Heal Thyself

Dr.Bones had an A.I. powered Tricorder and Dr. Long, in Mike Judge’s “Idiocracy”, had three probes in the ear, anus, and mouth. Today even doctors are having trouble getting a qualified physician. Secretary Azar, due to huge health care demand and logistical problems during social distancing, recommended increased telemedicine and for state medical boards to loosen regulations. The government even approved non-Hippa compliant Skype and Google conferencing apps to be paid by medicare!

Medical boards micromanage with self-righteous zeal more than current state governments with total lockdown, even in rural areas without covid. The medical boards have responded passive aggressively, requiring a doctor to apply for a state medical license for each state in which a needy patient lives. They require new patients, that need care, to be traditionally seen in person before telemed can then be utilized. This freezes-out undoctored patients from getting care while local doctor offices are shuttered! Mississippi has the fewest physicians per capita, but 1,200 physicians wanted to help by telemed and went through the expense of applying for a Mississippi license. The board decided they could only consult with patients they had already seen in another state , from in-person consults, as the board representative noted there were more than an adequate number of physicians with the ratio of 191 doctors per every 100,000 citizens.

The best the average Joe can do is find a triage Advanced Practice Nurse (APN) to refer to a specialist. With financial obstacles, insurance denials, and long wait lists for specialists, it is crucial to be your own barefoot doctor before seeking even triage. An ER visit will bankrupt you and shotgun diagnostics by the primary care provider will as well as they are under time pressure trying to guess which specialist to turf you to. Mother nature gave us a brain and the Greeks gave us the concept of logic(Induction and Deduction). If you apply a systemic review of all body functions to I.D. symptoms and signs, observable physical changes, you can induce the forest from the many trees. That allows your provider to take your written down theory to segregate you to the correct specialist who can deduce the exact illness at less expense and more expeditiously. Your search engine via internet is your improvised tricorder!

Photo by Hush Naidoo on Unsplash

To wit, let us start. Notice when the signs/symptoms started, duration exactly or continuous, and any variation. Does anything ameliorate it or exacerbate it or precipitate it? What time of day or circumstances does it progress? Is it progressive or stable? What home remedies or other provider interventions have been tried or failed? Try to narrow down to at least broad categories: Degenerative diseases are insidious onset and progressive, neoplastic diseases cause weight loss, hard knots or spots, or blood from orifices. Infectious disease cause fever, weight loss, lassitude, or pain. Psychiatric illness causes mood disorder, irrational thinking or anxiety. Endocrine disease causes weight change, change in vital signs or change of bodily habit/routines. Parasitic disease causes pain or blood and is associated with tainted food /exotic food or insect or tropical environs/travels. Vascular disease causes loss of central nervous system (CNS) function or peripheral symptoms or classic shortness of breath (SOB) or chest pain. Nutritional disease come from odd diets or GI absorption/gut signs. Abnormal movements,loss of sense or alteration if consciousness is neurological. Toxic exposures come from an angry wife giving you rat poison (Like my uncle Ranzy experienced for being too stingy with his wife!). Obviously self-induced toxicity from drugs or withdrawal depends on being honest with yourself.

We all need to be more self reliant as the world has changed. Form a close network of friends and family and try to befriend the obnoxious doctor or lawyer uncle whose opinions you abhorred growing up. Educate yourself so you do not have a family doctor putting a probe in all your openings trying to catch a clue as to what you have developed. Hopefully we will not President Camacho as our leader.

Disease and Incompetence

It is a truth universally acknowledged, that a nation, in the throes of a dire predicament, must be in want of a competent government.

To be honest, that truth is not universally acknowledged. It is particularly the case that the wanton incompetence of some governments in the face of the COVID pandemic has many wondering about the role of government at all. So, let’s look at what we know so far about how competence, or its lack, has affected outcomes. 

Why think of this in the context of a “new normal”? Because the pandemic is not going away, but what we demand and expect from governments should be shaped by what is essential in the context of existential threats from disease and other challenges. COVID shows what governments can and should do in our immediate futures.

Where you live can kill you

In a nutshell: how well a government led the response to COVID has, so far, an effect on mortality of at least 2,000 fold. Meaning: in one reasonably affluent country, the death rate is 0.3 / million, while in another of comparable size it’s nearly 800. A cluster of countries have kept their death tolls in single digits / million; another cluster has death tolls from 100 to 600. It’s amazing.

The lessons, perhaps simplified: preparedness; rapid response; respect for the numbers and the science; leading the people to join in sharing the mutual sacrifice for the mutual benefit. Do these well, and your country and your economy gets through this. Do these poorly, and a vast death toll and economic devastation are the consequences.

A rapid response

The need for early, fast and firm response is driven by the inexorable maths of exponential growth. Consider: COVID’s early spread in many countries had the number of infected individuals rising at 25% per day. That’s just insane growth. At that rate, in just 31 days the number of infected individuals rises 1,000-fold. (To be precise: 1.25^31 = 1,009.) A country that postpones action for a month faces a 1,000-fold larger challenge. 

Thus, the vast range: Taiwan, like some other countries, had a pandemic preparedness plan and started acting to it even before they had confirmed cases. Unlike some others, it stuck to it. It enforced compliance – but had a populace already used to the arrival of contagions from China. It had medical expertise in the country’s leadership – including an epidemiologist as the number 2 in the whole country.

Comparing COVID mortality to date with wealth and population. 

Data from Our World in Data (COVID mortality as of 19th May, 2020, .csv files), IMF / Wikipedia for GDP/capita (nominal) and population data. The three countries indicated by colors are discussed further in this piece. Circles are proportional to population.

Some notes:

  • The 19 countries whose outcomes (so far) are depicted here are all Western-style economies with democratic governments and a generally free press. They have roughly similar economies.
  • Three countries (USA, UK and Australia) have bombastic, populist leaders. One has done well in fighting COVID; the other two have not. Australia’s death rate is about 1% of those in the USA or the UK – and nobody can describe Australians as normally meek and compliant.
  • The country with the weakest government institutions – Belgium (which didn’t even have a functioning government from 2007 to 2011) currently has the worst COVID outcomes.
  • A particular and stunning peculiarity: NONE of the Asia-Pacific countries have more than 6 deaths per million – but this cannot be attributed to Confucian compliance with central leadership since Australia and New Zealand are in this list. In contrast, NONE of the Atlantic / Mediterranean countries have less than 30 deaths per million.

What do we want from leaders? What do we want from government?

Do we want a self-proclaimed superman as leader? “I alone can fix it” (Donald Trump, Republican convention, 2016). Do we want leaders who aim to unify us and create strength from cohesion? “trust your values — our values — and to hold me responsible for living up to them” (Ronald Reagan, Republican convention, 1980, cited in the same article). Do we want Government to be the first place to solve problems for the people (what Britain’s Tories sneered at as a ‘Nanny State’)?

And then comes a super-national-scale crisis, and the criteria for government come into sharp focus.

As the COVID pandemic slowly resolves, it will eventually be a task for historians and pundits to analyze which government approaches worked, and which did not. It’s definitely early to make definitive conclusions, but it’s not too early to look across the various countries’ (and USA states’) responses and note some that seem to have worked so far, and some that seem utterly disastrous, to date. Let’s assume that “worked” and “disastrous” can be quantified by counting COVID death rates (COVID-caused deaths per million people).

If you scan the data, and reject those with dodgy data (I don’t believe Mexico’s or China’s data or those from lots of countries) you still end up with death rates that vary by factors greater than 2,000. Literally: your chance of dying was better or worse by vast factors depending quite narrowly on WHERE you live. The weirdness of this defies easy explanation.

The large ranges continue within countries and within regions: I live in Northern California which has far lower COVID contagion rates than the Los Angeles and San Diego regions.

It’s hard – impossible for now – to peel out unambiguous causes. But let’s look at a few countries, each under democratic governments, of similar sizes (geographic and population), with a vigorous, caustic free press, each relatively wealthy and reasonably literate, and with comparable and generally adequate access to inexpensive health care: Italy, Taiwan, Britain.

Italy – a country on fire with COVID

Italy’s prior experience with plagues and epidemics is well-known, since its role in the 13th to 18th centuries included much worldwide trade: the word “quarantine” derives from the Venetian dialect expression of 40 days – the time ships were supposed to be isolated before they offloaded crew and cargo.

Italy’s high death toll from COVID, what caused it? Was it …  a/ the high percentage of the population that was elderly? (nearly 95% of the deaths were of people aged 60 or older, and Italy has the 5th-highest median age of any country), b/ dense housing in older buildings with inadequate ventilation or sanitation? c/ vigorous community activities (can you imagine Italy without noisy cafes, markets or churches)? d/ multiple generations living together? e/ a communication style that tolerates proximity – cheek kissing – and noisy speaking? f/ smoking? g/ other diseases, comorbidities? h/ inadequate health care prior to or during COVID? I’ve probably missed a few, but even so: the likelihood of getting clear causality against these is slim. (Note, all the data on Italy are from the Wikipedia entry, HERE.)

A brief calendar of COVID in Italy

  • First cases emerged in late January via travellers from Wuhan (who had arrived on 23rd January)
  • First clusters emerged from mid- to 21st February
  • Lockdown started in specific towns from 22nd February and expanded nationwide around 8th March (nearly three weeks after clusters were identified): one month from cases arriving.
  • Case confirmation peak occurs around March 20th
  • Peak deaths around March 27th.

The chart below depicts the growth and tapering off of COVID in Italy.

Growth of COVID in Italy from the discovery of the first COVID clusters

If there’s one unambiguous lesson from Italy, it’s this: the two-plus week between identifying clusters and initiating widespread lockdown cost dearly in terms of deaths.

Taiwan gets COVID nearly right

Taiwan’s experience with Chinese-origin epidemics is recent and urgent. The SARS epidemic in 2004 found the country ill-prepared and with its representation at the World Health Organization shut off by the People’s Republic of China. This led Taiwan to bolster its epidemic response. By late 2019, it had a robust Center for Disease Control, modelled explicitly on the similarly-named USA institute, with a health command center explicitly set up to deal with epidemics. They’d planned for this for years, and knew they’d be on their own. Further, it had as the nation’s vice president an individual – Chen Chien-Jen – with a master’s degree in public health (and some years in medical practice, still focusing on pandemic response). Taiwan does have free and universal health care, but ⅔ of beds in Taiwan are in privately-operated facilities, with many or most services paid for through the central government.

But, proximity to China and the enormous, fluid flow of people across the Taiwan strait still left it vulnerable. As many as  850,000 of its citizens reside on the mainland; another 400,000 work there and rotate between work on the mainland and home in Taiwan. For work and for tourism, China send many visitors to Taiwan – 2.71 million last year. Add to these factors very dense housing, some old and with poor sanitation, extensive use of public transport, and a tradition of communal eating in the evenings. (see discussion of Taiwan’s predicament and response HERE)

IT wasn’t all bad. People throughout Taiwan would have seen Wuhan not as some strange, distant locale, but as a place where family members originated or worked. They knew of the potential of chimeric contagion from China. Many would have heard family word-of-mouth news, in addition to the TV or newspaper reports. They knew. (The data below are, again, from Wikipedia, link HERE.)

A brief calendar of COVID in Taiwan

  • Starting at the end of December, travellers arriving from Wuhan were subject to health tests upon arrival and contact tracing thereafter. (Note: they started acting BEFORE there were known cases in country!)
  • Taiwan’s first case emerged in late January via a traveller from Wuhan (who had arrived on 21st January)
  • Throughout January over 100 discrete measures were implemented, including a vast increase in production and distribution of masks (and mandatory mask-wearing) and of alcohol for hand sanitizers. The government invoked emergency measures to step up production of protective gear. Mask production reached 10 million per day in mid-March (at which point it started exporting them; some are sold, but many are donated to countries suffering worse from COVID, including the USA). By 20th January, Taiwan had on hand 44 million surgical masks, 1.9 million N95 masks and 1,100 negative-pressure isolation rooms. The existential threat from COVID meant political barriers and industry rivalries were, for the moment, set aside.
  • By 14th March, persons arriving in Taiwan had to go into 14-day quarantine.
  • Various measures including shuttering restaurants and businesses took effect.
  • The peak of new cases occurred around 20th March (even so, just 27 cases were reported on that day). There isn’t really a peak in deaths, because there were so few. As of this writing, only seven COVID deaths have occurred in Taiwan (an island with a population of just under 24 million).

By mid-May, Taiwan’s industry had largely retooled for safe return-to-work. (One large firm, well-known for its role in producing famous computers, took a few days to retool a factory to make protective equipment – for its own workers.) Mandatory face masks, temperature testing, contact tracing, and so on are everywhere. One recent informal estimate I’ve seen is that Taiwan’s economy, which was projected to have 2% growth this year before COVID hit, may still eke out moderate growth for calendar 2020.

UK gets COVID nearly completely wrong

It’s hard to imagine a country getting so much wrong about a pandemic. The UK had a highly educated population, broad access to a well-liked (but financially stressed) health care system, a world-leading set of universities and pharmaceutical companies. Even the World Health Organization relied for much of its epidemiological analysis on a UK group (the MRC Centre for Global Infectious Disease Analysis at Imperial College: this writer’s alma mater, although at a different time, and I know none of the participants). And yet …

It now seems that the first COVID cases in the UK may have occurred as early as late November. More certainly, several members of a choir returned from Wuhan in mid-December with COVID-19 symptoms. But, even as late as 22nd January, when the medical world was fully informed of the outbreak in Wuhan, the outbreak’s severity was only upgraded from “very low” to “low”. It was too late, as there were other cases and clusters, and travel bans were ineffective, as people continued to flow in from other countries in Asia and from Europe. People coming into the UK from known-affected countries throughout Asia and Europe were politely asked to self-isolate – if they already had symptoms. Again, we see a country that acted – gently – against COVID months after it was already spread out of control.

In mid-March, the Imperial College epidemiology group published a report (report 9) – which had already been shared with UK and USA leaders – predicting that significant non-pharmaceutical interventions were needed, else the death toll would reach a half million in the UK (and as many as 2.2 million in the USA).  Despite this the prime minister, throughout much of March, while steadily activating some of the machinery of the health system, was out in public, shaking hands with all he could. Through the middle of March, he took part in the debates and ceremonies at the Houses of Parliament – a grand but crowded and poorly ventilated place, with all members obliged to sit close to each other. The prime minister’s jaunty continuous handshakes caught up with him: he was hospitalized with COVID – including a few scary days in ICU.

On the same day as the Imperial report 9 was published, the British government “suggested” people should avoid pubs and clubs and theaters. Their enforced closing followed a week later. And, a few weeks later yet, it created a series of military field hospitals “Nightingales” (named for the 19th century pioneer of field medicine for the British Army, Florence Nightingale) – that took over exhibition halls and warehouses and aircraft hangars; they shut down airports to dedicate them only to medical flights. The government appealed for the public to volunteer to provide food and essential services to those shut in, or to provide childcare support for medical staffs and so on. They sought 200,000 volunteers and got over a million.

All that was so much, and so well coordinated. But all so late, in the face of unconstrained exponential growth. And such dissonance between the explicit capabilities of government and the ‘no problem’ leadership message expressed by the personal behaviors of Johnson and others.

Disclaimers: I’m British by birth, and have a PhD, in physics, from Imperial College, but have no contact with the Imperial epidemiology team. I’ve lived in Taiwan – and have at least once met both the current premier, Tsai Ing-Wen, and her predecessor, Ma Ing-Jou – but we don’t know each other. I am a US citizen and resident, but elected to not discuss the USA because there are no nations of comparable size and complexity to use as peers. I have no financial interests or conflicts to disclose.

A version of this document with more complete data source information is online at THIS LINK. That document may be updated as new COVID data become available.

Covid-19: Uniting and Dividing Us

There is a Chinese curse that supposedly says, “May you live in interesting times.” Whether we like it or not, we now live in interesting times. Regardless of the duration, or the costs we might need to bear, we will overcome this crisis like we have overcome others in the past. When we come out on the other side and take off our masks, our social behavior will be permanently altered. Will we do what we did after World War II, pull together, and build a global community, or will we be torn apart and drift towards another Cold War ?

We cannot welcome disaster, but we can value the responses, both practical and psychological.

Rebecca Solnit in How to Survive a Disaster

Coming Together

Facing a common enemy has sparked a communal spirit within us. Social distancing has, ironically, encouraged us to turn outward, care for our neighbors, and reconnect with our friends and families. By way of an example, I am doing something I haven’t done for years: calling my friends and family more often and having long, meaningful, and engaging conversations. Having everybody in the world going through similar experiences has inspired many of us to help out in our respective communities. There is an unprecedented outpouring of help and support from online community groups for people in high-risk categories and those in need. As the lockdowns spread across the world, it brought along the practice of collectively stepping out and applauding health-care workers. It’s an act that is part defiance, part support, and part celebration – we are all in this together. We feel helpless, but we are still here!

The collective cheering ritual started in Wuhan and spread across the globe in the virus’s wake.

This solidarity goes beyond a personal level. Doctors across the world are sharing their knowledge, treatments, and procedures. Researchers are collaborating on a global scale to create vaccines and improve virus detection. Industries across the globe are volunteering skillsets for research, as well as retooling their machines to make personal protective equipment (PPE) and ventilators. It has even compelled tech giants Apple and Google to team up and create a contact tracking system.

Doctors exchanging research notes on twitter

DRIFTING APART

The threat that is unifying us is also threatening to reverse the globalization trend toward Cold War levels. As the virus spread, it brought about competition due to the limited supply of existing ventilators and PPE. Several U.S. states were in conflict with the federal government regarding access to ventilators from the Strategic National Stockpile, in addition to bidding against each another to acquire the much-needed PPE and medical equipment. The friction between U.S. states/local municipalities and the federal government was most evident in the case of New York and SF. Would the states ever depend on the central government ? Should they?

On a global scale, problems in regard to acquisitions surfaced with news of nations stealing masks from each other. The pandemic exposed and even widened the divisions in the EU. This was evident during the early days of the epidemic in March when Italy got hit the hardest, and other EU nations refused to offer medical help and supplies. As the lockdown takes a financial toll on Italy and Spain, economically stable northern countries disagree on sharing the burden, causing the worst crisis since the EU’s inception. The tensions and the resulting distrust will likely surpass the damage caused by the virus.

It’s a reciprocal interest that Europe meets this challenge. Otherwise, we must abandon the European dream and say, everyone is on their own. Either we all meet this challenge, or the tribunal of history will judge us.

Italian Prime Minister Giuseppe Conte In an interview with Bild newspaper

Even after some semblance of normalcy has returned, travel restrictions are likely to continue. Travel across countries, something we had taken for granted, will never be the same. Borders that inhibit not only the entrance but exit as well have returned to a level beyond what the most ardent nationalist ever advocated. National sovereignty is being advocated as the best defense to an international threat


These contradictory trends are not new. They are an extension of the struggle between global solidarity and nationalism, now accelerated by the pandemic. As we continue to struggle, we are creating a new reality that will define us. We are not just observers; we are building history and performing together in this new and strange reality.

Photo by Filip Filkovic Philatz on Unsplash

Stay safe; stay well.

Covid Coup De Grâce

In my formative years my great uncle Dr. Walter Cale was a horseback doctor in Atkins, Arkansas, known for Atkin’s Pickles. He sold cucumbers for a living to the pickle plant and bartered medical services taking in chickens and eggs. His two-room home office took walk-ins with routine care in the front room and the back room housed his examination table, which he dropped ether solo doing surgeries. He was my physician and gave me the inspiration to shoot for the stars from our poultry farm. He did well financially and had community respect from all.

Library of Congress

Post-World War, third party insurance introduced pencil pushers between the doctor and patient. Big government socialists noticed and the American Medical Assoc. was offered the copyright to ICD publications and the American Psychiatric Assoc. was offered DSM copyrights if both organizations would back socialized medicine via medicare/then medicaid. The rank and file were sold down the river, so to speak, with golden retirement parachutes for leaderships.

The ensuing price controls and bureaucracy degraded medicine with physicians chasing the rabbit around the financial track. To reduce the added expense of the middle men, managed care was devised. Doctors found that patients would change MD care for a pittance cheaper charge. The physicians saw patients as a revenue source and not a friend and neighbor. Patients saw doctors as a commodity to sue as an insurance policy if health did not remain perfect. The government was glad to force doctors to take the mark of the beast as hospital privileges required the MD to accept medicaid patients and medicaid which forced MD’s to charge even the poor or uninsured the same price without discount or else be sanctioned.

Photo by Online Marketing on Unsplash

The low reimbursements required quick throughput, as with cattle, to cover expenses. The huge volume at low profit and degraded quality pleased the government as the MD’s were the highest revenue source for the Treasury as a group. Anecdotally, the expanding knowledge base and time pressures degraded quality. The government introduced electronic health records to slowly force treatment cookbook cascade methods like paramedics use in the military. Additionally, it takes so much longer to see the patient and electronically prescribe with typed notes that significantly fewer patients can be seen through office hours. This results in fewer claims to Centers for Medicare, etc. As in all socialist schemes rationing becomes necessary.

Now fast forward to present day and Covid is making older MD’s consider retirement rather than pay staff and expenses whilst being slowed further by Covid precautions/protocols. The risk of a subpoena by a trial lawyer, on behalf of employees or patients catching Covid, makes retirement look better. Telemedicine is slower, less accurate, depersonalizes, and devoids the last of the physician patient relationship. Older MD’s are a large proportion of practicing physicians. Covid may be the final coup de grâce if they are financially stable. It is now gotten to the point of being hard for a physician to find a practiced physician, good luck to the lay person.

BBC

Socialized medicine will be forthcoming rapidly. Already two thirds of physicians are hospital-employed minions controlled by number-driven men in Italian suits and manicured grooming. In one lifetime, this MD has seen the complete replacement of traditional care to a government-hospital industrial complex with a different “provider” yearly, if not semi-annually. It is impersonal and less beneficial than having a trusted doctor lobbying for you sincerely. Covid is the final nail in the coffin. We will be akin to Canadian and British NHS unless you are wealthy and can afford concierge care from a MD who has bailed from centers for medicare which makes it illegal for the MD or patient to bill for services. By the way, one can not bail from medicare Part-A without risking your social security check.

A strange new medical normal with fewer doctors, greater expense, scarce expensive medicines, and degraded services is on the horizon. Maybe we will still be able to leave our homes without Fauci’s/ E.U./U.N. Covid ID of alleged immunity.

Corona, Liberty, & Little Tyrants

“Those who would give up essential Liberty, to purchase a little temporary Safety, deserve neither Liberty nor Safety.”

Benjamin Franklin

I’m writing this article from one of the first U.S. cities to order public lockdowns, San Francisco. This local government isn’t really known for doing anything right, but even fools get things right on occasion. Luckily, we have bright people running local tech businesses who thought it best to play it safe and ordered their workers to work from home. The city of San Francisco then followed suit.

Now, we find ourselves in a city whose makeup will be changed after this event winds down. The major concern that I have relates to the unintended consequences of shutting down economies out of an abundance of safety all while I have internal conflicts with these mandates for the sake of liberty.

Personally, I don’t think the government has the constitutional authority to force businesses to shut down over something like this unknown and novel event. There are governments across this nation depriving business owners and private citizens the right of pursuit of happiness(free enterprise), the First Amendment by punishing citizens for worshiping their religion, violating the Second Amendment by discriminating against gun shops from operating during a time of crisis when protection is vital, violating the Fifth Amendment by depriving those of liberty with house arrest and property without due process without market rate compensation, the Eighth Amendment by issuing excessive fines for not wearing masks or sitting in a parking lot outside of a church, and scores of other violations of liberty. And for what? Safety? Is it safe to release criminals from jails but then threaten to arrest people going to parks or beaches and take them to jail for getting fresh air?

None of this makes rational sense.

The reality is that people are justifiably scared. There is an unseeable threat lingering among the population and making people ill, but that doesn’t justify creating other threats by overreacting with heavy-handed government mandates or regulations.

Elon Musk, Twitter

Entire industries have been shut down arbitrarily through edicts. Even Elon Musk isn’t immune from this. The local county officials have resisted efforts to allow him to reöpen the only U.S.-based Tesla assembly plant in Fremont, California. There are around 10,000 people who work at that factory who are not able to go to work and it’s putting an entire manufacturing company at risk.

People need to work and the notion that we can have on-going lockdowns is simply untenable. The lockdowns may have been well-intended, but they ultimately will cause more harm than good in the long term. We have gone along with them in the early days because it was reasonable to try and avoid overrunning our healthcare system and causing a breakdown in services. Through this preventative measure, we have slowed the rate of infections to a controllable rate where we aren’t facing hospitals going over their capacity.

However, we have continued to see the voices of little tyrants calling for more government restrictions and asking for the bankrupting of Americans on a whim. Take for example, California Governor Gavin Newsom. The rates of infection have been lower here than what were expected, yet he’s upset with the fact that people are going out to parks and beaches after two months of lockdowns. Who is he to put citizens on house arrest without committing a crime? No one. He still insisted on singling-out Orange County and Newport Beach for individuals going out and behaving responsibly, for the most part, by keeping their distance from others even though they were at the beach, away from their hamster cage at home.

Sheriff Don Barnes, Twitter

Fortunately, patriots in Orange County resisted the shutdown and staged a protest in Orange County along the beach and Orange County Sheriff Don Barnes publicly stated that he wouldn’t use his deputies to enforce Governor Newsom’s threat because he hasn’t seen those patrons as presenting a threat and that he takes his sworn responsibility of ensuring the liberties of his fellow citizens seriously. This public statement was heartening to see in a time where we are seeing many being forced to stay at home under defacto house arrest.

It’s time that we hold our mayors and governors accountable. These local entities have a much greater impact on our daily lives than larger government entities, but they are all still required to follow the U.S. Constitution. If they are insisting on lockdowns then what’s needed are metrics to base the decisions on. With metrics, a baseline is established for what has been documented and goals can be set for future rollback.

Government can’t force citizens into bankruptcy by depriving them the liberty to earn income or operate their businesses, especially upon purely arbitrary reasoning or gut feelings. That’s now how liberty works. We need to start releasing workers back to their jobs while wearing masks. Business owners and employees can make these choices for themselves and don’t need government to dictate to them how to behave. The majority of this social distancing is voluntary behavior. So, stop forcing closures which threaten people with increased financial and health risks.

I suppose a silver lining in all of this is that maybe our citizenry will reëxamine the civil liberties that they’re entitled to and defend them more actively. We aren’t serfs to tyrants. We are pervicacious Americans and this aggression won’t stand.

Plagues Return

Iron lungs in gym Courtesy of Rancho Los Amigos National Rehabilitation Center

There was a time when the United States, flush with cash and robust with plentiful food and roads and cars and televisions, became paralyzed with fear of a contagion. Pools and schools were closed. Quarantines were imposed, fear was everywhere, businesses failed, tempers were frayed. Of course, I’m referring to the late 1940s and early 1950s, when Poliomyelitis – Polio – stalked the land, crippling tens of thousands, killing thousands, ruining lives. There have been no cases of Polio in the USA in the past 40 years, but I could as easily have been referring to HIV-AIDS, which arose in the 1980s, and has killed 32 million people since.

The thesis of this site is that the new, post-COVID normal is to be different. That we will have to adapt, that we will have to change some key parts of our behaviors, our social constructs, our industries and economies. And that we benefit by thinking of the strange new world.

Equally likely is that the years before COVID were the unusual ones, the strange ones.  That plague-free times were abnormal, and that plagues, ghastly waves of pandemic diseases have time and time again raged, running unstopped and little hindered through vast populations.

We were never supposed to forget. How did we as society forget? There are plenty of educated adults around for whom COVID was their FOURTH widespread health epidemic – pandemic. Polio, HIV-AIDS, SARS and COVID. Or even their fifth or even sixth, if you add H1N1 flu, or Ebola. Nonetheless, collectively, we forgot.

Ebola Virus, CDC

Plagues, pandemics, pestilences, contagions have been a near-constant in the rise of humanity. As fast as our improving technologies win more battles, new diseases rise against us. Vaccines won the war against Polio, and may yet push adequately back against COVID: vaccines for coronaviruses are really challenging, but there are over 80 programs underway to create one for COVID / SARS-COV2. Strict quarantines pushed back on SARS and Ebola (which now has a decent vaccine). But we as humanity and our societies have not built strong enough systemic safeguards against future challenges.

The 1918 – 1920 ‘flu pandemic infected as much as one third of all humanity alive at the time, and killed tens of millions. Cholera killed over a million Russians in the mid-19th century, and killed tens of thousands in each of many countries for years around then. 

Earlier pandemics were even more fatal. Bubonic plague, black death, killed as much as half of Europe’s population in the decades (in the 14th century) when it ravaged Europe – the word quarantine dates to this time – from the Venetian-dialect word for 40 days (of isolation). Large outbreaks were noted as early as the 6th century, but major outbreaks occurred in the 17th and 19th centuries.

And while genocide did its part in enabling Europeans to take over the Americas (a ghastly truth), imported diseases killed more. As many as 20 million native Americans were killed by infections brought over the Atlantic by Western colonizers and invaders – particularly Smallpox – eradicating as much as 90% of the indigenous population. Parts of the eastern seaboard of what is now the USA were almost completely emptied by new diseases. A later outbreak of smallpox in southern Africa, again brought in by Europeans, erased large parts of the native Khoisan peoples.

Photo by CDC on Unsplash

Some diseases never went away, and still killed in vast numbers. Tuberculosis was responsible for about one half of deaths for adults (ages 15 to 35) in Europe’s major cities in the late 19th century. Other contagious diseases, diphtheria, cholera and more, were always there, killing by the thousands. Influenza and the common cold evolve and persist and kill.

No wonder that the Bible and Shakespeare and many other writings (notably Camus, Defoe, and Garcia Marquez) throughout history, have harped on plagues, pestilences. Invisible diseases with new, strange, and poorly-understood vectors and contagion.

The thesis of Strange New Normal, then, is not only that COVID alone will change society, or that we will change society specifically to deal with COVID. It’s also that we have a moment, now, to build societies that are more resilient against, and better prepared for major disruptions, black swans. Better prepared for the next pandemics. For history tells us: they’re coming, they’ve come before, they’ve never stopped coming.

For one thing COVID has shown is: we were (mostly) unprepared. Our systems were taut, with little room for slack, few inefficiencies. All gone was the padding, the fat that enables resilience. We were, for the most part, uneducated on pandemics. We’d forgotten.


Left: Image of “Doctor Beak”, a plague doctor, Rome, 1656. https://en.wikipedia.org/wiki/Plague_doctor
Right: Selfie of the author of this piece, heading out to buy groceries, California, April 2020.

Post-COVID Innovation

Never let a good crisis go to waste

– Anonymous

There are plenty of studies and books examining how rates of innovation and small-to-medium sized business (SMB) creation have plummeted in the US over the past several decades. Regardless of whether you take them at face value, and what the causes of the declines may be, the US and other countries are going to have a cavernous hole where SMBs used to be.

The coronavirus seems to have infected and warped our sense of time, leaving us in a liminal place. It’s difficult to delineate where “here” is and when “there” will arrive. Regardless of when the chronological murk clears, it may be useful to ask: how can we prepare for “there” in a way that will help the SMB ecosystem so that it comes out more robust than it was before?

I have many friends working at startups in the Bay Area, and I myself work at one that’s pivoted to help SMBs access the Paycheck Protection Program. So the question hits close to WFH.

The Opportunities 

The pandemic will desiccate SMBs, but it also creates opportunities. For example:

  • Swaths of the world just got a taste in entrepreneurship; ranging from re-tooling machines into ventilators to boosting robotics and drones innovations. They just experienced, firsthand, the very real “why” behind why any society needs to build robustly.
  • Many jobs have been lost and are not coming back. This means a portion of the workforce will (1) be forced to re-skill and (2) switch industries and potentially cross-pollinate ideas.
  • Many people are (1) experiencing self-directed, virtual education at home, and/or (2) watching their kids learn virtually. The result is a world that is much more amenable to virtual education and skill development. 
  • Regulation had been slow to change. Now Congress and state politicians have been forced to acknowledge the necessity of removing regulatory drag. Like how telemedicine regulation has advanced more in the prior weeks than in the previous years. 

How can we best feed these opportunities so that our SMB ecosystem doesn’t just survive but gains from this downturn?

Photo by Louis Velazquez on Unsplash

New Policy Norms = Part of Our New Normal

Our policy norms have been puréed in a food processor. As a simple example, consider how discussions of UBI, for most Americans, were far outside the Overton Window prior to February. 

Below are some of the most interesting tools I’ve come across for stimulating the SMB ecosystem, which could form the basis of our new view of “normal” policy: 

  • WPA – Many paths out of our current circumstances seem like they may need a new New Deal. Much of the country’s digital infrastructure is woefully out-of-date. E.g., the SBA’s digital infrastructure was nowhere near capable of doling out PPP loans. Let’s subsidize coding and similar boot camps that feed into jobs updating national, state and municipal digital infrastructure that’s woefully out-of-date. On the other side of this, we’d have a much more technologically literate workforce, poised to fill the tech skills gap.
  • Matching Investments – One of the contributors to Israel’s thriving SMB environment is Yozma, a program through which the government matches VC investments and offers tax incentives for foreign VC money. And Singapore has similar government matching. These programs seem to work well by supercharging private market incentives. 
  • Social Safety Net – We’ll need to correct for the risk-aversion that younger generations will have after experiencing the Great Recession and/or COVID-19. One way is through stronger social safety nets. This could take the form of universal basic income or nationalized healthcare. Sweden’s nationalized healthcare system, for example, is a likely contributor to the country’s high entrepreneurship rates.
    • A tragically large number of people have found themselves relying on social safety nets like unemployment and $1,200 living expense checks. This means a large number of voters are experiencing the white swan reasons that it’s wise to have safety nets. And such measures can be seen as investments. For a perfect example of why, just look at the J.K. Rowling Effect: give a single mother a safety net, and she won’t shift her citizenship for tax purposes when she later experiences outlying success.
  • Student Debt – The unprecedented student debt situation in the US is an obvious source of risk-aversion, and expanding debt forgiveness is an increasingly acceptable political topic. One option to promote entrepreneurship is to expand loan forgiveness programs to include SMB founders that, say, employ 5+ people for more than two years.
  • Immigration – Immigration could easily fill its own post or book. TL;DR: immigrants create SMBs at higher rates than native populations. We should be opening our borders much more to skilled immigrants.

What are your thoughts on how we can mend our SMB ecosystem to be stronger than before COVID-19?

Let’s Break Up With China

Saving People & The Planet

Photo by Fusion Medical Animation on Unsplash

China’s Role in Covid-19

I’m not really known for mincing words and I have a tendency to be pretty direct with what I want to say. This may be good or bad depending on the perspective. However, there is one area where I have no qualms expressing my opinion and that is the area regarding my views on China.

China’s CCP has helped bring the world’s economies to their knees through its oppression of free speech of heroes in China who tried warning the world of a dangerous outbreak called COVID-19.

We witnessed doctors and journalists in China being rounded-up, punished, disappeared, even dying from the illness they tried warning the world about. To China’s CCP, the appearance of stability and control was more important than the threat of a deadly pathogen that it tried to cover-up. Keeping up appearances prevented international health experts from the CDC and WHO from studying to help prevent an outbreak.

On top of that, China’s CCP has repeatedly lied about their infection rates and death rates while minimizing its actual blame and role in this whole tragedy. Instead, they launched a propaganda campaign of sending aid to European nations. Later which, those nations found the medical protective gear donated to them was counterfeit and offered no protection along with antibody tests failing to work at all.

China’s CCP lied and we must all hold them accountable. It’s time to examine our relationship with this regime. I think it’s time for the world to cut China out of the loop and repatriate or localize supply chains after this disaster. We will all need it for economic recovery in the end. The CCP will only continue to smile while it tries stabbing us in the back.

Photo by wu yi on Unsplash

What is the CCP?

China’s government is the Chinese Communist Party (CCP) and it is NOT the Chinese people. The CCP has spent generations brainwashing the populace with propaganda about how they have been wronged by others and that they can only survive through the CCP. China’s citizens are told that they must sacrifice their own goals for the CCP’s agenda and that they will be outcasts and enemies of the state if they have more children than their draconian restrictions describe as acceptable by the party.

The CCP has done this through the government-controlled national media outlets, continually feeding the people of China with social engineering to sway them towards outcomes the party favors. They’ve imbedded government proctors into companies to monitor how they behave or what they produce in efforts to control messaging, and they have created a large police state through a massive surveillance program along with technology/app integration.

Through this surveillance program, the CCP monitors, tracks, shames, reprimands, punishes, or abducts its citizens. This has grave implications on the civil liberties and human rights of the people of China and everyone who visits this nation. We have seen this play out with videos posted online of civilians walking across roads between lights and immediately having that individual’s I.D. plastered onto an nearby billboard and, presumably, being fined through text and having their “social credit score” docked points for being shamed while jay walking.

(Here is video from Daily Mail showing jaywalking tracking)

We have also seen the darker side of this where more than an estimated one million Uighurs have been imprisoned for practicing Islam. They are being sent to concentration camps in Western China to be “reëducated” to not have a higher belief other than the communist party. Uighur wives are being left with Han men who are CCP members. There are reports that the Uighur women are being forced to sleep in the same bed as the men from the Communist party, and being raped, for them to assimilate into the CCP “family.”

Photo by JC Gellidon on Unsplash

Aside from the Uighurs, the practitioners of Falun Gong are being imprisoned for following their beliefs. Both of these groups have suffered unimaginable treatment and are being used as Guinea pigs for the CCP’s organ harvesting program. These political prisoners have had their organs involuntarily harvested to supply a $1Billion+ Chinese secondary market. Foreign nationals are allowed to schedule an organ transplant and fly-in to receive organs from nearby concentration camps of Uighurs and Falun Gong.

What was their crime to warrant having their organs and lives take from them? Threatening the agenda and undermining the messaging of the CCP itself. The CCP sees any free-thinking or outside thought contrary to its stance as a threat to its stability and a crime against the people of China. So, do you find yourself not supporting oppression and lack of free speech? Then you’re a criminal and you’re subject to die in a concentration camp.

Photo by Sharon McCutcheon on Unsplash

China’s CCP is also practicing predatory infrastructure loan traps to expand its influential reach across the globe. It has created a predatory program called the “Belts & Roads Initiative”(BRI) where they enter into agreements with nations, mostly poor and under-developed, where they bring in Chinese labor to build highway and railway systems to connect cities for commerce. The problem is that these expenses are massive and the nations have no way of paying off the debt. The debt represents 15% of many nations’ GDP and some of those nations, such as Kenya, owe 72%+ of its debt to China through these sorts of programs or even upwards of 70% of a nation’s GDP.

Is the CCP just super generous and wanting to give out $5Trillion worth of free money? No, absolutely not. The CCP is playing the long game where it is waiting for those nations to default or take out more loans to pay the interest on their older debts. With this, China is buying exclusive mining rights for hundreds of years in poor nations where it can exploit them for their natural resources to pay off a previous debt from building roads. In other places, they’ve trapped island and port nations so that China can cancel the debt owed in exchange for waterway access and ports for hundreds of years. This is a game of dominance, much like the board game “Risk,” and the world is largely ignoring this predatory behavior.

Photo by Priscilla Du Preez on Unsplash

However, it doesn’t end there. China’s CCP has stolen the Intellectual Property of the world’s tech and telecom companies to roll out analogues to then sell back to nations in Europe. Chinese theft of I.P. is at an all-time high with 25% of companies reporting that China has stolen from them in the last year alone. That’s where Huawei comes into play. It is trying to sell its 5G communication networks across Europe and the world. Is the CCP wanting to connect people and improve lives? No. The CCP is wanting to control data and have access to communications across the globe where they can continue to expand its theft of I.P. and control what the world sees about China’s actions through pressuring freedom of expression in nations that still have civil liberties. Why? Because that’s what China’s CCP does domestically in China. It controls through fear and through suppressing the free speech of dissenting voices.

This is the CCP. This is what we are empowering and supporting with our trade dollars. This is one of the many reasons that we need to stop enriching the Chinese government and have it die on the vine from economic collapse.\

Photo by chuttersnap on Unsplash

International Trade

We, as Americans, have turned a blind eye to China’s atrocities for the last thirty years. Offshore manufacturing has settled into China and caused a huge economic boom there, under the auspice of “Special Economic Zones”(SEZ) through the concessions that the CCP has made, by allowing for foreign entities to have manufacturing facilities operate for export using Chinese labor.

These changes have given easy access to American companies to produce their goods without the constraints and obligations of labor requirements domestically. In the short-term, it helped boost companies’ stock values and returns by trying to position them to as “service industry” while manufacturing is offloaded overseas. In the long-term, this represents a threat to the companies doing business in China through state-sponsored Intellectual Property theft of their products, it’s a threat to globalized dependence on supply chains, it’s a threat by enriching a dangerous regime to export its oppressive ideology, it’s a threat by empowering the CCP’s flagrant digital abuses with state-sponsored hacking efforts, it’s a moral hazard that the companies are complicit in the human rights and civil rights abuses that their efforts finance, and it’s an existential threat to the globe through both building up a totalitarian regime’s adversarial military forces while also contributing to out-of-control maritime transportation pollution.

Aside from the threat of the totalitarian efforts of China’s CCP, the pollution caused by supporting its export economy is helping to destroy our planet. Approximately 20% of the atmospheric pollution on our planet comes from the oceanic transport industry.

Localizing Supply Chains

After we stabilize our workforce and financial footing, America and other nations need to focus on helping their people and nearby neighbors.  We can do this by refocusing how our commercial supply chains are organized and through modernizing our transport infrastructure.

While off-loading manufacturing, we’ve neglected our domestic infrastructure, treating it more as a relic of our past industrial might from a post-war era where the future was full of amazing promise that we could only dream up for a sci-fi film. Instead, that capital was sent to China they have built the modern cities that America began dreaming of in the 1950s.

According to information compiled by Statista,there are approximately 34,000 General Cargo Ships, Bulk Carrier Ships, and Container Ships cruising our oceans at any given moment. This is how we largely obtain goods from China, through oceanic transport.

Photo by Roger Hoyles on Unsplash

Cargo ships don’t use regular fuel to move their goods. They use the cheapest and most filthy sludge that money can buy, and it’s called “Bunker Fuel.” Bunker Fuel is a byproduct of oil refining where the thick tar-like sludge is left over. That is what ships use for fuel. It’s one of the most awful forms of petroleum used in our modern era as it emits horrendous amounts of sulfur and pollutants into the atmosphere. This pollution is largely overlooked and unregulated because those ships are out in the open ocean and out of view of everyday citizens. Out-of-sight, out-of-mind.

According to a report by iNews UK, it’s estimated that each cargo ship creates the same amount of pollution as 50 Million passenger cars. They also state that a mere 15 of the large container ships create more pollution than all of the passenger cars on the planet combined. If that doesn’t make you think about our supply chains and the implications of offshore dependence, then I don’t know what will. On average, it takes around 12 days for a cargo ship leaving Shenzhen, China to arrive in Los Angeles, CA. During that time, it will burn on average 63,000 gallons of the Bunker Fuel sludge every day for a total of approximately 750,000 gallons during the voyage.

We are polluting our planet for cheap plastic crap from China and I hope that everyone can take this down time to think about the unintended consequences of our doing business with the CCP.

Photo by Jorge Aguilar on Unsplash

A Solution Could Be Mexico

I have thought a lot about what we could do to both create jobs in America, reduce dependency on an adversary like China’s CCP, and lift-up our neighbors.

If American companies would both repatriate manufacturing and relocate supply chains to nearby neighbors, then we could both have a wonderfully vibrant economy and social stability. I think Mexico would appreciate it. I went to school with many international students and I had one sharp classmate, who is from Mexico, explain very succinctly how our economies are intertwined. He said, “If America sneezes, Mexico gets a cold.” If our economy slows down, then Mexico is at risk of much more drastic downturns and currency devaluation.

Mexico is full of amazing and talented people that we can rely on. We would have a much better experience in trade with them as an ally than what we have with our adversary, the CCP of China.

Here are a few bullet points that I think could help improve our position.

  • Immigration issues with Mexico could largely be solved through increased manufacturing and trade with Mexico. As we increase trade with our neighbor, their economy will boom and become more stable while also increasing the per capita annual wages of its citizens. This will create a more stable environment for the Mexican people and improve their quality of life immensely.
  • We can also address the drug cartel crisis that torments and plagues the people of Mexico. With increased individual wealth and increased jobs opportunities creating a better life, the drug cartels will become less and less relevant as a source of money that can be given to the people to do their bidding for them. It won’t be worth the hassle.
  • We can expedite prototyping and shipment to the U.S. for our supply chains. Instead of waiting 40+ days to receive products through oceanic shipping from China, our businesses could have their products in a matter of days to better address changing trends and market needs without having to plan four or more months in advance.
  • A larger number of good-paying railway jobs can be created from an increased distribution system as it becomes an ever-important focal point for logistics.
  • Reduced pollution. Trains move smaller amounts of cargo than cargo ships (around 10%) but they are quicker, they consume less fuel through a hybrid diesel-powered electric generator, and they burn a cleaner type of fuel that releases fewer atmospheric pollutants.
Photo by Clark Tibbs on Unsplash

Let’s Be Better

We can vote where our dollars go in support of products and companies. We aren’t powerless. Corporations have switched to interactive marketing platforms focusing on increased involvement with customers through social media accounts. It’s an invaluable source of information that gives them insights on consumer trends and how to better improve their products or services in a rapid fashion.

All we really need to do is vote with our dollars and let our voices be heard. This also applies to supporting candidates who support initiatives to bring jobs back to the Americas and condemn regimes like the CCP for their horrendous human rights violations and crimes.

We can be better. We don’t have to have blood on our hands from doing business with the CCP. Let’s use our power as consumers to hold corporations and government accountable and use our resources to build up states and nations who value human rights and free trade.

We are all in this together and we are the only people who can help get us out of this predicament.

Photo by Free To Use Sounds on Unsplash

Social Distancing When You Don’t Have A Tape Measure

Without a ready vaccine, social distancing has been the primary method of slowing the spread of the coronavirus. Since social distancing’s effectiveness requires mass participation, it has created a some public health communication challenges. It’s not just that the public needs to be convinced that social distancing is important and effective, they need to know how to do it. Specifically, they need to know how far away 6 feet is. 

The best way to communicate distance is through a familiar reference point. Of course coronavirus is a worldwide problem and these reference points  vary from place to place. Here are some examples of how governments around the world are getting the word out:

Colorado

San Diego

Florida

Wisconsin

Baltimore

Kansas City

Kentucky

Knoxville

Missouri

New Mexico

Texas

Utah

American Red Cross

Australia

Canada

Guatemala