician’s campaign promises is a low bar to clear. Height varies. Trump has been pretty solid so far. But Joe? Snake bellies would clear that.

          1. Look at the other fundamental Confucian relationships, and work out a story pattern that fits one of the relationships that isn’t husband/wife. Master and servant might work, Oni servants are a bit of a thing in Onmyou.

          2. XD. Run with it?

            The question is, it a case of “can’t write romance” or “can’t write romance the way everyone else does”?

            I’ve read your work, you do fine.

              1. *contemplates* You know, I wouldn’t worry about that.

                The fade-to-black was invented for a reason.

          3. Do a kid’s book?

            Get the song and start filking?

            … now I want to try to write something like that, and my grand total oni knowledge is the whole cannibalism thing.

          4. And now my back-brain is jumping up and down going “Hey, take the Beauty and the Beast setup, add in some Kakuriyo Bed and Breakfast for Spirits, and have the kidnapped one decide that the monster needs a keeper.”

            1. *Snrrrrk*

              The tiny fragment of image I had was that it’s the oni’s sister who’s trying to set him up with Hapless Human Protagonist, because she wants to get married to her oni beau and well, you know parents, they want to see the eldest son settled first and he is not being cooperative.

              1. That’s a really good justification– maybe borrow one of the trollish midwife patterns and the sister swipes a human based off of what she knows the human can do?

                If you used the idea of fairy ointment you could even have some conflict between the going home/staying thing, especially if the gal is familiar with the whole “put out the eye if you see them later” trick.

                1. Coming up with the professions of all involved is going to take some work, yes… since I think the human gal knows folklore very well indeed.

                  Also, plotbunnies pointed out that with the current mania for masks? All kinds of youkai and shapeshifters would have a field day.

                  1. *laughs* English doctorate with a focus on folk-lore!

                    No debt, because she’s got one of those “pay for the kid until they get out of college” endowments that happen sometimes when a kid is orphaned– a local starts a fund raiser, and makes a trust-fund; can even make it something like the local bank does it as a matter of course when a kid loses a parent.
                    (one of those “doing well by doing good” things, since they get to administer the cash and have all the legal hoops already jumped through) Also lets you have her make deer in the headlight eyes if someone asks how, exactly, that works– and gives a cut-off that won’t require drama, or a route to create drama, as needed.

                    Can have her traveling, even, doing research for a new section of study– that will give an excuse to have her know everything about everything in, oh, English folklore, but ignorant about Japanese, or whatever setup you want.

                    2. You could even work in some of your usual research nuggets, since most people know that warriors were supposed to be able to do the painting and stuff– I’m sure there were lines where being able to do that stuff was not acceptable. Of course, could also go as simple as “as a warrior, he’s a great painter” if that kind of detail isn’t available in English.

                    4. No debt, because she’s got one of those “pay for the kid until they get out of college” endowments

                      –
                      See Fred Cassidy in ‘Doorways In The Sand’ by Roger Zelazny. His uncle left an endowment ‘to provide for college’. After fifteen years or so, the college started trying to force him to graduate.
                      ———————————
                      Wexroth: “You’re a drone, Master Cassidy.”

                    5. That was serialized in Analog; and made the subscription worthwhile. My body isn’t the sort for buildering, but I can understand the third gargoyle on the right.

                    6. OTOH, when I was in a recent discussion in Goodreads about it, we could take the cops undercover as a kangaroo and wombat without blinking, but the professors’ attitude was fiercely debated.

                      The consensus was that it was plausible, but only because they disliked him on other grounds. A less — eccentric perpetual student would be welcome as long as the bill was paid.

                    1. I’m trying not to take anything too seriously ATM. I just want the brain to sit down and work on something, and it’s apparently refusing to do the more-serious stuff I had plotted before the ongoing Shutdown of Doom.

                  3. “… with the current mania for masks”

                    I keep thinking, “Now I know where Jack Vance got the inspiration for “The Moon Moth.”
                    –

          1. Ex-Navy SEAL turned bodyguard deciding the best place to hide out with his principal (a drop-dead gorgeous European heiress who he totally has not fallen head-over-heels in love with. Nope, definitely not) is his old hometown. Population ~200. Where everybody recognizes him.

            And when they’re inevitably discovered and she’s inevitably kidnapped by the baddies, he calls up some of his former SEAL buddies, and together they launch an illegal armed incursion into a foreign country (Canukistan, if you must know) to rescue her.

            Dude goes from being hyper-competent for the first two acts to an absolute dumbass in the third.

            1. Have something happen that rattles his noggin pretty hard–not so much that he’s out, but enough that he’s not really thinking straight.

              1. …. I think I can work that into my outline without much trouble. The fact that he’s already kinda messed-up in the head (he’s a death-seeker at the beginning of the story) won’t hurt my cause any.

                1. Dude goes from being hyper-competent for the first two acts to an absolute dumbass in the third.

                  Hmmm… it’s not that it’s unrealistic, it’s that it will be enormously disappointing to the reader.

                  So what you need is a highly-convincing, character-consistent reason (and a properly paced progression) for him to go from hyper-competent to dumbass.

                  … good luck with that!

                  1. I may be able to make this work.

                    Their location has already been compromised multiple times and multiple attempts made against the heiress as a result. So our hero knows somebody’s giving them up, but isn’t sure who and doesn’t know who he can trust. There are only a few places he can think of that would be secure enough for them to hide out, and since he can’t get her into Coronado, Virginia Beach, or Dam Neck, his hometown is the next best place.

                    Said hometown is located on a small island off the coast of Maine. Only accessibly by boat. He remembers it as a sleepy fishing village with maybe 3 phones on the entire island. And it’s still kind of that way, only now there’s cell coverage and Internet service.

                  2. Bad guys inject him with a massive dose of a long term psychotic drug. He fights through it, but in the process does innumerable dumbass things.

                2. Is it possible to have super-competent, then dumbass, then recovering-to-competent in the third act? (With maybe a hit of super just as TSHTF at the climax.)

                  I’m afraid super, super, dumbass is going to be too much of a downer for the current days.

                  Super, dumbass, then at least competent will make for more satisfied readers. You get to torture your MC and get a redemption arc in one story.

                  1. I’m thinking he realizes that he screwed up when they arrive at his hometown and he realizes that it’s no longer the sleepy, isolated community he remembers.

                    But he’s committed to the situation (he ditched their comms and credit cards prior to departing and he doesn’t really have enough cash to get them anywhere else) so he makes the best of it.

                    1. That could work. Fall into a hole then let him work his way out of it. Redemption arc wins, and it might be something related to the hole that lets them triumph at the end. (“I took us to $ISLAND because they had $REALLY_USEFUL_TOOL, but it’s not where it used to be. Towards the end, $PRINCIPAL “are you looking for something that has $THIS_CHARACTERISTIC? I saw something odd at $OLD_COOT’S_STORE”)

                      And yes, I don’t commit fiction. My suggestions may be worth precisely what you’ve paid for them.

                1. And if the stupid thing is going to his hometown… well, points were made above about there being pluses not just minuses.

            2. Workable, if the hometown is like where I grew up.

              Sure, everybody knows everybody else. And the local back porch network runs at the speed of sound, so nothing gets left out easily.

              But.

              Nobody travels. Everyone is suspicious of newcomers. Anyone from out of town, even if they are known, doesn’t get any info on the town other than “y’all take care now and G-d bless.” Allowing, even leading on strangers is considered high art. Knowing a secret than no one else does is extremely valuable. The internet, while known, is mostly used not to spread town gossip but to order things online.

              Small towns can take xenophobia to heights not often seen in the first world and the modern age.

              1. It’s kind of like that. Fishing village on an island off the coast of Maine. Close enough to the mainland and scenic enough that there’s a fair amount of tourist traffic, enough so that the locals are friendly to out-of-towners and unfamiliar faces wouldn’t be commented on unless they stayed on the island longer than normal. Aside from lobstermen plying their trade and housewives making shopping trips to the mainland, few folks travel.

                1. On or off season? Tourist towns on season you can blend in easier, and most tourists don’t stay long enough to be a problem. Off can be more complicated and easier at the same time.

                  I used to live in a tourist trap, and between the bar and the part time stuff, I got to meet a lot of the locals. Once they accept you, there’s more leeway. If the female asset gets a part time job during the season, that’s a good way to be almost invisible. Forgettable, more like. She may be pretty, but pretty girls in tourist towns are a dime a dozen- many go there because the money can be quite good depending on where you work, and the employers take note of the ones that draw in paying customers.

                  As for being stupid, if he’s been out of country and in craphole places for a while, readjusting to the world can be weird. Instincts built for combat and danger don’t fit as well. Add to that romantic confusion, lack of adequate sleep, plot tension, possible head injuries, and voila. Instant dumb@$$.

                  1. Probably on-seasons, but it’s not a tourist trap per se. Most folks come to visit on day trips to take in the island’s “scenic beauty” or to see the novelty of a place in the US with no cars. There’s a small inn on the island for the relative handful of tourists who stay overnight or for a week or two.

                    Blending in would be hard for the girl regardless since she has a very noticeable, very distinct accent (Scottish brogue with a bit of a French accent mixed in since she lived in Monaco for quite a while).

                    1. Can she be mute? Sign language wasn’t hard to pick up, but for some people it may be tougher. Some positions don’t require much talking- houskeeping for example- or much dealing with the public.

                      If not that, she can be a long term tourist, a biologist studying the local fish/insect/bird life, a climate researcher, or some other esoteric bullcrap. Extra bonus if someone with knowlege of her “specialty” actually shows up and gets suspicious of her for all the wrong reasons.

                      If said non-tourist trap has good fishing, some longer term cabin rentals could be available, and its another excuse to be anti-social. Local fishermen around here will rent a cabin with shore access and an internet connection, and most likely the locals will hardly if ever see them. Even a small boat on the water with a line in the water is usually left alone for the most part.

                      The isolation of that last can be a double edged sword to your ex-military protagonist. It is thin concealment, not cover. That will raise his tension level quite a bit. Also, he has to sleep sometime, and help if any exists would take time to get to him, or he to it if he must E&E with the asset.

                    2. Not mute, but I like the “long-term tourist” idea. She’s already an aspiring author (secretly, for reasons), so she could be “looking for peace and quiet to get in touch with her muse” or some such excuse.

                    3. That works. If she looks like she has money, it could go the eccentric rich angle. Those are familiar enough to pass without serious questions. Studying the setting, maybe. She wouldn’t be invisible, but she’d be a bit more accepted. People like money. They also like people who seem interested in the things they are interested in.

                      If she’s snagged one of the few fishing cabins, then there could be a bit of tension in it for her, too. Fishermen can get competitive about those cabins and the associated fishing spots. Jealousy occurs, and associated shenanigans. Maybe a false foe to confuse the protagonist as well.

                      There are also other settings as well, if you want to flesh it out a bit. Knitting/cross stiching circles are still enough of a thing in some small towns she might be invited. If her needlework is awful, she *will* be taken under someone’s wing for lessons unless she’s also rude. Another angle for the protagonist to watch, and worry over.

                      If the local economy is trying to recover from, say, widespread loss due to pandemic or democrat laws or something, they’d be happy to have anyone spending money in the town, and much less likely to drive them away. Good for the protagonist, but for his opponents as well, making it easier for them to get in.

                      Speaking of the opponents, they are going to face the same sorts of difficulties in finding a place and staying unnoticed. Long term camping on an island would raise eyebrows, but be necessary if all the cabins were taken. Similarly, p*ssing off the locales would hurt their cause as well, hampering their movements. Perhaps busybody locals, or local law enforcement could bedevil them if they aren’t careful.

                      Or, being an island, you could give them a boat. Mobility and privacy, but if it doesn’t follow fishing patterns it *will* be noticed and commented on by the locals. Also, being Maine, storm season would need to be watched. Storms on the water in Maine are no joke.

                      You’ve got quite a bit of potential there. Hardly as breaking of reader trance as some I’ve read recently. See what your first readers think once you’ve got a few chapters down.

                    4. They already have a boat. Our hero is independently wealthy (not a gazillionaire like the heiress’ daddy, but has enough to be comfortable). One of his ex-SEAL buddies started his own business after leaving the service and hit our hero up for some investment capital. The business took off and our hero’s minority stake in the company was soon worth a big chunk of change.

                      After leaving the service, he cashed out and bought (second-hand) a 45′ custom-built Downeaster-style motor yacht.

                    5. And while they’re not recovering from pandemic or Dimocrat laws, the price of lobster has been falling continuously, and since lobster fishing is the town’s primary source of income.

                    6. Leading to an increased reliance on tourism, and possibly shrinking population, some places turned into fishing huts/tourist bed & breakfast joints.

                      Surf casting is not as common as freshwater fishing, but it has its adherents. So you have probably your antisocial few who want a place out of the way, maybe a few nature enthusiasts or weirdo campers, possibly even some of Foxfier’s photographers plus the locals and the opposition team, masquerading as one of the above.

                    7. Also, if she’s a rich tourist, locals will be more likely to encourage others not to bother her. Don’t Eff with the money is a tourist town’s cardinal rule, after all.

                    8. Adding to Dan’s rich tourist idea– “great aunt who was a frustrated wanna be author gave her a trust fund to Follow Her Dream” would explain having the money to live without working, but not make her expected to be rich-rich.

                    10. So, yer sayin’ she sounds like she’s from Nova Scotia? 😛

                      One of those things she could just let folks assume, and never quite confirm.

                2. Oh, and there’s also photography– if for the villains, get them tripped up by knowing nothing; if for her, make sure one of them knows enough to use the “I am an enthusiastic gal who doesn’t know ANYTHING” angle.

            4. Kind of like Sosuke Sagara in Full Metal Panic! then? Badass in combat, dumbass in civilian life. Joined at an early age, poorly socialized, approaches every situation as either ambush or infiltration. Everybody thinks he’s paranoid and unstable until it turns out there really ARE enemies lurking in the shadows…
              ———————————
              “Sosuke! Why did you ambush the pizza boy?!”

                1. It’s a hoot. Sergeant Sosuke Sagara is a highly competent soldier, but fairly clueless about everything else. Assigned to protect high-school girl Kaname Chidori after her secret talent makes her a kidnapping target for an underworld organization.

                  He’s nearly immune to embarrassment because, things go wrong in combat. She’s not.

                  1. I like the dramatic side of the source material a little better than the comedic. Still sore that the author opted not to have the hidden war escalate to a hot war where the Soviets lose. I can understand not wanting to sell books about the gleeful nuking of Moscow to the Japanese, but that was what I really wanted from the series.

                    Anyway, the other thing she has going on is that she really wants to fit into Japanese culture as normal. She grew up overseas a fair amount, and for all that she is capable, is maybe a little out of touch with Japanese society. Also a bit troubled because of her mother’s death from cancer, IIRC.

                    She’s back in Japan on her own, in school and passing for normal when this kid shows up, behaving weirdly, and attracting attention in her direction. She is seriously Not Happy about that, and becomes deeply invested in trying to make him behave ‘normally’.

                    Then the airplane is hijacked. She also starts to fall for him.

                    Mixture of drama, comedy, and highschool romance. Other two elements wind up supporting the romance plot.

            5. A man in love with hot chick but in denial about that is sort of a working definition of brain-damaged.

              Works the other direction, too — denial does not enhance mentation.
              –

              1. Oh yeah, she’s fallen hard for him too.

                Which is not to say that their relationship probably isn’t unhealthy and dysfunctional on multiple levels (her family is extremely emotionally abusive towards her and he’s the first one to ever demonstrate genuine kindness, compassion, and caring towards her; he’s a death-seeker haunted by watching his best friend get his brains blown out right in front of him, and deep down he knows he’s messed up but holy sh*t this woman has been through a far worse hell than him for way longer than he could’ve managed to, and she’s still keeping it together).

              2. Oh, and FWIW, he’s in denial because a bodyguard cannot under any circumstances let himself become emotionally attached to his principal, and he is a professional goshdangit!

                Whereas she’ll admit it to herself but nobody else, because a) there’s nobody she can really admit it to but him and b) she’s utterly terrified of confessing her feeling to him only for him to reject her, scorn her, hurt her, etc.. She’s been burned that way far too many times before,

                  1. That and her self-esteem and sense of self-worth are so utterly in the toilet (she’s been told she’s worthless and unwanted pretty much since the day she was born) that she honestly doesn’t believe he cares about her beyond his professional duties and him apparently being a decent sort of fellow, and if he does than she certainly doesn’t deserve it and either way he’ll inevitably hurt her just like everyone else she’s opened herself up to.

                    1. A more universally plausible angle, yes, but if she likes him, it’s not the one that will come to her mind. Even if she’s been burnt before by the whole “acting nice because they’re an employee”. (And we both know some employees don’t bother!)

                      It’s one of those things that hits really close to the heart for a lot of gals; if she were the main character, it would be advisable for her to make this development obvious at some point by commenting on how there were a lot of really good people in the area, they all treated her kindly even though she wasn’t the one paying them, and have it explained that they like her. Putting her figuring out he likes her, too, or that he likes her, can be then or later. 😀

                    2. Part of the reason the whole paranoid mess from the crazy left is effective is that “they don’t REALLY like you, they’re just doing it because _______” is a hightly effective angle against women.

                      …now I’m wondering if “that was no accident, they’re out to get you,” also from the Left, is similar for guys.

      2. Just had a bunny tell me it was time for a Prototype fixit. Because covid subway transmission in NYC means that the siege in Manhattan is a little too contained.

      2. Consider that that may be inverted, It might be worth considering that keeping the fires of anger in check is generating the despair. Should that be true and you figure a way to deal with it, please tell me.

    4. Keep in mind that the religion which declares that also warns us that this vale of tears is but a way station and that, “In My Father’s House” there are much nicer accommodations awaiting.

      To despair in this realm is to deny the message at the bowl’s bottom.

      But gads, I’m getting tired of this porridge.
      –

    5. That doesn’t mean you have to have the slightest faith in any temporal institution or historical process.

  11. I’m glad I got the eye stuff done in 2017 and ’18. Each retina procedure entailed several followup visits (day after, week after, then every 3 months). My next scheduled appointment for that is the end of August, and I think it might happen on time. Maybe.

    Talking to businesses, Despicable Kate Brown was quoted as saying “We have done a good job flattening the curve, but we haven’t crushed it, and we need to crush it.”. Great job of moving the goal posts, there. Easy to understand numeric goals and everything. Now, if they could be published somewhere other than the Capitol basement (the one with “beware of the alligators”), that would be nice.

    I have a few short term medical visits coming up. The blood draw for clotting time should happen on time (was OK at the beginning of April), while the dental (x-ray, gum pocket check and cleaning) probably won’t happen in mid May. My cardio stuff is due in June and July; not sure if the imaging portion will happen. That’s at the hospital, and *if* they get reopened soon, they’ll be swamped for a while. Demographics here mean a lot of cardiologists are busy, normally.

      1. But, he’s right. We don’t shriek. We shout back, we curse, and we roar. He doesn’t want to see what we do after that.

        1. Since it could be ‘Open Pandora’s box’ and Ms. Pandora’s… is not a hat box, but just happens to be metal, dark brown or dark green, and contain lead-sealed brass?

          1. There are a lot of less extreme measures, though. A few government buildings lose power, and restoring it takes a while, because…

            Government vehicles break down, parts are not available…

            Keys to critical doors go missing, like armories and equipment rooms…

            We are the people who know how things work. Extreme leftists can’t learn too much about the real world, because that would threaten their delusions. Throw sand in the gears, and expose their incompetence.

          2. I don’t want to go there. WE don’t want to go there. Just because we believe in the rule of law does not mean we will happily go along with the rule of “experts” and “top men.”

            2. Not only that, but “rule by experts” was what Eisenhower was warning against in his farewell address. “Yet in holding scientific discovery in respect, as we should, we must also be alert to the equal and opposite danger that public policy could itself become the captive of a scientific-technological elite.”

              1. There is danger in excess on both sides.

                When public policy- political discourse- begins to affect not only what research gets done but *how* said research is treated in the field, it perverts the pursuit of knowledge itself. The scientific method is a precise tool. It does not care about “consensus” or “settled science.”

                Does the observed data conform to the original hypothesis? No? Fix your hypothesis. If it does, publish so your peers can test it themselves, tear it down if they can, and if not, refine its use.

                When the same people that run the DMV are running, say, your healthcare, or the rockets that are supposed to get you to space, you might want to worry a bit.

              2. Yes, but that part of Eisenhower’s warning was immediately tossed in the memory hole by not only the leftists but the establishment (although now the establishment is pretty much leftist also) while they take great joy in loudly repeating his “military-industrial complex” warning. That is not a surprise because one warning supports the narrative and the other one (the “experts” one) goes against the narrative.

                1. All of the experts support the warning against the “military-industrial complex” but recognize the second one as just paranoia.

                  Not trust experts? That’s crazy talk! All of the experts agree that you can trust experts.
                  –

          1. Does he have *any* clue what the reaction of anybody who isn’t a “go along to get along” type will be to that?

            In a nation as heavily armed as yours?

              1. Dick Francis used that in one of his novels. The protagonist took up his rifle, but instead of engaging the bad guys directly, shot the power transformer feeding their hideout. Which complicated the baddies’ situation tremendously…

                1. Which book? I don’t remember that, which may mean that there is a Dick Francis novel I have not read yet. At least I can hope.

              2. Noisy. There are quieter, safer, and surer ways.

                But seriously, folks. We don’t want to open that toolbox of skills. We don’t want to be pushed to that point. They cannot “make us” do anything- the choice, the freedom is and always was ours to make.

                It will profit no one, should that day come. Should we deem it better to make our defense with copper and lead instead of words and ballots. That will indeed be a sad day for every American. May it never come to pass.

                For once, I’d like someone on the other side to take us seriously when we tell them this. It would be far better to work together and allow each to do his own thing. Want hippy-dippi socialist communes with heavy taxation and healthcare supplied, with xis and xers and no discrimination or hate, protecting all the little marginalized and compartmentalized articial minority categories? Have at it, with my blessing! Just don’t force a single soul to do it. Let them come of their own free will. And don’t use my money to do it with.

                Heck.

                I’d even donate a few dollars to them if they’d do that all on their own. Seriously. Just make it all completely and absolutely voluntary. Have your safe spaces. Have safe words, even. Work out a way to pay those that supply the water and power services, and the land taxes, and the applicable state and federal taxes. We won’t even use that money on anything you don’t want, not even the military, just enough to keep the Constitutional obligations going.

                Just don’t force one person to go along with you when you do. That’s all I ask.

                And if they can’t agree to that, I believe that tells all what they *really* want.

                1. I always though the strands of conductive stringy stuff method that was reportedly used as a special munition to drop power to air defense coordination sites from the air would be trivially reproducible using those t-shirt-air-guns, with the plus that the fault is clearable with some cleanup work rather than requiring replacement of heavy metal things.

                  But I also agree, not really the box one wants to open.

                2. It is better, by far, to first employ “Irish Democracy” to enhance their understanding of the drawbacks of autocratic rule.

                  It may be time we learned to shuffle.
                  –

              3. At least out here, after the still-unsolved incident where a number of unknowns shot up a major transformer yard (OK, typing that it sounds like they were trying to prevent them folding into giant robots or something) PG&E has significant hardened everything down to the local transformer substation level – anything with passive oil cooled hardware now has barriers significantly more substantial than chain link fence between public spaces and the gizmos, and the big switching stations now have really tall hard walls, and a lot more cameras and lights.

                Doesn’t mean there’s no shot, but you can’t roll up to the chain link and expend lots of ammo like the original perps did.

                1. So the Metcalf Incident is still unsolved? Considering that the list of suspects outweighs a Midsomer Murders episode by 100X, I’m not terribly surprised, though it means that the perps were either very closemouthed or were persuaded to be quiet by other means. (Depending on the meaning of “persuasion”.)

                  If the substation is now a strong point, it has to get power in and out. The solution will be left as an exercise for the highly motivated perpetrator student.

                  1. That was supposed to be highly motivated perpetrator. The BC let me sleep, but the SD card in my CPAP hit end of life in the middle of the night, taking the machine down. “Blessed are the pessimists, for they have backups.”

                    1. Huh. My Resmed 10 will run without the SDcard. Though I don’t know if it will run with a full or corrupted SDcard…

                    2. Hmmm… need to test myour CPAP to see if it will run without the SDevil’s card. Thanks for the heads up.

                    3. At least on a ResMed S9, the machine operates without the SD card. However, when the card is inserted (sort of), the machine doesn’t do anything until the machine syncs up the card for the next session.

                      This card was old, and I’d been taking it out every day to shove data into the OSCAR monitoring program (SleepyHead was the now-obsolete predecessor, both open source projects.) This gets rough on the contacts, and as best as I can tell, the machine had poor contact with the card and it started to sync the card. While I was sleeping. However, it stuck, and I woke up with the cool-down flow; enough so that Sleepy Pete thought it might be working, but low enough to trigger apnea with a good breath. That got my attention.

                      Pulling the card started the flow again (I don’t know the S10; so YMMV), and re-inserting the card let it run through the balance of the night. Not being sure if the machine was going to work made it hard to fall asleep…

                      I know my sleeping quirks, and will drop to taking data once a week. (IIRC, the S9 keeps a full set of data for 9 days, then it drops to a summary.) There is a BlueTooth variant of the SD card, but I’d rather not try it.

                      I keep a stash of spare cards, so this morning’s activity was to let the machine initialize a new card. The next item was to order another pack. Not sure of the lifespan; this is the first failure mode of its kind that I’ve encountered.

                      FWIW, the amount of data on the card is actually quite small. There’s usually only 32MB worth of data on each card. However, I haven’t seen SD cards smaller than 16GB lately, so…

                    4. Does OSCAR make use of the USB output of the Resmed 9?

                      I still have Sleepyhead on the laptop, but I only dump the card to it a few times a year. Once the DME got the settings tweaked everything was stable.

                    5. Does es OSCAR make use of the USB output of the Resmed 9?

                      My initial answer was “What USB outlet?”, but I saw a connector in back. I assumed it was for the S9 oximeter, but a bit of search says RM offers an adapter. Long way of saying I don’t know. You’d have to ask the people who know the program. I’d try on the www dot apneaboard dot com forum.

                      As I did with SleepyHead, I use the SD card. I’ve run into a bug where really bad numbers get counted twice as the card is read, so you have to rebuild the data from the backup. (No idea if it’s Linux only.) My clear-airway numbers suck raw eggs, so I have to do it every time. The 4GB cards ResMed offered are unfindable, but generic 16GB cards work fine.

                      OSCAR picked up as a fork of SleepyHead when JediMark stopped supporting SH, so it’s not too different. The user interface is a bit smoother. Data can be ported from SH to OSCAR. Might have to redo the profile. I’m actually on a pre-release version, but it’s good enough.

      2. I’m looking forward for the layoffs hitting the government workers. A few thousand screaming public employee union members might do the trick. (Not to mention a dozen or three public employee union leaders who are getting screamed at themselves.) DKB is planning a special section to strip away more of our constitutional rights redo the budget because of lower income.

          1. Only if congress doesnt buckle. I’d give odds that states get infusion by end of may.

        2. I’m looking forward for the layoffs hitting the government workers. A few thousand screaming public employee union members might do the trick.

          –
          My last employer could be affected. The software target is Public Works County, City, Tribal. Largest installs are CA/WA Counties. There are other departmental portions, but the biggest is Public Works. If they actually start loosing clients they might have to cut employees loose. But doubt it. They’ve perpetually been understaffed. Sold software comes with annual use fee & maintenance fees (no pay annual, quit using it, no way to enforce that, but they stop getting support & updates). I’ve seen what happens when upper county management asks why the extra system & forces the drop. It isn’t pretty when auditors come along & the county gets slapped with “where is this information?”, face fines orders or loose funding. It happened a couple of times. Clients had to pay to bring software up to current, then enter multiple years of data to get the information they needed for the auditors. One time it was state auditors, the other time it was for federal auditors. I got to baby sit the poor county employees who got stuck with making everyone happy.

          Plus now company is owned by a Canadian company. But still based in the states.
          –

      3. We’re “better at home” because our idiot governor believes hears only the left’s shrieks.

        FIFY.
        –

  12. My wife is supposed to have knee replacement at the end of May and they’re having her go through the pre-op processing. They haven’t cancelled it but. I can’t see how they’ll do it since the hospital is one of NJs WuFlu centers down to the MASH tents out front. If they postpone, we have no idea when they’ll get to her. She can’t walk and next step is a wheelchair but, hey, under socialized medicine she wouldn’t get it anyway.

    We lived under the NHS for a number of years, some things were very good but you might have to wait a year for something they will do here in days to weeks.

    In any case, It’s Saint George’s day so Cry God for Harry, England and Saint George. If not England then Genoa Georgia, Barcelona, or any number of others

    1. Local news has stories on how they are removing the MASH tents, pretty much unused, from hospitals here in Silicon Valley except for the ones at the designated hospital for charity care. Given the county public health dashboard says county hospitals are only using 86 medsurg beds out of 1,500+ for Chinese Coronavirus from Wuhan China where Winnie is God-Emperor cases, I’m not sure what that one hospital is using the tents for – maybe that’s where they are shooting their dance videos.

      And on the ICU side this county is only using 72 ICU beds for COVID-19, out of 311.

      All told the county has 44% medsurg beds free, 34% ICU beds free, 99% of the “Surge” beds (I assume tents and the huge empty thing they set up at the convention center), and 78% of the ventilators are not in use.

      So naturally we have to stay locked up to prevent overwhelming the hospitals.

      1. USNS Comfort left NYC today. Only171 patients used it.

        I was told by a friend who’s a nurse at the hospital I’m talking about that the MASH tents were set up because it’s easier to get negative air pressure there than in the hospital building. Where I live is not nearly as corrupt and badly run as NYC or the NJ cities, so I tend to believe that they had actually thought it through and made preparations. Certainly our hospitals are better run than NYC Public hospitals are?

        The private and university NY hospitals are the best you’re likely to find anywhere, but not the public ones. The doctors and nurses are fine and as good as you’ll find. The problem is that the city loots them and keeps them underfunded.

  13. Pingback: COVID19 update, April 23, 2020: community immunity testing results from Belgium; non-COVID19 hospital care; India | Spin, strangeness, and charm

  14. NY WuFlu news. NYC infection rate 21.2% Preliminary denominator is 1.8 million. death-rate using confirmed + probable. 0.83% That’s worse than I expected but it is died with covid + died maybe with covid not died of covid. At least 1/3 of dead were patients in nursing homes, but they stopped reporting that. Death rates by age are the same seen everywhere. It’s a good number to keep in mind since it’ll be the scare number the politicians turn to.

    Rest of state breakdown is interesting. Long Island 17.7%. Westchester/Rockland 11.7%. Rest of State 3.6%. The counties are the main commute to NYC counties and all the commuting is done by train to the subway. That’s what I do, where I live in NJ is a commuter county too so I’m betting it’ll be around 15%. In my town all but 1 of the dead were out of a nursing home and that person was unwell.

    Staten Island has a very high infection rate considering it’s a very low density place compared to the rest but it’s where all the cops, firemen, nurses, EMS, etc., live.

    The infection rate is expected to increase and the death rate decrease since the anti bodies take time to develop so the denominator may still be too low. The NYC Pregnant woman screen was 14% so all the data are consistent. I figure that I now live in the lowest WuFlu risk place in American so, of course, they’re keeping us locked up longest.

    NY has had the highest test rate so the diagnosed to infected ratio should be lower than some other places. It’s around 11x in NYC vs the 20 to 50 seen elsewhere.

    Again, we thank you for giving up your lives to cover for our politicians panic and mistakes 😜

    1. The most interesting will be the MLB antibody testing – broad geographical span plus a solid sample size across office staff, janitorial, management, and all the way up to players and owners. That should be easy to correct to get good snapshots all across the country.

    2. And yet NYC and NY State refuse to shut down the single greatest place that the virus is spread in the country, if not the world; the NYC subway system. Meanwhile they apparently intend to keep us under house arrest until at least Memorial Day. As Glenn Reynolds notes: Tar and Feathers.

  15. ********************************************************************************
    We interrupt this commentary to bring you a non-special unbulletin.
    ********************************************************************************
    Sit back, relax, and have a snippet of less serious nonsense.
    ********************************************************************************

    Sam glared at the phone as he hung up. “Damnit. We’ve got another murder to deal with.”

    “Murder?!” Vanessa exclaimed, then paused a moment, and with voice of sinking feeling, “or.. murder?”

    “The second. Not that the first is good, but at least I.. we.. know how to investigate homicides.”

    “Animal Control and Forensics already on it, then?”

    “Yes. It looks like the same insane mess as the others. Van, this all screams ‘magic’ to me, but the only magic I know exists is sleight-of-hand stuff. Not woo and hocus-pocus.”

    “It’s gotten worse, Sam.”

    “How could…? Oh no… I haven’t seen the news today, oh boy.”

    “Some wag found a couple purported group disappearances, and nearby odd appearances of groups of crows that correlate with the time windows. Happened last year. And the name.. you can just guess.”

    “I was afraid of that. I was really hoping nothing before this April could be found, especially nothing before January. So… now we have CORVID19 in the headlines. Great! Bloody freakin’ wonderful! Just as the other nonsense was finally winding down.”

    “Look on the bright side.”

    “What bright side, Van?”

    “It’s not crow-gate.”

    ********************************************************************************
    We now return to the regular commentary, already in progress.
    ********************************************************************************

  17. Last update because I think it’s all over for WuFlu and now comes the politics. Cuomo announced estimated death rate of infected 0.5%. 95% are elderly or high risk. Death rate for the rest 0.025%. A note, the rates almost certainly go down from here if these tests follow previous serology testing patters. best estimate for NYS around 0.10 and NYC at 0.25%

    Perspective, average seasonal influenza Infected death rate 0.10%. If you’re not very unwell, WuFlu is 4 times less deadly than the flu. All in NYS will likely settle at about the annual average for seasonal flu. 24 mm unemployed.

    Tell your friends. Seriously. This is a game changer. This is NY who had it worst, managed it worst, and has the most liberal city in America (upstate not so much). it came from Saint Andrew Cuomo, not some dirty republican. There is no real basis for social distancing now, never mind lock-down.

    Time to blast this from the rooftops. democrat party, Let my people go!

    1. “If you’re not very unwell, WuFlu is 4 times less deadly than the flu”

      If you’re not very unwell, the flu isn’t as deadly as the flu.

      1. True and untrue. if the evidence I have available from CDC , and I’m not an expert on flu, is correct then the flu kills a relatively higher proportion of healthy people than WuFlu does. So flu is deadlier for the well than WuFlu. Sick people die with both at a higher rate.

        I was just reading that they’re conflating the IFR and CFR for flu and WuFlu. IFR for flu is estimated at 10bp. IFR for WuFlu best estimates now about 40bp. CFR for flu apples to apples 10% ish. CFR for WuFlu same basis 3-6. Flu is way too high but the denominator is basically hospitalizations. They’re saying the CFR for flu is 10bp and it’s running all over the place. I really think that Twitter is the worst thing humans ever invented.

        Perhaps we should institute a math and logic competency requirement before one is allowed to tweet. I mean the new oligarchy is rule by experts, no.

        I’m also wondering if the proportion of old and sick dying in US is driven by NYS Health Commissioner Zucker’s decision to require nursing homes to take in currently sick WuFlu patients, which caused further infection among the vulnerable. They also denied the nursing homes PPE if the NY Post is accurate. Take out NYC nursing homes and this thing becomes very small indeed.

        1. A week ago, the Seattle Times reported that half of all WA fatalities at that time were in nursing homes: 300 of 603.

          When this is all over we need to take a very serious look at nursing homes and figure out if there are reforms that would reduce the propensity for community spread without making them hospital-expensive.

          A friend of mine is a caregiver at a long-term care facility here in Seattle. Her facility at the time we chatted a couple weeks ago had zero cases, but she volunteered that other facilities run by the same company did, and she wasn’t surprised because “they aren’t very clean”.

          1. This. My wife volunteers at a nursing home and does hospice. Some of them are dumps. We need to change that and tighten up,P the hygiene and staffing rules.

            Zucker should really be prosecuted or at least sued for negligence. The woman whose mother died as a result of his actions looks to be just the type to hold a grudge. Buy some popcorn.

        2. And then you get the Spanish Influenza which went after healthy young adults by preference.

          The reason why my grandmother was the only ambulatory member of her family was that she was the youngest. (Fortunately, she knew how to make oatmeal. Unfortunately, she didn’t know how to make anything else.)

  18. My husband had a crown fall off a tooth on the 5th. We called the dentist first thing on Monday afterward, found out it’s considered non-emergency unless he’s in pain or shows signs of infection. Best suggestion they could give him was to use Fixodent to stick the crown back on — but the tooth is so far down that it won’t stick. There’s hope he’ll be able to make his regular appointment on May 6, but by then it’s possible the tooth will be to the point the dentist can’t just stick the crown back on with dental cement, and he’ll either need a new crown for $$$$ or the tooth will have to be extracted.

    And right now the stay-at-home order is not the only lockdown I’m experiencing. Stress usually makes my innards go the other extreme, so I’m thinking my thyroid is losing more function, especially when I woke up this morning with my fingers stiff and had to stretch them to get them loosened up, just like I did about a month before I showed major hypothyroid symptoms in 2018. I’m going to send a message to my endocrinologist about it, giving her a heads-up and asking if there are any symptoms I need to be watching for as danger signals, but I’m expecting she’ll tell me to just wait until my scheduled blood draw mid-May and then make the determination of what to do.

    2. For what it’s worth, one fix for a crown problem (if the cement won’t do it) is to insert a post in the remainder of the tooth. Had this happen; the first time, the crown was cementable, but the second time, it took some of the tooth with it. The post can be stainless (normal, I’m told), or carbon fiber (what worked for me; a nickle allergy makes stainless problematic.)

      I don’t know if it’s a DDS procedure, or if you need a DMD surgeon; my DDS was on vacation at the time, but the practice partner is the surgeon. It’s a simple procedure, assuming there’s no root canal issues.

    3. When there’s no tooth to stick the crown to, but the root is still sound, the dentist can build up a mount for the crown to sit on. (I have two of those. One tooth broke off flat and level with the gum, and the other broke diagonally. Evil, evil silver-amalgam fillings.) Also, for future reference… gold and zirconia don’t require as much tooth be removed as for ceramic crowns. (And the price diff isn’t much.)

      Generally it takes several iterations (a few weeks to several months apart) for thyroid dosage to stabilize, until it reaches the level of complete replacement. Not at all uncommon to require an increase after a few months, to control symptoms. Also, if you’re on LT4, ask to try Nature-Throid [not Armour] instead (65mg=47mcg)… sometimes the difference is miraculous, because it adds T3, calcitonin, and possibly other hormones that may be more necessary than is commonly believed.

  20. The rule of thumb says that for every 1% unemployment rises there will be 40,000 lives cut short. Most of those will be suicide, some will be due to foregone medical treatment, some will be shot robbing banks.

    The underlying calculations were done in the Sixties, so it reflects “Greatest Generation” moral codes. I don’t know if it has been updated for Boomers and Beyond.

    And, of course, this is no ordinary sort of unemployment, so there’s no telling what the consequences will hold.
    –

  21. We got one of those “essential” outpatient surgery slots for my son. Doctor was happy because it relieved him of one more surgery from his upcoming backlog. Today, I filled out a survey the hospital sent us. I expressed my displeasure that they rushed us out of there so fast, they hadn’t bothered to see whether he could tolerate foods following anesthesia. He vomited everything for the next several hours. They didn’t give us a prescription for anti-nausea meds (I’ve had outpatient procedures multiple times and so far, that is a standard thing.). They didn’t tell us what to do about wound care if the incision sites stated bleeding. And that also happened. Nausea from anesthesia and wound care are two of the primary topics addressed EVERY time we have had a procedure. This same hospital addressed them (and gave us prescriptions for the nausea) when my spouse had appendicitis just this last September. But now? Only the COVID patients seem to matter. Everyone else is “are you done yet? are you done yet? Leave already!”

  22. BLOODY! F*CKING! HELLFIRE!

    PA’s primary has been rescheduled to June, and…

    …wait for it…

    ALL voters statewide can…. [insert Drumroll here] VOTE BY MAIL!

    My beloved homeland just went Forever Red.

    1. And our [REDACTED] piece of [REDACTED] Governor is NOT, as had previously been reported, reopening the entire state come May 8. No, he’s only reopening the Northeast and “North-Central” regions of the state. No timeline for the other 2/3s of the state.

      ***eatinging mother****ing inbred son of a $5 *****….

          1. May be needed. Hopefully not. Or perhaps Barr grows a pair and his prosecutors go after them for deprivation of rights under color of law.

            1. That is an excellent idea. I’ve found one gets instantly better behavior from badge-adorned little tin gods by quoting USCode Title 18, Sections 241-242…

    3. 1. It’s just the primary — that deck has been stacked long since.

      2. If they are still trying to pull that come November they will have to show cause, and their mismanagement* of the Woo-Hoo Flu will be hardly credible cause for returning them to office.

      *Yes, mismanagement, obviously apparent by that point if they’re still trying to keep the state closed while almost all of the other states are up and running.
      –

      1. Assuming it’s not a “second wave.” Media insanity has gone unnoticed by a lot of the masses, except they are lapping up orangemanbad like a dog and antifreeze.

        I’d rather be the dog.

  25. I haven’t seen the order, but have seen the press release. Our maddening but occasionally connected to reality Oregon overnor is opening medical (and dental, und so weiter) access to non-essential stuff as of May 1st. It’s on the medical practice to ensure that any COVID CCPooties don’t get transferred, and everything is subject to review every two weeks, but it’s a start.

    My hair looks like Christopher Lloyd’s Doc Brown on a bad day, but if it goes another month or two, I can impersonate a 67 year old hippie. Either that, or I’ll have a really short crew cut. 🙂

    We’ve been stuck with votefraud by mail since before we moved from The People’s Republic.

    1. “… if it goes another month or two, I can impersonate a 67 year old hippie.”

      You realize, of course, we are at dire risk of an epidemic of man-buns?

      I suspect there are a great many women looking at their ever extending roots and calling doom and damnation down on governors.
      –

      2. You realize, of course, we are at dire risk of an epidemic of man-buns?

        –
        I’d rather use hedge clippers.

    2. My hair looks like Christopher Lloyd’s Doc Brown on a bad day

      –
      The idiots that claim barber shops are ‘not essential’ have never seen mine when it’s out of control. It’s gone Full Einstein.

      1. Just appreciate that if your worst complaint is that you need a haircut in the midst of this panic, things are actually going quite well.

        1. Yeah, I’m doing all right. We’re retired, so income is staying steady, and we don’t have debts. It’s not me that I’m worried about.

          The “nonessential” beauty shops/salon/barber/Great Clip employees get my worry. Those shops were a place to work when the lumber jobs went away (AFAIK, several were formed by former mill employees, or their spouses). Several got clobbered by the Summers of Recovery, but this will be hard on the rest. We’ll see just how many reopen.

          Jewelry and furniture stores were also highlighted as nonessential. One watch needs a battery, so that’s waiting. Several of the jewelry shops had minimal personnel, one to three owners/workers. The big one has a bunch, since they do a lot of custom work. (They’ve also tried to screw $SPOUSE with double billing, so we don’t go there anymore…) One of the town’s furniture stores has been giving “I’m in trouble” vibes for a few years. This might finish it.

          We had a surge in dental practices (apparently because it got covered via Medicaid) recently. I expect a bunch of the newbies to be gone or to go under.

        3. And yes, not getting a haircut is not the worst of my worries. Getting the medical tests to ensure that the tricky medication is dosed right. (Too little == risk of death, too much == Major risk of death, with a narrow window between the two), that’s the big worry.

      2. I normally wear “a haircut.” Being cheap I let it get pretty shaggy between cuts, but it always gets cut to “James T. Kirk, except without the pointy sideburns.”

        I needed a haircut before I got sick last year. Now… when the barbershop re-opens, I can either get the same old thing, a righteous mullet, or perhaps a truly impressive Mohawk…

        1. To impress anyone with a mohawk these days you’ve got to dye it electric blue, neon pink, fiery fuchsia or some other unnatural colour.
          –

      3. Yeah, I call my hair when it reaches its current state “Mad Science” style.

  26. Forgive the pseudovent.

    The most destructive part of this whole fustercluck is that there will be no actual learning done from it. Orangemanbad will be the excuse for every death. Not one of the below deficiencies will be corrected.

    Ny returning kung flu to ESFs
    NYC decreasing mass transit frequency
    FDA/CDC testing cluster
    Failure at every level from hospital to federal to maintain emergency stockpiles.
    Offshoring and JIT
    Failure to learn from or listen to allies (ROC, SK,ETC)
    Possibly leaving intl air too long (depends on p0)

    Instead we will get president Abrams or Harris, MMT, Nationalized healthcare, and further boot on communication.

    2. If the Federal government is left to its own devices, it is incapable of learning those things.

      But individuals are not so bureaucratically blinkered, and individuals may not make the choice of leaving those organizations alone.

      What individuals will choose to do, and their net impact, are not things we can predict and understand. We are probably in one of the periods where the simpler models of society break down. We should distrust our models. We should also have faith, and not despair about our every personal action. Some of our personal choices are futile, bailing an ocean with a ladle. Some are Dutch boy with his finger in the dyke. Some are worthwhile, but the exact paths are beyond our ability to forecast. Some we can actually see are worthwhile.

      Having eyes on Federal bureaucracy as it busily ensures that everyone publicly thinking about this is moved to its center of lessons identified and promptly ignored must be disheartening.

  27. And the drive toward “Greater West Virginia” grows stronger …

    Top Virginia health official warns state lockdown could be ‘two-year affair’
    … During a Friday afternoon briefing on the coronavirus response, Virginia Health Commissioner Norman Oliver said Democratic Gov. Ralph Northam’s “Phase One” coronavirus response plan, which involves business closures and social distancing, could last for as long as two years.

    “I, personally, think Phase One will be a two-year affair,” Oliver said. “There are a lot of people working on this, and I hope they prove me wrong, but I don’t see it happening in less than two years.”

    A Virginia Department of Health representative immediately attempted to walk back Oliver’s comments, suggesting that Oliver meant the coronavirus will be with Virginians for two years and not that state-mandated lockdowns would continue that long.

    But a proposal of what the commonwealth will look like as health officials worry about a second wave of the virus in the fall is yet to be seen. …
    –

    1. For those interested, here’s an in-depth discussion of the effects of such a diversion of Virginia counties to West Virginia, including consideration of joining the Virginia dissident counties to Kentucky or to Tennessee.

      Virginia Counties Can Become a Part of Another State
      Posted on November 15, 2019
      This #Vexit proposal is different from secession because it is simply a shift in borders that does not affect the balance of power in the US Senate. It does not create a new state or increase the number of states.
      –

    2. Dammit, they DO want to keep up this farce until the last corona virus dies of old age!

      Nobody can know anything about biology and ‘worry about a second wave’ of the SAME virus six months from now. That just ain’t how diseases and immunity work. There will probably be a new flu virus, probably originating in China, just like most years, but it will have nothing to do with THIS virus.

      Are they all idiots, or just pretending to be idiots? I can’t tell.
      ———————————
      Dark Willow: “Bored now.”

  28. Gee, you’d think this would be bigger news, even for the Washington Pest, which ran this under the “Transportation” heading:

    ‘Quarantine fatigue’: Researchers find more Americans venturing out against coronavirus stay-at-home orders
    By Katherine Shaver (Reporter covering urban planning and transportation issues)
    April 25, 2020 at 6:01 p.m. EDT

    Researchers tracking smartphone data say they recently made a disturbing discovery: For the first time since states began implementing stay-at-home orders in mid-March to limit the spread of the novel coronavirus, Americans are staying home less.

    The nationwide shift during the week of April 13 was relatively slight. However, any loss of momentum, particularly when stay-in-place orders remain in effect across most of the country, has some public health experts worried about “quarantine fatigue.” Any increase in travel, they say, is premature when staying home remains the most effective way to limit the spread of the virus until widespread testing and contact tracing become available.

    “We saw something we hoped wasn’t happening, but it’s there,” said Lei Zhang, lead researcher and director of the Maryland Transportation Institute at the University of Maryland. “It seems collectively we’re getting a little tired. It looks like people are loosening up on their own to travel more.”

    Zhang said he anticipates the number of people staying home will continue to drop as some states begin allowing businesses, beaches and other public facilities to reopen. That process began last week in South Carolina and Georgia.

    Public health experts say any data showing widespread public resolve or cooperation beginning to wane is noteworthy. Because this is the first U.S. pandemic in 100 years, they don’t know how long people are willing to tolerate cabin fever for the greater good.

    They say they’re not surprised, however, that a slide occurred in a week that saw the first highly publicized challenges to such orders by protesters and President Trump, who tweeted his support to “liberate” states from shutdowns. The White House also released federal guidelines that week for states seeking to reopen their economies. And a growing number of governors, including in Texas, Minnesota and Vermont, set dates for when they planned to gradually lift restrictions.

    [SNIP]

    By April 17, the researchers found, the share of people presumed to have stayed home — meaning their phones didn’t move at least a mile that day — declined from a national average of 33 percent to 31 percent, compared with the previous Friday. That came after six weeks of the staying-home percentage increasing or holding steady.

    The number of work trips remained about the same. However, the average number of personal daily trips grew to 2.5 per person, up from 2.4 the previous Friday — a 4 percent increase. Trips between counties and states also increased.

    Because the study’s sample size is so large — more than 100 million cellphones observed monthly — even slight changes are statistically significant, Zhang said.

    Dr. Wilbur Chen, an associate professor at the University of Maryland School of Medicine, said it’s too soon to know whether the findings reveal a one-week blip or the start of a trend. Chen, a member of Maryland Gov. Larry Hogan’s (R) covid-19 task force, said he’s keeping a close eye on the data, but researchers won’t know for several weeks if more travel led to more coronavirus hospitalizations or deaths — the two most reliable measures of the virus’s spread.

    “But it all makes sense,” Chen said. “If people are out and about, there’s more risk of transmission, and when there’s transmission, you have more cases of hospitalizations and deaths.”

    George Rutherford, an epidemiology professor at the University of California at San Francisco, said he’s concerned to hear that more people are venturing out while infections remain on the rise in much of the country.

    “We’re going to have to do this carefully,” Rutherford said of states beginning to ease restrictions. “Letting people decide for themselves because they’re bored is not a good way to do it. . . . This is not the time to be letting up.”

    Experts have theories about why the week of April 13, the most recent data available, became a tipping point. Many homebound Americans hit the mental milestone of the fifth week, technically entering a second month, with no clear end in sight. Even with the boom in video calls and virtual cocktail hours, they say, feelings of loneliness and isolation continue to mount. Balmy spring temperatures also probably drew people out, particularly in warmer regions where a hot, sticky summer will soon descend.

    It’s also no coincidence, they say, that resolve would begin to wane amid the Trump-supported protests, even as most Americans tell pollsters they support stay-at-home requirements.

    Lorien Abroms, a public health professor at George Washington University, said it doesn’t help that the public has received “mixed messages,” including Trump’s “tacit support” of the protesters.

    “I think the message is getting out that you can give in to your fatigue and say ‘It’s enough,’ ” Abroms said.

    Some people also might have mistakenly believed they could safely start bending the stay-at-home rules, experts say, when some governors began to publicly announce how and when their economies would begin to reopen.

    “People can feel it’s coming, so they get more antsy,” said Susan Hassig, an associate professor of epidemiology at Tulane University. “It’s kind of like a kid before Christmas.”

    Governors in Georgia, South Carolina and Tennessee announced reopening dates Monday, after the latest cellphone data was analyzed. However, the percentages of people staying home in those states as of April 17 already were among the lowest in the country, between 23 percent and 26 percent.

    Travis Gayles, the chief health officer in Montgomery County, Md., called the potential problem of residents losing patience “an important point that I think every jurisdiction across the country is grappling with in terms of making sure we reinforce our message related to shelter-in-place.”

    Gayles said he wasn’t familiar with the data, but questioned whether Montgomery residents might have ventured out more after the county began requiring shoppers to wear face coverings in stores, pharmacies and other retailers.

    Even so, Gayles said, “The message is very clear. We’re still encouraging folks to stay home and only come out when they need to,” such as to go to work or the grocery store.

    The reversal first became apparent last week, when the Maryland researchers continued to analyze the movements of smartphones via location data from apps. The aggregated and anonymous data, while imperfect, is an easily obtainable and consistent way to measure how much people move about, Zhang said. He said researchers are sharing the mobility data with government officials and epidemiologists modeling the spread of covid-19.

    The nationwide drop in the researchers’ “social distancing index” started April 14. That was one day before thousands of protesters in Michigan received national attention for jamming roads around the state capitol, demanding that the restrictions be eased and people be allowed to return to work.

    The social distancing index reflects how much people stay home, as well as how much and how far they travel by plane, car, transit, bicycle and on foot, Zhang said. Phones that didn’t make any stops of 10 minutes or more, such as those on people out for a bike ride or walk with the dog, were counted as staying home, Zhang said.

    In the Washington region, the District and its suburbs all saw an increase in travel and a 1 percent to 5 percent drop in people staying home by April 17. The biggest drop occurred in Arlington County, where 50 percent of residents stayed home, down from 55 percent the previous Friday. However, Arlington tied with the District for the highest percentage in the region.

    In Montgomery, the number of those staying home fell from 45 percent to 43 percent, while Prince George’s County fell from 37 percent to 34 percent. In Northern Virginia, Fairfax County dropped from 46 percent to 44 percent, while Prince William County ended the week with 34 percent and Loudoun County with 37 percent.

    Of course, the data has its limits. Zhang said researchers are still trying to determine where people are going. If someone takes a round-trip drive to walk alone in the woods, for example, they would be counted as making two trips, even though they weren’t any more likely to spread or catch the virus.

    Hassig, of Tulane, said the data is interesting because the United States has such limited experience requiring residents to stay home for lengthy periods. Any quarantines typically are small enough that local health officers can check in daily to monitor people’s symptoms and encourage them to stay isolated. Moreover, she said, most last a maximum 14 to 21 days. “We can usually reduce the likelihood of substantial quarantine fatigue,” Hassig said. “. . . On this massive scale, the support and encouragement can get lost.”

    The coronavirus stay-at-home orders are far less restrictive than quarantines, but public health experts say convincing people to stay in will become harder as the weeks pass. The more effectively such orders lower rates of infection, they say, the more some people will incorrectly assume they’re no longer necessary.

    Most importantly, experts say, governments wanting to discourage people from venturing out need to better understand why they’re doing so. The response to restlessness, for example, might be to reopen larger parks or close more streets to traffic to allow people to get outdoors at safe distances. If some people are starting to drive for Uber or Lyft because they lost their retail job, the response might be more financial aid. For those feeling cut off, experts say, government messages of sympathy and compassion would help.

    “The isolation is real. The loneliness is real,” said Abroms, of GWU. “We need to add that in our messaging. . . . We have to acknowledge that it’s not easy to stay home.”
    –

    1. I’d say the biggest news is that Big Brother is tracking 100 million people without cause or due process. Does nobody see the iceberg right in front of us?

      1. It took digging, but I found this as the source for the data:
        Consent
        We only process de-identified data from users who opted in to share their location.
        and
        We allow users to easily opt-out through several paths: app settings, device settings, TrustArc and the Cuebiq App.
        https://www.cuebiq.com/location-intelligence/

        It’s down at the bottom.

        My guess would be that they use sources like the “find your device if it’s stolen” thing, those usually have an option to share anonymized location data.

        1. If you ‘opt out’ do you really believe they can’t still track you? How would you know? Cell phones have become so complex NOBODY can fully understand what’s in there. What did that last update do? What will the next one do? How could anybody keep up with it all?

          George Orwell never dreamed such power could exist.

          1. *polite smile*

            You have ever seen a phone bill, right?

            With the number called, and the number of minutes?

            You are aware that those calls are made by buying time from specific towers, right?

            Quit being paranoid about research that’s based on location apps that are set in a platform that by definition tracks where the bleedin’ phone is!

            1. It isn’t as if this is super-secret information — how many times a week does a cop show track somebody by his cell phone?
              –

              1. Or any ‘smart’ object– I refuse to have a watch with GPS in it, but there have been several murders that were solved because the victim’s activity didn’t match the reports. (in some of the cases, the murderer even thought to destroy the blue tooth pedometer– but didn’t know about instant sync, so it was all on the cloud)

                As far as privacy loss goes, I rate my phone lower than living in a place that has fewer than 1000 population. If you actively put a tracker on, it might rise to “nobody has the exact same car you do.”

                Having used the “find where you parked” apps, I’ll stick with neighbor-who-pays-attention being a bigger risk.

            2. It’s not paranoia if it’s true.

              The question is not, ‘Are you paranoid?’ The real question is, ‘Are you paranoid enough?’
              ———————————
              I used to think I was paranoid.
              I thought people were out to get me.
              Now I know the truth — they ARE out to get me!
              I feel so much better.

              1. It’s your government – of course it is out to get you … if necessary.

                The thing is, recognize you’re living in a glass house with no curtains and take appropriate precautions. You already knew they could track your credit/debit card usage and should have been aware of cell phones’ trackability.
                –

              2. That’s a popular line, but it’s false.

                It’s not paranoia if it is rational.

                Being worried someone might be secretly following an item on a platform that openly and mandatorily functions by knowing where that item is to a <30sqft area is not rational.

                1. I don’t worry about the existence of the capability; I worry about the protections against misuse.

                  1. +100

                    My solutions tend towards the end where they have to pay out multiples of however much they made by breaking the law, with the burden of proving they made it without the stolen information being placed on them.

                    With, of course, safeguards against the usual rabid pack of “but I didn’t know that permission to use the information with identity removed meant using the information with identity removed!” twitter mobs.

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