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  • March 17, 2020 at 2:22 pm #112482

    In reply to: Social aspects of the Virus situation

    Avatar photowv
    Participant
    InvaderRam wrote:
    wv wrote:

    Well, let me know if you meet any centrists or Rightwingers who change their views.

    voters or policy makers?

    ==================

    Voters.

    People dont change their minds for the most part. Leftist Friend of mine sent me this about her Rightwing Mom:
    “My mom posted a meme on facebook. It said something to the effect of ‘Italy is refusing to treat its elderly Coronavirus patients. That’s what happens with socialized healthcare!’
    After slamming my head into the keyboard several times, I had things to say.”

    I’ve seen that kind of thing over and over and over in my life.

    Granted some people change, and change does happen, etc.
    But by and large people dont change and change does not happen 🙂

    The Dem-Centrist-SuBSystem and the Rep-Rightwing-SubSystem are very effective at selling their stories.

    There has never been a corporate-propaganda system like this before, in the history of the world. This is something modern, something new.

    w
    v

    March 17, 2020 at 12:14 pm #112463

    In reply to: the testing fiasco

    Avatar photozn
    Moderator

    The 4 Key Reasons the U.S. Is So Behind on Coronavirus Testing
    Bureaucracy, equipment shortages, an unwillingness to share, and failed leadership doomed the American response to COVID-19.

    https://www.theatlantic.com/health/archive/2020/03/why-coronavirus-testing-us-so-delayed/607954/

    The COVID-19 outbreak has been a confusing time for Americans, but one thing has been glaringly clear: The U.S. is way behind when it comes to testing people for the coronavirus.

    Despite the fact that last week, Vice President Mike Pence promised that “roughly 1.5 million tests” would soon be available, an ongoing Atlantic investigation can confirm only that 13,953 tests have been conducted nationally. New York, which has shut down Broadway and has at least 328 coronavirus cases, is still failing to test patients who have worrying symptoms. As late as March 6, a busy clinic in Brownsville, Texas, a border city of nearly 200,000 whose population crosses back and forth from Mexico frequently, told me they could test only three people. By comparison, South Korea, which has one of the largest outbreaks outside China, is testing nearly 20,000 people a day.

    Testing is essential for identifying people who have been infected and for understanding the true scope of the outbreak. But when the initial test from the Centers for Disease Control and Prevention was rolled out to state public-health laboratories in early February, one of its components was discovered to be faulty. Since then, academic, clinical, and other laboratories have struggled to get or make new tests and diagnose patients.

    Though some elements of the breakdown are by now understood, the full extent of the difficulties laboratory directors have faced has remained largely opaque. Interviews with laboratory directors and public-health experts reveal a Fyre Festival–like cascade of problems that have led to a dearth of tests at a time when America desperately needs them. The issues began with onerous requirements for the labs that make the tests, continued because of arcane hurdles that prevented researchers from getting the right supplies, and extended to a White House that seemed to lack cohesion in the pandemic’s early days. Getting out lots of tests for a new disease is a major logistical and scientific challenge, but it can be pulled off with the help of highly efficient, effective government leadership. In this case, such leadership didn’t appear to exist.

    Here are the four main reasons the testing issues have been so bad:

    RED TAPE

    The Food and Drug Administration has a protocol called emergency use authorization, or EUA, through which it clears tests from labs around the country for use in an outbreak. Getting more of these tests up and running would greatly increase the capacity of doctors and public-health officials to screen patients for the coronavirus.

    Former FDA officials I spoke with said that during past outbreaks, EUAs could be granted in just a couple of days. But this time, the requirements for getting an EUA were so complicated that it would have taken weeks to receive one, says Alex Greninger, the assistant director of the virology division at the University of Washington Medical Center, which is located right near the heart of the American outbreak. Greninger told me clinical labs were not allowed to begin testing at all before they had received the EUA, even if they had already internally made sure their tests worked. Though these regulations are in place to ensure that faulty lab tests don’t get used on patients, several microbiologists told me they felt the precautions were excessive for a fast-moving outbreak of this scale. “The speed of this virus versus the speed of the FDA and the EUA process is mismatched,” he said.

    On February 28, Greninger and dozens of other clinical microbiologists wrote a letter to Congress complaining that the EUA process was slowing down the ability of their labs to deploy coronavirus tests. “Many of our clinical laboratories have already validated [tests] that we could begin testing with tomorrow, but cannot due [to] the FDA EUA process,” they wrote. The following day, the FDA changed the EUA process so that labs like Greninger’s could begin testing—they would just have to submit data for the FDA’s authorization two weeks later. But weeks had already passed during which many labs and hospitals were unable to use their tests.

    “The EUA pathway 
 has served for Ebola and Zika, etc.,” says Mark Miller, the chief medical officer at bioMĂ©rieux, an infectious-disease diagnostic company based in France. “And then you have a situation like now with coronavirus, which I don’t think any of us have ever lived through.”

    Margaret Hamburg, who served as the FDA commissioner from 2009 to 2015, told me that while she doesn’t have knowledge of what went on inside the FDA over the past few months, the agency could have proactively reached out to different national and international labs to see whether their tests could be approved for use in the U.S. For example, the FDA might ask a lab, “Would you be interested to try to redirect what you were doing for a MERS diagnostic to a novel-coronavirus diagnostic?” she says. Instead, as The New York Times reported, federal officials told one Seattle infectious-disease expert, Helen Chu, to stop testing for the coronavirus entirely. (In an email, an FDA spokesperson denied that the agency acted slowly. Ensuring the validity of tests is important, she noted, to prevent false results.)

    It looks like Chu was not alone. Dozens of labs in the U.S. were eager to make tests and willing to test patients, but they were hamstrung by regulations for most of February, even as the virus crept silently across the nation.

    HARD-TO-GET VIRUS SAMPLES

    Labs and companies need samples of the virus itself in order to make their tests, but delays in getting access to samples further slowed down the test-development process. The coronavirus originated in China, and as several microbiologists told me, the Chinese government does not allow specimens to be shipped outside its borders.

    Many researchers have had difficulty getting their hands on samples even as the virus has spread. “I was working the phones to try to get access to the virus,” Greninger said.

    BioMĂ©rieux just released three versions of its coronavirus test this week, after beginning work on it on January 23. Miller says that with every viral outbreak, the company’s biggest problem by far is getting access to virus and patient specimens so that it can validate its tests. Even when working with nonauthoritarian countries, a combination of government processes, researcher reticence, complex shipping regulations, and patient-privacy concerns makes getting samples difficult for diagnostic companies like his.

    Miller said it would help if researchers, governments, and companies firmed up pathogen-sharing contracts in advance of an outbreak, but so far that hasn’t happened. “The problem is that in the past, industry has been viewed as this dirty participant in all of this, and we can’t be trusted, and why would I have contracts with you?” Miller says. “But that’s ignoring the plain fact that we’re the ones that create the product in the end.”

    LACKING EQUIPMENT

    The type of test Greninger is making is called a lab-developed test. To be used in other labs, his test requires special instruments that extract and then amplify the RNA that makes up the virus. However, labs across the country—like those at many county hospitals—don’t have the tools to do this. They can only run a simple type of test called a sample-to-answer test. As late as this week, several lab directors told me that no sample-to-answer versions of the coronavirus test had been approved in the U.S. “That means that the vast majority of clinical labs in this country will not be able to do in-house testing at this time,” says Susan Butler Wu, an associate professor of clinical pathology at the University of Southern California.

    The U.S. health-care system is broken up into state and county public-health laboratories, which have different equipment than academic research institutions, which have different equipment than hospitals that diagnose patients. So the same test won’t necessarily work in different places. “We don’t have a nationalized health-care system where you put the same equipment in all the hospitals,” Wu says. “We have all these independent hospital systems with their own equipment in their own labs.”

    Even though some hospitals actually have the new, functional CDC tests, the extraction machines and reagents that are used to perform them are in short supply. “We’ve been pleading to the research laboratories to please, if they have RNA-extraction machines, to give them to the hospital,” says Michael Mina, an associate medical director in the department of pathology at Brigham and Women’s Hospital in Boston.

    LEADERSHIP AND COORDINATION PROBLEMS

    For months, President Trump has made light of the coronavirus, telling attendees at a Black History Month reception, for instance, that perhaps the virus could miraculously disappear. He claimed on Twitter that the U.S. has done a “great job” handling the outbreak. Such a cavalier attitude seems unlikely to have motivated health officials to take things seriously. It also contradicted advice from most public-health experts. Even Scott Gottlieb, who recently resigned as Trump’s FDA commissioner, wrote in The Wall Street Journal on February 4 that “it’s time to start testing more people.”

    Containing a new infectious disease requires a lot of close collaboration between the president, the CDC, the FDA, and other parts of the Department of Health and Human Services, several Obama-era health officials told me. “One reason we were able to move quickly [during the Ebola outbreak] was that there was a great deal of coordination and issue spotting and troubleshooting that went on,” Hamburg, the former FDA commissioner, told me.

    The different arms of the sprawling health department have to feel like they’re all pulling toward the same goal. “I think you have fabulous people at CDC and FDA all doing the best they can, but we always found it was incredibly important to have all the agencies together in the same room,” says Jesse Goodman, a former FDA chief scientist who helped manage the country’s response to the 2009 H1N1 outbreak. When issues came up that merited the attention of the White House, he says, they got it.

    Though Trump has proposed a payroll-tax break, as my colleague Peter Nicholas has pointed out, “Much of what he’s said publicly about the virus has been wrong, a consequence of downplaying any troubles on his watch.”

    On top of that, there’s reportedly been tension and infighting between the president and his HHS secretary, Alex Azar, as well as between the FDA and the CDC. Politico reported that Vice President Mike Pence, who has no background in public health, repeatedly sidelined Azar from the coronavirus-response task force, and the White House appears to be blaming Azar for any failures in its coronavirus response. Politico also reported that an FDA scientist was “initially rebuffed”—made to wait overnight—when he attempted to visit the CDC in order to help coordinate testing. (In an email, a CDC spokesperson said this was “in full compliance with standard security processes required for all individuals whether they are federal employees or other visitors.”)

    “I gather that there was a huge amount of infighting about who could or who should lead this, and there was a sense that a lot of people [inside HHS] weren’t considering it a major threat,” said a former Obama-administration official who has been in contact with current staffers and who related these private discussions under the condition of anonymity. “And why that was, I don’t know.”

    It’s possible that all of these other hurdles could have been cleared if officials at the highest levels of government had been working together smoothly. Instead, we’ve seen confusion, doubt, and even more delays.

    March 17, 2020 at 4:46 am #112441

    In reply to: notes from expert panel on the virus & other expert views

    Avatar photozn
    Moderator

    Dr. Rob Davidson@DrRobDavidson
    As an ER doc trying to treat patients who may have COVID-19, I can’t underscore enough how much harder the lack of testing is making our job. Yes we’re used to making life-or-death decisions with limited information, daily. But this scenario is very different. Here’s why: (1/12)

    For us data is everything. Board Certified Emergency Physicians (ER docs) are trained in pattern recognition & rely on research to know when the preponderance of evidence directs us toward one or another path of treatment that could significantly help or harm our patients. (2/12)

    With COVID-19, we doctors have very little evidence-based data on the basic science of transmissibility, incubation period or even what measures would be taken to protect patients (& providers). Our best evidence? What has occurred in China, South Korea & Italy thus far… (3/12)

    But the difference with these other countries with COVID-19 is that at the earliest point possible, a huge testing regime was used to determine the extent of the virus in the hospitalized “very sick” population & the “walking well” less-sick population. We don’t have that. (4/12)

    Because this novel #coronavirus causes such minimal symptoms in so many young people (including children) — as well as in older people at the onset of disease — we’re not able to determine cases based on symptoms. This is how we managed the SARS outbreak of 2002-2003. (5/12)

    SARS had a case-fatality rate of 10%, but the ability to ID cases early & isolate them significantly, limited its spread and kept fatalities relatively low. By contrast, COVID-19 cases are difficult to ID early above the background level of other respiratory viruses. (6/12)

    During the H1N1 influenza pandemic of 2009, the case-fatality rate was 0.1%, slightly higher than seasonal flu. That’s also ~50% less contagious than COVID-19. The point? With a highly contagious virus that’s difficult to diagnose clinically, early testing is critical. (7/12)

    Here’s the kicker: WHO had a test that worked, but it was rejected by the U.S. in January. Then, initial attempts to make our own test failed. As a result, as an ER doc I can’t get most patients tested. And it’s now known that the virus has been here for several weeks. (8/12)

    To get a patient tested, they have to have traveled to certain countries, had direct contact with a COVID19+ patient, or be ill enough to be hospitalized & have no other diagnosis. There’s no way around it: Tests are being rationed due to the Administration’s mismanagement.(9/12)

    Right now we’re not truly defining the extent of the virus in communities. Short of a complete lockdown,we’re dependent on everyone exercising caution when they have even minor symptoms, to avoid infecting those most at risk of dying (elderly & those with chronic disease).(10/12)

    The only path forward is a massive testing regime ID’ing relatively healthy individuals who are infected.Only then can containment stop the spread in communities. And perhaps the more “walking well” positives we get, the more we can convince people that the threat is real.(11/12)

    To be blunt: Our ability to fight this virus has been seriously hurt by right-wing pundits & the President, who convinced people it’s “just a cold” and will go away “like that.” For us ER docs to do our job, those comments need to stop. And massive testing needs to start. /END.

    March 15, 2020 at 8:12 pm #112384

    In reply to: notes from expert panel on the virus & other expert views

    Avatar photonittany ram
    Moderator
    wv wrote:

    Do we have any logic-based-guesses on when the Virus is really gonna get going in the USA ? How soon before it gets rolling? Do we know?

    w
    v

    It’s hard to get good estimates because we aren’t doing enough testing. It could be rolling right now. We could be a couple weeks away from the peak. It’s hard to say. This disease has an estimated R0 of about 2.5 to 3.2, meaning one person with the disease infects between 2.5 and 3.2 others. Compare that with the seasonal flu which has an R0 of between 1 and 2. That means when COVID-19 begins rolling, it could really roll.

    Btw, we now have 3 positive patients in our small community hospital. That’s 3 positives in about 80 tests which doesn’t sound terrible, but 2 of those positives were in the last 10 tests. Shit might be about to get real.

    • This reply was modified 6 years, 7 months ago by Avatar photonittany ram.
    March 15, 2020 at 1:31 am #112321

    In reply to: notes from expert panel on the virus & other expert views

    Avatar photozn
    Moderator

    from This coronavirus is unlike anything in our lifetime, and we have to stop comparing it to the flu

    Business Insider

    https://www.yahoo.com/news/coronavirus-unlike-anything-lifetime-stop-201955346.html

    …

    Our health care system doesn’t have the capacity to deal with this.

    Epidemiological experts keep talking about the need to “flatten the curve.” What they mean by that is that we need to slow the speed at which new cases are reported. We may not be able to stop the spread of the coronavirus, but we have to try to manage it. If 1,000 new cases happen over a month instead of a week, the health care system is more able to handle them.

    Here’s why this is a worry: Overall, our hospitals have fewer beds than other developed countries, according to recent data from the Organization for Economic Cooperation and Development. The United States had 2.8 beds per 1,000 residents. By comparison, Germany had 8 beds and China 4.3 per 1,000.

    The United States looks better when it comes to intensive care beds, but there’s tremendous variation between regions and states. If we experience what parts of China and Italy saw, we won’t have anywhere for sick patients to go. We will quickly run out of capacity.

    Even if we have the capacity, we may not have enough supplies.

    In a crisis moment, supplies like ventilators and N95 face masks will be key. But as National Geographic and other media have reported, the United States has only a fraction of the medical supplies it needs.

    “Three hundred million respirators and face masks. That’s what the United States needs as soon as possible to protect health workers against the coronavirus threat. But the nation’s emergency stockpile has less than 15 percent of these supplies,” the magazine reported.

    Others have reported shortfalls as well, and ProPublica has been hearing from health care professionals across the country who say their own institutions are running short of supplies. (Share your story here.)

    U.S. Surgeon General Jerome Adams tweeted at the end of February, “Seriously people- STOP BUYING MASKS! They are NOT effective in preventing general public from catching #Coronavirus, but if healthcare providers can’t get them to care for sick patients, it puts them and our communities at risk!”

    Another challenge: Hospital staff have been exposed too.

    And if that weren’t enough, there’s another problem. Health care workers who have been exposed to the virus are now quarantining themselves, further reducing available staff at hospitals. Kaiser Health News reported on the effects of this:

    “In Vacaville, California, alone, one case — the first documented instance of community transmission in the U.S. — left more than 200 hospital workers under quarantine and unable to work for weeks.

    “Across California, dozens more health care workers have been ordered home because of possible contagion in response to more than 80 confirmed cases as of Sunday afternoon. In Kirkland, Washington, more than a quarter of the city’s fire department was quarantined after exposure to a handful of infected patients at the Life Care Center nursing home.”

    This week, Banner Health in Colorado informed employees that a co-worker is among those with the coronavirus, The Colorado Sun reported. “People who came into prolonged, close contact with the woman in a Banner Health emergency room are being notified and asked to home-quarantine for 14 days, according to a source close to the investigation who spoke to The Sun on the condition of anonymity.”

    And my ProPublica colleagues reported Friday how some EMS workers are also being quarantined because of exposure. (It didn’t help, of course, that the EMS system was slow to get up to speed on the threat.)

    More than that, many health care workers have children and as schools begin to close, they have to figure out how to care for their own families.

    People in rural areas will have little care nearby should they be affected by COVID-19.
    Rural areas in the U.S. are losing their hospitals entirely, and residents are having to travel hours for care. According to the Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill, 126 rural hospitals have closed since 2010, including six so far this year. That’s about 6%.

    An analysis by the Chartis Center for Rural Health and iVantage Health Analytics this year found that about a quarter of the nation’s 1,844 open rural hospitalsare vulnerable.

    As The Washington Post described it last year, “Hospitals like Fairfax Community [in Oklahoma] treat patients that are on average six years older and 40 percent poorer than those in urban hospitals, which means rural hospitals have suffered disproportionately from government cuts to Medicaid and Medicare reimbursement rates. They also treat a higher percentage of uninsured patients, resulting in unpaid bills and rising debts.

    “A record 46 percent of rural hospitals lost money last year. More than 400 are classified by health officials as being at ‘high risk of imminent failure.’ Hundreds more have cut services or turned over control to outside ownership groups in an attempt to stave off closure.”

    …

    March 14, 2020 at 10:21 pm #112300

    In reply to: International articles, stuff, on Coronavirus… + Italy v. Singapore etc.

    Avatar photozn
    Moderator

    They’ve Contained the Coronavirus. Here’s How.
    Singapore, Taiwan and Hong Kong have brought outbreaks under control — and without resorting to China’s draconian measures.

    March 13, 2020

    link https://www.nytimes.com/2020/03/13/opinion/coronavirus-best-response.html

    HONG KONG — While the spread of Covid-19 is picking up speed in Europe and the United States, among other regions, the outbreaks in some countries in Asia seem to be under control.

    The epidemic in China appears to be slowing down after an explosion in cases followed by weeks of draconian control measures. And other locations have managed to avert any major outbreak by adopting far less drastic measures: for instance, Hong Kong, Singapore and Taiwan.

    All have made some degree of progress, and yet each has adopted different sets of measures. So what, precisely, works to contain the spread of this coronavirus, and can that be implemented elsewhere now?

    In late January, after a sluggish — and problematic — initial response, the government of mainland China put in place unprecedented containment and social distancing measures. It locked down major cities, notably Wuhan, the epicenter of the outbreak, and imposed various travel restrictions throughout the country.

    The testing capacity of laboratories was rapidly expanded. To relieve pressure on hospitals, patients with milder symptoms were placed in temporary isolation facilities set up in gymnasiums and event halls. New hospitals were constructed.

    People who had come into contact with anyone infected were sent to designated facilities, typically converted hotels or hostels, for prophylactic quarantine. Home quarantine was advised only for those only at slight risk of infection.

    Initially, almost all residents of Wuhan and other affected cities were required to stay at home; schools and workplaces remained closed well after the end of the Lunar New Year festival, around Jan. 27.

    The scale of these measures has been extraordinary: Almost 60 million people were placed under lockdown in Hubei Province alone, and most factories in the province are expected to remain shut until March 20. The economic costs are enormous. Already in early February, about one-third of approximately 1,000 small and medium-size businesses interviewed for one survey said they had only enough cash to survive for a month.

    But the restrictions seemed to have worked to contain the spread of Covid-19 in China: The number of new cases reported every day is now consistently much lower than it was a few weeks ago.

    But lockdowns and forced quarantines on this scale or the nature of some methods — like the collection of mobile phone location data and facial recognition technology to track people’s movements — cannot readily be replicated in other countries, especially democratic ones with institutional protections for individual rights.

    And so Singapore, Taiwan and Hong Kong might be more instructive examples. All three places were especially vulnerable to the spread of the infection because of close links with mainland China — especially in early January, as they were prime destinations for Chinese travelers during the upcoming Lunar New Year holiday. And yet, after all three experienced outbreaks of their own, the situation seems to have stabilized.

    As of midday Friday, Singapore had 187 cases confirmed and no deaths (for a total population of about 5.7 million), Taiwan had 50 confirmed cases including 1 death (for a total population of about 23.6 million) and Hong Kong had 131 confirmed cases including 4 deaths (for a total population of about 7.5 million).

    Since identifying the first infections (all imported) on their territories — on Jan. 21 in Taiwan and on Jan. 23 in both Hong Kong and Singapore — all three governments have implemented some combination of measures to (1) reduce the arrival of new cases into the community (travel restrictions), (2) specifically prevent possible transmission between known cases and the local population (quarantines) and (3) generally suppress silent transmission in the community by reducing contact between individuals (self-isolation, social distancing, heightened hygiene). But each has had a different approach.

    Singapore, an island, could readily take aggressive measures to block the arrival of the infection from China — and it did. Three days after the Chinese authorities alerted the world about the outbreak in Wuhan, Singapore started referring inbound travelers from Wuhan with a fever and respiratory symptoms for further assessment and isolation. It was also one of the first countries to cancel all inbound flights from Wuhan after identifying its first imported case.

    Travelers coming from affected areas were placed under mandatory quarantine; three university hostels were promptly converted into facilities to host them. The government compensated individuals and employers for any workdays lost.

    The Singapore authorities undertook especially intensive efforts to trace the contacts of people known to be infected. Hospital staff went to great lengths to interview patients about their recent whereabouts; when information was unclear or unavailable, the Ministry of Health retrieved additional data from transport companies and hotels, including by consulting CCTV footage.

    Large gatherings have been suspended. But to minimize social and economic costs, schools and workplaces have remained open. The Singaporean Ministry of Education — on an extensive FAQs web page — calls the closing of schools “a major, major decision” that would “disrupt many lives.” Instead, students and staff are subjected to daily health checks, including temperature screenings.

    Public-health campaigns were also reinforced to further improve Singapore’s already exemplary standards of cleanliness and public hygiene. A special government task force recently recommended five personal hygiene habits:using a tissue when coughing or sneezing; using designated serving spoons during group meals; using trays when eating or drinking to limit contamination in case of spills; keeping public toilets clean and dry; and regular hand washing. From the outset, the government has recommended the use of masks only for people who already are unwell.

    Taiwan, also an island, took a slightly different tack. Instead of promptly banning travel from China, it undertook a comprehensive effort to screen newcomers from suspect areas. As soon as early January — just days after the news of the outbreak in Wuhan — Taiwanese medical authorities would board incoming flights from Wuhan and inspect and screen travelers on the planes.

    It was only after the first imported case was identified on Jan. 21 that four major airlines suspended flights between Taiwan and Wuhan. A ban on all but flights from Beijing, Shanghai, Xiamen and Chengdu was implemented three weeks later.

    Taiwan has also taken a rather mixed approach in its efforts to reduce transmission within the community.

    Some state-run facilities have been used for quarantines, but home quarantine has been the predominant method of isolation even when state facilities were available. To ensure compliance, the government has enforced strict penalties against anyone who breaks an isolation order, including fines up to about $33,200.

    Organizers of mass events were encouraged to defer or cancel events; some religious institutions suspended services. It was announced that elementary schools and high schools would remain closed after the end of the Lunar New Year holidays, but only for two weeks. In fact, classes resumed on Feb. 25.

    The Taiwanese authorities also oversaw the controlled distribution of surgical masks from existing stockpiles through community stores, having also fixed their price. Taiwan’s main health messages — “Wear a surgical mask when coughing or sneezing,” “Wash hands thoroughly with soap” and “Avoid crowded places, including hospitals” — were displayed prominently on the Centers for Disease Control’s website.

    As of Friday, about 58 percent of all confirmed cases in Taiwan were believed to have resulted from local transmission. This is an important marker of success for Taiwan’s containment strategy: In many other places, local cases outnumbered imported infections by a far greater margin.

    Hong Kong adopted yet another approach, presumably in part because, unlike Taiwan and Singapore, the city shares a border with mainland China and is formally part of China, as a Special Administrative Region. (An average of 300,000 people crossed the border every day last year.) The authorities here focused less on completely blocking the entry of possibly infected people into the territory than on preventing transmission within the community.

    On Jan. 3 — again, very soon after the first declared case in Wuhan — existing temperature-screening stations at ports of entry were expanded, and local clinicians were asked to report to the city’s health authorities any patient with a fever or acute respiratory symptoms and a history of recent travel to Wuhan.

    But it took five days after the first imported case for travel restrictions to be placed on visitors from Wuhan and other affected areas and for six of the territory’s 14 border crossings with the mainland to be closed. (Another five crossings were closed later.) The number of visitors to Hong Kong from mainland China fell to a daily average of 750 in February.

    Starting on Feb. 5, anyone coming across the border — or arriving from elsewhere who had been in mainland China in the preceding 14 days — was required to undergo a mandatory 14-day period of self-quarantine.

    Extensive efforts have also been made to track down and quarantine the close contacts of confirmed cases. And in the event transmission might occur before an infected person displayed any symptoms, tracing included all contacts starting two days before the onset of the patient’s illness.

    Of Hong Kong’s 40,000 hospital beds, some 1,000 are negative-pressure beds, allowing confirmed cases to be properly isolated. Holiday camps and newly constructed public-housing units that were still vacant were rapidly repurposed into quarantine facilities.

    As of March 12, 62 of the city’s 131 confirmed cases were thought to have resulted from close contact with other confirmed cases. More than 24,700 people were still under quarantine this week.

    Hong Kong has also deployed very extensive measures to encourage social distancing. As early as Jan. 28, many civil servants were asked to work from home for the following month. Most large-scale events have been canceled or postponed. On Jan. 27, all kindergartens and schools were closed until Feb. 16; the decision was extended several times, most recently to at least April 20. Many classes have been conducted online.

    Although it’s still not clear whether or how much children contract and spread Covid-19, they are known major contributors to the transmission of influenza, and Hong Kong has been effective in stemming outbreaks of the flu by suspending classes four times over the past 12 years (in 2008, 2009, 2018 and 2019). Closing schools is a very invasive measure, but Hong Kong has a social structure that helps cushion some of the burden: Many families with two working parents already rely on domestic helpers or grandparents for child care.

    The government has mounted a public-education campaign to promote hand hygiene and environmental hygiene. Nearly everyone in Hong Kong wears a face mask in public.

    And now, the caveats. Singapore, Taiwan and Hong Kong, as well as China, all had to contend with the SARS outbreak of 2002-3 and they internalized the lessons of that experience. Institutionally, this has meant, among other things, that they developed testing capacity for new viruses as well as hospitals’ ability to handle patients with novel respiratory pathogens. At the individual level, the experience of SARS has prepared people to voluntarily display a tremendous amount of self-discipline in, say, avoiding crowds and heightening their personal hygiene. These places were better equipped to face an outbreak of the new coronavirus than many others.

    At the same time, if the inroads Singapore, Taiwan and Hong Kong — China, too — have made against Covid-19 are promising, these gains also are fragile. These governments will need to keep at their containment measures for many more months or else risk a surge in infections. Taiwan seems especially vulnerable because it appears not to be testing people enough.

    The Chinese government has taken something of a victory lap recently, prematurely. But even it seems to know that, despite its bluster: Judging from bans China is now imposing on travelers from certain European countries, it is well aware that cases of infection could be reintroduced from abroad.

    Containment, however valiant an aim, also comes with very high costs, social and economic, and it might be an impossible goal for some countries, especially by now. In some places, Covid-19 could already be too widespread to be stopped. The vast majority of infections still appear to be mild, though; many might not even require medical attention. In such cases, it would be better to forgo trying to contain the disease and instead focus on mitigating its worst effects, for example, by concentrating resources on preventing an overwhelming surge in demand for hospital care, particularly intensive care.

    Still, the central point is this: Each in its own way, Singapore, Taiwan and Hong Kong — three places with markedly different socioeconomic and political features — have been able to interrupt the chain of the disease’s transmission. And they have done so without embracing the highly disruptive, drastic measures adopted by China. Their success suggests that other governments can make headway, too.

    March 14, 2020 at 10:18 pm #112299

    In reply to: International articles, stuff, on Coronavirus… + Italy v. Singapore etc.

    Avatar photozn
    Moderator

    Italy’s Health Care System Groans Under Coronavirus — a Warning to the World
    In less than three weeks, the virus has overloaded hospitals in northern Italy, offering a glimpse of what countries face if they cannot slow the contagion.

    link https://www.nytimes.com/2020/03/12/world/europe/12italy-coronavirus-health-care.html

    ROME — The mayor of one town complained that doctors were forced to decide not to treat the very old, leaving them to die. In another town, patients with coronavirus-caused pneumonia were being sent home. Elsewhere, a nurse collapsed with her mask on, her photograph becoming a symbol of overwhelmed medical staff.

    In less than three weeks, the coronavirus has overloaded the health care system all over northern Italy. It has turned the hard hit Lombardy region into a grim glimpse of what awaits countries if they cannot slow the spread of the virus and ‘‘flatten the curve’’ of new cases — allowing the sick to be treated without swamping the capacity of hospitals.

    If not, even hospitals in developed countries with the world’s best health care risk becoming triage wards, forcing ordinary doctors and nurses to make extraordinary decisions about who may live and who may die. Wealthy northern Italy is facing a version of that nightmare already.

    “This is a war,” said Massimo Puoti, the head of infectious medicine at Milan’s Niguarda hospital, one of the largest in Lombardy, the northern Italian region at the heart of the country’s coronavirus epidemic.

    He said the goal was to limit infections, stave off the epidemic and learn more about the nature of the enemy. “We need time.”

    This week Italy put in place draconian measures — restricting movement and closing all stores except for pharmacies, groceries and other essential services. But they did not come in time to prevent the surge of cases that has deeply taxed the capacity even of a well-regarded health care system.

    Italy’s experience has now underscored the need to act decisively — quickly and early — well before case numbers even appear to reach crisis levels. By that point, it may already be too late to prevent a spike in cases that stretches systems beyond their limits.

    With Italy having appeared to pass that threshold, its doctors are finding themselves in an extraordinary position largely unseen by developed European nations with public health care systems since the Second World War.

    Regular doctors are suddenly shifting to wartime footing. They face questions of triage as surgeries are canceled, respirators become rare resources, and officials propose converting abandoned exposition spaces into vast intensive care wards.

    Hospitals are erecting inflatable, sealed-off infectious disease tents on their grounds. In Brescia, patients are crowded into hallways.

    Get an informed guide to the global outbreak with our daily coronavirus newsletter.

    “We live in a system in which we guarantee health and the right of everyone to be cured,” Prime Minister Giuseppe Conte said on Monday as he announced the measures to keep Italians in their homes.

    “It’s a foundation, a pillar, and I’d say a characteristic of our system of civilization,” he said. “And thus we can’t allow ourselves to let our guard down.”

    For now, Italian public health experts argue that the system, while deeply challenged, is holding, and that all the thousands of people receiving tests, emergency room visits and intensive care, are getting it for free, keeping a central principle of Italian democracy intact.

    But before the region of Lombardy centralized its communication on Thursday and seemed to muzzle doctors and nurses who spoke out about the conditions, there emerged troubling pictures of life inside the trenches against the infection.

    A photo of one nurse, Elena Pagliarini, who collapsed face down with her mask on in a hospital in the northern town of Cremona after 10 straight hours of work, became a symbol of an overwhelmed system.

    “We are on our last legs, physically and physiologically,” Francesca Mangiatordi, a colleague who took the picture said on Italian television on Wednesday, urging people to protect themselves to avoid spreading the virus. “Otherwise the situation will collapse, provided it hasn’t already.”

    A doctor in a hospital in Bergamo this week posted on social media a graphic account of the stress on the health system by the overwhelming number of patients.

    “The war has literally exploded and battles are uninterrupted day and night,” the doctor, Daniele Macchini wrote, calling the situation an “epidemiological disaster” that has “overwhelmed” the doctors.

    Fabiano Di Marco, head of pulmonology at the Papa Giovanni XXIII hospital in Bergamo, where he has taken to sleeping in his office, said Thursday that doctors literally “draw a line on the ground to divide the clean part of the hospital from the dirty one,” where anything they touch is considered contagious.

    Giorgo Gori, the mayor of Bergamo, said that in some cases in Lombardy the gap between resources and the enormous influx of patients “forced the doctors to decide not to intubate some very old patients,” essentially leaving them to die.

    “Were there more intensive care units,” he added, “it would have been possible to save more lives.”

    Dr. Di Marco disputed the claim of his mayor, saying that everyone received care, though he added, “it is evident that in this moment, in some cases, it could happen that we have a comparative evaluation between patients.”

    On Thursday, Flavia Petrini, the president of the Italian College of Anesthesia, Analgesia, Resuscitation and Intensive Care, said her group had issued guidelines on what to do in a period that bordered on wartime “catastrophe medicine.”

    “In a context of grave shortage of health resources,” the guidelines say, intensive care should be given to “patients with the best chance of success” and those with the “best hope of life” should be prioritized.

    The guidelines also say that in “in the interests of maximizing benefits for the largest number,” limits could be put on intensive care units to reserve scarce resources to those who have, first, “greater likelihood of survival and secondly who have more potential years of life.”

    “No one is getting kicked out, but we’re offering criteria of priority,” Dr. Petrini said. “These choices are made in normal times, but what’s not normal is when you have to assist 600 people all at once.”

    Giulio Gallera, the Lombardy official leading the emergency response, said on Thursday that he hoped the guidelines never needed to be applied.

    He also said the region was working with Italy’s civil protection agency to study the possibility of using an exhibition space abandoned by canceled conventions as a 500-bed intensive care ward.

    But, he said, the region needed doctors, and respirators.

    “The outbreak has put hospitals under a stress that has no precedents since the Second World War,” said Massimo Galli, the director of infectious diseases at Milan’s Sacco University hospital, which is treating many of the coronavirus patients. “If the tide continues to rise, attempts to build dams to retain it will become increasingly difficult.”

    Dr. Galli pointed out that while the government’s emergency decrees had sought to boost the hiring of thousands of doctors and health workers — including medical residents in their last years of medical school — it took time to train new doctors, even those transferred from other departments, who had little experience with infectious diseases. Doctors are also highly exposed to contagion.

    Matteo Stocco, the director of the San Paolo and San Carlo hospitals in Milan, said 13 members of his staff were home after testing positive for the virus. One of his primary emergency room doctors was also infected, he said, “after three weeks of continuous work, day and night on the field.”

    Dr. Puoti, of Niguarda hospital, said the doctors kept distance from one another in the cafeteria, wore masks during staff meetings and avoided gathering in small rooms. Still, he said, some had been infected, which created the risk of greater personnel shortages.

    “We’re trying to keep a humanly sustainable level of work,” he said. “Because this thing is going to last.”

    He said the hospital was trying to buy more respirators and preparing for the possibility that patients would come not only from the surrounding towns, but because of a wave of infections in Milan.

    Dr. Stocco said that moment had already arrived.

    Fifty people showed up in the emergency room on Thursday afternoon with respiratory problems, he said. The hospital had already canceled surgeries and diverted beds and respirators to coronavirus patients, and doubled its intensive care capacity.

    “The infection is here,” he said.

    Carlo Palermo, president of the association representing Italy’s public hospital doctors, said the system had so far held up, despite years of budget cuts. It also helped, he said, that it was a public system. Had it been an insurance-based system, there would have been a “fragmented” response, he said.

    He said that since about 50 percent of the people who tested positive for the virus required some form of hospitalization, there was an obvious stress on the system. But the 10 percent needing intensive care, which requires between two and three weeks in the hospital, “can saturate the capacity of response.”

    Many experts have noted that if the wealthy and sophisticated northern Italian health care system cannot bear the brunt of the outbreak, it is highly unlikely that the poorer south would be able to cope.

    If the virus spread south at the same rate, Dr. Palermo said, “the system won’t hold up, and we won’t be able to assure care.”

    Many experts have warned that Italy is about 10 days ahead of other European countries in the development of its outbreak. Chancellor Angela Merkel of Germany has raised the alarm that about 70 percent of Germans could get the virus.

    And reports of the overwhelmed Italian system have resonated in the United States, where President Trump closed flights to foreigners coming from Europe on Wednesday night.

    “The Italian disease is becoming a European disease and Trump, with his decision, is trying to avoid that this becomes an American disease,” said Romano Prodi, a former Italian prime minister and president of the European Union commission.

    “In any case I think that coronavirus is already also an American problem,” he said, adding that, because of the difference in the health care system, “it may be more serious than the European one.”

    March 14, 2020 at 10:57 am #112269

    In reply to: This President has got to go

    Cal
    Participant
    Mackeyser wrote:

    Italy 2.6%
    China 3.5%
    Iran 10.6%

    USA is currently at 2.7% We’ve only conducted 7000 tests TOTAL in the entire US thus far.

    We have ZERO handle on this, Drs are SCREAMING about symptomatic patients not being able to get tested and NO ONE knowing what to do if they clearly have COVID.

    It is entirely possible using the 70% threshold and just Iran’s numbers (ours could be substantially worse considering the federal and state responses), we’re looking at potentially 24.4M DEAD.

    As bad as Trump’s gov’t is handling the covid crisis, I think it’s unwise to think even 1 million people die in the US from Covid.

    The country is taking the virus seriously now with schools, sports, and events being cancelled. Even though our system is incredibly screwed up because of Trump, there’s still lots of professionals who will do a good job. The US probably won’t come close to doing as good as Germany and South Korea. But Germany has 4,000 cases and 8 deaths. Yes EIGHT!

    So this virus is hardly the 1918 Spanish Flu pandemic where millions died.

    And you can bet that Trump will be crowing about how well he managed the crisis.

    March 13, 2020 at 9:53 pm #112257

    In reply to: notes from expert panel on the virus & other expert views

    Avatar photowv
    Participant

    This site is purty good on the basics, Invader. At least thats what I’ve been told. See the actual link. I just cut and pasted a bit of it.
    Its ‘mutating’ btw. Two distinct strains as of now, from what i read from a Doc on a message board.

    link:https://emcrit.org/ibcc/covid19/

    basics

    COVID-19 is a non-segmented, positive sense RNA virus.
    COVID-19 is part of the family of coronaviruses. This contains:
    (i) Four coronaviruses which are widely distributed and usually cause the common cold (but can cause viral pneumonia in patients with comorbidities).
    (ii) SARS and MERS – these caused epidemics with high mortality which are somewhat similar to COVID-19. COVID-19 is most closely related to SARS.
    It binds via the angiotensin-converting enzyme 2 (ACE2) receptor located on type II alveolar cells and intestinal epithelia (Hamming 2004).
    This is the same receptor as used by SARS (hence the technical name for the COVID-19, “SARS-CoV-2”).
    When considering possible therapies, SARS (a.k.a. “SARS-CoV-1”) is the most closely related virus to COVID-19.
    COVID-19 is mutating, which may complicate matters even further (figure below). Virulence and transmission will shift over times, in ways which we cannot predict. New evidence suggests that there are roughly two different groups of COVID-19. This explains why initial reports from Wuhan described a higher mortality than some more recent case series (Tang et al. 2020; Xu et al 2020).
    (Ongoing phylogenetic mapping of new strains can be found here.)
    ———–

    stages of illness ??

    There seem to be different stages of illness that patients may move through.
    (#1) Replicative stage – Viral replication occurs over a period of several days. An innate immune response occurs, but this response fails to contain the virus. Relatively mild symptoms may occur due to direct viral cytopathic effect and innate immune responses.
    (#2) Adaptive immunity stage – An adaptive immune response eventually kicks into gear. This leads to falling titers of virus. However, it may also increase levels of inflammatory cytokines and lead to tissue damage – causing clinical deterioration. There is a suggestion that this could lead to virus-induced hemophagocytic lymphohistiocytosis (HLH)(Mehta et al.). More discussion about this entity and possible therapy here.
    This progression may explain the clinical phenomenon wherein patients are relatively OK for several days, but then suddenly deteriorate when they enter the adaptive immunity stage (e.g. Young et al. 3/3/2020).
    This has potentially important clinical implications:
    Initial clinical symptoms aren’t necessarily predictive of future deterioration. Sophisticated strategies may be required to guide risk-stratification and disposition (see below section on prognosis).
    Anti-viral therapies might need to be deployed early to work optimally (during the replicative stage).
    Immunosuppressive therapy (e.g. low-dose steroid) might be best initiated during the adaptive immune stage (with a goal of blunting this immunopathologic response slightly, in the sickest patients). But this is purely speculative.

    transmission

    (back to contents)
    large droplet transmission

    COVID-19 transmission can occur via large droplet transmission (with a risk limited to ~6 feet from the patient)(Carlos del Rio 2/28).
    This is typical for respiratory viruses such as influenza.
    Transmission via large droplet transmission can be prevented by using a standard surgical-style mask.

    airborne transmission ??

    It’s controversial whether COVID19 can be transmitted via an airborne route (small particles which remain aloft in the air for longer periods of time). Airborne transmission would imply the need for N95 masks (“FFP2” in Europe), rather than surgical masks. This controversy is explored further in Shiu et al 2019.
    Airborne precautions started being used with MERS and SARS out of an abundance of caution (rather than any clear evidence that coronaviruses are transmitted via an airborne route). This practice has often been carried down to COVID19.
    Guidelines disagree about whether to use airborne precautions:
    The Canadian Guidelines and World Health Organization guidelines both recommend using only droplet precautions for routine care of COVID19 patients. However, both of these guidelines recommend airborne precautions for procedures which generate aerosols (e.g. intubation, noninvasive ventilation, CPR, bag-mask ventilation, and bronchoscopy).
    The United States CDC recommends using airborne precautions all the time when managing COVID19 patients.
    Using airborne precautions for all patients who are definitely or potentially infected with COVID19 will likely result in rapid depletion of N95 masks. This will leave healthcare providers unprotected when they actually need these masks for aerosol-generating procedures.
    In the context of a pandemic, the Canadian and WHO guidelines may be more sensible in countries with finite resources (i.e. most locales). However, infection control is ultimately local, so be sure to follow your hospital’s guidance regarding this.

    contact transmission (“fomite-to-face”)

    This mode of transmission has a tendency to get overlooked, but it may be incredibly important. This is how it works:
    (i) Someone with coronavirus coughs, emitting large droplets containing the virus. Droplets settle on surfaces in the room, creating a thin film of coronavirus. The virus may be shed in nasal secretions as well, which could be transmitted to the environment.
    (ii) The virus persists on fomites in the environment. Human coronaviruses can survive on surfaces for up to about a week (Kampf et al 2020). It’s unknown how long COVID-19 can survive in the environment, but it might be even longer (some animal coronaviruses can survive for weeks!).
    (iii) Someone else touches the contaminated the surface hours or days later, transferring the virus to their hands.
    (iv) If the hands touch a mucous membrane (eyes, nose, or mouth), this may transmit the infection.
    Any effort to limit spread of the virus must block contact transmission. The above chain of events can be disrupted in a variety of ways:
    (a) Regular cleaning of environmental surfaces (e.g. using 70% ethanol or 0.5% sodium hypochlorite solutions; for details see Kampf et al 2020 and CDC guidelines).
    (b) Hand hygiene (high concentration ethanol neutralizes the virus and is easy to perform, so this might be preferable if hands aren’t visibly soiled)(Kampf 2017).
    (c) Avoidance of touching your face. This is nearly impossible, as we unconsciously touch our faces constantly. The main benefit of wearing a surgical mask could be that the mask acts as a physical barrier to prevent touching the mouth or nose.
    Any medical equipment could become contaminated with COVID-19 and potentially transfer virus to providers (e.g. stethoscope earpieces and shoes). A recent study found widespread deposition of COVID-19 in one patient’s room, but fortunately this seems to be removable by cleaning with sodium dichloroisocyanurate (Ong et al 2020).

    when can transmission occur?

    (#1) Asymptomatic transmission (in people with no or minimal symptoms) appears to be possible (Carlos del Rio 2/28).
    (#2) Transmission appears to occur over roughly ~8 days following the initiation of illness.
    Patients may continue to have positive pharyngeal PCR for weeks after convalescence (Lan 2/27). However, virus culture methods are unable to recover viable virus after ~8 days of clinical illness (Wolfel 2020). This implies that prolonged PCR positivity probably doesn’t correlate with clinical virus transmission. However, all subjects in Wolfel et al. had mild illness, so it remains possible that prolonged transmission could occur in more severe cases.
    CDC guidance is vague on how long patients with known COVID-19 should be isolated. It may be advisable to obtain two paired RT-PCR tests (one of the nasopharynx and one of the pharynx), with each pair collected >24 hours apart, prior to discontinuing precautions.

    R⌀

    R⌀ is the average number of people that an infected person transmits the virus to.
    If R⌀ is <1, the epidemic will burn out.
    If R⌀ = 1, then epidemic will continue at a steady pace.
    If R⌀ >1, the epidemic will increase exponentially.
    Current estimates put R⌀ at ~2.5-2.9 (Peng PWH et al, 2/28). This is a bit higher than seasonal influenza.
    R⌀ is a reflection of both the virus and also human behavior. Interventions such as social distancing and improved hygiene will decrease R⌀.
    Control of spread of COVID-19 in China proves that R⌀ is a modifiable number that can be reduced by effective public health interventions.
    The R⌀ on board the Diamond Princess cruise ship was 15 – illustrating that cramped quarters with inadequate hygiene will increase R⌀ (Rocklov 2/28).

    March 13, 2020 at 8:19 pm #112237

    In reply to: notes from expert panel on the virus & other expert views

    Avatar photonittany ram
    Moderator
    Zooey wrote:

    I read that even as more test kits come in, our facilities can run only about 1,000 tests/day anyway.

    But since there is nothing much that can be done for patients apart from IVs and comfort care, I’m not sure testing really makes that much difference. I don’t know what can be done except for everyone to stay away from crowds, wash hands all the time, and stop breathing.

    I hope RBG is in a bubble tent.

    Not testing from the beginning is where we really dropped the ball. Testing early and often is how you stop an outbreak in its tracks. It allows you to find and contain infected people before the disease gets into the community. Once its in the community, the opportunity to contain it is lost, as zn’s article says.

    Gearing up for this outbreak has been a nightmare for my small community hospital. We are not staffed well enough to deal with the logistics of coordinating the billion moving parts involved in this. We send the covid-19 specimens we collect to the VT Dept of Health Lab. I’ve been there for meetings and seminars many times. It is a brand new and modern lab but they are also not staffed to deal with this. Tensions are high. I got in a shouting match with the state’s Public Health Compliance chief over the phone when they decided we could no longer send specimens in the manner they initially requested. There I was with 20 specimens from suspected covid-19 patients that the state lab was telling me they wouldn’t accept. As it turns out, one of those specimens was positive for the covid virus (SARS-COV-2). It was the first positive specimen in VT.

    Of course, testing isn’t perfect and a negative result does not ensure the patient isn’t infected. In the beginning when they were trying to determine the best way to test for the virus, the CDC recommended that we collect lower respiratory cultures (sputum or bronchial lavage), upper respiratory specimens (nasopharyngeal swab, oropharyngeal swab, and nasal wash), and a stool and urine specimen in case additional testing was necessary. That’s a lot of specimens to be collecting and testing. As it turns out, the best results come from sputum and the lavage. The problem is, a productive cough isn’t a typical symptom so sputum is often hard to come by, and you can’t collect a lavage (flood the lungs with saline and suck up the contents) easily especially when you are talking about dozens of people a day. So they settled on the nasopharyngeal (NP) and oropharyngeal (OP) swabs and winnowed that down further to just the NP swab. Remember that patient who tested positive? He was tested early on when we were still collecting multiple specimens from all those different sources. We were able to get a sputum from him, so we sent it along with an NP swab, OP swab, and nasal wash to the state lab for testing. The sputum and nasal wash came back positive. The NP and OP swabs were negative. The NP swab is now the specimen of choice, but if that was all that we had sent, we might not know we had a patient with covid-19. Don’t get me wrong, testing is still effective and necessary in dealing with this outbreak, but as I said before, it’s not perfect.

    March 13, 2020 at 7:49 pm #112233

    In reply to: This President has got to go

    Mackeyser
    Moderator
    Billy_T wrote:

    Worst possible president at potentially the worst possible time.

    Merkel recently told Germans that 70% of their country could catch the virus. Its lethality rate hasn’t been determined yet, but the usual estimates are somewhere between 1-4% of those who contract it. If just a quarter of Americans catch it, we could be looking at well over a million fatalities here.

    Trump has lied about all of this from Day One, seeing it as a crisis for himself, his reelection, Wall Street and Corporate America, not as a public health crisis. He isn’t even trying to hide this, except in his scripted speeches, and even in those, he keeps lying about the science.

    At this point, I almost don’t care who the Dem nominee is. They could run a ham sandwich and the nation would be better off, if the ham sandwich beats Trump. We won’t be proactively better off, of course. It’s a matter of “less damage.” But I prefer that to more damage.

    Regardless, this is really one of those proverbial “chickens coming home to roost” moments. The deadly combo of capitalism and right-wing ideology, weaponized by both major parties, has left us largely without the tools we need to cope with this. Centuries of gaslighting about its supposed wonders, while it’s worked to destroy our capacity to act collectively to solve the crises it (capitalism and wingnuttery) creates.

    We’re hollowed out. We’re gutted. Our Commons is in tatters. But our ethos remains “I got mine, go fuck yourself!!”

    At a moment when we need to do a 180° on that ethos, etc. etc.

    Italy 2.6%
    China 3.5%
    Iran 10.6%

    USA is currently at 2.7% We’ve only conducted 7000 tests TOTAL in the entire US thus far.

    We have ZERO handle on this, Drs are SCREAMING about symptomatic patients not being able to get tested and NO ONE knowing what to do if they clearly have COVID.

    It is entirely possible using the 70% threshold and just Iran’s numbers (ours could be substantially worse considering the federal and state responses), we’re looking at potentially 24.4M DEAD.

    In order for us to remain at 2.7%, we’d need to RADICALLY shift the entire healthcare system to addressing this as they did in Italy and China.

    But we won’t. Which is why so many are gonna die.

    If you look at what this looks like for countries that are ahead of us in this by a few weeks, it’s literally the stuff of nightmares.

    That’s it. Nightmares.

    Sports is the crucible of human virtue. The distillate remains are human vice.

    March 13, 2020 at 4:53 pm #112227

    In reply to: notes from expert panel on the virus & other expert views

    Avatar photoZooey
    Moderator

    I read that even as more test kits come in, our facilities can run only about 1,000 tests/day anyway.

    But since there is nothing much that can be done for patients apart from IVs and comfort care, I’m not sure testing really makes that much difference. I don’t know what can be done except for everyone to stay away from crowds, wash hands all the time, and stop breathing.

    I hope RBG is in a bubble tent.

    March 13, 2020 at 1:30 am #112217

    Topic: notes from expert panel on the virus & other expert views

    in forum The Public House
    Avatar photozn
    Moderator

    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.

    March 12, 2020 at 7:01 pm #112190

    Topic: Sleepy Joe is what the voters want

    in forum The Public House
    waterfield
    Participant

    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.

    ADVERTISING

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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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    March 9, 2020 at 6:30 pm #112094

    In reply to: US health care system costs 4X more than Canada’s M4A

    Avatar photowv
    Participant

    Italy:https://internationalliving.com/countries/italy/health-care-in-italy/

    Overview of Italian Healthcare

    Italy ranks among the World Health Organization’s top 10 countries for quality health services (by contrast, the U.S. only holds 37th place, despite being the highest spender). However, although medical facilities are considered to be adequate for any emergencies, some public hospitals are reportedly overcrowded and under-funded.

    Of course, you don’t have to rely solely on public health facilities. Like many Italians, you can avail of the parallel private medical service—known as the assicurazione sulla salute—that caters for patients covered by private medical insurance.

    However, in some small towns, particularly in the south, you will only be able to access the public health system—private doctors and hospitals congregate in bigger cities where residents are more likely to have private medical insurance.

    According to rankings, the best medical care, especially in an emergency situation, is likely to be found in the northern hospitals in cities like Milan and in central Italy near or in Rome. Reportedly, English-speaking doctors are particularly easy to come by in Rome and Milan as well.
    Italian Health Insurance

    Italy has a national health plan (Servizio Sanitario Nazionale), which provides for hospital and medical benefits. In Italy, healthcare is considered a right and the national health plan is designed to provide for all Italian citizens and residents, including U.S. and Canadian citizens who are legal residents of Italy.

    With the Servizio Sanitario Nazionale most care is free or low-cost, including consults with a general physician, hospital visits, lab work, and medications. However, each region is responsible for managing its own care, so expect differences between regions and carefully research the specific region you want to retire in.
    Healthcare Costs in Italy

    Though costs vary based on a number of factors including region and whether you have private insurance or not, expats report costs as reasonable. One expat couple based in the south reports paying just $236 per year to cover their health insurance. And hospital visits are reportedly free in urgent cases. In non-urgent cases, a small co-pay may be expected.
    Pharmacies and Medication

    For over-the-counter medications in Italy, you’ll need to visit a pharmacy. These are standalone shops and unlike in the US, you won’t find them in grocery stores. Look for the large green cross (often lit up) and you’ll find your nearest pharmacy. Pharmacists in Italy are used to consulting with patients, so if you aren’t sure what kind of medication you need or what the equivalent of an American brand is here in Italy, ask the pharmacist. In general, you’ll find many of them speak English very well.

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    March 3, 2020 at 8:11 pm #111887

    Topic: What The Stakes Are ~ Robinson

    in forum The Public House
    Avatar photoZooey
    Moderator

    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.

    February 17, 2020 at 12:02 pm #111399

    In reply to: Buttichex

    Avatar photoZooey
    Moderator

    The Long List of Reasons Why I Will Never Vote for Pete Buttigieg
    Ronald W. Dixon

    https://medium.com/@ronaldwdixon/the-long-list-of-reasons-why-i-will-never-vote-for-pete-buttigieg-b4279c1fbd6f

    Earlier this year, I published a long blog post detailing the many reasons why I would not vote for former Vice President Joe Biden if he became the Democratic nominee. Unfortunately, many of the other candidates vying for the nomination are almost as deplorable as Biden, and former South Bend, Indiana Mayor Pete Buttigieg is no exception.
    Buttigieg does not have the same level of experience as Biden, but what little we know about him shows that he failed as a small-town mayor and is willing to flip-flop, take money from the wealthy, and outright lie in order to attract supporters, and if he were to nab the nomination, I would be unable to support him because 1) I would not really know for certain what he truly stands for entering the general election, 2) he is prone to flip-flopping under the influence of special interests, whereby making any of his campaign promises illegitimate, 3) what little experience he has gained was fraught with controversy, 4) many of his ideologically-consistent views and proposals are deeply troubling and hardly progressive, and 5) he has demonstrated a sheer lack of ethical backbone and no interest in being truthful with the American people.
    As I did in my thorough analysis of Biden’s record, I will present my arguments in the form of an alphabetized list. Feel free to use the search function (CTRL + F) to locate a specific topic.
    If you have any suggested additions or revisions, please feel free to let me know! Otherwise, on with the list:
    Austerity: Buttigieg has signaled his support for austerity measures aimed to reduce the deficit. His rhetoric, though, virtually mirrors what we see from neo-liberal “deficit hawks” who go after social safety net programs while giving tax breaks to the rich and further bloating the military. Buttigieg notes that his austerity advocacy is “not fashionable in progressive circles”, but the reason austerity is not “fashionable” with us is because it is based on conservative economic theories that 1) fly in the face of basic macroeconomics, where the government investing in programs and efforts that help the American people would make our country more fiscally solvent in the long-term, 2) have consistently failed the middle and lower classes, originating with President Reagan’s “trickle-down” policies, and 3) harm the bulk of the American people while simultaneously benefiting the rich and doing nothing to address the debt without sado-masochistically harming the most disadvantaged members of society.
    Buttigieg talking with wealthy donors at a billionaire-sponsored wine cave event in 2019.
    Buttigieg talking with wealthy donors at a billionaire-sponsored wine cave event (2019).
    Billionaire Support: Buttigieg receives donations from 40 billionaires and their spouses, much larger than the zero billionaires who donate to Bernie Sanders’ campaign. Whereas Sanders actively rejects money from billionaires, Buttigieg welcomes them with open arms, drinking alcohol with them in the wine caves of the rich and powerful as they advise him on policies that would benefit the elite at the expense of the American people.
    Bulldozing Homes in Black and Latinx Communities: Mayor Buttigieg’s administration implemented a program which heavily pressured poor, disproportionately African American and Latinx homeowners to vacate their properties so the city could bulldoze them in an attempt to gentrify these portions of the city. Specifically, Buttigieg’s municipal government employees would threaten community members whose homes were placed on the demolition list with hefty fines and penalties for violating city codes, hoping that they would give-up so the city could tear down their homes. While some homeowners eventually received support to help bring their homes up to code, many homes were still demolished under Buttigieg’s watch.
    Called Striking Workers “Social Justice Warriors”: In his memoir, Buttigieg referred to striking food workers at Harvard as “social justice warriors”, a right-wing term universally used as a pejorative against progressives, usually feminists specifically.
    Campaign Doesn’t Offer Health Insurance: Whereas the Bernie Sanders campaign for president offers their employees comprehensive health insurance, including access to mental healthcare, as well a union contract, the Pete Buttigieg campaign does not offer health insurance at all, instead providing employees with a stipend to buy their own insurance off of the Obamacare exchanges. In contrast, even Barack Obama’s 2008 presidential campaign offered it’s employees health insurance.

    Buttigieg pledging not to take money from banks during his campaign for Indiana State Treasurer (2010). He later flip-flopped when running for president.
    Conflict of Interests: In 2010, while running for the Indiana State Treasurer’s office, Buttigieg said that he would not take money from banks that would do business in his office because it would create a conflict of interest or the appearance of a conflict of interest. Later on in the interview, he swore to not take any bank contributions. He later flip-flopped, accepting millions of dollars in campaign contributions from Wall Street and even hiring a Goldman Sachs executive as his national policy director.
    Environment: Given the impact that climate change has already had on our lives, and given the fact that the lack of immediate action will result in an utter catastrophe for human civilization, presidential candidates need to push for environmental plans that seek to immediately mitigate and reverse climate change. Whereas Sanders’ Green New Deal plan calls for $16 trillion worth of investments that would lead us to a future where renewable energies are the norm while reaching net-zero carbon emissions by 2030, the Buttigieg plan would only invest about $2 trillion and reach the same emissions goal by 2050. Given how we are already beyond the “point of no return”, according to some environmental experts, such a milquetoast plan is far too inadequate to address the global challenges of climate change.

    Buttigieg arguing that incarcerated felons should lose the right to vote (2019).
    Felon Voting: Buttigieg argued during a CNN townhall that incarcerated felons should not have voting rights, a stark contrast the Bernie Sanders’ view that felons are still citizens who ought to be able to engage in the democratic process.
    Healthcare: Prior to running for president, and even during the early days of his campaign, Buttigieg touted a Medicare for All, universal healthcare approach to solving the international disgrace that is our current system of allowing private insurance companies to gatekeep essential healthcare access. While he previously supported healthcare as a human right, which can only be achieved through a universal healthcare system, Buttigieg now supports what he calls “Medicare for All Who Want It”, a neo-liberal program which doesn’t guarantee healthcare at all. Instead, it provides a “public option” that still requires patients to deal with co-pays, deductibles, out-of-pocket maximums, co-insurance, in-network availability, and all of the other problems associated with private insurance
except replacing the insurance company with the government. In contrast, a true universal healthcare program makes surprise bills and upfront costs relics of the past, instead allowing you to go to the doctor in exchange for slightly higher taxes, a system that would save us all money.
    What makes Buttigieg’s plan even more egregious, though, is that he would implement a “supercharged” version of the previous Obamacare tax penalty, which would automatically enroll people into the public option if they don’t have insurance and then, likely during tax season, retroactively charge them for premiums. Whereas the Affordable Care Act charged an annual fine equal to the greater of $695 or 2.5 percent of their income (before it was ruled unconstitutional), ButtigiegCare could stick those who already couldn’t afford insurance (public or private) with more than $7,000 in fines. A universal healthcare system, meanwhile, would not include any fines; you simply receive healthcare and pay a modest tax on earned income, a tax that’d be far less than what most Americans pay for premiums, let alone co-pays, deductibles, and other surprise medical bills.
    Another challenge that the Buttigieg plan would face is that it assumes that it has the capacity to automatically enroll low-income members, who would receive free or low-cost insurance, depending on their financial situation. Whereas a true universal healthcare plan would be free to anyone who visits a doctor’s office or hospital, Buttigieg’s alternative assumes that the government knows every single individual’s financial situation in real-time or that our bureaucracy is large enough to be able to identify all of these individuals, particularly those who never register or apply for other government benefits, such as housing support or Medicaid.
    The Buttigieg plan is also the textbook definition of a neo-liberal farce; instead of providing healthcare as a public good, the poor must go out of their way to prove that they are poor enough to receive this service, a screening process which will needlessly expand our bureaucracy and allow millions of Americans to slip through the cracks, an outcome that would be all but impossible under a true universal healthcare system. And how do you even begin going about the process of continuously auditing the citizenry to ensure that their income matches how much they should pay? The plan is needlessly convoluted and neo-liberal beyond repair.
    Unfortunately, this is one of the many examples where Buttigieg originally took the progressive position (universal healthcare) and then took a sharp-right turn after receiving large contributions from Wall Street, even going as far as to outright lie about his consistency on the issue. Buttigieg has allowed the rich to ethically compromise him through his recent opposition to a true universal healthcare system, a program which would save lives and encourage us to actually receive the care that we need.
    As a side note: Buttigieg recently argued in a tweet that a true universal healthcare system would take away health insurance from union workers who already have decent insurance coverage. Unfortunately, Buttigieg’s weaponization of unions in his crusade against universal healthcare is fallacious and offensive to actual union organizations and negotiators. First, not all union employees have good insurance. Second, the ones who do generally only have it because the union fought vigorously for it, at the expense of other benefits, such as pay increases, investments in their retirement plans, paid parental leave, and student loan debt forgiveness. Third, a universal healthcare program would free unions to negotiate for the above benefits and more without having to disproportionately focus on the employers’ attempts to push insurance costs onto their workers. Fourth, union plans, while generally superior to most other plans, are worse than universal healthcare, which provides all services with no costs in exchange for a modest tax. Even the best insurance plans come with the price of lower wages and/or higher deductibles. Fifth, most Americans are not unionized, so this debate completely and totally ignores their needs.
    At the end of the day, Buttigieg needs to stop weaponizing unions in his corporatist attacks against Bernie Sanders and Medicare for All.

    Higher Education: Buttigieg slammed universal higher education in a campaign ad because it would benefit the children of rich parents. In reality, though, public goods ought to be available for everyone. Otherwise, you require recipients of these programs and services to prove that they have less means than the wealthy while the rich kids are, by and large, more likely to go to expensive private schools anyway. By the neo-liberal logic proposed by Buttigieg, we ought to means test K-12 education, which we clearly will not do because education is a public good. Additionally, Buttigieg is opposed to universal student debt cancellation, a plan that Sanders touts on the campaign trail.
    Immigration: During the first Democratic debate, Buttigieg voiced the opinion that the federal government should decriminalize illegal border crossings. Specifically, after raising his hand when the question was asked of all of the candidates whether they support decriminalizing illegal border crossings and making them civil offenses, Buttigieg said the following:
    Let’s remember, that’s not just a theoretical exercise. That criminalization, that is the basis for family separation. You do away with that, it’s no longer possible. Of course it wouldn’t be possible anyway in my presidency, because it is dead wrong.
    During the second Democratic debate, however, when challenged on his views concerning border crossings, he flip-flopped, declaring that “illegally crossing the border will still be illegal,” brushing off the debate over “the finer points of which parts of this ought to be handled by civil law and which parts ought to be handled by criminal law”. He later said that it should remain criminalized when “fraud is involved”.
    Instead of holding a consistently progressive view that supports immigrants fleeing their native countries who have personally witnessed the failures of our broken immigration system while simultaneously dealing with life-or-death situations that forced them to escape to the United States in the first place, a qualified progressive candidate should stand firm in their support for immigrants, not waiver at the slightest bit of pushback, as Buttigieg has done.
    McKinsey & Company: Shortly after graduating from Oxford University, Buttigieg decided to accept a consulting position at McKinsey & Company, a “cult-like management consulting firm” which has been involved in, among other things, advising companies to perform mass layoffs to save money, dealings with authoritarian governments, such as China and Saudi Arabia, and working with Purdue Pharma, the ones who predatorily went after chronic pain patients and got many Americans addicted to OxyContin. In his auto-biography, he argued that he joined the company to gain real-world experience, a faulty argument, given the fact that a graduate of an elite university would have been able to find employment at an ethical business or organization relatively easily. Instead of admitting regret for working for such a large corporation, he said that it was an “intellectually informing experience.” He also downplayed his experience, noting that he merely worked on PowerPoint presentations, even though one of his projects involved working on a contract in Afghanistan that explored how best to extract natural resources. When it suits him, though, he will positively tout his McKinsey experience, declaring that “I cut my teeth in the business community” while working for the firm.
    The press release showing supposed support for Buttigieg’s “Douglas Plan for Black America”.
    The press release showing supposed support for Buttigieg’s “Douglas Plan for Black America”. Top “endorsers” Devine and Cordero didn’t actually endorse the plan, and Thigpen is a Sanders supporter (2019).
    Mischaracterizing Support for the Douglas Plan: In response to Buttigieg’s persistent near zero percent support among the African American community, his campaign unveiled the “Douglas Plan for Black America”. In an attempt to make Buttigieg look good with black voters, his campaign published a letter allegedly signed by over 400 prominent South Carolina supporters, with African American leaders highlighted near the top of the letter. The problem, though, was that many of them were not Buttigieg supporters; the campaign sent a letter to these leaders asking them to opt-out of having their name included on the press release, so many of those listed did not expressly give any consent for their names to be used. It also turns out that approximately half of those listed on the letter are white people, some were repeats, and many did not live in South Carolina at all. There was even a Bernie Sanders surrogate listed. To make matters even worse, one of the stock images used to promote the plan was taken in Kenya.
    Opportunity Zones: Buttigieg has praised the concept of “opportunity zones”, where the wealthy develop unused or unoccupied land tax-free. While Buttigieg supports such programs for allegedly benefiting municipalities, what they actually do is gentrify communities, giving tax breaks to build luxury condos that only benefit the wealthy while displacing poor, disproportionately minority residents from their homes. Bernie Sanders, meanwhile, has criticized the concept of opportunity zones, which are one of the many regressive fixtures of President Trump’s 2017 tax law, and progressives in Congress are fighting to get rid of this opportunity zone program altogether.

    Buttigieg defending the racist Tea Party during his appeal to conservative voters while running for Indiana State Treasurer (2010).
    Praise for the Tea Party: During Buttigieg’s failed run for Indiana State Treasurer in 2010, he attended a conservative event to try and win their support. During his speech, he praised the Tea Party, insisting that they are “motivated by real concerns about the direction of our government.” The Tea Party is a Koch-funded, racist organization that helped to societally legitimize the bigotry that they kept closeted until Barack Obama became president.

    Jordan Chariton confronting a Buttigieg staffer over his African American video journalist’s press credentials being yanked from him (2020).
    Racially Profiling Black Journalists: During a New Hampshire rally, Jamal Jones, a progressive African American video journalist, had his press credentials physically yanked away by a Buttigieg campaign staffer who was previously stalking him. When a colleague of his, Jordan Chariton, confronted a staffer about the incident, she said that it was because he was being “disruptive”. When Jordan pressed further, asking how interviewing those waiting in line to attend the event was “disruptive”, and asked if this is how the campaign treats the press, the staffer walked away.
    South Bend Police Department Controversy: As Mayor of South Bend, Indiana, Buttigieg fired the city’s first African American police chief, Darryl Boykins, for exposing racism within the department by recording racist conversations between other police officers. Boykins was later reinstated, but in a demoted position. He received a $50,000 settlement with the city after he sued for racial discrimination. Additionally, Karen DePaepe, a city official who listened to the recordings and preserved the most damning conversations, was also fired by Buttigieg, and she also won a lawsuit against the city, costing municipal taxpayers $235,000. Buttigieg has refused to release the tapes to the public.
    Supreme Court and Electoral College Reforms: At the start of his presidential campaign, Buttigieg called for abolishing the Electoral College and increasing the number of Supreme Court Justices, along with other reforms to the nation’s highest courts. After his financial bundlers told the campaign that these two issues were not popular, though, Buttigieg dropped these ideas from his campaign, thus further showing the impact that special interests have had on his candidacy.
    Trade: During the Iowa democratic debate, Buttigieg indicated that he supports the United States Mexico Canada Agreement (USMCA), Trump’s take on the failed North American Free Trade Agreement (NAFTA) that offers very little improvements while still allowing large corporations to focus on profits over the well-beings of their employees. The new deal also fails to implement any job creation requirements, and it has no language that addresses climate change at all. Bernie Sanders, meanwhile, opposes Trump’s trade agreement.
    Universal Childcare: Unlike Senators Bernie Sanders and Elizabeth Warren, Pete Buttigieg opposes funding universal childcare, instead allowing parents to apply for tax credits, a complex process which would require parents to 1) either learn the tax code or seek help from a preparer, 2) have the means to pay for the childcare until they receive the yearly credit, and 3) even know about the credit in the first place, as opposed to the benefit being made universal for all parents with young children.
    As this article has demonstrated, Buttigieg is not fighting for the best interests of the American people. Indeed, when considering the fact that he has been ethically compromised by the rich, has a failed history as Mayor of South Bend, Indiana, regularly deploys conservative talking points, and actively fights against progressive policies that would actually universally benefit the American people, and, instead, backs neo-liberal alternatives that would do little to reverse climate change, reduce wealth disparities, achieve true universal healthcare, make education a public good, and mitigate the power that the rich and powerful have over our country, we ought to come to the conclusion that Buttigieg should not be the one to challenge Trump this November. We simply cannot afford more of the same, and I would much rather have a progressive rematch in 2024 than being forced to defend Buttigieg’s mediocre first term as president against a conservative insurgent.
    A Buttigieg presidency would fail to resolve the underlying symptoms that led us to Trump, and anointing him as the standard-bearer for the party would either make it more likely for Trump to win re-election or, in the long-term, allow an even more reactionary Republican to beat the Democrats in 2024 or 2028. Only Bernie Sanders brings the systematic reforms, the “revolution”, that we need to address widespread inequality and clean-up the federal government. Anything less only allows these problems to continue festering, regardless of which party is in power.
    Therefore, I cannot, in good conscience, support Buttigieg if he wins the Democratic nomination. Alternatively, like I said if Biden were to get the nomination, I would likely vote for the Green Party candidate.

    • This reply was modified 6 years, 8 months ago by Avatar photoZooey.
    February 16, 2020 at 9:59 am #111373

    In reply to: Saturday Morning Observations: Surgeons and pain

    Avatar photoBilly_T
    Participant
    TSRF wrote:

    Hang in there, Billy.

    If your doctor knew both needed additional work, he should have tried and scheduled it to do both at the same time (unless you had to drive yourself home; then I can see why they wouldn’t do that).

    From a clinical standpoint, I think doctors don’t consider short term pain at all. They are focused on the end result.

    By far and away, the worst surgery I have had was tonsil removal at 25. They cut them out and then basically took a flamethrower to the back of my throat. I couldn’t eat for a week and dropped about 10 lbs.

    On my follow up, at 2 weeks past when I was basically back to normal, I asked my doctor why he didn’t warn me how shitty I was going to feel. He laughed and said, “You may never have brochitis again. Isn’t that worth it?”

    I think that is how the majority of them think.

    Yeah, I drove myself in for that visit. I think that’s why he didn’t just do the other one. Plus, he said they typically don’t. I’m guessing the “unsaid” part there was “Well, if we screw up and blind you, we can’t blind you in both eyes. One will do.”

    ;>)

    Another pattern I’ve noticed with doctors and their staff — with exceptions, of course. More and more they seem to expect the patient to tell them if they need something else, X, Y or Z. They seem far less proactive about things than in the past.

    For instance, the dilation was strong for both eyes, but they didn’t proactively hand me special sun glasses for the drive home, and I was kinda sorta out of it and forgot to ask. I had my own pair, but they proved woefully insufficient, it being a bright, but cold afternoon. The dilation created a situation almost as bad as the initial surgery. Well, not as bad. A different kind of “assault” on my senses, especially my sinuses.

    I shouldn’t have driven, though I took my time, took back roads, got out and stopped here and there to break up the drive a bit.

    Anyway . . . as a culture I think all of the self-service stuff has infected even the medical field. IMO, we can blame its beginnings on self-service gas stations, and then ATMs . . . from there, it’s been consumers as a part of the workforce ever since.

    The young probably would just say “Ok Boomer” to all the above. But I think things were better when we weren’t expected to be both consumers and laborers in the same space and time.

    February 15, 2020 at 11:36 am #111354

    Topic: Saturday Morning Observations: Surgeons and pain

    in forum The Public House
    Avatar photoBilly_T
    Participant

    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.

    February 2, 2020 at 1:53 pm #110898

    In reply to: superbowl thread including reactions & highlights

    Avatar photozn
    Moderator
    wv wrote:

    Why in the world did so many teams pass on him. His talent just looks UnGodly. And Obvious. Was he different in college?

    When he came out he was seen as this wild Air Raid offense qb who needed a lot of work. Which he got–Reid benched him for a year. So what you’re seeing is not just Mahomes, it’s Mahomes plus a redshirt year of Reid’s coaching.

    Happens. Marino fell in his draft year too.

    Here’s a typical description of him from his draft year:

    http://www.nfl.com/draft/2017/profiles/patrick-mahomes?id=2558125

    WEAKNESSES Can be inconsistent in his approach. Needs to play inside the offense and show more discipline. Too eager to go big game hunting. Ravenous appetite for the explosive play can also bring unwanted trouble. Willingness to default to playground style appears to limit his ability to get into a consistent rhythm. Needs to improve anticipatory reads and learn to take what the defense gives him. Decision making can go from good to bad in a moment’s notice. Operates from a narrow base and allows his upper body and arm to race ahead of his feet. Has a dip and wind-up in his standard release. Explosive delivery and follow-through causes some throws to sail. Needs better touch on intermediate and deep balls. Carries ball a little low in the pocket. Impatient. Will leave pocket prematurely rather than standing in and winning in rhythm. Better as a scrambler than pure runner. Looked a little less mobile in the open field this season.

    DRAFT PROJECTION Round 1-2

    SOURCES TELL US “He’s got a great arm, big balls and he’s mobile. He is going to drive his head coach crazy for the first couple of years and there is no getting around that. If it clicks for him and he’s coachable, I think he could become a special quarterback.” – NFC executive

    NFL COMPARISON Jay Cutler

    BOTTOM LINE Mahomes is a big, confident quarterback who brings a variety of physical tools to the party, but he’s developed some bad habits and doesn’t have a very repeatable process as a passer. Mahomes’ ability to improvise and extend plays can lead to big plays for his offense, but he will have to prove he can operate with better anticipation and be willing to take what the defense gives him in order to win from the pocket. Mahomes will be a work in progress, but he’s a high ceiling, low floor prospect.

    -Lance Zierlein

    January 21, 2020 at 9:04 am #110607

    Topic: fwiw I will be absent a lot on Tuesdays

    in forum The Rams Huddle
    Avatar photozn
    Moderator

    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.

    January 4, 2020 at 9:34 am #110071

    Topic: George Saunders: Lincoln in the Bardo

    in forum The Public House
    Avatar photoBilly_T
    Participant

    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.

    December 30, 2019 at 8:47 pm #109921

    In reply to: tweets … 12/30 & 12/31

    Avatar photozn
    Moderator

    Chris@BiggameCB
    J.Goff finished the Rams final 5 games with a 98.6 QB rating, 66% completion percentage, averaging 328 yards per game, 11 touchdowns, 4 INTs, 0 fumbles. IMO a promising finish to the season after a rough stretch.

    đ’„đ’Ÿđ“‚ 𝐾𝓋𝑒𝓇𝑒𝓉𝓉@Jim_Everett
    Lots of chatter about TEs in the #Ramily. It usually takes 2-4 years to get a college TE up to
    @nfl standards. Higbee & Everett are a great combo together for 2020 (prayers both stay healthy). Personnel groupings can be expanded having these two studs ready. Be patient folks!

    IMO, @sonofbum would be the @RamsNFL DC for as long as he’s willing and able to coach. #Lifer #Stud #Keeper

    December 22, 2019 at 10:37 pm #109655

    Topic: McVay … 12/22 … transcript

    in forum The Rams Huddle
    Avatar photozn
    Moderator

    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.”

    December 15, 2019 at 11:44 am #109372

    Topic: tweets & things…Rams + around the league… 12/15 & 12/16

    in forum The Rams Huddle
    Avatar photozn
    Moderator

    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.

    December 14, 2019 at 11:58 pm #109362

    In reply to: Hey zn

    Avatar photozn
    Moderator

    It has nothing to do with anyone deciding anything and it’s not just happening to you. For some reason, the anti-spam software here is marking some posts as pending. Best I can do is “approve” them. To find out what the problem is, I need to alert RM–he can fix this, I can’t. So stay tight and be patient. I now look frequently for “pending” posts and fix things as soon as I can.

    So I assure you it has nothing to do with anyone having problems with you posting. It’s just a software issue of some kind.

    December 12, 2019 at 4:57 pm #109281

    In reply to: tweets … 12/12 thru 12/14

    Avatar photozn
    Moderator

    Safety Blitz

    Gurley’s New Rushing Style Works

    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 fast or as strong but whatever changes he has made are working.

    November 19, 2019 at 11:06 am #108378

    Topic: McVay … 11/19 … transcript

    in forum The Rams Huddle
    Avatar photozn
    Moderator

    Rams Head Coach Sean McVay – Nov. 18, 2019

    (On an update regarding WR Robert Woods)
    “There’s no update. He’s (WR Robert Woods) still handling that personal matter and we’ll probably have a little bit more of an update on that later on in the week.”

    (On if he expects WR Brandin Cooks to return this week)
    “We do. He’s (WR Brandin Cooks) been in great spirits, he’s been in good shape. The anticipation is that he will be able to play this week.”

    (On injury updates following Sunday’s game)
    “Came out pretty good. Your typical bumps and bruises, but the tight ends that were banged up going into it, they came out in good shape. For the most part, ‘Brock’ (DL Michael Brockers) had his little elbow deal, but he ended up coming back into the game. It was as healthy as we’ve come out of a game with all the guys that did play.”

    (On OLB Dante Fowler Jr. exiting late in Sunday’s game)
    “I think it was probably more of just catching his (OLB Dante Fowler Jr.) wind. He’s good.”

    (On what Brockers’ injury was)
    “He just irritated his elbow. Not exactly sure what it was. As soon as I went out there – I think, probably, one of those deals where it kind of just scares you initially more than anything. Once you kind of settle in you realize, ‘All right, you’re okay,’ and he came back and he did a great job to finish it out.”

    (On him going out on the field to check on Brockers)
    “If a guy stays down there, usually I end up going out there just to make sure they’re okay and just kind of check on them. That was the case and as soon as we got out there, you felt pretty good just based on the feedback he was able to give to us.”

    (On if T Rob Havenstein will be available this week)
    “I would say he’s (T Rob Havenstein) probably going to be doubtful for this week. He is making good progress. To have a finite answer on exactly when he’ll play a week from today is difficult. I think the anticipation – just originally with that injury – was that it’s probably going to be a couple weeks. That’s why he’ll most likely be doubtful, but you don’t want to rule him out quite yet.”

    (On QB Jared Goff saying Sunday was one of his favorite wins as a Ram and if he can relate to that feeling)
    “Any win is a good win. We’ll certainly take that – it was the most recent one, so it was certainly a fun one. I think all the things that went on and the way that our team continues to stick together through the good, though the bad and all those different types of things – I think the mental toughness, the resilience that they really embody and personify is something that I think is really powerful. I love the way that our guys just hung tough. I love the way that yesterday provided a lot of opportunities for guys that didn’t expect to be in some of the positions they were in last night. To show that the game’s not too big for them and I love the way that we found a way to win as a team, which is always the goal.”

    (On if there are circumstances that took place on Sunday that may translate to future games or if it was a one-off)
    “I think it’s a combination of both. Obviously, when you end up having a late adjustment because of something that occurred with a player that’s a big-time contributor – but then you always talk about, ‘How do you want to win games as a team? What do we feel like the best way to put all three phases together?’ I think what we’re all learning is that the ways that we do that with this year’s team is maybe different than what we’ve seen. The most important thing is what’s the best way for this team to be able to win football games. I think that’s something that we’re continuing to learn. Each week based on the opponent we play might look like a different answer in terms of the matchups, but I think yesterday was a good indicator of some things that you might want to see moving forward.”

    (On if the team felt a little bit of a relief or if there were extra emotions after winning Sunday’s game)
    “I think the guys would be better served to answer that than me. I was really pleased with just the amount of different things that went on – the guys found a way to bond together and win a football game. Whether that be overcoming injuries, whether that be opportunities for some guys that hadn’t played to step up, whether that be some things that are way bigger than football going on, I think there is a lot of different things. Anytime that you’re coming off of a disappointing outcome the previous week – especially when it was the bye – you have a tendency to feel like, ‘Man, it’s been so long since we’ve played a good game.’ But, because of the two-week stretch since we had won coming off the bye, then you don’t get the result you want. I think there was a lot of things that went into it, but I think the guys were pleased with the win, to answer your question.”

    (On if the tight end usage was something he planned coming in or if it was exacerbated by not having Woods)
    “It’s a little bit of both. They do a good job of mixing some of their personnel groupings and we wanted to be able to run the football. Some of the run concepts that we felt like would give us the best chance to be able to move the football consistently and do some things that we wanted to do against that front structure. We felt like the best way to do that would be out of the two-tight-end personnel grouping. Obviously, there is going to be some adjustments when one of your starting receivers that’s a main contributor for you ends up not going right before kickoff.”

    (On what it says about the tight ends and offensive tackles to be able to keep Bears LB Khalil Mack off the stat sheet)
    “It says they did a great job. He is a game wrecker, he is a big-time, special, unique player. I thought the ability to be able to kind of consistently stay patient with the runs, consistently move the ball – I think we’ve got to be better in some of those third-down situations when we do run it, but I thought just the commitment overall. Then what we were able to get in terms of some of the ways we were limited in having to throw the football outside of a few drop backs here and there, limits really the ‘opps’ that he has and I think that’s a credit to those guys that you just mentioned.”

    (On what he remembers about Ravens QB Lamar Jackson from when the team had training camp practices with the Ravens in 2018 and what he thinks about what Jackson is doing this season)
    “As you’re just diving into the initial part of getting familiar with the Ravens, I think you saw a dynamic athlete, you saw a guy that was just getting used to
I mean, you think about the early stages of where you’re at in your development as a rookie quarterback right in the beginning of training camp. That’s a lot of stuff that those guys are getting accustomed to. You could see the athleticism, but then when you look at what he’s done so far, it has been impressive in terms of the ability to put pressure on defenses with the way that he can beat you in a couple different ways. I think (Ravens Offensive Coordinator) Greg Roman has done an outstanding job. They’re one of the best offenses. They’re on track to have less punts than anybody in the history of the league over the course of a season. I think they had zero punts yesterday. Dynamic playmaker, builds the guys around him, have a confidence because of his swagger and confidence. When he is delivering the football, he’s throwing the ball accurately. In a lot of instances, they’re dictating structures because they’re able to be so efficient and such a threat of the run and the pass that can come off of it.”

    (On how CB Troy Hill has done since taking over the starting position and if that role became increasingly difficult for him after adding CB Jalen Ramey to the other side knowing that quarterbacks would want to avoid Ramsey)
    “Yeah. I think in some instances, if that’s what a team wants to do, you typically say, ‘All right you might see a little bit more work.’ But I think (CB) Troy (Hill) has done a great job continuing to improve. (Cornerbacks) Coach Pleasant does an outstanding job with those guys as a whole. Helping really to fine-tune the fundamentals, the techniques. Troy has always had the skill set in terms of his lateral agility, his just body control, overall speed. I think you’re seeing him play at a really high level. He ends up having a pick yesterday, gets a sack on the one that gets flushed out on the sideline, he’s making tackles. I think he’s playing really good football right now. Really, I thought our secondary as whole did a great job last night. To minimize – where you talk about the biggest gain they had was on a 19-yard gain where we ended up dropping a coverage responsibility in a man pressure we had. I think that’s a real credit to those guys and I thought it was a real positive to see (CB) David Long (Jr.) play his first extensive action – 15 snaps, did a great job. That’s a reflection of those guys on the backend with (Safeties) Coach ‘E’ (Ejiro Evero) and Coach Aubrey doing a great job coaching those guys up.”

    (On how much harder the challenge is against Baltimore)
    “When you look at just the production that they’ve had offensively, it is getting increasingly difficult. I think that’s something that you embrace as a competitor. I know our guys will be excited about the challenge and the opportunity to compete against one of the best and most productive offenses in the league this year.”

    (On when the defense is playing really well and if that changes or impacts anything he does as a playcaller)
    “Yeah, it certainly does. At the end of the day, the goal is to win the football game. Regardless of how you end up doing it, a win is a win. Now, certainly, that doesn’t mean you don’t want to be efficient and operate with consistency offensively, but I think it does enable you to feel like
I don’t necessarily know if conservative is the word. But you want to play a smart, complementary game. I think yesterday indicated our ability to approach the game like that. There are still some instances where, as a whole, as good as the defense played there’s some things we talked about that we expect them to do at a really high level. Same thing with the offense and the special teams, and like anything else we expect to get better from this. I think it’s always easier to be able to teach and have guys learn from it when you do get the result that you want. But we do want to continue to focus on that process.”

    (On how RB Todd Gurley was feeling today and if he will continue to use him in the same way in which he did in yesterday’s game or if it’ll be a game-to-game evaluation)
    “I think if he’s feeling good. That’s what you want. Obviously, that was the most work that he got this season. I think the thing that we had discussed that we talked about it last week, don’t miss the opportunity if he’s feeling good and getting into the flow like he was in Pittsburgh. I think more than anything he can really draw on that, feel good. So, yes if that’s something that he continues to feel good, with his body responds the right way, which every inclination that I have is he’s feeling good. That is something that you’d like to see because when the ball is in (RB) Todd’s (Gurley) hands good things happen. I love as much as anything the way he responded after what happened on the first touch.”

    (On after watching the film how he felt about the offensive line’s performance)
    “Just physical. You saw a lot of downhill, direct runs. I just thought you could feel, especially for a lot of guys making their first extended action, wasn’t too big going against a great front with a bunch of different play-makers on that front. I just thought that they played with a consistent physicality, a toughness, the way they were finishing. I thought there was a good energy in and out of the huddle. Obviously, able to keep Jared clean where he wasn’t getting hit. They did a very, very good job. I thought (Run Game Coordinator) Coach (Aaron) Kromer’s guidance, and then you talk about (T) Andrew Whitworth’s leadership, (C) Austin Blythe’s command at the center spot with those two big guards, and then (T) Bobby Evans doing a nice job stepping in at the right tackle position.”

    (On how he goes about trying to simulate Ravens QB Lamar Jackson’s mobility and option concepts they run during practice this week)
    “That’s a hell of a question. That is something that we’ve started to discuss as a group with our defensive staff. It’s hard to find somebody that has the skill set, in terms of the athleticism, to put the pressure on your defense, but then can also throw the football. Those are some things that we’re working through. But typically you would like to say, ‘All right, is it maybe even something where you explore a really unique athlete that can throw it?’ Because you don’t want it to be so predictable if you just put a guy in there. We’ve got some guys that might be capable of mimicking and emulating him, but he is certainly the man and playing at this rate for a reason. It’s hard to truly do that.”

    (On if there is any concern for the wellbeing of Woods)
    “No, we feel good. He’s in a good place. We feel good about where the situation is at and his wellbeing, and that’s very, very important to us.”

    November 18, 2019 at 9:15 am #108325

    Topic: McVay, Goff, Kupp, Ramsey, Donald … 11/17 post-game … transcripts

    in forum The Rams Huddle
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    Rams Postgame Quotes – November 17, 2019

    ***

    Head Coach Sean McVay

    (Opening Remarks)
    “First and foremost, with (WR) Robert Woods not being there tonight – it was a personal matter. That’s all we are going to say about that. We love him, respect him, we are with him and his family all the way and that’s really where we will leave that at. As far as the game tonight, really pleased with our team. To be able to find a way to win as a team, that was the goal, that always is the goal. It was a little bit different than typically what we are accustomed to seeing, but a win is a win, we will take that. I love this group, love the way that they continue to battle. I thought our coaching staff did a great job. Hats off to the Bears. They are a tough, physical football team. We were pleased to come away with a win tonight.”

    (On what point did he know Woods wasn’t going to play today)
    “A couple hours before the game.”

    (On if he made a conscientious effort to put the ball in RB Todd Gurley II hands)
    “That was part of the gameplan tonight and I thought he did a great job. What I loved the most about what (RB) Todd (Gurley II) did, is after we put the first carry on the ground, he didn’t flinch, he came back and had some good, tough, physical runs and made some good catches out of the backfield and he was a big-time contributor tonight. I thought our offensive line as a whole – I can’t say enough about (TE) Johnny Mundt and (TE) Tyler Higbee battling through, where they were banged up, they were questionable coming in to the game. For Johnny Mundt to be able to play really his first extensive action like that and do a great job battling against a really physical front – with some of the personnel groupings that they were playing on defense – I thought was a real impressive night for those guys. Just kind of grinding it out had to be patient and a lot of that is a result of being able to play as good of defense as we did tonight as well.”

    (On holding the Bears to seven points and how good the defense played tonight)
    “Unbelievable. They continued to make stop after stop. I though (DB) Troy Hill’s interception was big. The thing that I thought was as big as anything is when offensively, when we turn it over the first two possessions – for the defense to be able to stand up and not let any points come off those turnovers was huge. Really, our defense was outstanding and that’s what we expect from them. I thought they did a great job.”

    (On if he was committed to more of a conservative approach on offense)
    “Yes, and really I thought at the most timely spots our guys rose up. To be able to see (WR) Josh Reynolds make some timely catches, I thought the third down, where he ended up having poor leverage on (Bears CB Kyle) Fuller, broke that leverage, (QB) Jared (Goff) delivers him a good ball. What a play by Jared Goff in the empty formation to recognize kind of a trap-type coverage where Fuller comes off on the out-break from Josh and he opens up the hole shot from (Tight End) Gerald (Everett). I hate that the one big play to Josh came back, but really I loved the way that our guys overcame it. To see (RB) Malcolm (Brown) end up punching that one in was big and then to be able to close out the game in a four-minute situation and be able to take a knee, that’s always a good thing for us.”

    (On if he expected this good of a performance from the offensive line)
    “Yeah, it is. That’s what we expected. That was the type of game that we thought it would be and I thought those guys did a great job. Until you go back and look at the tape, it’s hard for us to say but I did think there was a lot of situations where you are a little bit more conservative. I thought they did a great job just continuing to battle. It was a physical football game and really pleased with those guys as a whole.”

    (On which point in the week he decided he was going to use Gurley heavily in this game)
    “I think you always have a plan as the week evolves, but you certainly never know exactly how a game’s going to unfold and sometimes it changes. I thought our ability to stay in some manageable situations, the efficiency we had specifically early on in the game was critical for that, and like we talked about, I didn’t think I did a good enough job against the Steelers of kind of recognizing the way that he was running and you don’t want to make the same mistake twice.”

    (On if he recognizes the way that Gurley is running now, and if we will see him featured more during the remainder of the season)
    “I think so. That’s an ideal situation, but we’ll continue to look at this film and we’ll see how we want to put together our next game plan. Anytime you get Todd involved like that, it’s usually always a good thing for our offense.”

    (On what he liked about CB Troy Hill’s performance, which included six tackles, a sack, and an interception)
    “All those things you just mentioned, and I thought he just continued to compete. He’s a complete corner and if he gets his opportunities, he’s got the ball skills to be able to deliver. That was a big play right there if he’s coming up in run support, but a lot of different coverage principles that we activated tonight and I thought (CB) Troy (Hill) did a great job in addition to really the 10 (players) around him and all the different personnel groupings we activated.”

    (On if he expects to get some clarity on when WR Robert Woods will return in the next day or two)
    “Yeah, it’s hard to say. I don’t want to give a finite answer on that. I most importantly want to be able to talk to him afterwards. I talked to him before the game, but want to be able to check with him and out of respect for his family, that’s why we’re just kind of leaving it at what it is.”

    ***

    QB Jared Goff

    (On Rams Head Coach Sean McVay putting the ball in RB Todd Gurley II hands to control the offense)
    “I think we kind of knew what type of game it was going to be. That was the type of game it was it was to run the ball and it was specifically (RB) Todd (Gurley II) the way he was moving the ball and the way he was moving, it worked. It worked really well. I just couldn’t be more proud of the guys who stepped up today. It doesn’t happen everywhere in the league where you have two O-linemen go down, you have (TE) Johnny Mundt, who’s banged up you have (TE) Tyler Higbee who’s banged up and we are going to play you guys the entire game almost. They stepped up and I couldn’t be more proud of them.”

    (On what was the challenge knowing WR Robert Woods wasn’t going to be available for the game)
    “He’s a stud for us and we want him out there. We are thinking about him right now, but I thought (WR) Josh (Reynolds) and (WR) Cooper (Kupp), the same reason. We learned before the game what was going on and needed those guys to step up and they didn’t flinch. I can’t stress enough of how proud I am of my teammates – specifically the guys that had to step up today.”

    (On Kupp not having a catch last week and how nice was it to have him contribute to the offense this game)
    “Anytime I can connect with him is great. We were able to get a little bit more on the same page this week, we weren’t throwing the ball as much as we usually do. It was the way to win the game today. We had to handle it that way and I thought he did a great job.”

    (On how he was able to turn it around and keep it together after back-to-back turnovers)
    “It’s never ideal and never something you want. I was really kicking myself – just knowing that, like I spoke about, that was the type of game it’s just, ‘Don’t turn the ball over and take care of the football.’ Just a bad throw by me. Again, I can’t stress enough the ability to overcome and how you see these guys just consistently fight, and fight, and fight. And those young guys in the huddle the way that they are locked in, it’s so special. It was a big win for us.”

    (On if he could sense a feeling of urgency around the team knowing they needed a win to stay in the playoff hunt)
    “I don’t think we’re thinking that big-picture right now. We were really focused on beating the Bears today and I think that you could feel the urgency with that coming off last week’s disappointment, just knowing that we needed to get this done today a few plays go here, there, the other, you never know what happens. We were able to make somethings happen and those guys up front stepped up and did their thing. We were able to run the ball and you could see what happens when we get that going.”

    (On McVay’s ability to adjust his gameplan based on what the team had going)
    “It was tremendous. Again, I think he is only going to continue to grow as a coach and I think tonight was a perfect example of him knowing what type of game it was going to be. Really relying on Todd and really relying on me to make good decisions and I let him down on that one. Just consistently taking care of the ball. Again, knowing what type of game it was going to be we wanted to do that, and I thought he did a great job.”

    (On the interception he threw in double coverage and how he puts plays like that behind him)
    “That one was tough, that was just a blatant bad decision and bad throw. It’s going to happen, you don’t want them to happen, but it’s bound to. I think, for me personally, I’ve always had a good way about myself to get over that stuff pretty quickly, but that one ate at me for a little bit. Like I spoke about, I knew this game was just take care of the football and we would win the game. As soon as I did that, I’m like, ‘What are you doing? throw the ball away.’ Glad I learned from it, made some good plays the end of the game. I just been doing it my whole life and have to. You have no other choice.”

    (On if the defense playing well gives him confidence that he is going to have a chance)
    “I think the way that they’ve been playing – specifically the last few games – like you’ve mentioned, it’s given us so much confidence and given us so much ability to go down the field and try to make plays and do different things. We need to be better for them, there is no doubt about that. I think tonight was a unique game and I think we’ve could have been a lot better, especially early on. I think the way that we kept responding, kept responding, we would go three-and-out, we’d punt it away, het the ball back and maybe again, and eventually, kept chipping away, kept chipping away, kept chipping away, and I think that last drive we got our mojo back, we were rolling. It felt like how we usually are on offense and it’s a good feeling right now.”

    (On if him saying how he usually is involved Gurley II)
    “I’m speaking more specifically in the pass game, of course the way he’s playing was tremendous. I think on that last drive, we don’t have the best look and we’re just getting open and I’m able to make some throws to the guys and they are making great catches and we are making stuff a little bit off-schedule. That’s how we should play, that’s the rhythm we need to play in and I think that Todd, like you mentioned, being able to run like he did, was able to get us into that rhythm.”

    (On him being emotion with Gurley II coming off the field)
    “I told him he fights, he fights, man. He’s been through the ringer and that dude fights and I couldn’t be more proud to be his teammate.”

    (On Gurley II getting a season-high number of touches and how that affects the passing game)
    “Yeah, anytime we can run the ball like that it’s going to open things up, especially in the play-action game, and I think that’s kind of what you’ve seen from us the last few years – when we’re at our best is when we’re running the ball really well, and there have been games where we haven’t and we’ve overcome it throwing for a million yards, but that’s not usually how we want to do it. Today was a game where we leaned heavily on him, leaned heavily on him and (RB) Malcolm (Brown) and I thought they both stepped up. You see the type of players they are and the type of people they are. It’s special and again, couldn’t be prouder.”

    (On how good the offensive line was given the changes made in the lineup)
    “Huge. Huge. Can’t stress it enough. You think about (T) Bobby Evans making his first start against (Bears OLB) Khalil Mack, who’s arguably the best rush-end in the league and it was a non-factor. He did his thing. He stepped up, he did his thing. We were doing different things to help them out, but not that much, to the point where he was just playing well. And then (OL) David Edwards continues to get better, continues to do his thing. I thought (OL) Austin Blythe directed the offense, directed the O-Line like a champ up front, and then (OL) Austin Corbett stepped in as well. Last week was his first time playing, and this week to just come in there, the way that all of them are just so non-reactive, every single play is just so dialed, so focused, so steely-eyed, and just ready to go. And obviously (T Andrew) Whitworth is who he is and we know that, but I just thought those guys just stepped up so well and I couldn’t be prouder. Couldn’t be prouder.”

    (On if winning with only 11 completions was the way he wanted to win the game)
    “It’s one of my favorite wins as a Ram, no doubt. I think with all the circumstances, being at home in front of our home fans and the way that the game was going, I don’t care how many times I throw the ball, how many times we run the ball, how many completions, attempts, yards, touchdowns, interceptions. The way that game went, and the way that we fought, and the way that we continued to fight all the way until the end in that last drive, the way that that exemplifies that, I think it’s up there in the top of my head as one of my favorite wins as a Ram, and again I couldn’t be prouder with the guys on this team.”

    ***

    WR Cooper Kupp

    (On what they need to do to see more of an explosive offense)
    “We just got to seize the opportunities. They’re there we just have to do a better job executing, starts with us at receiver. There’s some stuff that we did today, I mean even me specifically. There’s some stuff that I did that cost teams games and at the end of the day that’s what it is. You talk about being process driven over results driven. It’s really easy for us to walk out of here feeling good because we got a W. Obviously, you love getting a W. If we’d be process driven and understand the things that we did today, some of the things that I did today really cost teams games and the things that I can not do are inexcusable.”

    (On if he feels extra pressure to help out the defense that’s been play so well)
    “No, no pressure. We don’t have to make a push or anything like that. They’re playing lights out. I love seeing those guys compete. We just have to go out there and execute. That’s the bottom line. We keep saying, ‘We got to be better, we got to be better.’ We will be better, well it’s time for us to be better. We just have to execute. We have to execute, the stuff’s there. We just have to be better.”

    (On how great it was to see RB Todd Gurley back playing)
    “Man, that was great. You see the O-line, some of those guys stepped up huge, especially early on the run game was popping. Getting some good chunks. you see that kind of stuff should open up things in the pass game as well with play actions. It was great to be able to move the ball like that. We love being able to run down hill and see Todd lowering his shoulder again. It’s fun stuff.”

    ***

    CB Jalen Ramsey

    (On his perception on how the Rams got the win against the Bears)
    “I think the team played well — enough to get the win, basically. The defense played extremely well. We’ve been stacking up some good performances lately – tonight was another good performance. We let them get one ‘tud’ (touchdown), but that was OK. We never doubted, we had confidence throughout the whole game, through all the adversity. We had the offenses is back and then the offense came up big towards the end of the game to, you know, finish out the win, basically. It was a good team win.”

    (On how much the Rams needed to win tonight’s game to stay in playoff contention)
    “We weren’t really thinking about it. It was just the next game on the schedule and the most important because it was the game that was right in front of us. That’s about it.”

    (On how much of an accomplishment for the defense it was to hold the Browns to seven points)
    “Yeah, I would think so. In the past however many weeks, we’ve played well defensively. I feel like since I’ve been here — not saying it’s because of me – but I’m saying since I’ve been here, I’ve noticed the defense is really good. The defense performs well and we are just going to keep on trying to build off of that.”

    ***

    DT Aaron Donald

    (On holding the Bears to seven points)
    “We just played good as a defense, everybody flying around and, you know, played solid football. We gave up two plays, but at the end, I feel like we played strong.”

    (On if they had a different mentality going into the game as a defense considering all of the personnel changes on the offense)
    “Well our mindset every week as a defense is to try to dominate and do everything we can. I feel like we’ve been doing that week to week. We’ve got to continue to do it, clean up the little things we’ve been having mistakes with. But overall, I feel like we’ve been playing good football.”

    (On what he liked from the defensive effort against the Bears)
    “I feel like we made good plays. We got the ball back to the offense, we had turnovers, we made big plays when we needed to do it, and we came away with a win.”

    October 31, 2019 at 7:40 pm #107611

    In reply to: Rams news in the bye week

    Avatar photozn
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    Jared Goff receives a C+ as the Rams get graded at their midseason point

    Vincent Bonsignore

    https://theathletic.com/1339690/2019/10/31/jared-goff-receives-a-c-as-the-rams-get-graded-at-their-midseason-point/?=twittered

    Just before Sean McVay and the Rams left London to begin their bye week and start to prepare for the second half of the season, the third-year coach provided a glimpse into what might unfold during the seven-day break. He tipped his hand a bit in terms of where he thinks his Rams are heading into the last eight games of the season.

    “Our staff will get some rest and look at ourselves, figure out what can we do a great job of from an evaluation standpoint, especially these first eight weeks, and then putting ourselves in a position to hopefully peak at the right time,” McVay said.

    He could not have been any clearer, most notably with the “peak at the right time” tag line.

    In many ways McVay saw exactly what everyone else did during the first eight weeks of this Rams’ season: A talented team that, for whatever reason, simply hasn’t put it all together on a consistent basis. And while it’s understandable for him to hope the Rams will be able to soar to their highest peak at just the right time to make another run at the Super Bowl, at this point that seems more like a wishful possibility than a full-on certainty.

    The Rams’ inability to develop a productive and consistent run game at any point of the season is a worrisome inefficiency that has rendered their offense less explosive and balanced than in years past. Todd Gurley provided the backbone of their offensive operation the last two years, and their ability to play off his production in the pass game often made them unstoppable.

    But with Gurley on a load management program — and unable thus far to flash the explosiveness and power he showed before a late-season injury last year — and the offensive line simply not performing up to past standards, the Rams’ offense looks and feels decidedly different.

    That, more than anything, is the cause of their 5-3 record and third-place standing in the NFC West. And as they self-evaluate and begin plotting their attack for the next eight games, it behooves them to figure out a way to run the ball more productively and consistently.

    That said, as the Rams hit the midway point of their season, here is the first half report card by position:

    Quarterback
    Grade: C+

    Jared Goff leads the NFL in passing yards with 2,367, but among qualified quarterbacks his 86.8 QBR is 28th in the league. He was much better the last two weeks against the Atlanta Falcons and Cincinnati Bengals, posting ratings of 99.8 and 119.3, respectively, a sign that when Goff is protected and given time to stand in the pocket he can do damage.

    But he hasn’t consistently been afforded a high level of protection over the majority of the season — partially the result of an inconsistent run game and a leaky offensive line — and when Goff has been asked to carry more of the burden to make up the difference, the results have been uneven to say the least.

    In addition, teams have been determined to take away the Rams’ big pass plays by playing deeper zone cover concepts, forcing Goff to be more patient and operate more underneath. The last two weeks are proof he is getting better in that area, by utilizing his tight ends more and consistently finding Cooper Kupp in open spaces, but the quality of opponent has to be taken into account.

    Goff can play better, but he also needs his offensive line and running game to be better, too.

    Running back
    Grade: C-

    Todd Gurley has 92 carries for 355 yards. To put that in perspective, at this point last season Gurley had 169 carries for 800 yards. And his 436 total yards from scrimmage this year is down considerably from the 1,151 he had at this point last season.

    Gurley isn’t being utilized as much as he was in the past and he simply isn’t playing as well when he is being used. Whether that’s due to lingering issues with the left knee that broke down last year, or him not being able to get into a groove within in a much more guarded usage pattern, Gurley just isn’t the force he’s been the last two seasons.

    And that is a major problem the Rams continue to try to work around.

    The question now is, will the Rams begin easing the workload management program Gurley has been operating in, or is this just the new reality?

    Backups Malcolm Brown (154 yards on 37 carries) and Darrell Henderson (119 on 29) have been more effective than Gurley, but Brown has missed time with a foot injury and Henderson doesn’t appear ready to assume a bigger role.

    One way or another, the Rams must get their run game squared away, whether by unleashing Gurley or expanding the role of Brown or Henderson.

    Wide receiver
    Grade: B+

    Cooper Kupp has returned from last year’s knee injury with a vengeance, and his 792 receiving yards on 58 catches provides proof of what the Rams missed late last season after he was lost to a knee injury. Robert Woods has been efficient with 471 yards on 38 catches while Brandin Cooks has fallen off with 27 catches for 402 yards. Cooks suffered his second concussion of the season against the Bengals, and his overall production has been diminished by injuries and the way defenses are taking away the Rams’ long ball. If he can stay healthy the rest of the way, it behooves the Rams to find a way to get him more involved downfield.

    Offensive line
    Grade: C

    Things have picked up recently with this group, with the improved play of tackles Andrew Whitworth and Rob Havenstein and rookie left guard David Edwards solidifying that spot in place of the injured Joe Noteboom. But it’s been a bit of a roller coaster all year implementing three new starters — including center Brian Allen — and dealing with right guard Austin Blythe’s ankle injury. The hope all along was that this group would be ascending over the second half of the season after going through an early learning curve with so many new faces. The Rams need that to be the case.

    Tight end
    Grade: B

    Gerald Everett continues to emerge as a target for Goff with 26 catches for 297 yards, and there are signs that his production will continue to rise as Everett takes advantage of the defensive mismatches he’s facing. Tyler Higbee has been his typically steady self as a reliable pass-catcher when called upon and as a run and pass protector.

    Defensive line
    Grade: B

    Aaron Donald continues to be a game-breaker at the line of scrimmage, and while his five sacks leave him off the pace of last year’s 21.5-sack total, the pressure and problems he creates for offensive lines helps free up teammates to do damage. Michael Brockers has been solid at tackle with 34 tackles and 1.5 sacks, and first-year starter Sebastian Joseph-Day has been more than adequate at nose tackle. Rookie Greg Gaines, who the Rams had high hopes for, has not been able to get on the field much, and Tanzel Smart and Morgan Fox have provided only spot duty.

    The Rams have been solid in run defense, giving up 96.9 yards per game, and the defensive line is a big reason why, with its ability to make plays and tie up blockers so that second-level defenders can attack and clean up.

    Inside linebacker
    Grade: B+

    Cory Littleton has a team-high 66 tackles and is putting himself in line for a big payday after this season. He keeps getting better as an all-around defender capable of plugging holes, extending laterally to play sideline-to-sideline and being an asset in pass coverage. The Rams have been star-crossed opposite Littleton, with projected starter Micah Kiser suffering a season-ending shoulder injury during the preseason and replacement Bryce Hager dealing with injuries over the last month. But rookie Troy Reeder has been solid, with 31 tackles in three starts.

    Outside linebacker
    Grade: B+

    The Rams have gotten sturdy play from this group, led by Clay Matthews and his team-high six sacks before he went down with a broken jaw five games in. Matthews is expected back soon after the break, and will provide a big-time lift. Dante Fowler Jr. has really raised his play, with 6.5 sacks, solid run support and 32 total tackles. Rotation players Samson Ebukam and Ogbonnia Okoronkwo both have been good off the bench, giving the Rams a nice mix of reserves and starters. The pressure this group creates while playing off Donald’s brilliance has been a bright spot this year.

    Cornerback
    Grade: B+

    The Rams hit the reset button on this position by parting ways with both Marcus Peters and Aqib Talib in trades over the last two weeks. Both were set to be free agents at the end of the year, and given an opportunity to cut ties now and save $8 million in cap space while also making room for All-Pro corner Jalen Ramsey, the Rams opted to blow up the position early.

    Ramsey has been mostly terrific in his first two Rams games and his ability to play man-to-man coverage is a game changer for Wade Phillips’ 3-4 defense. He’s now free to be much more aggressive with his blitz packages, knowing Ramsey can deal with his assignment one on one. Troy Hill has been steady opposite Ramsey and the Rams are high on youngsters Darious Williams and David Long Jr. Combined with slot corner Nickell Robey-Coleman, the Rams have been in good shape thus far at corner.

    Safety
    Grade: A

    The Rams suffered a huge blow when John Johnson went down with what appears to be a season-ending shoulder injury, although rookie Taylor Rapp and valuable reserve Marqi Christian have stepped up in major ways. Rapp is playing like a veteran both as a tackler (43) and pass defender. Opposite them, veteran Eric Weddle has been everything the Rams hoped for, with 59 tackles and as the quarterback of the defense. This group’s ability to be flexible in pass and run coverage is invaluable.

    Special teams
    Grade: B

    Greg Zuerlein has made 16 of 20 field-goal attempts, although one of the misses resulted in a back-breaking loss to the Seattle Seahawks. Given his usually high standards, Zuerlein has been a bit off this year, but there’s no cause for alarm. Johnny Hekker is averaging 44.2 yards per punt, down two yards from last year.

    Coaching
    Grade: B

    The Rams’ record might not indicate it, but Sean McVay is handling some situations with a deft hand in order to put the Rams in prime position to make another run. An organizational edict to manage Todd Gurley’s workload — and Gurley simply not being as explosive and productive as in years past — has forced McVay to work around a major disruption to his offense. He’s also had to deal with injuries to three starters.

    He hasn’t complained or pointed fingers. He’s simply gone about trying to find answers. He didn’t always locate them in the first half, but the Rams are a missed field goal from being 6-2. As the season progresses and McVay continues to push buttons to manage the health and spirit of his team, it will be interesting to see how it all plays out. But for now, he’s doing an admirable job.

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