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It Was Inevitable Since Trump Was Elected That Calamity Was No Longer Imminent-- It Is Here


Yesterday, Iowa reported 2,816 more cases of COVID-19 and 83 more deaths. The state has had nearly a quarter million cases so far-- 76,170 cases per million Iowans. The only states that have fared worse in the pandemic are North and South Dakota. And all three have unintelligent Trumpist governors who have rejected science and embraced ideology in dealing with the pandemic. The people living in their states have suffered horrible consequences. Iowa Governor Kim Reynolds, like Burgum in North Dakota and Noem in South Dakota should be indicted for-- at best-- negligent homicide, if not mass murder.

This week, Elaine Godfrey's essay for The Atlantic, Iowa Is What Happens When Government Does Nothing tells the story of how government inaction in the name of a bogus right-wing doctrine-- "freedom" and "personal responsibility"-- has resulted in a deadly out-of-control pandemic.

In 2008 and 2012, Iowan flocked to the polls to elect Obama. They believed in Hope and Change. It didn't happen and they got grumpy. In 2016 Bernie pretty much tied the Democratic establishment candidate in the first-in-the-nation contest between them. Though the establishment was primed to steal the caucuses for Hillary-- and she wound up with 29 delegates to Bernie's 21-- Hillary took 49.9% of the votes to Bernie's 49.6% of the vote. Iowa has 99 counties. In the 2016 general election, Trump swept the state by nearly 10 points-- 798,923 (51.8%) to 650,790 (42.2%)-- and won 93 of the counties. Of the 6 that remained loyal to the Democrats, 5 had been Bernie counties during the caucuses. Iowans, apparently, still wanted Hope and Change, but real hope and real change.

Last month, Iowans were still not buying into what the Democratic establishment was selling. Trump beat Biden by a significantly wider margin than in 2016-- 897,672 (53.2%) to 759,061 (45.0%) and Iowans flipped two blue congressional seats red and reelected an unaccomplished Trumpist senator, Joni Ernest 51.8% to 45.2%, even with the Democratic establishment hack outspending her $55.3 million to $29.5 million. The Democrats failed to gain a flip a single seat in either chamber of the state legislature, leaving the Republicans in unitary control of state government.

Godfrey introduced her essay by warning her readers that "To visit Iowa right now is to travel back in time to the early days of the coronavirus pandemic in places such as New York City and Lombardy and Seattle, when the horror was fresh and the sirens never stopped. Sick people are filling up ICUs across the state. Health-care workers... are being pushed to their physical and emotional limits. On the TV in my parents’ house in Burlington, hospital CEOs are begging Iowans to hunker down and please, for the love of God, wear a mask. This sense of new urgency is strange, though, because the pandemic isn’t in its early days. The virus has been raging for eight months in this country; Iowa just hasn’t been acting like it."

She got right to the point-- a point that could be made when explaining the horrors being experienced now in the Dakotas, Nebraska, Missouri and across the Midwest and the South: "The story of the coronavirus in this state is one of government inaction in the name of freedom and personal responsibility. Iowa Governor Kim Reynolds has followed President Donald Trump’s lead in downplaying the virus’s seriousness. She never imposed a full stay-at-home order for the state and allowed bars and restaurants to open much earlier than in other places. She imposed a mask mandate for the first time this month-- one that health-care professionals consider comically ineffectual-- and has questioned the science behind wearing masks at all. Through the month of November, Iowa vacillated between 1,700 and 5,500 cases every day. This week, the state’s test-positivity rate reached 50 percent. Iowa is what happens when a government does basically nothing to stop the spread of a deadly virus. So is North Dakota (107,536 cases per million residents). So is South Dakota (95,402 cases per million residents). So is Nebraska (69,639 cases per million residents). So is Utah (65,244 cases per million residents). So is Arkansas (55,384 cases per million residents). So is Mississippi (54,923 cases per million residents). One in ten Dakotans have been infected with the coronavirus. Holiday in Cambodia?

Eli Perencevich, an Iowa infectious-disease doctor told Godfrey that "In a lot of ways, Iowa is serving as the control group of what not to do." He predicted that the state’s lax political leadership will result in a "super peak" over the holidays, and thousands of preventable deaths in the weeks to come. "We know the storm’s coming," Perencevich said. "You can see it on the horizon."

Is it really Reynold's fault? I think so-- and so does Godfrey. She wrote: "The first cases of the coronavirus in Iowa were recorded here in early March, when a group of infected locals returned home from an Egyptian cruise. As cases rose, Reynolds closed schools for the rest of the school year and most businesses for about two months. But by May 15, she’d allowed gyms, bars, and restaurants in all of Iowa’s 99 counties to open up again. She did not require Iowans to wear a mask in public, ignoring requests from local public-health officials and the White House Coronavirus Task Force and arguing that the state shouldn’t make that choice for its people. 'The more information that we give them, then personally they can make the decision to wear a mask or not,' Reynolds said in June. She also wouldn’t require face coverings in public schools, where she ordered that students spend at least 50 percent of their instructional time in classrooms. When Iowa City and other towns began to issue their own mask requirements, Reynolds countered that they were not enforceable, undermining their authority... Infections exploded in meatpacking plants, where managers were allegedly taking bets on how many workers would get sick. After students returned to schools and universities in the early fall, Iowa had the highest rate of COVID-19 infections in the country. In October, when Iowa was in the thick of community spread, Reynolds showed up, maskless and smiling, at a campaign rally for Trump at the Des Moines airport. (Her let-them-get-sick attitude toward the pandemic hasn’t been unusual among Republican governors, though there have been exceptions, including Mike DeWine of Ohio and Larry Hogan of Maryland.) By late November, the number of new COVID-19 cases in Iowa was higher than at any other point in the pandemic, and as many as 45 Iowans were dying of the disease every 24 hours in a state of just 3 million people. Outbreaks were reported in 156 nursing homes and assisted-living facilities in Iowa, and the virus ran rampant in the state’s prisons."

The state's hospital system is breaking down and there aren't enough ICU beds, nor doctors, nurses and trained staff-- many suffering moral distress themselves-- to care for sick Iowans now. Rural hospitals are being overwhelmed across Iowa, and many face bankruptcy, in part because they’ve been forced to cancel elective procedures. "What makes all of this suffering and death exponentially more painful," continued Godfrey, "is the simple fact that much of it was preventable. A recent New York Times analysis clearly showed that states with the tightest COVID-19 restrictions have managed to keep cases per capita lower than states with few restrictions. Reynolds is in an admittedly complicated situation. She, like other governors, is facing enormous pressure to protect people’s livelihoods as well as their health. But a mask mandate is free. And failing to control the virus is, unsurprisingly, very bad for business. 'We want to take care of people ... It shouldn’t be this hard, and that makes us mad,' Dana Jones, a nurse practitioner in Iowa City, told me. 'There are people to blame, and it’s not the patients.' When Reynolds finally announced a spate of new COVID-19 regulations on November 17, the rules limited indoor gatherings to 25 people, and required that Iowans wear masks inside public places only under a very specific set of conditions. Four of the doctors and nurses I interviewed laughed-- actually laughed-- when I asked what they thought of the new regulations. The policies will do basically nothing to prevent the spread of the virus, they told me."

State lawmakers’ response to Reynolds’s handling of the pandemic breaks down along partisan lines. “She’s done a good job balancing people’s constitutional rights with a few restrictions that have been commonsense,” Representative Dave Deyoe, a Republican from central Iowa, told me, arguing that tighter restrictions in more liberal states haven’t led to lower death rates. Although this is a common argument among Iowa Republicans, it’s an unfair one. Many Northeast and West Coast states have had more total deaths because they were badly hit by the virus early in the pandemic, before strong measures were put in place. In the past seven days, Iowa’s death rate has been at least twice as high as that of New York, New Jersey, and California.
Democrats in Iowa believe that Reynolds’s inaction has always been about politics. Early on, she’d assumed an important role making sure that Trump would win Iowa in the November election, State Senator Joe Bolkcom, who represents Iowa City, told me. “She did that by making people feel comfortable” about going out to eat, going to bars, and going back to school. “She mimicked Trump’s posture” to get him elected. Ultimately, Reynolds was successful in her efforts: Trump won Iowa by 8 points. But Iowans lost much more.
Iowa's problem is not that residents don’t want to do the right thing, or that they have some kind of unique disregard for the health of their neighbors. Instead, they looked to elected leaders they trust to tell them how to navigate this crisis, and those leaders, including Trump and Reynolds, told them they didn’t need to do much at all.
...The crisis in Iowa’s hospitals could be improved in a matter of weeks if Iowans started wearing a mask whenever they leave the house and stopped spending time indoors with people outside their households. But doctors posting diagrams to Facebook can do only so much... Without state leadership on board, none of those changes will happen... Reynolds needs to order bars closed and restaurants to move to takeout only, at least until the surge is over, public-health experts told me. Reynolds and other state leaders could frame mask wearing and self-isolation as a matter of patriotic duty.
...An end to the pandemic is in sight: The United States is mere weeks away from being able to vaccinate health-care workers and vulnerable members of the public. It would be helpful if, when it’s time to distribute those vaccines, local hospitals were not on the verge of collapse. But right now, Iowa is on a disastrous path. Experts expect to see a spike in COVID-19 cases in the state roughly one week from now, two weeks after the Thanksgiving holiday. That spike will likely precede a surge in hospitalizations and, eventually, a wave of new deaths-- maybe as many as 80 a day, Perencevich, the infectious-disease doctor, estimates. Add Christmas and New Year’s to the mix, and Iowans can expect to see nothing less than a tsunami, Perencevich says.

Two other Atlantic writers, Alexis Madrigal and Robinson Meyer, noted yesterday that the country as a whole has passed the hospital breaking point. "A month ago, in early November," they wrote, "hospitalizations passed 60,000-- and kept climbing, quickly. On Wednesday, the country tore past a nauseating virus record. For the first time since the pandemic began, more than 100,000 people were hospitalized with COVID-19 in the United States, nearly double the record highs seen during the spring and summer surges. The pandemic nightmare scenario-- the buckling of hospital and health-care systems nationwide-- has arrived. Several lines of evidence are now sending us the same message: Hospitals are becoming overwhelmed, causing them to restrict whom they admit and leading more Americans to die needlessly. The current rise in hospitalizations began in late September, and for weeks now hospitals have faced unprecedented demand for medical care. The number of hospitalized patients has increased nearly every day: Since November 1, the number of people hospitalized with COVID-19 has doubled; since October 1, it has tripled. Throughout that time, health-care workers have worried that hospitals would soon be overwhelmed. 'The health-care system in Iowa is going to collapse, no question,' an infectious-disease doctor told our colleague Ed Yong early last month. The following week, a critical-care doctor in Nebraska warned, 'The assumption we will always have a hospital bed for [you] is a false one.' These catastrophes seem to be coming to pass-- not just in Iowa and Nebraska, but all across the country. A national breakdown in hospital care is now starkly apparent in the coronavirus data.

Many states have reported that their hospitals are running out of room and restricting which patients can be admitted. In South Dakota, a network of 37 hospitals reported sending more than 150 people home with oxygen tanks to keep beds open for even sicker patients. A hospital in Amarillo, Texas, reported that COVID-19 patients are waiting in the emergency room for beds to become available. Some patients in Laredo, Texas, were sent to hospitals in San Antonio—until that city stopped accepting transfers. Elsewhere in Texas, patients were sent to Oklahoma, but hospitals there have also tightened their admission criteria.
...Since March, most of our writing about the pandemic has focused on the near-term future. We’ve described data as worrying or ominous, words implying that the worst is soon to arrive. There’s a good reason for this forward-looking approach: It gives people a sense of what’s coming, and it helps people make decisions to protect themselves or their family.
But ominous no longer fits what we’re observing in the data, because calamity is no longer imminent; it is here. The bulk of evidence now suggests that one of the worst fears of the pandemic-- that hospitals would become overwhelmed, leading to needless deaths-- is happening now. Americans are dying of COVID-19 who, had they gotten sick a month earlier, would have lived. This is such a searingly ugly idea that it is worth repeating: Americans are likely dying of COVID-19 now who would have survived had they gotten September’s level of medical care.



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