Tuesday’s essay on how the US dealt with Covid provoked a great deal of response (see below). The opinions were mixed, but reading through them this morning, I could see that some people thought I was making light of the virus. The opposite is true. The virus was a massive killer. My argument is that the government’s response to it, which was fueled by media-generated fear mongering, made it a great deal worse. What I’m doing in the follow up pieces is to tackle one element of misinformation and mismanagement at a time. Today I’m talking about the early fears about running out of ventilators.

The COVID Response. What We Got Wrong.

Part II: Ventilators 

Remember all the hullabaloo about ventilators? All those media stories in the early days of Covid about the “critical shortage” of ventilators?

Like this story, titled There Aren’t Enough Ventilators to Cope with the Coronavirus, published by The New York Times in early 2020?

According to this article, and dozens like it at the time, US hospitals were terribly under-equipped to handle the case loads of Covid patients, and were “desperate” because ventilators  are a “crucial tool to keep patients alive…and can be the difference between life and death for those facing the most dire respiratory effects of the coronavirus.”

(The article went on to criticize the Trump administration had failed to “develop a national strategy for accelerating the production of ventilators.”)

Also in April of 2020, the New England Journal of Medicine published an article titled Critical Supply Shortages — The Need for Ventilators and Personal Protective Equipment during the Covid-19 Pandemic that went so far as to estimate the number of ventilators needed as being “several hundred thousand to as many as a million.”

One opinion piece published in April, 2020, 2 Harvard Law professors and a UP professor of critical care said the shortage of ventilators was so severe that doctors were routinely being forced to withhold ventilation from some not-so-severe patients in order to make ventilators available for more severely sick patients, which “will probably cause them to die when they might have gone on to live long and healthy lives with the treatment.”

“Do you remember that there were a few doctors and nurses that spoke out against the excessive and improper use of ventilators because of all fear? One instance that briefly went viral, a NYC nurse accused NYC hospitals of “killing patients with ventilators” by intubating them when other, less dangerous, treatments were available?”

And then… nothing. We stopped hearing about ventilators and the critical need for ventilation. The virus was still spreading like wildfire, but the ventilator crisis seemed to have disappeared.

This story was the story in those early months of 2020. It was front page news. And it was political fodder for politicians as well.

Do you remember the fight between Governor Andrew Cuomo and Trump over the need for ventilators? Cuomo was saying that New York needed “a minimum of 30,000 to 40,000 ventilators,” to which Trump replied, ““I have a feeling that a lot of the numbers that are being said in some areas are just bigger than they’re going to be. I don’t believe you need 40,000 or 30,000 ventilators. You go into major hospitals sometimes, and they’ll have two ventilators. And now, all of a sudden, they’re saying, ‘Can we order 30,000 ventilators?’”

So there was all that. And then, suddenly, nothing more. The media stopped covering the “crisis” and politicians stopped talking about them. And Americans stopped worrying about them.

What happened? Had supply met demand?

Well, supply did increase. By thousands of units per week. But by the end of 2020 more than 140,000 ventilators were sitting unused in warehouses and hospital storage areas. And only a small fraction of the 30,000 to 40,000 ventilators that Cuomo ordered were ever used.

Why was that story never told? And why have we heard nothing about ventilation since?

It is, to me, a story of fear mongering and irrationality. And of a media that took a fixed position on a health issue rather than treating it as a question. And the reason they did that was because Trump, whom they despised, “downplayed” the need for so many more ventilators. As all those unused ventilators started piling up in warehouses all around the country, it begged the question: Why weren’t they being used?

And the reason for that was known all along. Ventilators are very imperfect medical tools. They can indeed be life saving in certain situations, but they have such a great propensity to cause damage, including killing patients that use them, that they have always been used sparingly and only with extreme care.

The big lie about ventilators was that they were not miracle machines, and they were not in critically short supply.  Instead they were being used on patients that would not have normally been candidates for them. US hospitals were using them well beyond the historical need and well beyond the use of them in other developed countries. One example: the US compared to the UK:

 In July of 2020, US hospitals had 14,000 COVID patients in ICUs on ventilators. In the UK, with 20% of the US population, the number was less 86. In January of 2021, US hospitals had 29,000 patients ventilated, compared to 3,600 in the UK. Bottom line: On a percentage basis, the US was ventilating considerably more COVID patients than any other country in the world.

The bottom line: in 2020, tens thousands of people sick with Covid were put on ventilators that should probably have been treated with other, more traditional, and safer, procedures. And because of the high probability of bad outcomes from ventilation, it’s reasonable to assume that this hysteria about them contributed to thousands of unnecessary deaths.

Here are some of the serious problems with ventilation and why they are meant to be used sparingly: (from Yale Medical School):

Infection: The breathing tube in the airway can allow bacteria to enter the lungs, which can lead to pneumonia. A ventilator can also damage the lungs, either from too much pressure or excessive oxygen levels, which can be toxic to the lungs.

Delirium and other PICS (post-ICU problems): Treating an illness with a ventilator often causes three lingering problems – loss of physical functions, loss of cognitive functions, and mental health issues.

Other post-ventilator physical problems: The lack of movement from being in a ventilator causes many persistent physical problems after the patient is discharged that require months of physical therapy.

What I Believe: About Entitlement

It’s unfortunate, but it seems to be a universal trait.

I’m talking about Homo sapiens’ ability to feel entitled to anything we become accustomed to. Whether we deserve it or not.

I noticed this in business many years ago. I’d make a deal with a group publisher that consisted of a good base salary and a bonus based on a profit percentage. Sometimes, through no fault of the publisher, profits were less than expected. So, I gifted them an unearned extra bonus as a gesture of good faith. Of course, they were grateful for that. And I thought, “Well, that’s that.” But what I discovered the next time profits were down, and I didn’t give them a bump because I felt they could have done more, they were upset. They felt like I was cheating them. They felt entitled to a bonus they were never promised and didn’t earn.

I noticed this again when raising children. If ever I relaxed on a rule – say, allowing them to play a little longer before bedtime – the next day, they would feel wronged if I insisted on going back to the scheduled bedtime.

I discovered it yet again when I sponsored a baseball team in Nicaragua. The ballplayers were very grateful for their new uniforms in year one. But when they heard that I expected them to wear the same uniforms in year two, they were outraged. They threatened to go on strike unless I gave them new ones. I didn’t. They gave in.

This happens in every sort of charitable giving, whether it’s through an institution, individual, or the state. The definition of charity is giving someone something they did not earn. When you give a panhandler a few dollars for whatever need he claims to have, it’s very clear to you that what you are doing is a voluntary act. That he is not entitled to your money. And so, you expect him to be grateful.

And when you give a panhandler a dollar bill, like I did a few months ago, and she looks at it with disgust and tears it up and throws it in your face because you gave her a five-dollar bill the previous day, that’s entitlement. And that’s bad.

I was talking about this to a friend and colleague at Rancho Santana last night, and he sent me this clip of a conversation between Conan O’Brien and Louis CK that puts it in a humorous light.

We Were Not Just Wrong. We Were Hysterically Wrong.

Part I: The Complaint

Think back to the early months of 2020. Do you remember what was happening? Do you remember what we were thinking back then? Do you remember what we were doing? When I think about those months, I can’t find a fairer word to describe our behavior than hysteria.*

Think back. Remember the early predictions of a 10% mortality rate? Do you remember how we worried about how long the virus could linger on everything from apple skins to paper bags to plastic handles?

Do you remember how we shut down our beaches because we believed that the virus could spread itself in the sea breeze? There were even discussions about whether it could survive in the ocean!

Do you remember that hospitals would not allow family members to be with their loved ones, even during their final hours of life?

Looking back on all that now, it seems certifiably crazy. But it wasn’t just a brief, initial overreaction. Have you thought about all the things that we were thinking and doing in the second half of that year and in the following 18 months? Are you aware of how many things we believed (and were told to believe by the CDC and government health officials) that turned out to be dead wrong?

We want to believe that what we did was sensible. That we always “followed the science.” We want to believe that we began with an abundance of caution (better-safe-than-sorry), and then scaled back the regulations and restrictions as we learned more.

But that’s not what happened. In retrospect, it’s becoming increasingly obvious that we took part in a massively destructive and very much unscientific government-sponsored exercise in fearmongering, gaslighting, witch hunting, and mass manipulation.

And it cost us dearly. In human and financial capital. A cost that cannot be recouped.

Early in 2020, when I was writing about COVID regularly, it was obvious that some of what we were being told made no sense. On top of that list was the mortality rate. It was said to be as high as 30% before falling to 10%, where it was widely publicized, resulting in a tidal wave of fear that spread through the developed world. Today, we know that the mortality rate was much, much lower. More importantly, we know that this should have been obvious to anyone that had the slightest knowledge of logic, as I argued in those early blogs.

That initial level of fear has abated. For most of us, it’s almost entirely gone. We all know dozens of people that have contracted COVID and recovered fully.

We now have more than 30 months of experience with the virus and with our reactions to it. And we have data from hundreds of national and international studies and dozens of mega-studies. What they are telling us is that many, if not most, of the important “facts” we were told about COVID by WHO, the CDC, and the media were downright false. And many of those falsities were being promoted by health professionals that knew, or should have known, better.

The US lost tens of thousands of profitable businesses, trillions of dollars in revenue, and two years of critical schooling for our youngsters. This is a big deal. And the media should be writing about it.  What they are doing instead is gradually letting out bits and pieces of truth, hoping that the public will not realize they were bamboozled.

They want to bury the “facts” they were reporting. Or, if that can’t be done, they want to be seen as blameless. And if that can’t be done, they want to be forgiven.

Last month, The Atlantic published an essay by Emily Oster in which she acknowledges that a good deal of what the media reported was false and/or misleading. But she argues that it was done with good intentions. There’s no point in pointing fingers now, she says. We should give the media (and others involved) a sort of pandemic amnesty. “Let’s focus on the future,” she writes. “And fix the problems we still need to solve.”

Another tactic from the media that I’ve been seeing lately also admits to promoting the falsehoods, but makes light of them, as if the lockdowns and the mandates were all in good fun.

For example, this editorial from The Washington Post.

I’ve been up to my neck in business issues. And yet, it’s Thanksgiving. Surrounded by family, I should be spending most of my time with them.

J, my editor, who knew I was feeling the crunch, was kind enough to find and forward me this essay. I wrote it 15 years ago while on a trip to India, just before I decided to build a community center here in Nicaragua. Since then, our family has spent most Thanksgiving holidays here, as we are doing now. So, it seems fitting to dust off this piece and offer it to you today. I enjoyed it. I hope you will, too.

A New Business Pops Up in Nicaragua 

On the trip from the airport in Managua to our house at Rancho Santana, Nestor updated K and me on the local news. The election went off without a hitch, he told us, smiling. Government employees were told to photograph themselves voting for the president. Not that it would have made any difference. The candidates that were going to run against him were put in jail or under house arrest. It is a one-party government now. But there are no demonstrations. The universities are open for business. The streets are open. Business is recovering, although it’s still a fraction of what it was several years ago before the crackdown.

But there is one area of business that is doing very well, he told us. That’s the business of transporting people from countries all over Latin America, the Caribbean, and even the Middle East from the airport to the Mexican-Honduran border, where they sign up with the cartels to be smuggled into the US. “They are coming in by the busloads,” he said. “Every day. They pay $200 to get to the border and then pay the cartels thousands to take them up to the Rio Grande.”

“Why are so many flying into Nicaragua now?” K asked.

“Word has gotten out,” Nestor said. “It’s an easy trip into Nicaragua and from there up through Honduras and to the border.”

“So, how many are coming?” I asked. “And from where?”

“It’s crazy,” he said. “It used to be mostly Central Americans. Now it’s every country from South America. Plus Haiti and Jamaica and other Caribbean islands. There are even people flying in from Europe and the Middle East.”

It’s estimated that about 2.5 million people crossed into the US illegally last year. About two million of them, after reaching US territory, turned themselves in, claiming political asylum. They were booked in by the US immigration service, and then given a court date to adjudicate their claim. Soon after that, they are sent in planes and buses to various undisclosed US locations. (Just in case you are wondering: About 99% of that transportation is done and paid for by the federal government by order of the Biden administration. The totality of all the immigrants that were sent to Martha’s Vineyard and NYC and DC account for less than 1% of the total.)

An Introduction to “Realitivity” 

I’m working on an idea for a book that I will probably never finish. It will exist in the library of two dozen could-be bestsellers that I’ve been working on for years. Like the rest of them, I was excited about this one when it first occurred to me. And after a few months of chewing it over, I’m still liking it.

I’m calling it realitivity. (That’s realitivity, not relativity.) As in keeping it real. It’s based on the law of entropy, which, as you know, says that everything in the universe is programmed to degrade. And that any theory or system not designed with that law in mind is due to fail. One of the fundamental insights of realitivity explains what happens when we apply the law of entropy to human behavior.

Take, for example, the behavior of Frank Abrokwa, the guy that achieved his 15 minutes of fame by assaulting a woman with his feces in the NYC subway. (I mentioned him in my Nov. 2 blog post.)

He is the dictionary definition of repeat offender. (His most recent arrest was his 45th.) And his freedom to continue to serially assault New Yorkers has been due to the city’s catch-and-release policy that has recently been fortified with “cashless bail.”

I was speaking about him with a friend. “Abrokwa is mentally unbalanced,” he said, offering that as a justification for allowing him to be on the streets all these years.

I understand the sentiment. There is a difference between crimes committed purposely and intentionally by people that know they are doing something they shouldn’t be doing, and the same crimes committed by people that are insane. The first are obviously immoral. While the latter, lacking the element of willfulness, are clearly not.

That’s the rub.

I’ve been thinking about this. And here’s some of what I’ve come up with…

Criminal law is not a moral code. It is not established to support some view of morality. (As opposed to, for example, Sharia law.) The primary purpose of criminal law is to protect the public from crime and, in cases where the crime is especially egregious, to give those people affected by the crime (i.e., the victims’ families and, in extreme cases, the public at large, a sense of retribution).

Furthermore, the concept of “not guilty by reason of insanity” is illogical. The determination of guilt should be restricted to one question: “Did the accused commit the crime?” If the accused is judged guilty, he should be subject to incarceration. Tout de suite. And the length of his incarceration should be determined not just by the severity of the crime, but also by the likelihood that he will do it again.

In the case of Mr. Abrokwa, the question of culpability is easily answered. His crime was videotaped. By my logic, he should be incarcerated. No questions asked. Catch-and-release for a repeat offender like him doesn’t work. How long he should be put away should depend upon (1) the severity of the crime, which, as a non-lethal assault, is in the moderate range, and (2) the likelihood of his repeating it, which is very high.

That satisfies the criminal justice issue. But it leaves open the question of human justice. Is it fair to treat two criminals the same way when one committed the crime consciously and purposely and the other one was obviously out of his mind?

The answer is no. It’s not fair.

So, in terms of “punishment,” how do we distinguish between them?

When, as in the case of Mr. Abrokwa, it’s clear that the criminal is crazy, the state should do what it can afford to do to give him some sort of medical or psychological treatment to stabilize his mind. But if and when his mind is deemed stable, he should not be given a “go out and do it again” pass. The length of his sentence should not be shortened. He did the crime, so he should do the time. The human justice obligation is met by treating him during the full term of his sentence.

Those are my thoughts at the moment. What do you think?

Late Wednesday afternoon, one of the Mules asked me if we were still planning to have our book club meeting at the cigar club, as planned. I replied, “Why wouldn’t we?”

He said, “Because of the storm.”

I said, “Oh, that. When is that supposed to hit?”

He said, “Tonight.”

I said, “Well, the cigar club is basically a cement bunker filled with booze. I’m going. So is Frank, the bartender. And Olio, the restaurant down the street, is delivering the food.”

He said, “I’ll be there.”

It was raining when the meeting began at six. And it was raining when it ended at ten. There were apparently gusts of wind here and there, but we never noticed them. When I went to bed, it had stopped raining. I woke around two in the morning and looked outside onto the beach. It was beautiful and calm.

Thursday morning, it was bright and sunny.

This is what happens 9 out of 10 times that we are alerted to an impending hurricane. That’s why it’s difficult for long-term Floridians to put much stock in weather reports, especially urgent ones. And that’s why we get a kick out of coverage like this:

What Are My Thoughts? 

JS, my editor, thought I should write something about the election results. So, I’ve been thinking about what I think and, so far, I don’t have any thoughts worth writing about. But I do have a feeling about the results. On both a state and a federal level, I feel a bit safer about the future than I felt a week ago. With more of a balance in the House (and maybe the Senate), there should be a slightly better chance that Congress will do an overall better job by passing fewer laws and spending less money and generally reducing their power and presence. Okay. Maybe that’s optimistic. Still, as Hem said, isn’t it pretty to think so?

What I Believe: About Gun Control

I think everyone should have the right to own a gun. Or guns. But I also believe in gun control. I can’t, for the life of me, understand the arguments against, at the very least, banning assault weapons.

The best argument in favor of assault weapons is a political and theoretical one. It’s based on the second amendment, which states that “the right of the people to keep and bear arms shall not be infringed.” But the primary rationale for the second amendment was not for protection against robbery or personal assault. It was for protection against tyranny. Our founding fathers had risked their lives defending America from tyranny, in large part with state militias. They recognized that the government they were establishing could one day devolve into tyranny. To prevent that, they wanted citizens to be armed.

So, if that was the intention, and we want to hold fast to the intention, it’s difficult to argue with the right for all Americans not just to be armed, but to be armed to the hilt so they could militia-up and fight governmental tyranny.

But as a pragmatist, I can’t see that playing out in the real world.

Tyranny is a real threat. And we should be on guard against it. I just don’t think the answer is a deluge of automatic weapons.

That’s where my thinking is now. And I would be wasting your reading time if that was all I had to say on the subject. But, in researching assault weapons, I discovered something interesting. It’s something you may not know.

I assumed that assault weapons were responsible for most of the homicides in America. It turns out, that’s not true.

According to FBI data, handguns are the weapons of choice for most killers in this country. In every one of the past 20 years, the overwhelming majority of murders involved handguns. And an NIH study confirmed that, depending on the year, assault rifles accounted for between 2% and 12% of all homicides.

In the chart below, you can see that, in this particular year, automatic handguns and rifles were used in 329 murders, or about 2% of the total.

Conclusion: This is not to say that assault weapons are not a problem. When it comes to mass shootings, they are, indeed, the weapon of choice. Assault weapons are involved in more than 80% of mass killings, according to FBI data. (Interesting: The greatest mass killer in American history must certainly be Charles Cullen – i.e., The Good Nurse. And he didn’t use a weapon of any kind.) Given my thoughts on applying the death penalty to serial killers and mass murderers (see what I said about capital punishment in Tuesday’s issue), logic compels me to favor significant restrictions, including serious psychological screening, for owning assault weapons.