L.A. County gives up on containing coronavirus, tells doctors to skip testing of some patients

https://www.latimes.com/california/story/2020-03-20/coronavirus-county-doctors-containment-testing?fbclid=IwAR0WbZEFPXvi83iGptYup2FtDs-vI0LHzV32Vk7SEaIEfrNPpd3SzgvPSEc

The nation’s second-largest municipal health system has told its staff that it is essentially abandoning hope of containing the coronavirus outbreak and instructed doctors not to bother testing symptomatic patients if a positive result won’t change how they would be treated.

The guidance, sent by the Los Angeles County Department of Health Services to its doctors on Thursday, was prompted by a crush of patients and shortage of tests, and could make it difficult to ever know precisely how many people in L.A. County contracted the virus.

The department “is shifting from a strategy of case containment to slowing disease transmission and averting excess morbidity and mortality,” according to the letter. Doctors should test symptomatic patients only when “a diagnostic result will change clinical management or inform public health response.”

The guidance sets in writing what has been a reality all along. The shortage of tests nationwide has meant that many patients suspected of having COVID-19 have not had the diagnosis confirmed by a laboratory.

In addition to the lack of tests, public health agencies across the country lack the staff to trace the source of new cases, drastically reducing the chances of isolating people who have been exposed and thereby containing the outbreak.

For years, state and local health officials have been warning that steep cuts to federal grants meant to boost preparedness for a pandemic would mean there wouldn’t be enough equipment and staff on hand to respond in the crucial, early stage. Those fears have come to fruition now, officials said.

A front-line healthcare provider who was not authorized to speak to the media and requested anonymity said county doctors are interpreting Thursday’s letter and other advice coming from senior L.A. County public health officials to mean they should only test patients who are going to be hospitalized or have something unique about the way they contracted the virus.

They are not planning to test patients who have the symptoms but are otherwise healthy enough to be sent home to self-quarantine — meaning they may never show up in official tallies of people who tested positive.

The letter also says that, with the increasing availability of tests at private labs, the health department will focus on testing aimed at detecting and preventing outbreaks in hospitals and “congregate living settings,” such as nursing homes.

Department officials did not immediately respond to a request for comment.

BANKS PRESSURE HEALTH CARE FIRMS TO RAISE PRICES ON CRITICAL DRUGS, MEDICAL SUPPLIES FOR CORONAVIRUS

https://theintercept.com/2020/03/19/coronavirus-vaccine-medical-supplies-price-gouging/?fbclid=IwAR2sXHwwqFEThedPxQPxCkhXuscEreaziqoNES5DwB9xPDdMw9hwHDS6vIA

IN RECENT WEEKS, investment bankers have pressed health care companies on the front lines of fighting the novel coronavirus, including drug firms developing experimental treatments and medical supply firms, to consider ways that they can profit from the crisis.

The media has mostly focused on individuals who have taken advantage of the market for now-scarce medical and hygiene supplies to hoard masks and hand sanitizer and resell them at higher prices. But the largest voices in the health care industry stand to gain from billions of dollars in emergency spending on the pandemic, as do the bankers and investors who invest in health care companies.

Over the past few weeks, investment bankers have been candid on investor calls and during health care conferences about the opportunity to raise drug prices. In some cases, bankers received sharp rebukes from health care executives; in others, executives joked about using the attention on Covid-19 to dodge public pressure on the opioid crisis.

Gilead Sciences, the company producing remdesivir, the most promising drug to treat Covid-19 symptoms, is one such firm facing investor pressure.

Remdesivir is an antiviral that began development as a treatment for dengue, West Nile virus, and Zika, as well as MERS and SARS. The World Health Organization has said there is “only one drug right now that we think may have real efficacy in treating coronavirus symptoms” — namely, remdesivir.

The drug, though developed in partnership with the University of Alabama through a grant from the federal government’s National Institutes of Health, is patented by Gilead Sciences, a major pharmaceutical company based in California. The firm has faced sharp criticism in the past for its pricing practices. It previously charged $84,000 for a yearlong supply of its hepatitis C treatment, which was also developed with government research support. Remdesivir is estimated to produce a one-time revenue of $2.5 billion.

During an investor conference earlier this month, Phil Nadeau, managing director at investment bank Cowen & Co., quizzed Gilead Science executives over whether the firm had planned for a “commercial strategy for remdesivir” or could “create a business out of remdesivir.”

Johanna Mercier, executive vice president of Gilead, noted that the company is currently donating products and “manufacturing at risk and increasing our capacity” to do its best to find a solution to the pandemic. The company at the moment is focused, she said, primarily on “patient access” and “government access” for remdesivir.

“Commercial opportunity,” Mercier added, “might come if this becomes a seasonal disease or stockpiling comes into play, but that’s much later down the line.”

Steven Valiquette, a managing director at Barclays Investment Bank, last week peppered executives from Cardinal Health, a major health care distributor of N95 masks, ventilators, and pharmaceuticals, on whether the company would raise prices on a range of supplies.

Valiquette asked repeatedly about potential price increases on a variety of products. Could the company, he asked, “offset some of the risk of volume shortages” on the “pricing side”?

Michael Kaufmann, a vice president at Cardinal Health, said that “so far, we’ve not seen any material price increases that I would say are related to the coronavirus yet.” Cardinal Health, Kaufman said, would weigh a variety of factors when making these decisions.

“Are you able to raise the price on some of this to offset what could be some volume shortages such that it all kind of nets out to be fairly consistent as far as your overall profit matrix?” asked Valiquette.

Kaufman responded that price decisions would depend on contracts with providers, though the firm has greater flexibility over some drug sales. “As you have changes on the cost side, you’re able to make some adjustments,” he noted.

The discussion, over conference call, occurred during the Barclays Global Healthcare Conference on March 10. At one point, Valiquette joked that “one positive” about the coronavirus would be a “silver lining” that Cardinal Health may receive “less questions” about opioid-related lawsuits.

Cardinal Health is one of several firms accused of ignoring warnings and flooding pharmacies known as so-called pill mills with shipments of millions of highly addictive painkillers. Kaufmann noted that negotiations for a settlement are ongoing, and noted that the company has told local officials that discharging the litigation would allow his company “to distribute free goods.”

Owens & Minor, a health care logistics company that sources and manufactures surgical gowns, N95 masks, and other medical equipment, presented at the Barclays Global Healthcare Conference the following day.

Valiquette, citing the Covid-19 crisis, asked the company whether it could “increase prices on some of the products where there’s greater demand.” Valiquette then chuckled, adding that doing so “is probably not politically all that great in the sort of dynamic,” but said he was “curious to get some thoughts” on whether the firm would consider hiking prices.

The inquiry was sharply rebuked by Owens & Minor chief executive Edward Pesicka. “I think in a crisis like this, our mission is really around serving the customer. And from an integrity standpoint, we have pricing agreements,” Pesicka said. “So we are not going to go out and leverage this and try to ‘jam up’ customers and raise prices to have short-term benefit.”

AmerisourceBergen, another health care distributor that supplies similar products to Cardinal Health, which is also a defendant in the multistate opioid litigation, faced similar questions from Valiquette at the Barclays event.

Steve Collis, president and chief executive of AmerisourceBergen, noted that his company has been actively involved in efforts to push back against political demands to limit the price of pharmaceutical products.

Collis said that he was recently at a dinner with other pharmaceutical firms involved with developing “vaccines for the coronavirus” and was reminded that the U.S. firms, operating under limited drug price intervention, were among the industry leaders — a claim that has been disputed by experts who note that lack of regulation in the drug industry has led to few investments in viral treatments, which are seen as less lucrative. Leading firms developing a vaccine for Covid-19 are based in Germany, China, and Japan, countries with high levels of government influence in the pharmaceutical industry.

AmerisourceBergen, Collis continued, has been “very active with key stakeholders in D.C., and our priority is to educate policymakers about the impact of policy changes,” with a focus on “rational and responsible discussion about drug pricing.”

Later in the conversation, Valiquette asked AmerisourceBergen about the opioid litigation. The lawsuits could cost as much as $150 billion among the various pharmaceutical and drug distributor defendants. Purdue Pharma, one of the firms targeted with the opioid litigation, has already pursued bankruptcy protection in response to the lawsuit threat.

“We can’t say too much,” Collis responded. But the executive hinted that his company is using its crucial role in responding to the pandemic crisis as leverage in the settlement negotiations. “I would say that this crisis, the coronavirus crisis, actually highlights a lot of what we’ve been saying, how important it is for us to be very strong financial companies and to have strong cash flow ability to invest in our business and to continue to grow our business and our relationship with our customers,” Collis said.

The hope that the coronavirus will benefit firms involved in the opioid crisis has already materialized in some ways. New York Attorney General Letitia James announced last week that her lawsuit against opioid firms and distributors, including Cardinal Health and AmerisourceBergen, set to begin on March 20, would be delayed over coronavirus concerns.

MARKET PRESSURE has encouraged large health care firms to spend billions of dollars on stock buybacks and lobbying, rather than research and development. Barclays declined to comment, and Cowen & Co. did not respond to a request for comment.

The fallout over the coronavirus could pose potential risks for for-profit health care operators. In Spain, the government seized control of private health care providers, including privately run hospitals, to manage the demand for treatment for patients with Covid-19.

But pharmaceutical interests in the U.S. have a large degree of political power. Health and Human Services Secretary Alex Azar previously served as president of the U.S. division of drug giant Eli Lilly and on the board of the Biotechnology Innovation Organization, a drug lobby group.

During a congressional hearing last month, Azar rejected the notion that any vaccine or treatment for Covid-19 should be set at an affordable price. “We would want to ensure that we work to make it affordable, but we can’t control that price because we need the private sector to invest,” said Azar. “The priority is to get vaccines and therapeutics. Price controls won’t get us there.”

The initial $8.3 billion coronavirus spending bill passed in early March to provide financial support for research into vaccines and other drug treatments contained a provision that prevents the government from delaying the introduction of any new pharmaceutical to address the crisis over affordability concerns. The legislative text was shaped, according to reports, by industry lobbyists.

Joe Grogan, director of the Domestic Policy Council, listens during a coronavirus briefing with health insurers in the Roosevelt Room of the White House in Washington, D.C., U.S., on Tuesday, March 10, 2020. The window for fully containing the coronavirus has passed in some parts of the U.S. and the White House will roll out plans later Tuesday to mitigate its impact. Photographer: Al Drago/Bloomberg via Getty ImagesJoe Grogan, director of the Domestic Policy Council, listens during a coronavirus briefing with health insurers in the Roosevelt Room of the White House in Washington, D.C., U.S., on Tuesday, March 10, 2020. Photo: Al Drago/Bloomberg via Getty Images

As The Intercept previously reported, Joe Grogan, a key White House domestic policy adviser now serving on Donald Trump’s Coronavirus Task Force, previously served as a lobbyist for Gilead Sciences.
s
“Notwithstanding the pressure they may feel from the markets, corporate CEOs have large amounts of discretion and in this case, they should be very mindful of price gouging, they’re going to be facing a lot more than reputational hits,” said Robert Weissman, president of public interest watchdog Public Citizen, in an interview with The Intercept.

“There will be a backlash that will both prevent their profiteering, but also may push to more structural limitations on their monopolies and authority moving forward,” Weissman said.

Weissman’s group supports an effort led by Rep. Andy Levin, D-Mich., who has called on the government to invoke the Defense Production Act to scale up domestic manufacturing of health care supplies.

There are other steps the government can take, Weissman added, to prevent price gouging.

“The Gilead product is patent-protected and monopoly-protected, but the government has a big claim over that product because of the investment it’s made,” said Weissman.

“The government has special authority to have generic competition for products it helped fund and prevent nonexclusive licensing for products it helped fund,” Weissman continued. “Even for products that have no connection to government funding, the government has the ability to force licensing for generic competition for its own acquisition and purchases.”

Drug companies often eschew vaccine development because of the limited profit potential for a one-time treatment. Testing kit companies and other medical supply firms have few market incentives for domestic production, especially scaling up an entire factory for short-term use. Instead, Levin and Weissman have argued, the government should take direct control of producing the necessary medical supplies and generic drug production.

Last Friday, Levin circulated a letter signed by other House Democrats that called for the government to take charge in producing ventilators, N95 respirators, and other critical supplies facing shortages.

The once inconceivable policy was endorsed on Wednesday when Trump unveiled a plan to invoke the Defense Production Act to compel private firms to produce needed supplies during the crisis. The law, notably, allows the president to set a price ceiling for critical goods used in an emergency.

• This topic was modified 5 years, 3 months ago by zn.

Notes from UCSF Expert panel – March 10

University of California, San Francisco BioHub Panel on COVID-19

https://www.linkedin.com/content-guest/article/notes-from-ucsf-expert-panel-march-10-dr-jordan-shlain-m-d-/

March 10, 2020

Panelists
Joe DeRisi: UCSF’s top infectious disease researcher. Co-president of ChanZuckerberg BioHub (a JV involving UCSF / Berkeley / Stanford). Co-inventor of the chip used in SARS epidemic.
Emily Crawford: COVID task force director. Focused on diagnostics
Cristina Tato: Rapid Response Director. Immunologist.
Patrick Ayescue: Leading outbreak response and surveillance. Epidemiologist.
Chaz Langelier: UCSF Infectious Disease doc

What’s below are essentially direct quotes from the panelists. I bracketed the few things that are not quotes.

Top takeaways
At this point, we are past containment. Containment is basically futile. Our containment efforts won’t reduce the number who get infected in the US.
Now we’re just trying to slow the spread, to help healthcare providers deal with the demand peak. In other words, the goal of containment is to “flatten the curve”, to lower the peak of the surge of demand that will hit healthcare providers. And to buy time, in hopes a drug can be developed.
How many in the community already have the virus? No one knows.
We are moving from containment to care.
We in the US are currently where at where Italy was a week ago. We see nothing to say we will be substantially different.
40-70% of the US population will be infected over the next 12-18 months. After that level you can start to get herd immunity. Unlike flu this is entirely novel to humans, so there is no latent immunity in the global population.
[We used their numbers to work out a guesstimate of deaths— indicating about 1.5 million Americans may die. The panelists did not disagree with our estimate. This compares to seasonal flu’s average of 50K Americans per year. Assume 50% of US population, that’s 160M people infected. With 1% mortality rate that’s 1.6M Americans die over the next 12-18 months.]
The fatality rate is in the range of 10X flu.
This assumes no drug is found effective and made available.
The death rate varies hugely by age. Over age 80 the mortality rate could be 10-15%. [See chart by age Signe found online, attached at bottom.]
Don’t know whether COVID-19 is seasonal but if is and subsides over the summer, it is likely to roar back in fall as the 1918 flu did
I can only tell you two things definitively. Definitively it’s going to get worse before it gets better. And we’ll be dealing with this for the next year at least. Our lives are going to look different for the next year.
What should we do now? What are you doing for your family?
Appears one can be infectious before being symptomatic. We don’t know how infectious before symptomatic, but know that highest level of virus prevalence coincides with symptoms. We currently think folks are infectious 2 days before through 14 days after onset of symptoms (T-2 to T+14 onset).
How long does the virus last?
On surfaces, best guess is 4-20 hours depending on surface type (maybe a few days) but still no consensus on this
The virus is very susceptible to common anti-bacterial cleaning agents: bleach, hydrogen peroxide, alcohol-based.
Avoid concerts, movies, crowded places.
We have cancelled business travel.
Do the basic hygiene, eg hand washing and avoiding touching face.
Stockpile your critical prescription medications. Many pharma supply chains run through China. Pharma companies usually hold 2-3 months of raw materials, so may run out given the disruption in China’s manufacturing.
Pneumonia shot might be helpful. Not preventative of COVID-19, but reduces your chance of being weakened, which makes COVID-19 more dangerous.
Get a flu shot next fall. Not preventative of COVID-19, but reduces your chance of being weakened, which makes COVID-19 more dangerous.
We would say “Anyone over 60 stay at home unless it’s critical”. CDC toyed with idea of saying anyone over 60 not travel on commercial airlines.
We at UCSF are moving our “at-risk” parents back from nursing homes, etc. to their own homes. Then are not letting them out of the house. The other members of the family are washing hands the moment they come in.
Three routes of infection
Hand to mouth / face
Aerosol transmission
Fecal oral route
What if someone is sick?
If someone gets sick, have them stay home and socially isolate. There is very little you can do at a hospital that you couldn’t do at home. Most cases are mild. But if they are old or have lung or cardio-vascular problems, read on.
If someone gets quite sick who is old (70+) or with lung or cardio-vascular problems, take them to the ER.
There is no accepted treatment for COVID-19. The hospital will give supportive care (eg IV fluids, oxygen) to help you stay alive while your body fights the disease. ie to prevent sepsis.
If someone gets sick who is high risk (eg is both old and has lung/cardio-vascular problems), you can try to get them enrolled for “compassionate use” of Remdesivir, a drug that is in clinical trial at San Francisco General and UCSF, and in China. Need to find a doc there in order to ask to enroll. Remdesivir is an anti-viral from Gilead that showed effectiveness against MERS in primates and is being tried against COVID-19. If the trials succeed it might be available for next winter as production scales up far faster for drugs than for vaccines. [More I found online.]
Why is the fatality rate much higher for older adults?
Your immune system declines past age 50
Fatality rate tracks closely with “co-morbidity”, ie the presence of other conditions that compromise the patient’s hearth, especially respiratory or cardio-vascular illness. These conditions are higher in older adults.
Risk of pneumonia is higher in older adults.
What about testing to know if someone has COVID-19?
Bottom line, there is not enough testing capacity to be broadly useful. Here’s why.
Currently, there is no way to determine what a person has other than a PCR test. No other test can yet distinguish “COVID-19 from flu or from the other dozen respiratory bugs that are circulating”.
A Polymerase Chain Reaction (PCR) test can detect COVID-19’s RNA. However they still don’t have confidence in the test’s specificity, ie they don’t know the rate of false negatives.
The PCR test requires kits with reagents and requires clinical labs to process the kits.
While the kits are becoming available, the lab capacity is not growing.
The leading clinical lab firms, Quest and Labcore have capacity to process 1000 kits per day. For the nation.
Expanding processing capacity takes “time, space, and equipment.” And certification. ie it won’t happen soon.
UCSF and UCBerkeley have donated their research labs to process kits. But each has capacity to process only 20-40 kits per day. And are not clinically certified.
Novel test methods are on the horizon, but not here now and won’t be at any scale to be useful for the present danger.
How well is society preparing for the impact?
Local hospitals are adding capacity as we speak. UCSF’s Parnassus campus has erected “triage tents” in a parking lot. They have converted a ward to “negative pressure” which is needed to contain the virus. They are considering re-opening the shuttered Mt Zion facility.
If COVID-19 affected children then we would be seeing mass departures of families from cities. But thankfully now we know that kids are not affected.
School closures are one the biggest societal impacts. We need to be thoughtful before we close schools, especially elementary schools because of the knock-on effects. If elementary kids are not in school then some hospital staff can’t come to work, which decreases hospital capacity at a time of surging demand for hospital services.
Public Health systems are prepared to deal with short-term outbreaks that last for weeks, like an outbreak of meningitis. They do not have the capacity to sustain for outbreaks that last for months. Other solutions will have to be found.
What will we do to handle behavior changes that can last for months?
Many employees will need to make accommodations for elderly parents and those with underlying conditions and immune-suppressed.
Kids home due to school closures
[Dr. DeRisi had to leave the meeting for a call with the governor’s office. When he returned we asked what the call covered.] The epidemiological models the state is using to track and trigger action. The state is planning at what point they will take certain actions. ie what will trigger an order to cease any gatherings of over 1000 people.
Where do you find reliable news?
The John Hopkins Center for Health Security site. Which posts daily updates. The site says you can sign up to receive a daily newsletter on COVID-19 by email.
The New York Times is good on scientific accuracy.

Observations on China
Unlike during SARS, China’s scientists are publishing openly and accurately on COVID-19.
While China’s early reports on incidence were clearly low, that seems to trace to their data management systems being overwhelmed, not to any bad intent.
Wuhan has 4.3 beds per thousand while US has 2.8 beds per thousand. Wuhan built 2 additional hospitals in 2 weeks. Even so, most patients were sent to gymnasiums to sleep on cots.
Early on no one had info on COVID-19. So China reacted in a way unique modern history, except in wartime.
Every few years there seems another: SARS, Ebola, MERS, H1N1, COVID-19. Growing strains of antibiotic resistant bacteria. Are we in the twilight of a century of medicine’s great triumph over infectious disease?
“We’ve been in a back and forth battle against viruses for a million years.”
But it would sure help if every country would shut down their wet markets.
As with many things, the worst impact of COVID-19 will likely be in the countries with the least resources, eg Africa. See article on Wired magazine on sequencing of virus from Cambodia.

Column: Why sleepy Joe Biden is exactly what voters want
Joe Biden
Joe Biden campaigns in Philadelphia.(Mandel Ngan / AFP-Getty Images )
By VIRGINIA HEFFERNAN
MARCH 12, 20209 AM
One candidate inspired a stampede of voters on Tuesday. He also managed, for the time being, to take big money out of politics.

But it wasn’t Sen. Bernie Sanders. The Bellwether of Burlington promised to do these things, but in the end, he wasn’t the one who got the big turnout without the big bucks. It was former Vice President Joe Biden, a hoary has-been who reps what Sanders likes to call the “corporate wing of the Democratic Party.”

Once upon a time, Biden may have embraced that role. Decades ago, the first time he ran for president, he was an ace fundraiser — a sweetheart of the DNC, till that campaign fizzled and he was proclaimed the “once hot” Democrat in a news headline. This time he started with an exceedingly modest war chest and low expectations, only to build something more than momentum out of thin air.

It should be said that the Biden of 2020 didn’t try to run without big money. He probably wouldn’t have been averse to a lot of sweet corporate windfalls. And don’t expect him to turn them down now. They just didn’t come his way early on. Before his victories on Tuesday, he’d raised about $76 million to Sanders’s $134 million in grassroots donations.

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No wonder Biden’s touching but rattletrap campaign has had all the hallmarks of involuntary thrift. He didn’t just fail to appear in several primary states; in many, his campaign barely set up card tables. And the Biden comms efforts are still so threadbare that even his fundraising emails look like they come from cardboard boxes stamped “1987.” (We must have those bumper stickers blasting Reaganomics around here somewhere.)

Biden hasn’t even paid an agency to develop a snappy hashtag. #IAmTiredAndDontHaveAnyMoney, in fact, might have been the campaign’s default theme till about a week ago. At least it’s relatable.

But, money or no, and razzle-dazzle or no, Biden voters have showed up. Biden added four of the six Tuesday night states to his win column, including the big prize, Michigan, and as of Wednesday, he had pulled ahead in Washington, which is still counting votes. All those victories followed his Super Tuesday blowout: Virginia, North Carolina, Alabama, Tennessee, Oklahoma, Arkansas, Minnesota, Massachusetts, Texas and Maine.

There is a theoretical “path forward” for Sanders, but Biden seems to be the presumptive nominee now. It says something that President Trump, when he’s not producing COVID-19 covfefe on Twitter and from the Oval Office, is back to attacking him. Even Sanders, who announcedhe would stay in at least through Sunday’s debate, admits that Biden may be winning the “electability” contest.

Which brings us to turnout. The Sanders campaign regularly prophesied that new voters — voters who grew up with student debt, bank failures, rapacious capitalism and endless wars — would be impelled to the polls by the promises of a revolution that would lift up the working class.

That prediction missed the mark, but Tuesday’s polling places were hardly empty. Indeed, there was record-breaking turnout, especially in Michigan. It’s just that the votes were cast for Biden, from a formidable group now considered Biden’s coalition: African Americans, suburban women and non-college-educated whites.

It’s admittedly hard to imagine Biden spiking anyone’s adrenaline. He’s low-key in the extreme on the stump. He’s regularly praised for “humility” now — an odd quality for a presidential candidate, from whom voters usually want dreams, ambitions, plans, pep rallies.

But for a country suffering from tinnitus after four years of a headbanger president, Biden’s quietude is welcome.

Election forecaster and political scientist Rachel Bitecofer calls the powerful force that keeps prospective voters away from the polls “comfort.” When choosing a candidate, you ask yourself for whom (and for what) you’re going to forfeit your comfort — get a babysitter, change clothes, jump on a bus and stand in line at a polling place, or even make sure a mail-in ballot gets to the registrar on time. For decades, Democrats have given one answer: a dreamy candidate who makes their hearts race.

Not this time. If Democrats have long been accused of wanting “savior” presidents — and staking everything on presidential elections while ignoring the rest — this election may mark a turning point.

If the Biden wave is any indication, Democrats are no longer looking for that kind of perfection. They’ll settle for a break from the jackhammer noise — from Trump, from Michael Bloomberg, from Sanders, from cable news, from their bloviating relatives, from Twitter.

The lesson going into next week’s primaries seems to be that voters will give up “comfort” because their situation now is not all that comfortable. Discomfort is ever-present even when we’re at home on the sofa self-quarantined with our hand sanitizer. A virus is stalking the planet. Kids are shut out of schools. Our savings are plummeting. The president is disturbed, senseless and tyrannical.

What’s driving turnout now, and what will drive it in November, isn’t infatuation with a savior. We aren’t head over heels. We aren’t buying Big Ideas. We’ll move heaven and earth to get to the polls, to turn in our ballots, because we want to stop tossing and turning and get some sleep again.

And sleepy Joe is just the guy for bedtime stories and lullabies.

@page88

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https://www.currentaffairs.org/2020/03/what-the-stakes-are/?fbclid=IwAR2W1m2bTUVPbyByRkbuGHpMrbZaVE3LDNzHHapr8KDkC8nzc-4UnfpbxtA

Nathan J. Robinson
filed 03 March 2020 in 2020 ELECTION
I feel like I’m going crazy. I have a pit of terror in my stomach that never goes away. I am stressed and afraid at every moment.

To me, a set of facts about the world is difficult to deny:

If Donald Trump is reelected in November, very bad things will happen to a large number of people. Climate change will worsen. The brutalization of immigrants will escalate, with dementia patients and diabetics deported to their deaths. Workplace safety and labor protections will be gutted. Public assets from the national parks to the postal service will be sold off to corporations. A global arms race will intensify, possibly with civilization-ending weapons placed in outer space, waiting to destroy us at a moment’s notice.
To stop these things from happening, we have exactly one chance on exactly one day: Nov. 3, 2020. On that day, something extremely difficult must be done: well over 60 million people must be motivated enough to put aside whatever else they are doing in their lives in order to go to polling stations and cast ballots.
Donald Trump will do whatever it possibly takes to prevent this from happening. He has a colossal amount of money. He is ruthless. He will say anything. Do anything. He will attack candidates from the left if he has to. He will mock their physical appearance. He will lie about them shamelessly. And he is the most powerful man in the world. Trump has the triple advantages of incumbency, low unemployment, and a decent approval rating. It will be incredibly difficult for anyone to beat him.
The Democratic party “establishment,” meaning the people who have been in leadership positions in the party, does not actually understand Trump. They do not see why his message is appealing. They don’t understand how talented he is. They think he is stupid. They don’t know why he thrives, and they don’t understand why they’re failing to effectively oppose him. When his approval rating rises, it mystifies them. When nobody comes to their rallies, they don’t know why. They didn’t get what was going on in 2016, when their own message was totally out-of-touch with ordinary people’s concerns. They will not admit that his State of The Union address was terrifyingly effective. They think that by pointing out that Trump is a liar and a cad, they can hurt him.
Even in a concerningly out-of-touch and inept party, Joe Biden stands out as uniquely out of touch and inept. It’s not just that he seems mentally not-that-with-it, but that he fundamentally can’t organize people. He certainly can’t inspire them. In fact, Biden’s political instincts are atrocious: he constantly told Iowa voters to “go vote for someone else,” and 85% of them did. He tells millennials he has “no empathy” for them. He promises no change. He is a serial liar who fabricates absurd details about his life story, like fictitious arrests and a history of civil rights activism.
The only other Democratic candidate than Joe Biden who has a viable chance at the Democratic nomination is Bernie Sanders. This is almost universally accepted.
Between the two of them, Bernie Sanders is the only one with even a chance of beating Trump. As in 2016, Bernie is different from other Democrats in that he knows how to speak to Trump’s own voters. Not only does he beat Trump consistently in head-to-head polling, but he offers ordinary people an ambitious social democratic agenda that is designed to deal with their real-world problems. He has a decades-long record of fighting hard for them to get healthcare, decent wages, and family leave. He has waged an often lonely struggle on behalf of those whose interests are too frequently ignored in Washington, even taking on the Obama administration over cuts to Social Security. When Bernie tells working people he is in their corner, they can believe him, because he has acted on the same clear set of values for decades. Plus, Bernie’s supporters are motivated. They get out and knock doors for him in the cold. They will do whatever it takes for him. (And on the flipside, if Joe Biden was nominated, millions of them would probably not only decline to put in the same level of organizing energy, but would simply stay home, unwilling to assist a candidate who has made it clear he has no empathy for them.)
Many wealthy and powerful Democrats will do whatever it takes to stop Bernie Sanders from being the nominee. This means that they will do whatever it takes to make sure that Joe Biden is the nominee. Already, Pete Buttigieg and Amy Klobuchar have dropped out and thrown their support behind Biden. Barack Obama has apparently “sent the signal” to Democrats that they need to come together behind Biden. Some Democrats even appear to be funneling money to supporting Elizabeth Warren’s campaign, so that she can continue to siphon enough votes away from Bernie Sanders to keep him from winning the nomination.
If these Democrats succeed in stopping Bernie, perhaps through a contested convention in which superdelegates override the plurality vote, and they put the feeble and uninspiring Biden at the top of the ticket, it will be an absolute calamity. Bernie’s supporters, many of whom already dislike the party for working hard to stop Bernie in 2016 and the incredibly fishy Iowa caucus shenanigans, will simply give up on the Democrats. Millennials will leave the party in droves, feeling that their votes don’t matter. Some will probably support a third party candidacy. Others will argue that in the interests of pragmatism, they should still vote for a dishonest and weak candidate who says he has no empathy for them. Their appeals will mostly fail. The party will be riven with bitter conflict. Biden will have no clear message, no strategy. He will perform embarrassingly in debates with Trump, forgetting his words and seeming to wonder why he is even on the stage. (He will also have no good explanation for what his son Hunter was doing for that Ukranian gas company, which will be the subject of constant discussion.) Trump, being a bully, will seize his advantage and relentlessly mock Biden’s performance. Trump will (as he has before) talk a lot about how Sanders was “robbed” by a “rigged” primary, delegitimize Biden’s nomination, and stoke the intra-party conflict. Biden will look dazed and confused on Election Night, as Democrats wonder yet again how they managed to lose to Donald Trump of all people.
If Bernie is nominated, things will go differently, though we do not yet know quite how. Trump’s propaganda machine will try to brand Sanders a communist who hates America. Will this work? It is not clear. Sanders has been an open socialist in the public eye for a long time without it affecting his popularity, but the war that is waged against him will be relentless. And, of course, liberals might not pitch in to help Sanders. Many of them repeat right-wing talking points about him already, scaring people by implying Sanders wants to leave them uninsured. Sanders and his army of organizers will do their damndest to expose Trump for the fraud he is, to unite working-class people behind a candidacy that truly speaks to their interests, and behind an ambitious agenda for single-payer healthcare, a comprehensive climate plan, a living wage, and an end to the indentured servitude of student debt. Will they succeed? This I do not know. Everything else here seems clear as day to me. But how exactly a Sanders-Trump race will play out is mystifying indeed. There are strong reasons to believe Sanders will win, like his strong fundraising in Obama-Trump swing counties, voters’ high assessments of his honesty and credibility, his declining to antagonize conservatives on some cultural issues and ability to speak to conservative audiences, and of course, all of the actual polls. But I have never thought that it was certain Sanders will beat Trump. What I think is that it is certain any other Democrat will lose.
I run all these facts through my head all day, every day. If Trump gets reelected, untold horrors will be released. Unless Sanders prevails, Trump will get reelected. Therefore Sanders must prevail. We must do everything possible to get Sanders the nomination. There is no alternative.

This same reasoning seemed just as obvious to me in 2016, when Democrats didn’t notice that nominating Hillary Clinton was a catastrophic blunder, and proceeded to lose to Donald Trump, ignoring the warnings of people like me and Michael Moore. And when I say I feel like I’m “going crazy,” it’s because it’s really hard for me to believe that after all these years, the lessons have still not been learned. “Oh my God,” I think. “They’re really going to do it again. They’re still not going to nominate Bernie. They’re going to put up another establishment candidate, this time an even weaker one who doesn’t even have the promise of ‘historic change’ that Hillary would have represented.” They’re literally going to fight Bernie to the death, even if it very obviously would result in the suicide of the Democratic Party as an institution.

It’s kind of hard to believe that this is really what’s happening. But it is! They’d rather nominate Joe Biden and have him lose to Trump than let Bernie try something different and novel. Hindsight should be 2020: have we really not realized that Bernie has a special ability to bring people together? Have you seen his rallies? Have you watched his campaign ads? This guy can make people cry. People would walk through fire for Bernie. Why do you think that is? It’s because Bernie makes them feel cared about (or, in the words of one nonvoting felon, “he’s the only one who thinks I’m a person”). He makes them feel less alone. He makes them feel part of something beautiful, something exciting, something that might actually change things for the better. Bernie can take people who feel alienated and uninterested in politics, and he can make them believe that a better world is possible.

It’s so weird to me that people don’t get this. Do they really believe the idiotic attacks on Bernie’s “radicalism”? Look at Bernie’s agenda: a national health insurance plan, of the kind that exists successfully all over the world. A giant ambitious climate investment plan, of the kind that we absolutely need if we are going to save the earth because this is a fucking emergency. A living wage that allows people to actually afford to pay their rent and feed themselves. What is the problem here? Why are people like Barack Obama and Beto O’Rourke prepared to destroy the Democratic Party and put the entire future of the planet at risk in order to stop this? What exactly is the threat that Bernie poses?

Even at his most ambitious, Sanders’ plans resemble things that exist today in many European countries, like making college education free the same way we make high school free, or having the government fund ambulance services just as we have government fire departments. And the plans are obviously not going to be implemented in their most ambitious form—everything gets watered down through the legislative process. Whatever changes Bernie could possibly bring about would be pretty modest and inadequate, and even Bernie-skeptic Paul Krugman admits Bernie poses no threat to the economy. The Wall Street Journal, in its opinion section, treats Bernie as an insane socialist radical bent on turning America into Venezuela. But in its news section, where they have to tell business-owners the truth, they admit that the changes he would bring are modest, like making CEO pay more reasonable, making it easier to unionize, boosting the minimum wage, lowering drug prices, legalizing marijuana, letting farmers fix their own farm equipment, and letting post offices offer banking services. As Matt Yglesias notes, Bernie Sanders is nothing to fear: he’s relatively moderate and does well in elections. During his time as a city mayor he proved himself to be a competent and progressive executive.

So why do people freak out about him? Why, when he makes the entirely correct point that the Cuban government teaching children to read was good but its authoritarianism is bad, do people accuse him of sympathy for Castro’s repression, as if we should be incapable of holding two ideas in our heads at the same time? (Likewise, the Chinese government’s poverty-reduction is positive while its massive ethnic detention camps are very, very bad.) Why do people suggest Medicare For All is fiscally irresponsible when it’s very clear that it will save people money and prevent tens of thousands of people from dying every year? Why, when Bernie has been on the right side of history from every issue from gay rights to the Iraq War, do people treat him as insane and lacking judgment? Why are people like Obama willing to risk destroying the party and imperiling the earth in order to keep this man from being president?

Forget 1972
The charitable answer, and the one they would probably give themselves, is that do not share my view of point #7 on my above list. They simply do not think Bernie is “electable.” They think he would lose to Donald Trump, that because he is too “far left” he would be the equivalent of George McGovern in 1972, and would lose in a landslide. They think he would hurt the prospects of “down ballot” Democrats, with Democratic members of Congress in conservative districts being forced to share the ticket with a socialist. They will insist that it is not Bernie’s agenda that they despise. They simply believe he threatens the party. He must be stopped at all costs in order to save democracy. I think many Democrats have probably convinced themselves of this, which is why some have been willing to entertain the prospect of nominating Mike Bloomberg to stop Sanders. If it takes a racist, sexist, transphobic Republican to save the party, so be it. Better victory with Bloomberg than defeat with Bernie.

The fact that many high-up people in the Democratic party think this way is frightening. Because if they are completely convinced that Bernie can’t beat Trump, they’re not going to step aside at any point and let him be the nominee. They will fight him to the bitter end, because they will tell themselves that in doing so they are being pragmatic. If their actions result in tearing the party apart through a disastrous brokered convention, they will still insist that their actions were right, because they think anything that stops Bernie has to be done. Yes, even if that means overriding the popular vote with superdelegates.

In order to get people who think this way to stop trying to destroy Bernie’s candidacy, we would need to convince them that they are wrong about the electability thing. They have an absolute conviction that “a candidate too far to the left cannot win,” therefore they must stop a candidate too far to the left from getting the nomination. If this means getting Elizabeth Warren to stay in and siphon away some Bernie votes, they will implore her to stay in. If it means bribing Amy and Pete with promises of cabinet posts, they will do that. I am sure many people have been on the phone to Barack Obama begging him to step up and endorse Joe Biden in order to “save the party.” I would not be surprised if Obama did just that if Biden has an even passable Super Tuesday result.

But the theory of politics that drives this conviction is delusional. The idea that “a far left candidate cannot win” is ingrained as part of the prevailing ideology. People believe it to their core. Voters are on an ideological spectrum, and you’ve got to appeal to the “median” voter in order to win. Go too far toward one end of the spectrum, and you lose. This is the rationale that many “moderate” candidates give for trying to sound sort of like Republicans—see Bill Clinton promising to gut welfare. You get the “Democratic base” but then you “expand” it to peel away Republicans. If you ask what the proof of this theory is, you get one answer: 1972, in which the “too liberal” George McGovern lost badly to Richard Nixon.

This theory, however, needs to be completely discarded. The core mistake of it is that it sees voters as primarily ideological. In fact, as anyone who has knocked doors for a while can tell you, voters are deeply weird and idiosyncratic. It’s not that they’re in the “center,” it’s usually that they’re all over the map: people have some really conservative opinions alongside some really left-wing ones. It’s not uncommon to meet a voter who thinks immigrants are stealing our jobs but private insurance should be abolished, or who thinks Trump is being persecuted but thinks reparations are sensible. The “median voter” idea is a bad one precisely because the “spectrum” is a bad concept to begin with. Yes, there are clusters of tendencies, and there are lots of “partisans.” But people actually will surprise you: you’ll meet plenty who are considering both Bernie Sanders and Mike Bloomberg, and can tell you almost nothing about either of them. (A friend of mine tells me that in 2016, his aunt’s entire perspective on the race was: “It’s between a clown and a robot, and I’ll take the clown.” She spoke for millions.)

What if, and I know this sounds crazy, politics is less about ideology than about personality, narrative, and organizing? Under a personality theory, if you put a likable, charismatic, right-winger against a hesitating and disagreeable left-winger, the right-winger would win. But if the qualities were inverted, and the right-winger was dislikable and the left-winger was charismatic and compelling, the result would also be inverted.

Here’s a very rough folk theory of elections to consider: the person who loses is the one who seems the most like a loser. I realize this sounds silly, and hindsight will inevitably influence the assessment, but the people who lose do often seem like the kind of people who would lose. Bill Clinton and Barack Obama are charismatic, likable, inspiring winners. John Kerry and Al Gore are humorless, uninspiring bores. When we run people that people like and are inspired by, we win. When we don’t, we lose. I’m not saying this theory is an all-explaining or universally correct one. Just that it makes as much sense to me as the solely ideology-based theory.

How about another folk theory? Organizing matters. If a socialist knocks on 100,000 doors and spends the most time persuading voters, they might beat a conservative. (A DSA member who became a Virginia House of Delegates member, Vaughn Stewart, told Current Affairs he believes he won not because he was a socialist, but because he showed up and met with people.) Under this theory, a fascist party could win even if most people aren’t fascists, if the fascists are the best-organized.

Perhaps George McGovern just wasn’t very persuasive, likable, or organized. (He was a also a big fat Liberal, more Elizabeth Warren than Bernie Sanders.) If there are more variables that matter than ideology, then the simple “Bernie can’t win because he’s a leftist, Biden will have more of a chance because he’s a centrist” is dangerously false. It doesn’t just matter what Biden’s ideology is. It matters whether he can organize and inspire. Even if it was harder for a left-wing candidate to win, if the left-wing candidate is the one with the giant grassroots fundraising and door-knocking apparatus, they might be your best bet.

But I don’t actually think it is harder for a left-wing candidate to win, and I think people who assume this assume it in part because they don’t really understand what the “left” is or what our theory is. Socialist values pose a significant threat to the wealth and power of certain people in society who have a strong self-interest in making sure people misunderstand and distrust socialists. But actually, the left stands for ideas that, once people understand them clearly and see through all the myths, have the possibility of mass appeal. Medicare for All is popular, and it would probably be far more popular if you explained to people exactly how it worked and what it would mean for them, and showed them how it would affect their pocketbooks and their experience with the healthcare system. Instead, pollsters ask things like “Would you support Medicare For All even if it took away your private insurance and increased your taxes?” and people get jittery, because they think that means they’re going to be uninsured and have less money. People try to mislead the public about what the left is trying to do, then when the public swallows the misconception, we are told that America rejects left ideas. It’s silly.

Sure enough, there is evidence that Bernie Sanders would be something different from anything we’ve seen before, in terms of whose appeal he would attract. Joe Rogan, who we can think of as more naturally Trump-sympathetic, prefers Sanders over other Democrats. Ann Coulter is weirdly sympathetic to him. Even Tucker Carlson understands that Bernie will have a unique power to appeal to Trump voters. (I have given a longer explanation here of how the left can present a formidable case against Trump that can weaken his turnout, neutralize his message, and leave him struggling to figure out what he can say in response besides “But socialism!”) Those who fear Bernie will hurt “down ballot” Democrats in conservative areas do not get it: Bernie is far more likely to appeal to conservatives than Hillary Clinton was, because Bernie is not going to drip with contempt for them and call them all a “basket of deplorables.”

If the left were given the ability to make its case clearly to the public, to explain what it is we actually believe and want, our agenda would not be “crazy.” It’s only crazy because people keep calling it crazy and refusing to have a serious discussion about what, for example, AOC’s poverty plan would mean for people, or how much it would really cost to get rid of student debt (not nearly as much as you think). If Bernie is the nominee he will actually get a chance to speak to millions of people directly and at length for the first time. And when people get to see Bernie up close, rather than through the distorting prism of media coverage, they like him.

Maybe the reason people distrust the left is that you have the paper of record publishing sheer fabrications about how Bernie Sanders represents the “end” of the liberal values of compassion, tolerance, and optimism. What are they talking about? Bernie Sanders’ campaign is built in compassion, he’s gotten into trouble for how far he takes his toleration of opponents’ speech, and it’s all built on the optimistic idea that we can establish a decent standard of living for everyone. This is just a disgusting lie, but here it is in the nation’s leading “liberal” newspaper from one of Barack Obama’s favorite columnists.

I’ve been so depressed to see just how nasty the attacks on Sanders have gotten, how far divorced from reality they’ve become. Even Elizabeth Warren is now portraying Bernie Sanders as a useless do-nothing (he’s actually phenomenally effective and can rattle off dozens of achievements). How sad it is to watch someone who could have been a natural ally in turning America into a true social democracy running a scorched earth campaign to deny Sanders the nomination however she can. Sometimes it feels like being pummeled from all directions, and you just want to lie down and give up. You, too? Is everyone going to turn on us? What on earth is wrong with you people? The Sanders movement is something beautiful and necessary. It offers people something important to believe in. People like Obama and Warren are really going to expend their resources in trying to crush it completely and demoralize the millions of people for whom it means so much? Warren came in 5th place in the last primary, and knows that her continued presence in the race will help Biden secure the nomination. Is this just spite at this point? Is she being paid? What is going on?

A crude Marxist analysis, of course, would say that it’s all a matter of class. Ultimately, Sanders is a candidate fighting on behalf of the working-class against a party dominated by rich capitalists and members of the professional-managerial class, all of whom stick together at the end of the day. Bernie poses an existential threat to their power and status, because he thinks Congress should be full of bartenders rather than lawyers and business owners.

Perhaps Democrats trying to stop Bernie really think he can’t beat Trump. As I say, there isn’t really evidence of this, beyond the theory that the word socialism will turn toxic in a way it hasn’t so far. Still, they might be sincere in their error, for all I know. For some of them, however, there is something else: Bernie’s success would discredit and humiliate them. And whether they know it or not, that may be subconsciously affecting how they think about him. Let us say Bernie did beat Trump, and that he did pass Medicare for All, and that it was a success. What would that mean for people like Nancy Pelosi, Barack Obama, and Hillary Clinton? It would mean that they were wrong when they had not chosen to fight for these things. Completely wrong. In fact, they stood in the way of progress and prevented us from getting things we could have had all along. They “compromised” all of the important values for nothing. They should have been standing with Bernie and instead they were standing against him, creating needless barriers to fundamentally important social changes.

But it’s even worse than that for them: if Bernie beats Trump, liberalism is over. I don’t mean in the sense David Brooks means, that the liberal values of free expression and democracy are over. Bernie has fought for those his whole life. I mean incrementalist politics that declines to forthrightly challenge the distribution of power and wealth. Because if Bernie beats Trump in 2020, it will show that Bernie was right that he could have beaten Trump in 2016. And if Bernie could have beaten Trump in 2016, then all of the horror of Trump’s presidency—the kids in cages, the poisoned environment, the pardoned psychopaths—was avoidable. It didn’t need to have happened. It happened because liberals stood in the way, because they insisted on coronating Hillary Clinton instead of listening to those of us who were shouting over and over “YOU NEED BERNIE IF YOU ARE GOING TO WIN.” This mess will have been their fault. They could have let Bernie go after Trump with a powerful left populist appeal. Instead they chose to run a D.C. insider who hasn’t talked to a person without a college degree since before they went to college. If Bernie wins in 2020, it will show that this was the fuckup of the century, that it put the entire planet at risk, that they understood absolutely nothing about politics and the limits of the possible. It will show that every compromise Barack Obama made was unnecessary, and every person who thought “pragmatism” meant setting aside your principles sold their soul and didn’t even get the lousy T-shirt.

My theory for why some people hate Bernie so much is that Bernie shows them a person they could have been, but found some excuse not to be. They didn’t have to sell out. They could have stood alone, never ceasing to fight against injustice. But they did sell out, and the only consolation they got was that it was the reassurance that they were pragmatic and sensible and smart. What if it wasn’t even that, though? What if it was incredibly dumb? So I’m not surprised they’ll do anything they can to keep Bernie from being the nominee. If left policies and politics turn out to work, to engage people and improve things, people will have spent their life on the wrong side. And it’s probably easier to reelect Trump than to stomach the revelation that you were deeply wrong in a way that caused terrible harm.

Okay, but let’s go back to the facts: Objectively speaking, the future of the planet depends on Bernie getting this nomination and then beating Trump. If either one of those things doesn’t happen, we’re fucked. Don’t take my word for it. Think about it. Play the scenarios out in your head. Imagine how a brokered convention will go. Imagine how embittered Sanders’ voters would be if he had the nomination snatched out from under him. Imagine how Joe Biden would campaign, and how the size of his events would compare to the size of Trump’s. How anemic would his campaign be next to the well-oiled Sanders machine? How many young people would go around in Biden shirts? Come on.

I feel so crazy, because I want to scream: please, for the love of God, just try to look at things as they are! There are still people supporting Elizabeth Warren, because she’s the candidate of their “hearts.” Do they know how much is at stake? Do they know what will happen if we don’t get Bernie? There are people trying to prop up Biden and force a brokered convention. Do they know that getting Pete and Amy behind Biden does not make him any better or more competent a campaigner? Do they know that it will only provide the illusion of strength until such time as he faces Donald Trump? Do they care what will happen as a result of that? Do they realize just how big the threat of climate change is? Do they seriously think that even if Joe Biden scraped himself somehow across the finish line he would do anything about it as president? Do they think the Sunrise Movement would have a friend in Joe Biden like they would in Bernie Sanders? What is the thinking here? What is the theory? How do you think this is going to play out? Are they really going to let the goddamn planet burn to save us from a social democrat? How can you be that indifferent to the fate of billions? I’ve been feeling such rage at people like Warren and O’Rourke, but it’s almost subsided into just a deep, deep sadness. How depressing it is that there can be people with so much indifference to what will happen as a result of their actions.

My co-editors worry sometimes that I have been publishing too many pro-Bernie articles. They are concerned that Current Affairs could end up seeming like a propaganda outlet. Frankly, they’re probably right. I’ve been strident this election season. (I’ve been vicious to poor Pete, for instance.) But I swear it’s not because of any great cultish adoration for Bernie Sanders. I do not want to be writing all the time about Bernie Sanders, believe me. I wish I could write about so many other things. (As one example, I’d like to be attacking Bernie from the left during a Bernie presidency.)

The reason I’ve been writing incessantly since 2016 about the critical importance of electing Bernie is that I sense the extreme urgency of our political moment, and this cranky old man from Vermont has rather remarkably ended up in the position where his election is a necessary step in moving this country forward and saving it from barbarism and self-destruction. If I could, I would write 10 pro-Bernie articles a day, not because I am a “bro,” but because I am so afraid all the time about what happens if we don’t get this done, and all I want to say over and over is “Don’t you see? Please. PLEASE. We need this. It is so important. How do you not see the importance? Do you not realize what’s at stake?” It sounds so arrogant. So accusatory. So insane. I don’t want to be like that. I’ve become an angrier person this election season. I’ve lost friends. I’ve flunked my schoolwork. I’ve alienated colleagues. I’ve made people think I’m nuts.

But since we founded Current Affairs in 2016, I’ve been trying to say the same thing over and over in however many ways I can, because it feels so obvious to me that it occupies me constantly and if it isn’t understood and acted upon it will cause such catastrophic harm: we need Bernie. We have got to make this happen. We have an opportunity here. It won’t come again. We are lucky we got a “do-over” in 2020, but this is it. We can have something incredibly good, or we can have something incredibly bad, and there is no in between and we’ve got to choose and choose now.

The only thing that keeps me from going insane is the fact that I am not, in fact, at all alone. The millions of people who fight for Bernie: they all get it too. That’s why they’re out there spending every moment of their day working for him, giving him all the money they can. Forklift operators, truck driver, fast food workers: they sense that at last, there is someone in politics who might really make a difference to their lives. The activists in the youth climate movement know that there is finally someone for whom climate change carries the right amount of urgency, who doesn’t just see it as a phrase to toss out and indicate Deep Concern about, but who sees it as something that if we do not fix now will have terrible consequences. Bernie gets it in a way nobody else does.

When Bernie had his heart attack, I and so many of these others panicked. And people made fun of us and couldn’t believe how dependent we were on “one guy” being our “savior.” But Bernie isn’t a savior. Bernie is a vehicle for carrying out our aspirations. He’s a means to the end of a better future. I wish we had other vehicles. But he’s the one we’ve got right here and now, and we have to do everything possible to make sure we don’t miss this chance.

I hope today goes well. It needs to. So much is on the line.

Recently had both eyes done for cataracts. Still in recovery mode. My right eye followup was Thursday — the left eye was done first — and complications were found. The doc thought he saw a retinal tear, so he booked me with yet another specialist for Friday (yesterday). That doctor found tears in both eyes, and I had an (unexpected) surgery on the left eye that day.

I’m beginning to notice a pattern with surgeons. They seem not to actually think what they do might, um, kinda hurt patients. They seem so convinced of their skills — and they do have them — that patients shouldn’t worry bout a thing.

The laser fix for the tear actually did hurt, and I pride myself in having a very high threshold for pain. More than 17 years of chemo and its side-effects, I think, gives me that right. But, again, this hurt. Its only saving grace was its relative short time frame (five minutes, perhaps?). I can see it being used by torturers for a longer time, and breaking down the victim fairly easily. But the doc seemed not to really consider the possibility of pain, though perhaps he did just a bit, because he kept telling me we’re almost finished, we’re almost finished, etc.

Next week, I get the other eye done, but with a different fix. Instead of a laser, they’ll freeze it somehow. If any of you guys have ever dealt with anything similar, and have any advice, would greatly appreciate the new knowledge.

Will generally be back late (9 PM?) on Tuesdays.

So if you want content–do everyone a favor and provide it! That would be cool.

If there’s an issue, like another post accidently marked “pending,” be patient.

Enjoy your Tuesdays. Don’t burn the place down.

Kinda late to the dance on this one, but just finished his Booker-winning novel (2017). Really liked it, but it took some time to get used to. Experimental, polyphonic, a cast of 166 voices. Mostly about one single night in a kind of Nowhere zone for “souls,” somewhere between life, death and perhaps, reincarnation. Lincoln and his son, Willie, are the ultimate focus.

I probably should have picked a different book as my first foray into ebook formats. It was difficult enough to get used to Saunders’ unique style, but adding the strangeness of the small screen didn’t really help matters. And all the while, I felt guilty for breaking an old promise: never go over to the Dark Side and read in that new-fangled way.

The idea, however, of using an app to gain access to all kinds of books was too much of a temptation. Saving the trip to the library, doing all of this from home, etc. But it kinda baffles me — some of the rules. You have to put a hold on a lot of the books and wait your turn. They aren’t always available. I would have thought that, it being digital, they’d always have plenty of copies. Perhaps it’s a copyright thing, and it costs libraries per digital copy. Not sure. It also could just be their way of keeping track of things. Anyway . . . Old dog, new tricks, etc.

If any of you plan to read the book, be patient with it. It’s not a “page-turner,” at least not at first. Read on, cuz it gets better and better. Much humor, much compassion and pathos, and very wise in places. I thought of various books, plays and authors as I read, but the ones that rose to the top of the list were Flann O’Brien, Beckett (dark Vaudeville, sorta kinda), Wilder’s Our Town, and a dash of Dickens here and there.

I can see why it won awards.

Rams Head Coach Sean McVay – – Dec. 22, 2019

(Opening Remarks)
“Yesterday, (CB) Jalen (Ramsey) got a knee banged up. We’re continuing to evaluate and see how – he ended up continuing to play through it, but we’re going to look at just seeing how he feels as the week progresses. (T) Bobby Evans did return from the hip pointer that he got. He should be okay, but we’ll take it day-to-day with him. With (RB) Darrell Henderson (Jr.) – with his ankle, he ended up tweaking it on his first carry and then felt it on his second carry. He’s going to need to get that thing cleaned up, so we’re probably going to put him on ‘IR’ (injured reserve).”

(On which ankle Henderson Jr. injured)
“It’s his right ankle.”

(On if Henderson Jr. will have a procedure immediately)
“He’ll have it done after Christmas. He’ll have it done at some point this week, but we’ll wait until after Christmas so he can still enjoy Christmas.”

(On if Ramsey’s injury is something they will monitor and if he had an MRI)
“We’re getting further updates on that. We want to be as smart as possible. He tweaked it, he felt it, he was able to play through it. As we’re continuing to gather information, I’ll have a little bit more for you as the week progresses.”

(On if Ramsey has already had an MRI or if he will in the future)
“He’s going to. We’re going to get him a further evaluation.”

(On if Henderson Jr.’s injury will require surgery)
“He had a high ankle sprain. It’s unstable, so he’ll need to get surgery. The specifics of that – it’s not something that’s too evasive. It is something that will require to go in there and get it cleaned up. When he gets back – I don’t think it’ll be anything too long that will force him to miss a bunch of time.”

(On if he knows the severity of Ramsey’s injury)
“I don’t. It’s his ‘LCL’ (lateral collateral ligament). Just figuring out the specifics of, ‘What type of grade strain is it?’ Then I’ll be able to have some further updates for you as he’s talking with the doctors, I get a chance to talk to those guys and then we’ll have some further information for you guys later this week.”

(On how he balances maintaining the health of the team going into the offseason versus wanting to win against Arizona to close out the regular season)
“I think you want to be smart about it, you don’t want to force guys to play that aren’t in the position to be able to do that. I do think we have a lot of good competitors. You’re always pushing through some bumps and bruises at this point, but if it is something where they are going to have it fixed or you’re putting them at further risk for injury, we would definitely take that into consideration and we wouldn’t want to expose guys for that.”

(On how he is processing what happened in last night’s game against the 49ers)
“A lot of the same as what it felt right after, extremely disappointing. You put as much into it and you want to see more success collectively with the group. How much goes into this season and all really geared towards giving yourself an opportunity to compete afterwards, but that isn’t the only reason you do it. You get to go through a lot of good and some bad this season. I think that’s forced us to learn a lot about ourselves, I know it has for me personally. Really, my focus is on finishing this season out the right way. Once we get to that point where the season is finished, there will be a lot of good self-refection. There will be a lot of good evaluation – for everybody – and for us to be able to look at what we can do to be better and hopefully avoid these types of seasons, as we move forward, and as we learn, as we grow together.”

(On his comments after the game where he compared the loss to the 49ers and the Super Bowl loss)
“It’s hard to compare. I think everything is so fresh. When you’re talking right after a game too, the emotions are very real, they’re very raw. It still hurts. In all those losses, like I said, they take a little bit out of you. What you can’t be afraid of is that feeling of getting up and continuing to battle and fight and try to do the best job that you can for your team as we try to finish up this season the right way. It’s all been disappointing. I really think what both those games represented, in different manners, was the finality of the season last year, and then yesterday, represented the finality of our opportunity to have some games past the 16 that we’re guaranteed. They both hurt a lot, but every single loss does. I think it’s just because you care so much and you want to see the people that you’re doing it with have success, that’s really why you do it. When we haven’t had the success that we’ve wanted, it hurts. You can’t be afraid of that hurt, like we’ve talked about.”

(On if there is significance finishing with a winning record)
“I think so. Yeah, I think it’s important. I think it demonstrates, too, the character that I do believe we have in this locker room. For guys to continue to compete, we’re going to battle and we’re going to compete to the best of our ability to try to finish out with a winning record. That is something that I said to the team today and I think it’s important for us. We know the challenge because Arizona is a tough football team.”

(On how potentially finishing with nine wins feels like a year after playing in the Super Bowl)
“I think because you want to try to have those temporary milestones that you want to accomplish. For us, the goal at hand and what we can accomplish this week is to try to establish a winning record based on where we’re at after 15 games. Is it where we wanted to be? I don’t think anybody would have said that before the season. It is where we’re at and all we can do is handle it the right way. That’s all we know how to do.”

(On where he thinks they fell short as a whole this season)
“I think overall, just the consistency. I think there’s been instances in all three phases where there’s been some really positive things and then there’s been some other instances where I don’t think we’ve played up to our capability. That’s all of us – that’s coaches, players, we’re all in this thing together. Ultimately, you‘ve heard us talk about it before, consistency is the truest measurement of performance. Unfortunately, I think our inconsistency as a team ended up hurting us. We saw what we were capable of when the things were going well, and we saw how it can look when they’re not going well. It’s been a real big learning opportunity this year. It is something that you want to really make sure that you go back, you reflect on an you say, ‘All right, how can we try to be more consistent week in and week out? What are the things that I can do, that we can do in terms of how we’re setting up our offseason?’ Everything is going to be evaluated and I’m excited about attacking that challenge after this week. That’s where our singular focus will be is on focusing on this week and the Cardinals game because that’s what we’re going to finish this season off the right way. I think you owe it to the players, to everybody in this organization. Then, after that, then we’ll have a good chance, unfortunately, a lot longer than we’re accustomed to, to really look inward and reflect on what are the things that we can do to move forward and be better attacking next season?”

(On how he feels)
“I sound a lot worse than I feel. I kind of got a little bit of a head cold earlier this week. It sounds worse. I feel like I’m turning the corner. I just sound bad.”

(On what’s going on with T Rob Havenstein)
“He’s (T Rob Havenstein) been practicing. He hasn’t really been in a position where he feels like he can do the things to play at a high level. So, we wanted to be smart with this and not push him. Bobby’s done some good things, but really, it’s been more of a reflection of how he’s felt during the week of practice, where could he really push through it, maybe. But, he’s not feeling totally good enough to be able to have that anchor, that stability that you need. We’ve just been smart and patient with it and taking his feedback and the doctor’s. We’ll see what this week looks like.”

(On this being the last game with this group together and how much emphasis he puts on that)
“I think it’s important. You want to make sure that you cherish every moment and you make sure that you maximize the day. There’s a lot of things that this season has given you – I think especially a perspective and appreciation. It is a blessing to do be able to do this for a job. You think about, especially coming around the holidays, and some of the things that I know when you get upset about certain things you kind of have to take a step back and realize you’re very blessed to even be in this position. I think you want to make sure that you appreciate, enjoy the opportunities, appreciate the relationships that you build – knowing that inevitably there is change that occurs year in and year out whether it be good or bad. For us, this will be the last time with this team that we’ll get a chance to go out and compete together. I think we want to be able to enjoy the week of preparation and let’s see these guys go out on a good note.”

Safety Blitz
I see a more patient runner who reads the blocks before taking an angle ala L Bell. Muscling through the trenches waiting for a big play. Doesn’t seem as explosive but whatever changes he has made are working.

Still would like him catch a few more passes.