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  • Dr. Kemia

Flecti Non Frangi


Dear Everyone:


The human soul doesn’t want to be advised or fixed or saved. It simply wants to be witnessed – to be seen, heard and companioned exactly as it is.

~Parker Palmer~


If you’ve had a difficult week of it, please know you’re not alone. Nothing – nothing at all right now – feels good or looks good to the vast majority of Americans, regardless of political affiliation or personal beliefs.


“I had a rough one yesterday”

“I thought I was holding up, but…”

“My dad has COVID and isn’t doing well”

“I am so incredibly lonely. I never expected this”

“I can’t keep this up. Working from home is not working for me.”

“I am failing my kids and failing at my job”

“I’m closing my business”

“I am afraid for my students”

“My colleague died…”


These are just a few of the messages I’ve received in the last 24 hours (well. If I’m going to be transparent, the first one I sent…).


There’s a Latin phrase, “Flecti Non Frangi” that means “to be bent, not broken.” It’s the heart of true resiliency – that ability to absorb the pain or trauma, to bend without breaking and to emerge on the other side somehow *better*.


And I’ve been wondering: will we emerge from this bent but stronger? Kinder? Wiser? More patient? More understanding? More willing to create and maintain space for each other? Will we have absorbed lessons that shape us in powerful, and empowering, ways?


I don’t know.


Individually, perhaps, depending on our social and economic supports, our resiliency going in, our willingness to bend, and a multitude of other forces that will coalesce to either mitigate or amplify our individual trauma. Personal choices factor in, but many elements are out of our control.


Collectively, America, I’m worrying about us.


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So, where are we?


The point of the suppression strategies enacted by the majority of U.S. states was to accept short-term economic pain as the price of getting the virus under control. Ideally, these strategies – in particular physical distancing and stay-home orders – would ease once infection rates began declining and the country had prepared itself—through enormous, widespread testing, an army of contact-tracers and infrastructure to support extended isolation and quarantine—to quickly recognize and respond to the inevitable micro-flares we will see when these restrictions are relaxed.


America currently has none of these preparations in place, whole-scale.


Furthermore, due to freedom of movement in America, people (and their viral tagalongs) can easily cross state lines. In a situation where some states remain under distancing guidelines and others do not, we risk the worst of both worlds: poorly controlled spread requiring repeated future lockdowns, thus extending economic pain and uncertainty.


There IS room for partial optimism. Only a month ago, epidemiological modeling warned that the death toll in the U.S. could be upwards 2.2m Americans. As of last night, the death toll was 51,000. Some hotspots are cooling: NYC, deemed the “epicenter of the world” for Coronavirus reported its fewest new cases in a month on April 20th, and the death toll is finally trending down. Equally promising is the data out of NY published just last night confirming what we have long hoped: that with the benefit of widespread testing, and antibody testing in particular, we see that the denominator of this disease is, in fact, far larger that the original data suggested. There are both long and short term implications of this, and it all bodes well for the postulate that the disease may burn itself out more quickly that initially feared.


Let me be very clear about this, however: these developments testify to the success of the distancing measures put in play. To run from these suppression strategies now would be akin to chucking your umbrella in the middle of a downpour because you haven’t gotten wet.


The problem, of course, is that we are woefully underprepared for what comes next, even by those measures outlined in the Whitehouse plan to reopen America. To safely and fully reopen, America needs – at a bare minimum – 500,000 tests per day (and I’m giving you the lowest recommended number I could find – many, if not most, public health experts are quoting numbers 2-10 times higher). The purpose for this level of available testing is to allow local health departments to catch, isolate and do aggressive contact tracing on ASYMPTOMATIC transmitters, as well as those who have Covid19 symptoms.


This month, the average number of daily tests in the U.S. was 150,000.


Importantly, a remarkably high number - about 20% - of all tests in the US are positive, suggesting that we are missing many, many mild or asymptomatic cases (in Taiwan, for comparison, 1:132 tests is positive). We probably have 15 to 20 times more infected people than confirmed cases – good news in that it suggests that the infection fatality rate (IFR) is lower than originally though, bad news in that we know the relaxing of distancing measures too soon will result in those asymptomatic people infecting many, many others without knowing or meaning to.


Material shortages and laboratory backlogs, further hindered by a lack of national coordination and sharply increased demand, have severely handicapped our testing capacity. The problem is solvable, but only with decisive, concerted federal action. As I recently mentioned: this is why we pay federal taxes – defense of country. A coordinated national effort constitutes not only the rational public health defense of our citizenry, but also the only reasonable *economic* defense. We cannot hope to reasonable and safely reopen without it.


Additionally, we have a critical shortage of contact-tracers. These are people deployed by hospitals or departments of public health to investigate where someone may have caught the disease, and who else they may have infected. Best estimates say we need 300,000 trained contact-tracers; we have 2,200 (Wuhan alone had 9,000).


We are not ready. But, ready or not, here some states go…


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As I’ve written previously, when developing public policy you must take into account the multivariate factors that influence the health of a population not only in the short term, but also long-term. There are consequences, some unavoidable and some unintended, to every policy decision made. Decisions were made to suffer short-term economic pain – and please understand I recognize and am in no way trying to diminish the severity of that pain for tens of millions of Americans – in order to prevent a mass casualty situation which, in all likelihood, would ALSO have resulted in economic devastation. This has been a Trolley Dilemma from the moment we became aware that there was no national plan for handling the crisis.


The question now is, where do we go from here?


I’m going to ignore the sophomoric tantrums of “freedom protesters” and instead address the very real, tangible pain and suffering felt by those who are out of work, losing their businesses, unable to afford rent or groceries, etc. The trauma – psychological, economic, emotional – is very, very real. They need to get back to work. They need to begin rebuilding. Those state officials who are extending – as we did in IL – shelter in place orders KNOW THIS. They understand. And they have no vested interest – they gain nothing – through the collapse of their state economies.


Why then, would they do this?


It is a matter of values and ethics. It also, I would argue, is a recognition that the economic reality of reopening too soon will serve only to prolong all the pain and suffering to date.


What difference can 30 more days possibly make?


A lot.


In 30 days we can train contact tracers. In 30 days, companies can have finally ramped up production to the point that tests (and reagent and other materials) *are* finally available in the quantities we need. In 30 days we will be a month FURTHER into flattening this curve, into protecting each other, into working out the systems of risk stratification that can keep the most people safe for the longest period of time.


In 30 days we will have data from European countries that issues lockdowns *except* for their elementary schools, and will know whether that was a necessary part of suppression, or a precaution we won’t need in the future.


In 30 days, people will have learned that masks save lives. And that when we all work together and mask in public spaces, we saying to each other, “your life is valuable to me.”


Undoubtedly, though, in 30 days we will also see more businesses fail. More people laid off. More bankruptcies. More economic pain.


And still I say: We can fix anything but dead, America.


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If this isn’t the soul-boosting post you were hoping it would be, I am genuinely sorry. There *is* a LOT of good news hidden in these sobering facts, not the least of which is that we have slowed the spread of this, significantly, in most places. I said early on that our entire job was to Buy Time for our healthcare systems to ramp up and prepare for those who would need critical care, and we did. We flattened the curve. In some places, frankly, we smashed it. And believe me: I danced a tiny gig last night when I saw the preliminary results on antibody testing out of New York.


But the federal response has not mirrored the efforts of the American people, and we can’t get the last two months of wasted time, back. We could have been ready – with tens of millions of tests and hundreds of thousands of trained contact tracers and a massive injection of capital into state public health systems. None of that was done, and now some state governors, unwilling or unable to bear the economic pain and suffering, are reopening on the hope that the inevitable spike won’t be *too* bad, that hospitals have expanded capacity enough, and that the death won’t visit them or theirs.


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So, what do we do?


First, don’t forget to hydrate. And sleep. And breathe – if you’re not breathing deeply, your autonomic nervous system cannot be balanced. Breathe deeply.


My dear friend implored me to “chocolate” today. I love people who verb nouns. I’ve chocolated all day.


Call your representatives. Insist on a strong federal response. Call again tomorrow and insist on the same. Be kind to whoever picks up the phone. I know I shouldn’t be at this point in my life, but I am still surprised at how far kindness takes us. Especially in times such as these.


Stay home if you can. Mask when you cannot. Wash your hands vigorously and often. Don’t touch your face.


Keep putting off nonessential services, please. And buy locally whenever possible.


BUT, if you have been putting off nonemergent healthcare, call your doctor. Talk to her or him. Telemedicine has gotten a huge boost in all this. Our hospitals have policies and systems in place, so PLEASE don’t ride out your chest pain, or unbearable abdominal pain, or newly discovered lump, or new facial droop, or other issue you’ve been putting off, at home. We know that other medical conditions don’t disappear in the face of COVID, and all steps are being taken to ensure your safety and health.


If you’re struggling, reach out. Phone a friend or family member and open with, “I’m having a hard time. You?” I can almost promise a you’ll hear, “me too. I’m in this with you.” If the hole is really dark right now, you aren’t alone there, either – there are many new, free hotlines that have been set up (links in the comments) to provide you a safe, secure and private place to share your darkest thinking. Please call. Depression lies. Anxiety lies.


#WeWantYouHere.


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One of the most powerful questions I’ve learned to ask myself in recent years is, “who do I want to be in this situation?”


What does it look like when the best version of me shows up? And how do I get from where I am right now, to the space that person occupies?


Sometimes it means taking a knee for a few days.


Sometimes it means taking a walk (or three).


Sometimes it means loud, angry music.


Sometimes it means writing it all down.


Sometimes it means a phone call to cry it all out.


Sometimes it looks like more work in the garden.


Sometimes it looks like a kitchen full of cake, cookies and bread.


And sometimes it means walking away from the whole thing, turning everything off and tuning into the now.


Always, though, it requires tending to the basics, care of others, and reframing the whispers of my lesser angels.


This middle part is hard, America, but we are getting through. First the pain, then the rising.


Keep being brave, generous and kind.


More soon


K


#CareInTheTimeofCovid

#Resilience

#BendDontBreak

#America

#TrustScience

#AnythingButDead

#Covid19

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