Wednesday, April 29, 2020

The Bullshit Factor

The endless screed of media and politicians have done a great job of burying facts with bullshit over the last few months.  Again this is a blood borne sort of kind of disease. Meaning you will have to come into close contact with someone to contract the Covid virus and that could be on a plane, touching the same surfaces, interacting with a sick person via numerous locations such as a hospital, work or public transport.  That one catches varying illnesses way.. that said this passes from 1 to 2 to 3 versus the convention flu 1 to 1.   And the long term health issues are more serious.

This week the highlight reel is on the serology tests of those who have antibodies present in their blood meaning that they 'had' Covid.  Again I to my recollection have had nothing so let me go into a test and see what is what.  And again we sill do not know what the rate for those testing pos with no symptoms or even those testing negative are in fact reverse and the margin of error on those.

I am exhausted about the subject and for the reality there is no blanket on how to handle this issue as rural less populated areas versus high density urban areas do no need to follow the same protocol lockdown, shelter in place that is being done in New York City. Now they are not exempt and they have their own issues with lack of hospitals, medical care available that can make situations worse but we are comparing apples to oranges.  So when you have a rural community in Georgia opening is one thing versus Atlanta with a major hub in the backyard.   And that also goes for bedroom communities outside major cities that have their own needs and often are communities of non-secular nature that do not follow any mainstream political orders as we have learned here from the Orthodox community but they do work, commute into the city.  Again its complicated and no Scientist can take into account each and every variable when coming up with a model.  Nate Silver has been quite clear on that so you are responsible for ultimately yourself.

Science works on the unknown and Politicians work on the known and they don't work well together at all.  So again the nightly lottery numbers come in and like the roulette wheel bet on black when all the dealer spins is red.  You will never win.

'There is no absolute truth': an infectious disease expert on Covid-19, misinformation and 'bullshit'

Carl Bergstrom’s two disparate areas of expertise merged as reports of a mysterious respiratory illness emerged in January

Julia Carrie Wong in Oakland
The Guardian
Tue 28 Apr 2020

Carl Bergstrom is uniquely suited to understanding the current moment. A professor of biology at the University of Washington, he has spent his career studying two seemingly disparate topics: emerging infectious diseases and networked misinformation. They merged into one the moment reports of a mysterious respiratory illness emerged from China in January.

The coronavirus touched off both a pandemic and an “infodemic” of hoaxes, conspiracy theories, honest misunderstandings and politicized scientific debates. Bergstrom has jumped into the fray, helping the public and the press navigate the world of epidemiological models, statistical uncertainty and the topic of his forthcoming book: bullshit.

You’ve been teaching a course and have co-written a book about the concept of bullshit. Explain what you mean by bullshit?

The formal definition that we use is “language, statistical figures, data, graphics and other forms of presentation that are intended to persuade by impressing and overwhelming a reader or listener with a blatant disregard for truth or logical coherence”.

The idea with bullshit is that it’s trying to appear authoritative and definitive in a way that’s not about communicating accurately and informing a reader, but rather by overwhelming them, persuading them, impressing them. If that’s done without any allegiance to truth, or accuracy, that becomes bullshit.

The idea with bullshit is that it’s trying to appear authoritative and definitive in a way that’s not about communicating accurately and informing a reader

We’re all used to verbal bullshit. We’re all used to campaign promises and weasel words, and we’re pretty good at seeing through that because we’ve had a lot of practice. But as the world has become increasingly quantified and the currency of arguments has become statistics, facts and figures and models and such, we’re increasingly confronted, even in the popular press, with numerical and statistical arguments. And this area’s really ripe for bullshit, because people don’t feel qualified to question information that’s given to them in quantitative form.

Are there bullshit narratives about the coronavirus that you are concerned about right now?

What’s happened with this pandemic that we’re not accustomed to in the epidemiology community is that it’s been really heavily politicized. Even when scientists are very well-intentioned and not trying to support any side of the narrative, when they do work and release a paper it gets picked up by actors with political agendas.

Whether it’s talking about seroprevalence or estimating the chance that this is even going to come to the United States at all each study gets picked up and placed into this little political box and sort of used as a cudgel to beat the other side with.

So even when the material isn’t being produced as bullshit, it’s being picked up and used in the service of that by overstating its claims, by cherry-picking the information that’s out there and so on. And I think that’s kind of the biggest problem that we’re facing.

One example [of intentional bullshit] might be this insistence for a while on graphing the number of cases on a per-capita basis, so that people could say the US response is so much better than the rest of the world because we have a slower rate of growth per capita. That was basically graphical malfeasance or bullshit. When a wildfire starts spreading, you’re interested in how it’s spreading now, not whether it’s spreading in a 100-acre wood or millions of square miles of national forest.

Is there one big lesson that you think that the media should keep in mind as we communicate science to the public? What mistakes are we making?

I think the media has been adjusting really fast and doing really well. When I’m talking about how to avoid misinformation around this I’m constantly telling people to trust the professional fact-based media. Rather than looking for the latest rumor that’s spreading across Facebook or Twitter so that you can have information up to the hour, recognize that it’s much better to have solidly sourced, well-vetted information from yesterday.

Hyper-partisan media are making a huge mess of this, but that’s on purpose. They’ve got a reason to promote hydroxychloroquine or whatever it is and just run with that. They’re not even trying to be responsible.

***But one of the biggest things that people [in the media] could do to improve would be to recognize that scientific studies, especially in a fast-moving situation like this, are provisional. That’s the nature of science. Anything can be corrected. There’s no absolute truth there. Each model, each finding is just adding to a weight of evidence in one direction or another.****

A lot of the reporting is focusing on models, and most of us probably don’t have any basic training in how to read them or what kind of credence to put in them. What should we know?

The key thing, and this goes for scientists as well as non-scientists, is that people are not doing a very good job thinking about what the purpose of different models are, how the purposes of different models vary, and then what the scope of their value is. When these models get treated as if they’re oracles, then people both over-rely on them and treat them too seriously – and then turn around and slam them too hard for not being perfect at everything.

Are there mistakes that are made by people in the scientific community when it comes to communicating with the public?

We’re trying to communicate as a scientific community in a new way, where people are posting their data in real time. But we weren’t ready for the degree to which that stuff would be picked up and assigned meaning in this highly politically polarized environment. Work that might be fairly easy for researchers to contextualize in the field can be portrayed as something very, very different in the popular press.

The first Imperial College model in March was predicting 1.1 million to 2.2 million American deaths if the pandemic were not controlled. That’s a really scary, dramatic story, and I still think that it’s not unrealistic. That got promoted by one side of the partisan divide. Then Imperial came back and modeled a completely different scenario, where the disease was actually brought under control and suppressed in the US, and they released a subsequent model that said, ‘If we do this, something like 50,000 deaths will occur.’ That was picked up by the other side and used to try to discredit the Imperial College team entirely by saying, ‘A couple of weeks ago they said a million now they’re saying 50,000; they can’t get anything right.’ And the answer , of course, is that they were modeling two different scenarios.

We’re also not doing enough of deliberately stressing the possible weaknesses of our interpretations. That varies enormously from researcher to researcher and team to team.

It requires a lot of discipline to argue really hard for something but also be scrupulously open about all of the weaknesses in your own argument.

But it’s more important than ever, right? A really good paper will lay out all the most persuasive evidence it can and then in the conclusion section or the discussion section say, ‘OK, here are all the reasons that this could be wrong and here are the weaknesses.’

When you have something that’s so directly policy relevant, and there’s a lot of lives at stake, we’re learning how to find the right balance.

It is a bit of a nightmare to put out data that is truthful, but also be aware that there are bad faith actors at the moment who might pounce on it and use it in a way you didn’t intend.

There’s a spectrum. You have outright bad faith actors – Russian propaganda picking up on things and bots spreading misinformation – and then you have someone like Georgia Governor Brian Kemp who I wouldn’t call a bad faith actor. He’s a misinformed actor.

There’s so much that goes unsaid in science in terms of context and what findings mean that we don’t usually write in papers. If someone does a mathematical forecasting model, you’re usually not going to have a half-page discussion on the limitations of forecasting. We’re used to writing for an audience of 50 people in the world, if we’re lucky, who have backgrounds that are very similar to our own and have a huge set of shared assumptions and shared knowledge. And it works really well when you’re writing on something that only 50 people in the world care about and all of them have comparable training, but it is a real mess when it becomes pressing, and I don’t think any of us have figured out exactly what to do about that because we’re also trying to work quickly and it’s important to get this information out.

One area that has already become contentious and in some ways politicized is the serology surveys, which are supposed to show what percentage of the population has antibodies to the virus. What are some of the big picture contextual caveats and limitations that we should keep in mind as these surveys come out?

The seroprevalence in the US is a political issue, and so the first thing is to recognize that when anyone is reporting on that stuff, there’s a political context to it. It may even be that some of the research is being done with an implicitly political context, depending on who the funders are or what the orientations and biases of some of the researchers.

It may even be that some of the research is being done with an implicitly political context, depending on who the funders are or what the orientations and biases of some of the researchers

On the scientific side, I think there’s really two things to think about. The first one is the issue of selection bias. You’re trying to draw a conclusion about one population by sampling from a subset of that population and you want to know how close to random your subset is with respect to the thing you’re trying to measure. The Santa Clara study recruited volunteers off of Facebook. The obvious source of sampling bias there is that people desperately want to get tested. The people that want it are, of course, people that think they’ve had it.

The other big piece is understanding the notion of positive predictive value and the way false positive and false negative error rates influence the estimate. And that depends on the incidence of infection in the population.

If you have a test that has a 3% error rate, and the incidence in the population is below 3%, then most of the positives that you get are going to be false positives. And so you’re not going to get a very tight estimate about how many people have it. This has been a real problem with the Santa Clara study. From my read of the paper, their data is actually consistent with nobody being infected. A New York City study on the other hand showed 21% seropositive, so even if there has a 3% error rate, the majority of those positives have to be true positives.

Now that we’ve all had a crash course in models and serosurveys, what are the other areas of science where it makes sense for the public to start getting educated on the terms of the debate?

One that I think will come along sooner or later is interpreting studies of treatments. We’ve dealt with that a little bit with the hydroxychloroquine business but not in any serious way because the hydroxychloroquine work has been pretty weak and the results have not been so positive.

But there are ongoing tests of a large range of existing drugs. And these studies are actually pretty hard to do. There’s a lot of subtle technical issues: what are you doing for controls? Is there a control arm at all? If not, how do you interpret the data? If there is a control arm, how is it structured? How do you control for the characteristics of the population on whom you’re using the drug or their selection biases in terms of who’s getting the drug?

Unfortunately, given what we’ve already seen with hydroxychloroquine, it’s fairly likely that this will be politicized as well. There’ll be a parallel set of issues that are going to come around with vaccination, but that’s more like a year off.

If you had the ability to arm every person with one tool – a statistical tool or scientific concept – to help them understand and contextualize scientific information as we look to the future of this pandemic, what would it be?

I would like people to understand that there are interactions between the models we make, the science we do and the way that we behave. The models that we make influence the decisions that we take individually and as a society, which then feed back into the models and the models often don’t treat that part explicitly.

Once you put a model out there that then creates changes in behavior that pull you out of the domain that the model was trying to model in the first place. We have to be very attuned to that as we try to use the models for guiding policy.

That’s very interesting, and not what I expected you to say.

What did you expect?

That correlation does not imply causation.

That’s another very good one. Seasonality is a great example there. We’re trying a whole bunch of things at the same time. We’re throwing all kinds of possible solutions at this and lots of things are changing. It’s remarkable to me actually, that so many US states are seeing the epidemic curve decrease. And so there’s a bunch of possibilities there. It could be because people’s behavior is changing. There could be some seasonality there. And there are other possible explanations as well.

But what is really important is that just because the trend that you see is consistent with a story that someone’s selling, there may be many other stories that are also consistent, so inferring causality is dangerous.

Tuesday, April 28, 2020

Try Try Again

Funny once again I read and with reading comes knowledge and knowledge is power.  Today I looked at the Flu of 2017-18 and it killed more people than the current Covid pandemic. Again these numbers are fluid as we have no fucking clue if Covid killed them or that they died of another illness but due to Covid and the crush in hospitals, the lack of a consistent medical examination post mortem we may never know the true numbers.

CDC estimates that the burden of illness during the 2017–2018 season was also high with an estimated 48.8 million people getting sick with influenza, 22.7 million people going to a health care provider, 959,000 hospitalizations, and 79,400 deaths from influenza. For Covid that is 57,640 and of course is fluid.

I want a 9/11 commission on this whole Covid crisis as again I have never understood the numbers, the reality behind the White House denials, the ever changing landscape of protocols, the hysteria and fear mongering and of course when they knew and why they did nothing and still are actually doing nothing.

At my coffee shop this morning the discussion is always Covid and today I found out the owner of a local liquor store had Covid came in after having a few days off, felt better but was certainly not tested to insure he was negative, had no protective gear on to prevent transmission and staff went nuts.  Some quit and some filed complaints. What that means is nothing but okay then.  Who was his Doctor and did he not explain that the virus sheds until you are negative, not when you feel well?

And if we do in fact actually turn into a military state with regards to tracking, testing and tracing the hardest hit communities are the ones currently being hit, Black and Brown ones.  The absurdity of this is the new drug wars and of course education and information does not provide the resources that cash fines and jails do.  Good luck with this one.

Then we have the stupid, and by those I mean medical professionals who have decided for some nutty reason to come to New York and "volunteer" on the front lines and then go home with a souvenir of Covid.  Again nothing in Tennessee shocks me anymore.  So was anyone on the plane with him contacted? I doubt it.

Then my Barista told me another story of his friend in Cincinnati who has not left her home in over three weeks because she is afraid.  She lives across the street from a park and there have been endless playdates, basketball games and the like, no one socially distancing and wearing masks and is afraid. So much for Mike DeWine the forefather for this bullshit clearly he is like the rest of the Covid Brigade, full of shit.  But I do wonder why she has not left her home, is she going to the park? Well if the answer is no then what is the problem?  And it was like my fight with the idiot here in charge of Health Services who informed me that her neighborhood she had people congregating on the stoops not practicing social distancing and that is why the parks are closed.  Really what has that got to do with parks and there is already an ordinance in place that permits you to call Police to shut that down as affecting egress or public safety.  Did she get back to me on that? No.

So we are sure that Covid is flying around the air waiting to land on an unsuspecting victim to literally squeeze the life out of you. Well in some situations yes ask that Doctor about that and his seat mate or his wife. Did he hug and kiss her and the kids when he got home.  My favorite about that was he had never been home alone in his entire life for four whole days. WOW just WOW.

So once again this falls to personal responsibility, having knowledge, common sense and some way of tracking, tracing and knowing your contacts.   That is a challenge but if you are aware you can be proactive and still leave the house.   So I leave you with this before I go out to enjoy the day. Just be safe! Whatever that fucking means. How about be proactive and take care of yourself and respect yourself by modeling that and in turn respecting others by giving them space, boundaries and letting them do their thing out of your airspace.

Is the coronavirus airborne? Experts can’t agree
The World Health Organization says the evidence is not compelling, but scientists warn that gathering sufficient data could take years and cost lives.

Dyani Lewis
April 2 2020

Since early reports revealed that a new coronavirus was spreading rapidly between people, researchers have been trying to pin down whether it can travel through the air. Health officials say the virus is transported only through droplets that are coughed or sneezed out — either directly, or on objects. But some scientists say there is preliminary evidence that airborne transmission — in which the disease spreads in the much smaller particles from exhaled air, known as aerosols — is occurring, and that precautions, such as increasing ventilation indoors, should be recommended to reduce the risk of infection.

Covert coronavirus infections could be seeding new outbreaks

In a scientific brief posted to its website on 27 March, the World Health Organization said that there is not sufficient evidence to suggest that SARS-CoV-2 is airborne, except in a handful of medical contexts, such as when intubating an infected patient.

But experts that work on airborne respiratory illnesses and aerosols say that gathering unequivocal evidence for airborne transmission could take years and cost lives. We shouldn’t “let perfect be the enemy of convincing”, says Michael Osterholm, an infectious-disease epidemiologist at the University of Minnesota in Minneapolis.

“In the mind of scientists working on this, there’s absolutely no doubt that the virus spreads in the air,” says aerosol scientist Lidia Morawska at the Queensland University of Technology in Brisbane, Australia. “This is a no-brainer.”
Confusing definitions

When public health officials say there isn't sufficient evidence to say that SARS-CoV-2 is airborne, they specifically mean transported in virus-laden aerosols smaller than 5 micrometres in diameter. Compared with droplets, which are heftier and thought to travel only short distances after someone coughs or sneezes before falling to the floor or onto other surfaces, aerosols can linger in the air for longer and travel further.

Most transmission occurs at close range, says Ben Cowling, an epidemiologist at the University of Hong Kong. But the distinction between droplets and aerosols is unhelpful because “the particles that come out with virus can be a wide range of sizes. Very, very large ones right down to aerosols”, he says.

And if SARS-CoV-2 is transmitting in aerosols, it is possible that virus particles can build up over time in enclosed spaces or be transmitted over greater distances.

Coronavirus tests: researchers chase new diagnostics to fight the pandemic

Aerosols are also more likely to be produced by talking and breathing, which might even constitute a bigger risk than sneezing and coughing, says virologist Julian Tang at the University of Leicester, UK. “When someone’s coughing, they turn away, and when they’re sneezing, they turn away,” he says. That’s not the case when we talk and breathe.

A study of people with influenza found that 39% of people exhaled infectious aerosols. As long as we are sharing an airspace with someone else, breathing in the air that they exhale, airborne transmission is possible, says Tang. *what kind of airspace, outdoors or indoors? ***What is the radius or square foot transmission rate, three or six feet, or no feet just sharing airspace in the world? 

The evidence so far

Evidence from preliminary studies and field reports that SARS-CoV-2 is spreading in aerosols is mixed. At the height of the coronavirus outbreak in Wuhan, China, virologist Ke Lan at Wuhan University collected samples of aerosols in and around hospitals treating people with COVID-19, as well as at the busy entrances of two department stores.

In an unreviewed preprint1, Lan and his colleagues report finding viral RNA from SARS-CoV-2 in a number of locations, including the department stores.

The study doesn’t ascertain whether the aerosols collected were able to infect cells. But, in an e-mail to Nature, Lan says the work demonstrates that “during breathing or talking, SARS-CoV-2 aerosol transmission might occur and impact people both near and far from the source”. As a precaution, the general public should avoid crowds, he writes, and should also wear masks, “to reduce the risk of airborne virus exposure”.  **in other words you are responsible for yourself and be smart and proactive or paranoid whatever works.

Another study failed to find evidence of SARS-CoV-2 in air samples in isolation rooms at an outbreak centre dedicated to treating people with COVID-19 in Singapore. Surface samples from an air outlet fan did return a positive result2, but two of the authors — Kalisvar Marimuthu and Oon Tek Ng at the National Centre for Infectious Diseases in Singapore — told Nature in an e-mail that the outlet was close enough to a person with COVID-19 that it could have been contaminated by respiratory droplets from a cough or sneeze.

A similar study by researchers in Nebraska found viral RNA in nearly two-thirds of air samples collected in isolation rooms in a hospital treating people with severe COVID-19 and in a quarantine facility housing those with mild infections3. Surfaces in ventilation grates also tested positive. None of the air samples was infectious in cell culture, but the data suggest that “viral aerosol particles are produced by individuals that have the COVID-19 disease, even in the absence of cough”, the authors write.**meaning that in a confined space there is a higher liklihood of transmission you know like hospital rooms, old folks rooms and jail cells.. or cabins on cruise ships, same diff. 

The WHO writes in its latest scientific brief that the evidence of viral RNA “is not indicative of viable virus that could be transmissible”. The brief also points to its own analysis of more than 75,000 COVID-19 cases in China that did not report finding airborne transmission. But Ben Cowling says that “there wasn't a lot of evidence put forward to support the assessment” and, an absence of evidence does not mean SARS-CoV-2 is not airborne. The WHO did not respond to Nature’s questions about the evidence in time for publication.

Scientists in the United States have shown in the laboratory that the virus can survive in an aerosol and remain infectious for at least 3 hours. Although the conditions in the study were “highly artificial”, there is probably “a non-zero risk of longer-range spread through the air”, says co-author Jamie Lloyd-Smith, an infectious-diseases researcher at the University of California, Los Angeles.  *meaning we fuck all don't know but hey that closed in idea applies like airplanes

Gaps to fill

Leo Poon, a virologist at the University of Hong Kong, doesn’t think there’s enough evidence yet to say SARS-CoV-2 is airborne. He’d like to see experiments showing that the virus is infectious in droplets of different sizes.

Whether people with COVID-19 produce enough virus-laden aerosols to constitute a risk is also unknown, says Lloyd-Smith. Air sampling from people when they talk, breathe, cough and sneeze — and testing for viable virus in those samples — “would be another big part of the puzzle”, he says. One such study failed to detect viral RNA in air collected 10 centimetres in front of one person with COVID-19 who was breathing, speaking and coughing, but the authors didn’t rule out airborne transmission entirely6.

Another crucial unknown is the infectious dose: the number of SARS-CoV-2 particles necessary to cause an infection, says Lloyd-Smith. “If you’re breathing aerosolized virus, we don’t know what the infectious dose is that gives a significant chance of being infected,” he says. An experiment to get at that number — deliberately exposing people and measuring the infection rate at different doses — would be unethical given the disease’s severity.

Whatever the infectious dose, length of exposure is probably an important factor too, says Tang. Each breath might not produce much virus, he says, but “if you’re standing beside [someone who’s infected], sharing the same airspace with them for 45 minutes, you’re going to inhale enough virus to cause infection”.

But capturing those small concentrations of aerosols that, given the right combination of airflow, humidity and temperature, might build to an infectious dose over time, is “extremely difficult”, says Morawska. “We could say that we need more data, but then we should acknowledge the difficulty of collecting the data,” she says.

Cautious approach

The assumption should be that airborne transmission is possible unless experimental evidence rules it out, not the other way around, says Tang. That way people can take precautions to protect themselves, he says.

Increasing ventilation indoors and not recirculating air can go some way to ensuring that infectious aerosols are diluted and flushed out, says Morawska. Indoor meetings should be banned just in case, she says.

Meanwhile, Lan and others are calling for the public to wear masks to reduce transmission. Masks are ubiquitous in many countries in Asia. In the United States and some European countries, however, health officials have discouraged people from wearing them, in part because supplies are low and health-care workers need them. The Czech Republic and Slovakia, however, have made it mandatory for people to wear masks outside the home. Tang thinks those countries have taken the right approach. “They are following the southeast Asia approach. If everyone can mask, it is double, two-way protection,” he says.

But Cowling thinks masks should be recommended for the public only after supplies have been secured for health-care workers, people with symptoms, and vulnerable populations such as the elderly.

Doctor Do Little

Below are several articles about Nashville's health care industry and to say they are not healthy are an understatement.

Music City in between drawing Conventions and Bachelorsluts is largely a health care city.  Vanderbilt combing the Hospital (a entity of its own) and the University is the largest employer and then the hospitality trade, Ryman Group, are also large players and in turn so is Nissan and Bridgestone for what it is worth are in the top 10.  The varying hotels and businesses that cater to hospitality are of course the most significant under-liar in the core of employees and we have seen that industry take a huge hit of furloughs and layoffs.  Only Las Vegas tops the list of that area followed by the larger tourism capitals which includes New York and New Orleans.   There is no counting across the country about that particular industry and how bad it is hit now and will be coming forward.

But the medical industry deserves special attention as that is largely the main contributor to the white collar industry that makes an economy diverse and is used to attract the like so in this case as Nashville tried to once again pivot and reinvent itself it was that business that gives a pretty face to the truths, that it is a city of largely young, ill educated and poorly trained workforce.  But by adding the data from the medical and the legal field (again it is state capital and that inflates those numbers artificially as well) it gives a higher median income in which to present a nice package of lies.  And no one lies like a Southerner.

Two are filing for Bankruptcy, one has furloughed staff, a CEO has taken pay cuts and one is selling off hospitals to meet analysts needs.

Again we have had a problem with regards to medical care for decades, from the vulture capitalists buying up practices and hospitals, to the closing of rural facilities and lastly public funding for public health has all lead up to this - a shit storm.

The crisis in public health can be told in this story from the New York Times from a public hospital in Ground Zero of the pandemic.  Just yesterday a Doctor from New York who contracted Covid after treating patients decided to end her life.  So as I watched Doctors and other "front line"workers comment and share their grief one comment stood out: "I did not sign up for this." Well bitch, yes you did.  When you entered the medical profession that oath "First Do No Harm" was one you took and yet repeatedly over the years we have heard one horror story over another about the failures of the medical system to protect and not do harm. The endless stories of fraud and malfeasance over Medicaid and Medicare are like legionnaires disease.  Or did you know that Medical Malpractice is the third highest cause of death in the nation?  So now you are in the middle of a major pandemic.  When did you not learn or know of these as they have been happening in this lifetime we just have been lucky - until now.

So again I am not out applauding, go funding or giving one flying fuck about their well being as they have proven time and time again they selectively do so using factors as age, gender, wealth and color to make the life and death panel decisions and are doing so now.  We will never get true and accurate numbers about any of this let alone from hospitals about what is going on there.  They were run for profit and run now into the ground by a storm that makes an F4 (gotta love the F) Tornado seem like a stiff breeze.

Tennessee home of the industry Core Civic that runs prisons and are Corvid outbreaks vs the other kind and of course the Life Care Centers old folks homes that one was ground zero in Kirkland, Washington; their numbers are spread all over the country.   Tennessee is a right to work state that prohibits unionization, collective bargaining, they have incredible OSHA issues on a normal basis, but now especially with Covid, and they have massive other problems that they ignore or simply lie about (all of which I have written about extensively on this blog).  Their own Nashville General Hospital in Nashville had its own controversies and issues  much like the one in the story from New York and this is the same in Harborview Medical Center in Seattle.  Until this massive storm hit we just thought its all good as it ain't happening to me.  Well in some way even if you did not contract Covid you caught the side effects.

We did this, we need to fix this, we need a single payer health plan and we need to fund health care across the board fairly and equitably and in turn follow that with education.  Private money can go fuck itself when it comes to the greater good.  And this is neither great nor good.

So as you glance at the finances I think we can see how we got here on a slow moving bus across a train track and the train is coming. Bottom line is that money spent on health care needs, fully staffing, training, have necessary equipment and of course allocation for emergent situations are not available to the masses and why the red tape and bureaucracy made this worse. Well we were asleep at the wheel and Jesus was already driving the bus.

Report: Another massive Nashville health care company considers bankruptcy

A second Nashville health care company this month could be headed for Chapter 11.

Envision Healthcare Corp. has hired restructuring advisers and is considering filing for bankruptcy, according to a Bloomberg report. The company is struggling financially as government regulations banning elective surgeries due to COVID-19 in most states have left Envision with few options to manage its $7 billion of debt, according to “people with knowledge of the matter.”

Envision was bought by private investment firm KKR for $9.9 billion in 2018. At the time, Envision was Middle Tennessee’s third-largest publicly traded health care company, with $7.8 billion of revenue in 2017. The company employs more than 25,000 clinicians in 45 states.

Envision is led by President and CEO Jim Rechtin, who was appointed to the job in February, just days before the COVID-19 crisis took hold in the U.S. He replaced long-time CEO Chris Holden.

Envision did not immediately respond to a request for comment.

Envision has experienced a significant decrease in patient volume during the pandemic, across all practices and specialties, according to a news release earlier this month, with decreases as high as 70% in anesthesia services and ambulatory surgery. Despite the influx of COVID-19 patients in certain areas of the country, emergency department visits are down 30% overall.

To counter those headwinds, Envision’s senior leadership team took temporary 50% salary cuts. Non-clinical employees have also seen temporary salary reductions as well as furloughs; in areas where patient volumes are low, clinical compensations were also be reduced.

In addition, performance bonuses, clinician profit sharing, retirement contributions, merit increases and promotions were temporarily suspended for all employees.

Envision has hired law firm Kirkland & Ellis LLP to advise the company of its restructuring options, including a potential Chapter 11 filing, according to the report. The sources said the situation could change depending on the length of the shutdown of elective surgeries and market conditions.

Envision’s debt has been trading at low levels, according to the report, with $1.23 billion of bonds due in 2026 trading for 30 cents on the dollar last week. The company’s lenders have hired their own advisers to negotiate with the company, according to the report.

Earlier this month, Brentwood-based Quorum Health Corp. filed for Chapter 11 bankruptcy in the U.S. Bankruptcy Court for the District of Delaware. As part of the filing, Quorum and its lenders entered into a restructuring support agreement, or RSA, featuring a “pre packaged” plan to reduce the company’s debt by $500 million and recapitalize the business.

Nearly five years after being spun out of Community Health Systems Inc., Brentwood-based Quorum Health Corp. has filed for Chapter 11 bankruptcy.

The filing was made Tuesday in the U.S. Bankruptcy Court for the District of Delaware, according to a news release. As part of the filing, Quorum and its lenders have entered into a restructuring support agreement, or RSA, featuring a “pre packaged” plan to reduce the company’s debt by $500 million and recapitalize the business.

Quorum and its hospitals will remain open and employees will continue to get paid, according to the release.

“We believe the financial restructuring plan announced today will strengthen our business and enable our community hospitals to continue the important work they are doing in addressing the COVID-19 crisis, as well as serve their patients and communities,” Quorum CEO Bob Fish said in the release.“Quorum Health has been transparent about the need to restructure our debt over the past year. We believe the RSA will significantly reduce our debt and annual interest expense and better position our company, our affiliated hospitals, and our hospital management and consulting company, for future growth. The RSA will also build on the significant progress we have made to strengthen our operations. We are grateful for the support of our financial stakeholders, which we believe represents a statement of confidence in our business and enables us to move through this process on an expedited basis.”

Quorum (Nasdaq: QHC), which has 12,000 employees and was spun out of CHS in 2015, is one of Nashville’s 10 largest publicly traded health care companies, according to Nashville Business Journal research, with $1.8 billion of revenue in 2018. The company has yet to file its 2019 earnings report.

The 24-hospital company has struggled financially over the past 18 months, fighting to buoy its share price as it sells hospitals to pay off debt. The company has received three delisting warnings from the New York Stock Exchange in the past year due to the company’s share price trading at less than $1 over a consecutive 30-day trading period and because its average market capitalization was less than $50 million over a consecutive 30 trading-day period.

Shares of Quorum were trading at 30 cents per share Tuesday morning, giving the company a market cap of $10 million.

Quorum had been considering a proposed recapitalization and buy-out of its public stock at $1 per share from private equity giant KKR, which owns more than 9% of Quorum’s outstanding shares and is the largest holder of its debt.


Nashville health care stocks are taking a beating from COVID-19.

HCA Healthcare Inc.'s stock price has lost nearly half if its value since its 2020 high of $151.04 per share, dropping 48.7%, to close at $77.46 per share Tuesday. Shares of HCA haven’t traded that low since November 2017.

HCA is not alone as stocks across industries have plummeted in recent days due to fears and precautions taken to slow the spread of coronavirus across the U.S. On Monday, the Dow Jones dropped 12.9%, its worst percentage drop since 1987, while the S&P 500 dropped 11.9% and the Nasdaq fell 12.3 %.

Many of the companies inside Nashville’s $46.7 billion health care industry are on the front lines of efforts to stop the spread of the virus and care for patients who fall ill from COVID-19.

HCA (NYSE: HCA) is the nation’s largest hospital operator, with more than 180 hospitals and 2,000 sites of care. Brookdale Senior living Inc. (NYSE: BKD), whose residents are particularly vulnerable to COVID-19, is the nation’s largest senior-living community operator, with more than 750 facilities in 45 states.

The List
Largest Public Health Care Companies in Nashville
Ranked by Revenue 2018
Rank Name Revenue 2018
1 HCA Healthcare Inc. $46.68 billion
2 Community Health Systems Inc. $14.15 billion
3 Brookdale Senior Living Inc. $4.53 billion

Brookdale’ stock price has also been hit hard due to COVID-19, dropping more than 76% from its 2020 high of $8.39 per share, to close at $1.99 per share Tuesday.

A little more than a month ago, SmileDirectClub's (Nasdaq: SDC) stock was trading at $15.33 per share. The company’s stock closed Tuesday at $4.89 per share, a 68% drop.

Acadia Healthcare Company Inc. (Nasdaq: ACHC), Community Health Systems Inc. (NYSE: CYH), Change Healthcare Inc. (Nasdaq: CHNG) and Quorum Healthcare Corp. (NYSE: QHC) have all seen their share prices drop by more than 50% from their 2020 highs.

While analysts expect most stocks across industries to eventually recover their losses, no one is sure how long the bear market will last.

“I’m buying a lot of things including bank stocks, although I own a lot of banks. I do think it’s an opportunity. I think we’re likely to have a recession, but I think it’s going to be V-shaped. This is all about the virus,” former Wells Fargo CEO Richard Kovacevich said in a CNBC report. “I mean, we’re talking about markets and so forth, but job No. 1 is we have to get this virus under control. We know how to do it. Other countries have done it. And it can be solved relatively quickly. [There] may be a lot of disruptions in our lives to do that, quarantines and so forth, but this is not a financial crisis. It’s not a banking crisis. It’s a health crisis.”


Franklin-based Community Health Systems Inc. is selling a trio of Southern hospitals.

CHS has agreed to sell the 231-bed Abilene Regional Medical Center in Abilene, Texas, and 188-bed Brownwood Regional Medical Center in Brownwood, Texas, to Hendrick Health System, according to a news release.

CHS has also agreed to sell its 84‑bed St. Cloud Regional Medical Center in St. Cloud, Florida, to Orlando Health, according to a separate news release. Orlando Health already held a minority ownership interest in the medical center and will purchase the remaining portion through the deal. Terms for both deals were not disclosed.

CHS (NYSE: CYH) is Nashville’s second-largest publicly traded health care company, with $13.2 billion of revenue in 2019. The company has closed, sold or agreed to sell more than 90 hospitals since 2017 to pay off debt incurred as a result of its $7.6 billion purchase of Florida-based Health Management Associates in 2014.

Tennessee hospitals, many of which were struggling prior to the Covid-19 pandemic, are losing approximately $1 billion per month during the crisis, according an analysis conducted by the Tennessee Hospital Association.

The state’s hospitals typically generate $1.7 billion of revenue per month, according to a news release.

Last month, Gov. Bill Lee banned elective surgeries at health care facilities across Tennessee in an effort to conserve dwindling medical supplies. Those surgeries, such as knee replacements, typically have higher margins than other medical procedures.

“Tennessee hospitals have taken all of the appropriate steps to conserve resources and create capacity for COVID-19 patients,” THA President and CEO Dr. Wendy Long (who is a member of Lee’s Covid-19 task force) said in the release. “These facilities have maintained expensive operations in preparation for and to serve Covid-19 patients while experiencing a dramatic drop in volume and services that typically comprise their core business. This creates a paradox of hospitals experiencing severe financial strain when their services are most needed.”

Across Tennessee, hospitals have had to adjust to the decrease in revenue, with several systems such as Williamson Medical Center furloughing workers due to reduced patient visits.

In early April, Nashville-Based HCA Healthcare Inc., the nation’s largest hospital operator, announced its senior leadership would take a 30% pay cut until the pandemic subsides to avoid layoffs, with CEO Sam Hazen donating the next two months of his salary to HCA’s charitable fund. Last week, Boomberg reported than Nashville-based Envision Healthcare is considering several options, including bankruptcy, as it struggles with decreases as high as 70% in anesthesia services and ambulatory surgery.

“In 2018, 71 hospitals in Tennessee had operating margins that were 2% or below, and 60 had zero or negative operating margins,” Dr. Long added. “It doesn’t take a pandemic to stress the system, and Covid-19 has made the situation much more difficult for many of our hospitals."

The state has deployed $10 million to help rural hospitals survive the pandemic. The federal CARES Act has more than $100 billion reserved to help the hospital industry, although it is not clear how much of that will go toward Tennessee hospitals.

During its first quarter earnings call last week, HCA said it expected to receive approximately $4 billion in accelerated Medicare payments thanks to the CARES Act.

“Recent funding opportunities for hospitals that are being made available at the federal and state levels are very much appreciated lifelines to this vital industry,” Long said in the release. “However, the reality is the impact is so massive that more assistance will be needed in order to ensure continuity of operations at hospitals and provide a necessary level of care. Now more than ever, Tennesseans need their hospitals to remain open and caring for their community.”

Yep, Still hate them

I loathe Millennials, I laugh at them, mock them and in the future will go out of my way to avoid them and since I am going forward with my Silent Vow that will eliminate the need to have an idle chatter with them at all.

Why I hate them - they are arrogant and ignorant. This group of coddled, group hugged and safe spaced to death bore the shit out of me.  The young women are either sluts or prick teases. And no they are not flirting they have no clue what that is thanks to sex education that came via the internet and social skills that are again emojis.  My favorite is their need to break their sexuality down to numbers. That is a good plan how human of you. Spock beam me up!

 They are sure that by fucking anything of any gender makes them au courant.  No you are a slut.  Yes I am shaming you.  As they say it takes one to know one and I certainly was but I kept my mouth shut, (well as I mean verbally discussing my sex life)  practiced safe sex, was #MeToo and sexually harassed and I made a lot of mistakes and I grew up. Then we have the prick teases, these are the girls who are sure if they withhold sex, only practice oral or anal then talk endlessly about nothing to no one in particular about the relationship they have when they are not really having any kind of relationship.  You know where you fight, you negotiate, you compromise, you walk out and back in, have make up sex, meet their family, their friends and have full exchange of life. Nope you have your friends and never the twain shall meet until you get a ring on it and then they become your "best friend" for life and everyone else is fucked off.  Well until a child comes then it is your childhood, lather, rinse, repeat.  My fucking god you are boring.

It should also explain the idiocy of Silicon Valley from Uber to WeWork.

I read this in The Guardian today and thought: Yes, how true. Especially this:

 Two years ago, research published by the Royal Society for Public Health found that a quarter of people aged 18-34 believed it was normal for older people to be unhappy and depressed – and across all age groups, nearly a third of people surveyed agreed with the statement “being lonely is just something that happens when people get old”. Strikingly, two-thirds of the respondents said they had no friends with an age gap of 30 years or more.

And this speaks volumes:

To make things even worse, the insecure realities of 21st-century life for younger people have fostered the idea that if older people have been lucky enough to buy their home and receive a half-decent pension, that somehow characterises them as the recipients of unjust luxury. These things have fed into a dysfunctional mess of stuff that resonates with where we have ended up: the key issue right now may be the rank incompetence of people in government, but our attitudes to older people are relevant, at least.

Now as we enter the election year it is not lost on me that both candidates are white men over 70 and that Bernie Sanders, the Millennial man of the year was as well.  Go figure but women who were all over the age and race gap were dutifully ignored.  Mother issues much?

Now the ugly truth about the way we warehouse the elderly and shove them into facilities that do anything but provide substandard care and in turn how the Covid virus devastated their residents. That all of this supposed lockdown was to prevent the elderly of which I am one from the Covid virus.  Okay then and where is my free lunch on wheels then?

One thing I learned in Nashville was that the supposed Christian youth were not very Christian. They had massive drinking problems, were prodigious liars and fucked like bunnies while professing to be good Christians.   Dump, Fuck, Hump, Suck all week and Thump on Sunday and lather, rinse, repeat on Monday.  I only met one individual whose Christianity was genuine and well practiced and he truly found love and joy from his dedication to Christ, the rest not so much.  Ben has since left Nashville and has a coffee shop in North Carolina and I hope his business succeeds as he deserves it.

This in contrast to my one friend whose obsession with the Bible is bizarre to the point of extreme and wants to be a Minister. Really? I have yet see him finish anything to completion and has waves of anger and rage that are well not very Christian, chase girls to the point of extreme almost like a 14 year old as this was his first time away from home so that led him on the pussy patrol in the most unhealthy way.   And he lies like no one I have ever met in my lifetime.

And what is more hideous is the Bible born misogyny and that hate of women is vested in scripture and what a way to validate and shame.  This essay in Medium sums up that quite horrifically. 

Misery loves company and no one loves misery more than a Millennial. They are the social media scolds, the endless outers and tattlers of their generation. They want everyone to feel their pain so have at it and I feel it alright, all right up my ass like anal warts.  They are sheep down to their Billie Ellish obsession who is pretty not good.

But OK Boomer!  What.ever. The ageism that will result from this will be a tsunami as the Millennial has to blame, point fingers and decry anything that shakes their world view and this is a quake sized shake.

 Get Woke you narcissistic morons you are the reason we are on lockdown as you ran amok for weeks ignoring the virus, having brunch and playing contact sports.  Dr. Brix was the first to even comment about that in the early days.  It is your fault assholes. Live with that.

And I am not alone with my thoughts on exactly what Millennials are - lazy fuckwits.  From the Atlantic:

So we dug into the data. The results for civic engagement were clear: Millennials were less likely than Boomers and even GenXers to say they thought about social problems, to be interested in politics and government, to contact public officials, or to work for a political campaign. They were less likely to say they trusted the government to do what's right, and less likely to say they were interested in government and current events. It was a far cry from Howe and Strauss' prediction of Millennials as "The Next Great Generation" in civic involvement. 
Millennials were also less likely to say they did things in their daily lives to conserve energy and help the environment, and less likely to agree that government should take action on environmental issues. With all of the talk about Millennials being "green," I expected these items to be the exception. Instead, they showed some of the largest declines. Three times as many Millennials as Boomers said they made no personal effort to help the environment. 

I found this in Entrepreneur Magazine and this I agree with and even the Boomer comment at the end.

1. They have a sense of entitlement.

Maybe we should blame social media and the Internet. The stereotypical millennial is addicted to immediate gratification -- and it’s not usually deserved. Straight from their entry-level positions, millennials demand from their employers to be inspired and entertained, to be immediately recognized for their work and made to feel as though they are changing the world.

I don’t think I sound like a fuddy-duddy when I say: get real. Employees don’t automatically receive these things. You earn recognition. You earn more meaningful projects. You have to go above and beyond what is expected. You don’t get awards and high-fives for just showing up.

2. They have a tendency to overshare on social media.

We know that young people have a problem sharing naked pictures of themselves on Snapchat. But workforce-ready millennials apparently also have a problem oversharing their important thoughts on sites such as Medium.

Take, for example, the 2,400-word blistering missive a young woman named Talia Jane wrote about the poor wages paid to entry-level types at Yelp/Eat24, where she worked. She addressed the post specifically to Jeremy Stoppelmann, Yelp’s co-founder and CEO. Unfortunately, Jane’s many, many passages about the high cost of living in San Francisco didn’t elicit the sympathy she presumably was hoping for. Nor was the very public post appreciated by her managers. (Jane was fired following her anti-Yelp rant.)

Related: 3 New Truths About Millennials and Their Careers

This weekend’s NYT article talked about Joel Pavelski, director of programming at Mic, a news site created by and for millennials. He told his bosses that he needed a week off to attend a funeral back home in Wisconsin. You can imagine how confused and disappointed they were when they discovered an essay he wrote on Medium describing how he spent his time off building a treehouse -- not attending a funeral. He even started the post this way: "I said that I was leaving town for a funeral, but I lied."

Unlike Jane, Pavelski was given a second chance. But what compelled these individuals to write these public posts? Social media is a wonderful means to communicate ideas, but it can be costly without a filter and a healthy dose of common sense.

3. Frankness verging on insubordination.

The NYT article also highlighted a few situations where entry-level millennials approached their company leaders to say or do things their bosses deemed inappropriate for the workplace. I’ve had similar experiences with millennial-age employees that left me to think, "Did they really just say that? To their boss? In public?"

Speaking your mind is one thing. It should be encouraged. But it’s detrimental without the filter of respect.

Millennial reality check.

It seems that a lot of traditional media have it out for millennials. The Atlantic hypothesized that millennials might be the most narcissistic generation of all time. The New York Post proclaimed that millennials need to “put away the juice boxes and grow up.”

In a February article, the NYT suggested that millennials are so lazy they’ve stopped eating cereal because they can’t be bothered to wash the bowl when they’re done. Just, wow.

These stories, and the descriptions above, feed into the millennial stereotype. Sure, some millennials think and behave this way. But they don’t all fit the stereotype. Many understand that big rewards require hard work and sacrifice.

Poor workplace decisions aren’t the product of one generation. There are plenty of gen Xers who act like idiots, too. Baby boomers aren’t immune to poor judgement either.

The Sound Inside

For the hundreds of millions now in lockdown or about to be what that experience will be like will be exactly the same number who are/were in lockdown. In other words: Different like everyone else.

The article below discusses how varying individuals across the globe are finding this distancing working out for them and the time it has enabled them to connect to their world beyond their door but also within their walls.

If there is one thing I have learned that we are a culture that is very afraid to be alone. It varies with age, gender, culture, religion and and race.  We have seen many faces of color the most affected by this virus and largely due to very condensed living spaces. When you have multi generational families living in small urban and dense environments you have a breeding ground of disease. Everyone is coming in and out each with their own contacts and in turn they touch each surface, meals are shared, facilities are limited for hygiene and the constant ebb and flow of those on varying schedules makes it challenging at best to establish a routine that in turn facilitates a spread of a virus.

Poverty is of course one aspect and the other is wealth.  Successful wealthy people travel, they come into contact with a multitude of associates, they are social and have many others who serve their needs and accommodate their schedules. They are often invisible and in turn come into close contact with the families and their belongings/lodgings and possessions.  They are contact surfaces and in turn they are also responsible for their households including children who go to parks, schools and other places where they in turn contact numerous individuals and surfaces that are all transmission for disease.

In other words we all come into contact with viruses and disease every day.  It is called being human, its what we do.  Unless you are a Hermit or are in some type of religious group or cult that socially isolates and well physically does as well you are not going to avoid any of this in some form or another. It could have been the cold you had earlier last year or the flu or some other ailment that knocked you out for a few days. Was it Covid? Does it matter if you are up and around and healthy now?  Were any of your friends, family, business associates knocked out by it shortly after or before you encountered them?  How many times do you inquire about someone's health in more than a general "How are you?" manner?   You don't and even if you you may listen but not hear them as few want to discuss their personal ailments.   Funny how we will disclose anything and everything on social media but during a pandemic we are as silent as a church mouse.

I grew up an only child so I was left to my own amusement most as I don't even recall children in my neighborhood other than the poor family behind my home who had children of special needs and varying ailments that set my family off as I recall ringworm once that to my Mother was equivalent of Covid.  So I was a loner early on and paranoid of disease apparently as I am actually a health freak about that and had a Father who could teach the CDC cleaning protocol.  So being lonely was not something I needed to fix, I could go to the local drug store and sit at the counter and chat with the lady who worked there and have a Coke.  I went to the Library all the time and the Librarians knew me well as did most of our local vendors.  The nearby Francine Seders gallery was one of my favorite places to spend time, I thought for the longest time it was a Museum.  And of course I walked Green Lake all the time and took joy in just that.

I noticed this social distancing more as a teenager and then sometime during my teen years I had enough.  I went to College and had the normal boyfriends, roommates and the like and hated every minute of it.  Went back home, transferred and lived at home until age 30.  Then I had to grow up and find a life.  And attempts at conventional life was tried and ultimately rejected. I sampled some of it in Nashville and again proven that people are assholes regardless of age, race, gender, of belief or politics. What those do is make it easier to label and in turn disregard or regard with whatever you feel is important to you.

We largely identify ourselves through our work or professional identity.  It is why we have decided to add to the list of Heroes, Doctors, Grocery Clerks, Amazon workers, Bus Drivers to the list of Front Liners or First responders in the hierarchy of import.  Funny those are often the lowest paid on the rung of the ladder of import, well other than Doctors and frankly that is bullshit, but we revere Athletes, Celebrities and CEO's because why. They make money.  We all want to be rich and we cannot and the rich have made sure of that but that I have written about extensively. What we have seen during this pandemic the rejection of celebrity and their strange Instagrams and other futile attempts to prove they are in this together with us from their mansions and homes that are still be attended to by the invisible work force to mind their homes, their children and their professional finances.   They will be fine.  I did see hysteria over the NFL draft but then again football people are not my people so guess what. I.don't.give.a.flying.fuck.

I keep hearing about these random acts of kindness and wonder where they are?  I have neither seen nor experienced them. I recall the Yoga Teacher in March saying, "I am your friend, I care" after demeaning me for talking about the VIRUS..well I was ahead of that curve...pun intended. Has she ever reached out to email or call me? No but they have on demand Yoga and since I paid already for a membership it's perfect contactless delivery.  In my building I watched the panic hoarding and hysteria and then that curve leveled off and guess what? It's back as I predicted hysteria by May 31 and its coming. Staff have quit which in this job market is a bad idea and unless he plans on going to work at an Amazon warehouse.   I am not sure what he is qualified for and he quit over Covid fear so that is the last place I would work. And because he quit no he does not get unemployment so there you go another millennial idiot.

As for that unemployment benefit that extends extra funds, that ends in July and that is when the lift on the lockdown will occur and that is not a coincidence as there are none.  I actually read the Executive Orders of the idiot Governor of NJ and in there was the date June 1.  So when he came out with his plan which was well no plan so okay then I already knew that there is no Memorial Day BBQ on the schedule.  And as the South opens up with its immense poverty and lack of health care for the poor watch Wave 2 hit there and here in the North with our liberal smugness it will be "I told you so."  So good luck there Georgia! But if not, thanks for being the lab rat and seeing if it works, we are not as stupid as you, so you first! Either/Or Neither/Nor we get it we really do.

And as I read all about the fears, the frustrations and the anger about having to live in social isolation and in turn try to find ways to feed the head, the heart and the stomach as well food shortages and all (again not happening we have a logistics issue that is the problem) we are not thriving or even demonstrating rational behavior.  And this is where we are, nowhere.  And we are not going anywhere anytime soon.

Isaiah 26:20
Go, my people, enter your rooms and shut your doors behind you. Hide yourselves a little while until the wrath has passed.

What does a pandemic sound like? For many of us at home, it’s a heartbreaking silence.

The Washington Post
By Robin Givhan
April 28, 2020

In India, the incessant beep-beep of cars has disappeared. In New York, Harlem’s heart has stopped beating. In the suburbs of Detroit, the chatter of neighbors is muffled. In Toronto, the trains no longer whistle, and in Marseille, every day sounds like a holiday. All around the world, the silence rolls in and out like fog. It hangs in the air — there but not there. Impenetrable and fragile, weightless and smothering.

It’s periodically disrupted — by the shriek of an ambulance siren, the rattle of a construction truck or the evening applause for first responders. For those lucky enough to work from their home, FaceTime and Zoom keep the afternoon buzzing with a new familiarity. But eventually, the silence comes.

We are deep in the horror and kicking our way to the surface. What does a pandemic sound like? Emptiness.

In March, Faith Heyison was in the thick of her professional duties — working with fashion designers behind the scenes in their showrooms and on their runway productions. Heyison was in her glory: the chaotic, exhausting whirl of creativity on a global scale. Her work regularly takes her to New York and Paris, and by the time she returns to Monsempron-Libos, the small town in southwestern France where she lives, she usually welcomes the peace and quiet that greet her.

But now the silence is not so much a well-earned gift as a voracious monster that has snuffed out the reassuring rumble and roar of daily life.

The Bible says, “Weeping may tarry for the night, but joy comes with the morning.” But sometimes in this age of covid-19, it seems that the sweet cacophony in our dreams is what soothes us, not the silence of our waking hours.

“I live alone. I am not permitted to visit neighbors or friends. I am not permitted to be somewhere other than my primary residence. I cannot take one of the few available trains to a coastal town. Everything would be closed anyway, including hotels. I cannot escape by means of an airplane to another country,” Heyison says in an email. “Even if I could, all I would find would be more silence.”

“Sleep is actually a welcome respite because in my dreams, it’s noisy,” she says. “I talk to people I know. I talk to people I never met. I am in places I know. I am in places I have never been. Sleep is the easy part. It’s waking up that is harder.”

Just past midnight, as Saturday blurs into Sunday, a walk sign on H Street NE in the nation’s capital glows white but there are no footfalls. The only sound on the empty sidewalk is the electronic bloop, bloop, bloop of the traffic signal counting down the seconds before . . . no one moves and the hush only deepens. No cars rumble through the intersection. The city’s inglorious streetcar, on its newly shortened schedule, stopped running hours ago and so there’s no impudent clanging of its horn, no squeal of its metal wheels on its track.

The late-night urban soundscape has become little more than digital chirps and the occasional guttural outburst from the lost soul wrapped in a vagabond’s blanket.

By Sunday’s light, H Street is free of the usual detritus that comes from the crowds of bar-hoppers, late-night diners and music lovers. Silence is litter-free.

Some people find the quiet calming. They feel closer to God. They give in to the stillness and consider their destiny. They have a silver-lining attitude: The air is cleaner; crimes rates have dropped; school shootings ceased in the United States. If you tilt your head and squint, the quieting of the world can be seen as a gift.

But when we, the agitated, try to breathe deeply and locate our spiritual center, it’s elusive.

“I keep thinking, ‘This is great, I’ll just sit here and simply be.’ But then my mind freaks out and it starts racing and then I’m like ‘Ahh, must make some noise,’” says Sara Ngwenya, who lives in Nottingham, England. “There’s too much reality that’s hidden in those pockets of silence, and I’m not sure I can handle it at the moment.”

The silence isn’t a respite; it’s relentless. It’s no longer the absence of sound; it is the sound.

“I’m kind of an introvert; I need to retreat,” says LaTasha Simmons, a nail technician who worked in Brooklyn — back when there was noise — and lives on Long Island. “This is forced silence instead of silence that you’re creating for yourself.” Instead of looking to it as a tonic to recharge from a hectic day, there’s no hurly-burly from which to withdraw. We don’t wind down because we never wound up.

What we lose when a great American city has no nightlife

What day is it? Sound is an aural calendar: the whoosh of weekday rush-hour traffic, the hoots of the Friday night bar brigade, the slam of shared bicycles into their electronic docks on a Saturday afternoon full of errands.

“Since the lockdown began, every day feels like a Sunday. You wake up, and you hear . . . nothing,” says Nicolas Icard, a 23-year-old communications student in isolation with his parents in Marseille, France. “I think people are divided between the calm that they might be experiencing in their lives and the fear of what will happen next.”

Instead of silence being part of the natural rhythm of life, life has flatlined. And the thought of resuscitating our beloved with a jolt is terrifying. In Florida and Georgia, the chattering crowds on beaches, the buzz of barbershop clippers, the zap-zap of tattoo needles aren’t noises of life; they’re a tolling of the bells.

The silence really can be deafening. When a normally high-volume city is abruptly put on mute, our brain is hypersensitive to the shift. What we've experienced is akin to leaving a loud concert and stepping into the hush of the night. The silence registers intensely. It's almost suffocating.

“It definitely leaves you alone in your head,” Simmons says. And for many of us, our head is filled with what-ifs and worst-case scenarios. “I need a little bit of noise to drown out the silence.”

The quiet shouldn’t be confused with loneliness, which is a mental state. And it’s not synonymous with solitude, although there are points of overlap, like in a Venn diagram, says Thuy-vy Nguyen, an assistant professor at Durham University who researches solitude and resiliency.

Solitude — or alone time — can be filled with moments of silence, but it can also be rich with music. And anyone who’s ever had an argument with a roommate knows it’s possible to have silence — or to get the silent treatment — when solitude would be much preferred.

Still, one wonders whether the discomfort with silence is exacerbated by solitude. Or can silence cause loneliness? Perhaps the brewing uneasiness is just the desire to hear someone say: You are loved. You are valued.

Nguyen began researching solitude long before the pandemic. She was especially focused on how older people respond to it. She and her colleagues were hampered by the amount of enforced alone time a subject could ethically be asked to endure. The pandemic has removed that hurdle.

Nguyen has learned that as long as subjects know that they have value to someone beyond their four walls, even if they didn’t have the ability to connect with that person, they could stave off loneliness.

Silence can be remedied with the click of a remote control. Throw open the home office doors and let in the whirling-dervish of a toddler. But this silence is unlike any other. It can’t be filled by bingeing on television or audiobooks. It requires the complicated, sweeping, unmatched symphony of life.

“I live in the suburbs, but there’s always things going on. And now, if you go outside, you’re barely seeing any cars. You see people walking and they all cross the street to move away from you. No one is speaking,” say Andi Rehm, a fashion stylist at Tender boutique in Birmingham, Mich.

The silence isn’t merely the absence of noise. It’s the fear of interaction. It’s judgment, longing and paranoia. It’s our distressed human condition amplified. When the sounds of nature — the birds chirping, the rustling leaves — become the soundtrack of a formerly vibrant, agitating city, at first you’re lulled into calm, says Karishma Sehgal, who blogs about sustainability and upcycling, from her home in Pune, in western India. Then you remember that life has turned inside out.

“Spring is in full gear, but there aren’t human sounds to chime in,” says Leah Rossi, a Toronto-based fashion stylist.

The volume of the natural world has been cranked up. Maybe it’s a greater power — the good Lord, Mother Nature, karma, the Fates — giving notice that humans are not in control of their environment; they must work in concert with it.
A woman walks outside of Kingman Park in Washington.
A woman walks outside of Kingman Park in Washington. (Amanda Andrade-Rhoades/for The Washington Post)

We troop through the streets on our essential errands. The sun might be shining and the sky may be blue but it sounds like a storm is coming. We hear the same heaviness in the air that precedes a tornado. We wait and watch for a thunderous funnel cloud that for most of us — blessedly healthy at home and without loved ones in hospitals — never comes.

“I took a walk this very morning,” says Daniel Lanzilotta, an artist in Harlem. The silence “is thick. It’s a sadness. I started crying under my mask.

“I went back home.”

Monday, April 27, 2020

Green Acres

This will be the new reboot in the upcoming years as not only relevant it is perfect timing.  Americans, unlike their European counterparts, have been migrating to the two coasts for decades. The reason being that they have the industry of capitalism, Wall Street and Silicon Valley.  They are yes an industry in and of themselves, a collective sort of with bees buzzing to the Queen bee and that is Apple in the Valley and Goldman in New York.  The varying hives around them have their own Queen and in turn bees that jump from flower to flower to source and thrive and spread their wings to build their hive and produce that honey that we love so much in America, Money.

Then you have the industry's adjacent that also thrive and live off the honey, in Hollywood that is the industry of film and television and in New York it is the larger Arts of Broadway/Theater, Music and Art.  And then they have the tendrils that have their own type of special honey made that is usually ties to the Gay collective in San Francisco and the West Village/Greenwich.  You got nothing in any hive without those queens and in turn their bees that include many of bees that migrate from hive to hive to add color to the pollen and flavor to the honey.

And Americans gravitate to IT.  I have lived in every it city ever.  I grew up in Seattle, lived in San Francisco, Austin, and Nashville. And now Jersey City so I don't have far to go to end up in the Queen's hive if I choose and seriously I don't choose there. There is something about the physical and social distancing that I like having Manhattan in my back yard versus my front.  No regrets here but I wish I had spent more time finding my hood and this for now works but I think I will still stay in the area but want to just be a little less 'it."

But I am also 60 and decided now to re-invent myself for the 100th time and finally write professionally.  I am using pandemic house arrest to seriously write and enter contest after contest and submit while actually focusing on my first book.  I would rather spend time doing that as that is what matters.  But I also need feedback and that is hard in isolation so I work around with hopes to find that needed voice to lend perspective to my writing.  I have a voice but like all it needs to be tuned.   And I hoped to continue to Substitute for awhile to also see another school district and system thought of as the best in the nation, so let's see as little could be as bad as Nashville.

But this is an expensive place, Nashville was not cheaper but it was if you made a decent living and if companies are looking to change the way they do business, smaller offices, more satellite workers and cheaper costs as there is no income tax, they are more than willing to give away free candy to add any color of collar to their community as they are right to work aka no unions, they have a very red flag flying high which is fine for the larger picture but if the hive wants a diverse bee community that may be a problem and in turn their infrastructure is horrific.  That said power is money and if you come bearing it they may address it as they are desperate right now post Tornado and post Covid.

I will never set foot there again unless it is for a very good reason and then I can float in like a butterfly and sting like a bee.

But again the reality is we all want to be near the Queen and this is New York after all; however, I do see many of the migrant/immigrants re-examining that idea after this pandemic.  If you have family in your native home or have them living with you in a small apartment these last six weeks you are ready to move anywhere so I suspect that suburbs will be very appealing and in turn child care is already in place so why not commute or commute into a bigger home office? I see that the need for green spaces and some privacy would be key and the key to that door is way more affordable.  The appeal of the in city high rise with elevators and dogs and people shoved in is appealing until a pandemic hits and then you go: FUCK THIS.

So yes I do see an exodus to what Thomas Wolfe negated by saying you cannot go home again. Oh yes, yes you can if you have not already.

The writer below debates this issue and in turn the reality of what America is truly like, the outsiders desperately wanting in and the insiders making sure that doors and windows are locked but they leave the curtains open to allow you to see inside to aspire and to in turn service them, entertain and amuse them and now in Pandemic Times (the new Paleozoic Era) serve them.  And in the interest of being served there are always disposable and replaceable.  Like tissues that apparently people did not use to sneeze or cough in and there you go.  See bees leave the hive and they sometimes don't come back. But the hive still thrives.  And it takes just a little smoke, no mirrors, to take the honey and the hive still thrives and does the work until disease takes it.  That is what is happening to the bees and we never saw it coming or did we? 

Does living in New York make any financial sense after this pandemic?

I’ve perpetuated the illusion that my family lives a stable life, but that was an absurd delusion, and it feels insane to continue as we have

Lynn Steger Strong
The Guardian
Mon 27 Apr 2020

Staring down the barrel of another decade of constant worry and part time work and clawing our way out of the rubble of the second recession, it feels borderline insane to continue as we have.

I have long known that much of my life’s frustrations come from trying to have it both ways. Though they were made available to me, I shunned more traditional and more stable careers. Instead, I have continued, time and again, to try to be a writer, knowing full well this is not a stable choice. I simultaneously hoped for and attempted to create a stable life for our kids. I continued to attempt to perpetuate the illusion that I live the kind of life that people with more traditional jobs are able to afford – we kept living in New York, with two kids, kept trying to have health insurance and sometimes go to the dentist, kept trying to send our children to good public schools and summer camps.

I wanted, in other words, to both be a writer and to live a life that cannot be sustained on the income of most writers. There are plenty of systemic failures in this country, but that miscue is solely mine. I always knew I’d have to have a second job, but again, I chose a path that offered no guarantee of stability. “Professor”, after all, used to mean some level of security, but now acquiring a tenure track position in academia has become something close to the equivalent of making it to the NBA. But I knew that going in.

Stability has long been little more than fantasy, is what I’m saying. But since this crisis – since our precarity has turned to terror, then futility; since the hole that we now find ourselves in has become too deep perhaps to ever claw our way back out – the absurdity of those delusions has become much more apparent. The shame I feel, toward all those years of pretending, is that much more pronounced.

We’re living, as we have before, contingent on the generosity of others. I’m sitting in a house that is not mine, paying for an empty apartment that we can’t afford. My husband has been furloughed from the job he’d just started that made it possible for us to afford our rent. I got an email from my best paying job this week saying my class for the fall cannot be guaranteed until a couple of weeks before it starts. I desperately reach out to editors asking to write for them. I’ve thought of posting online about editing services, but the hole that we’re entering into is not something any single thousand dollar gig will fill.

I keep thinking, what other forms can we imagine our lives into. My husband’s parents have a small camp in Maine that we could move to. There is no running water and no internet, the floors are not yet insulated, but also, there’s no rent. I could go back to teaching high school in a town that’s less expensive – in Florida, where we have family; in more rural places, where the rents are more palatable, but then I’m not certified to teach public school.

This crisis has highlighted how so much of our society is broken. It feels senseless, suddenly, to keep doing what we’ve always done. I know the institutions I am a part of are broken, top-heavy, do not care much for me, but they kept me afloat just enough – many of my bosses have been very kind – I was deluded enough, I guess, to stick around. It is that very American delusion which I would have said I’m not a part of, but I still was: the delusion that we do not denounce or depart the systems that exploit us, just in case, somehow, we find a way to achieve power within them.

It is also an American delusion that if you stay within the systems you will maintain some level of safety, that stability will come, that a base level of certainty will exist. I met a guy a few months ago, who told me about being an adjunct professor at the same place for 17 years, and then being offered an entry level, non-tenure track, three-year job when he threatened to quit.

As my husband and I have talked and thought more about leaving the lot of it – the city and our overpriced apartment, all my part-time gigs, his putting his head down in a few months and looking for work again – it’s become less and less clear what we’d lose if we left. We already don’t have health insurance. I have never had job security. Our community is the strongest and best part of our lives, but many of them have been laid low by this as well.

New York will probably always be my favorite city. As exhausting and precarious as each is, I love every one of my jobs. We love our kids’ public school. But staring down the barrel of another decade of constant worry and part-time work and clawing our way out of the rubble of the second recession, it feels borderline insane to continue as we have.

Next week still feels so far from this week. Right now, it’s hard to think much further than keeping everybody safe and sane. It’s hard to say what the other lives that we may try to make after this would look like. The tricky thing, always, about not having a lot of money, is that one seldom has much choice. But, for so long, we have been living as if we did not already know that we could not ever get to a place of solidity within the systems we’ve signed up for. Now that the absurdity of that delusion has been so thoroughly exhibited, it feels worth considering at least, what other shapes our lives may take.

Saturday, April 25, 2020

Cruise to Nowhere

I am not going to comment other than to note there is a link that included the video story of this debacle regarding Cruise ships and the spread of the Covid virus.

Note the dates of the journey and the absurd cover ups and lies that surrounding the issues regarding why these floating Petri dishes were allowed to continue and in turn why many ended up floating for days at sea with no end in sight and in turn making people sicker and even more exposed. What is more frightening is that like the airlines that were finally allowed to land on U.S. soil little was done to track and trace the passengers.  Gosh you think that would be priority one. No

What has happened is that we like to think we are the most powerful nation in the world and we have now shown the world we are morons.  We have elected for decades morons who have no clue how to manage or operate Government and in turn it opened the door for terrorism, under funding Government from public health to public education.  We have done little to improve the quality of life for Americans and we have doubled down on income inequality.  We have exposed our ugliness when it comes to racism, to sexism and to larger scale xenophobia and mostly we have exposed our full blown inability to manage a crisis.  We are now the laughing stock of the world and why Russia and China still feel the need to fuck with us makes me wonder how bad it is really there that they feel so compelled to do so.  I would be laughing my ass of at this point.

American exceptionalism is an oxymoron, emphasis on moron.

I lied, I commented.

The pandemic at sea

The cruise industry’s decision to keep sailing for weeks after the coronavirus was first detected on a ship helped carry the virus around the globe and contributed to the mounting toll, health experts and passengers say.

The Washington Post

On land, more than 300,000 people worldwide had contracted the deadly coronavirus, and the governor of California had just ordered all 39 million residents to stay at home. But as the Celebrity Eclipse cruise ship steamed north across the Pacific Ocean on March 21, hundreds of passengers crammed together on the ship’s pool deck and overlooking gangways.

As they stood shoulder-to-shoulder and crowded around pool chairs, the captain led the ship in a special salute to health-care workers of the world, an onboard version of the nightly applause adopted by some cities to honor medical professionals battling the novel coronavirus.

Five days later and thousands of miles away in the Atlantic, a group of British passengers aboard another ship, Coral Princess, likewise gathered elbow-to-elbow to cheer the United Kingdom’s National Health Service.

The celebratory mood did not last long. Soon, passengers on both ships were contending with flu-like symptoms.

There have been 150 coronavirus cases and six deaths reported so far among passengers of the two vessels, which finally docked weeks after the virus was declared a global health crisis, according to a Washington Post tally. Two people died on the Coral Princess before passengers could even come ashore in Miami.

The Eclipse and Coral Princess were among scores of ships that continued voyages even after early outbreaks on other vessels, carrying thousands of international passengers to far-flung ports and helping seed the virus around the globe, health officials say.

A Post review of cruise line statements, government announcements and media reports found that the coronavirus infected passengers and crew on at least 55 ships that sailed in the waters off nearly every continent, about a fifth of the total global fleet.

The industry’s decision to keep sailing for weeks after the coronavirus was first detected in early February on a cruise ship off the coast of Japan, despite the efforts by top U.S. health officials to curtail voyages, was among a number of decisions that health experts and passengers say contributed to the mounting toll.

The virus affected travelers on 55 ships and killed at least 65 people, though the full scope is unknown.

At least 65 people who traveled or worked on the ships have since died, according to The Post tally, although the full scope of deaths is unknown. A similar review by the Miami Herald also identified 65 deaths linked to ships.

“We here on land, we were seeing all the news, all the ships,” said Jennifer Paul-Slater, whose brother Gerald, a 72-year-old retiree from Atlanta, died of covid-19, the disease caused by the coronavirus, three days after disembarking the Celebrity Eclipse. “They could have taken more precautions.”

Public health experts say that a number of factors contributed to the rapid spread of the virus around the world, predominantly air travel; an estimated 4.54 billion people flew last year, compared to the 30 million passengers who traveled on cruise ships worldwide. But with hundreds of people dining, swimming and dancing together over a sustained period of time, the ships provide unique environments for disease to spread, they say.

“People on a large ship, all together, at the same time, all the time — you couldn’t ask for a better incubator for infection,” Anthony S. Fauci, the nation’s top infectious-diseases expert, said in February.

For their part, U.S. agencies struggled to manage the escalating crisis, initially deferring to the industry’s own plan to manage the pandemic. Until early this month, federal health officials also allowed passengers who left infected ships but appeared healthy to board commercial airlines home.

Even as the virus exploded into a global story, cruise officials failed to immediately recognize flu-like outbreaks as possible signs of the coronavirus, passengers said. In many instances, they did not immediately isolate passengers in their cabins when sickness broke out. In some cases, such as on the Celebrity Eclipse and the Coral Princess, those aboard said they were reassured by company officials there was no coronavirus infection on their ships — even as some travelers were wracked with fevers and coughs.

David Nystrom, 75, said he spent the last four days of the Eclipse voyage with his wife, Susan, in the medical clinic, wiping her brow and watching the ship’s crew administer her oxygen.

From her bedside, the Boca Raton, Fla., resident said he heard regular announcements from the ship’s captain, assuring passengers that the Eclipse was a “healthy ship” with no coronavirus on board.

“If they honestly thought that all these people who were getting sick had colds and bronchitis and pneumonia, I don’t know what to say,” Nystrom said.

Officials with the cruise industry said they took extraordinary efforts to limit outbreaks of the new virus on ships and get tens of thousands of passengers and crew home safely as the pandemic spread, going beyond measures adopted by other industries.

Bari Golin-Blaugrund, a spokeswoman for Cruise Lines International Association, said in a statement that there is “no conclusive evidence as yet” that cruise ships were responsible for bringing the coronavirus to specific destinations, such as the Caribbean. She said that the number of cases linked to ships is a “tiny fraction” of the global total.

“Everybody, including cruise lines, had to make difficult decisions based on the information that was available at the time, which was admittedly limited given the fact that the world was dealing with a brand new virus,” she said. “Still, cruise lines took immediate and aggressive action in response to this crisis.”

Carnival Corp., the world’s largest cruise company and the parent company of Princess Cruises, noted that federal health officials initially issued limited warnings about the risks of cruises and that the company voluntarily paused new voyages in mid-March.

Officials with Royal Caribbean Cruises, parent company of Eclipse operator Celebrity Cruises, said the ship did not have an unusual number of passengers with flu-like symptoms, and the crew did not believe there was an outbreak on board.

Despite high-profile outbreaks on several ships, industry leaders have insisted cruise ships are not more susceptible to the coronavirus than other places.

Arnold Donald, the chief executive of Carnival, said in an interview on “Axios on HBO” in mid-March that ships provided a “less risky environment” than being on shore and compared ships to Central Park, saying there is “a lot of natural social distancing.”

He insisted that cruise ships are not to blame for spreading the coronavirus.

“The illnesses aren’t created by the ship, they come from people coming from communities,” he told reporters April 16, noting that the “vast majority” of ships around the world remained coronavirus-free.

But top U.S. health officials said there is evidence that cruise ships have been a factor in the spread of the coronavirus, both aboard ships and through their travel.

A no-sail order extended for at least 100 days this month by Robert Redfield, the director of the Centers for Disease Control and Prevention, found “cruise-ship travel exacerbates the global spread of covid-19″ and “has not been controlled sufficiently by the cruise ship industry or individual state or local health authorities.”

Early warnings

One of the world’s first indications of the wild infectiousness of the coronavirus came in February, when it whipped through the Diamond Princess, a 2,666-passenger ship docked at a port in Japan.

A study published in March by the CDC found that the coronavirus was brought aboard by a passenger but quickly jumped to crew, including those responsible for preparing food, and spread quickly among ship workers from there.

More than 700 passengers and crew members ultimately tested positive and 13 died. Some Americans tested positive for the coronavirus only after they were aboard buses headed to government-chartered airplanes to be flown back to the United States.

James Lawler, an infectious disease expert at the University of Nebraska Medical Center who traveled to Japan to help evacuate Americans, said the Diamond Princess demonstrated the difficulty of attempting to discern sick from healthy people in a closed environment like a cruise ship.

“You just have to treat everybody like they’re infected," he said.

It was a lesson that the cruise industry and government agencies took weeks to absorb.

In late January, cruise lines started to step up health screenings and deny boarding to people who had recently been in China. Cruise officials assured passengers that they had increased cleanings on ships. More hand sanitizer became available as the crisis went on, passengers said. On some ships, buffet meals became plated affairs.

But top U.S. health officials did not view the measures as sufficient. On March 8, Fauci warned older people and those with underlying health issues to avoid cruise ships.

The following day, another coronavirus-stricken cruise ship docked in Oakland, Calif. The Grand Princess, which had left San Francisco on Feb. 21 for a cruise to Hawaii, had idled for days before officials decided to send many of its American passengers to military bases across the country for quarantine.

Ultimately, more than 130 people from the ship tested positive, and at least six have died, including five passengers and one crew member, according to authorities and the cruise line.

Health experts noted that the ships’ tight quarters, their communal eating and entertainment and older passenger demographics made them especially vulnerable.

“This is not to point blame,” said Marty Cetron, director of the CDC’s Division of Global Migration and Quarantine, in an interview earlier this month. “But we have to be honest about the science and the evidence.”

He said widespread testing of passengers on the Diamond Princess and the Grand Princess showed that the “attack rate” of the coronavirus on board was especially high.

“We don’t see those kinds of attack rates in other settings — even in household settings,” he said. “Even in cities experiencing outbreaks, this is pretty dramatic.”

Grand Princess travelers — who had been locked in their rooms, then held on military bases and confined to their homes — were stunned to watch people continue to board ships amid their saga.

“I’m shocked that they were still cruising out there,” said Jackie Eilers, a 72-year-old retiree in Castle Rock, Colo., who tested positive but had only mild symptoms.

Pushing back against restrictions

Tensions were running high as top officials from the Jamaican government squared off against top cruise executives in Florida for an emergency summit on March 6.

The coronavirus was spreading, and Caribbean countries worried about their citizens’ exposure began to impose new rules on ships and limit access to their ports.

When the Dominican Republic turned away a ship after reports of passengers with flu-like symptoms in late February, the ship’s operator, U.K.-based Fred. Olsen Cruise Lines, issued a statement calling the government’s move an “overreaction.”

Jamaica barred port entry Feb. 27 to people traveling from areas with known covid-19 outbreaks, such as Italy, and the following day denied entry to all Italian passengers who arrived on the Costa Luminosa ship. A few days later, officials put out interim guidelines that also required ships to document illness on board and conduct temperature checks.

The cruise industry expressed concern about the new rules, which upended scheduled stops for its vacationing guests, according to one Jamaican official involved in the negotiations with the cruise lines, who was not authorized to talk to the media and spoke on the condition of anonymity.

“I think cruise lines in general were challenging the whole process of the elevated protocols that were being forwarded by all destinations,” Edmund Bartlett, Jamaica’s minister of tourism, told The Post.

Roger Frizzell, chief communications officer at Carnival, which owns the operator of the Costa Luminosa, said the company was “looking for additional understanding and clarity tied to the new process, so we could plan and make decisions for our ships, guests and crew.”

Jamaican officials agreed to travel to Florida — the industry’s home turf — for negotiations. There, they met with several Carnival executives at the company’s headquarters in Miami, where the walls are lined with glass cases filled with intricate models of the cruise operator’s fleet. Later, the Jamaicans visited the Fort Lauderdale headquarters of MSC, another cruise line with a ship that had difficulty disembarking in Jamaica because a crew member had been diagnosed with the flu at the time. (The crew member later tested negative for the coronavirus.)

“There was clearly a view we were being too hard with our requirements. We felt that the public health interests at the time trumped the interest of the cruise lines,” Christopher Tufton, Jamaica’s minister of health and wellness, said of the meetings, which he described as “difficult.”

Frizzell described the meeting with Jamaican officials as “respectful, in the spirit of finding a mutually beneficial solution.” MSC Cruises said in a statement that it was “a productive meeting between two long-term partners," adding that it never raised concerns about Jamaica’s guidelines and had only requested the rules be clearly defined and that the cruise lines be given advance notice of new requirements.

The standoff threatened one of the region’s biggest economic drivers. Cruise companies employ thousands of people on Caribbean islands and deliver an estimated $2.5 billion in tourism dollars, according to industry estimates.

Two days after the Florida meetings, Jamaican authorities announced that after “rigorous” discussions, the cruise lines had accepted the country’s health protocols, including the submission of medical logs for review and the quarantining on board of anyone with symptoms who had visited a country with covid-19.

The announcement made no mention of barring visitors who had been in a country with a known coronavirus outbreak during the previous two weeks. But Jamaican officials told The Post that policy remained in place. Cruise vessels continued to visit Jamaica after the meeting.

The clout of the industry was also apparent in the United States, where Carnival chairman Micky Arison is a personal friend of President Trump.

The major cruise lines have avoided federal income taxes and labor laws by incorporating overseas and flagging their ships in other countries. Even so, Trump has bemoaned the pandemic’s effect on the industry.

By early March, several top health officials and members of the administration’s coronavirus task force wanted to impose a temporary ban on Americans going on cruise ships, as The Post previously reported. They included Health and Human Services Secretary Alex Azar, Centers for Medicare and Medicaid Services Administrator Seema Verma and Surgeon General Jerome Adams.

Behind the scenes, the industry scrambled to head off a no-sail order.

The day after meeting with the Jamaican officials, top cruise line executives huddled in Fort Lauderdale with Vice President Pence, the head of the White House coronavirus task force, arguing cruise lines could voluntarily contain the outbreak.

On March 10, the industry submitted a plan to the White House that proposed measures including stepped-up health screenings, monitoring of passengers and requiring a doctor’s note for passengers older than 70. At the time, Adam Goldstein, global chair of the Cruise Lines International Association, told The Post that it was “a very practical, actionable plan that makes a difference.”

Days later, under pressure from the administration, the industry abruptly went further, voluntarily suspending new voyages to and from the United States for a month.

It still wasn’t enough.

On March 14, the CDC issued a no-sail order for 30 days — and noted that there were already signs of covid-19 clusters associated with cruise ships, including in communities far from the water.

Tracking the spread

In Iowa, state health officials found that the state’s first 16 confirmed coronavirus cases were all part of a group that had recently returned from a cruise on the Nile River in Egypt. Pockets of cases were linked to the same cruise voyage in Houston and Maryland.

The March CDC study found that cruise ship-linked cases accounted for 17 percent of all known cases in the United States between the key early weeks of the spread from Feb. 3 to March 13. Those cases included passengers returning from the Diamond Princess, the site of one of the biggest outbreaks in the world in mid-February.

The biggest driver of the coronavirus cases in Australia has been an outbreak on the Ruby Princess cruise ship, which docked in Sydney on March 19. Authorities have opened a criminal investigation into the ship, which has been linked to 21 deaths and more than 600 positive cases.

And in France, authorities have grappled with a massive outbreak on a ship that had not yet carried any passengers.

There, the brand new Celebrity Apex — which boasted more than two dozen restaurants, bars and lounges and a venue towering 13 stories above sea level — had been preparing for its first sail, a four-night preview cruise scheduled to leave April 1.

By early March, 1,400 crew members were living on board the ship, preparing to welcome its first guests. A lawsuit filed by a crew member alleges that contractors continued to board the vessel, and Celebrity conducted crew drills even after signs of the coronavirus began to appear.

So far, 284 crew members have tested positive, according to French health authorities.

Rob Zeiger, global chief communications officer for Royal Caribbean Cruises, which owns Celebrity, said that the ship followed guidance from the French government and that in an effort to avoid the coronavirus, crew had been restricted from leaving the ship and their interactions with contractors were limited.

Along with airplanes, cruise ships also played a role in the spread of the virus in the Caribbean, a region with small island populations and a fragile health-care system. While air travelers brought the first cases to islands such as St. Lucia and Cuba, cruise passengers were the first confirmed coronavirus patients in places such as the Cayman Islands and Puerto Rico, according to local health officials.

While air travelers brought the first cases to islands such as St. Lucia and Cuba, cruise passengers were the first confirmed coronavirus patients in places such as the Cayman Islands and Puerto Rico, according to local health officials.

A Post analysis found that five ships — the Costa Favolosa, Costa Magica, Costa Luminosa, MS Braemar and MSC Meraviglia — made 18 stops in the Caribbean between Feb. 29 and March 11 while carrying someone who later tested positive for coronavirus.

Dozens of passengers who disembarked in their native countries in the region have since tested positive. Among former passengers from the Costa Favolosa, there have been at least 52 covid-19 cases and one death in Trinidad and Tobago, 13 cases in the Dominican Republic and two cases in the French territory of Martinique, according to local health officials.

“We knew there was an epidemic with international potential,” said Ted Cohen, an epidemiologist at Yale School of Public Health who examined data gathered by The Post, adding: “It was irresponsible for the industry to not be proactive in how to limit these activities in times of global crisis.”

Cruise lines said they followed all international regulations to prevent the spread of disease and took voluntary measures such as temperature checks and intensive sanitation measures. And they disputed the idea that their ships brought the coronavirus into the region, saying that while Caribbean residents who sailed on their ships have tested positive, there is not proof they contracted the virus on board.

"We have no evidence of any direct link of contagion between our ships and the territories of our destinations in the Caribbean and there is no scientific or health-related evidence or background to this,” Costa Cruises, which operates the three Costa ships, said in a statement.

MSC Cruises said it “has no reason to believe” that the Meraviglia contributed to any local outbreak, saying it screened the health history of its passengers and has had no known cases on any ships while sailing. After a Canadian passenger who had traveled on that ship tested positive after returning home, the ship isolated seven crew members who had contact with him, the company said.

Fred. Olsen Cruise Lines, which operates the MS Braemar, said that once it learned that two passengers from a previous Caribbean cruise had been diagnosed with covid-19, it arranged to test those currently on board who had flu-like symptoms. When six people tested positive, it barred passengers from disembarking until the ship ended its journey in Cuba.

‘This is covid-19’

The emergency medical treatment of passengers placed a significant burden on the region’s health-care infrastructure.

Much of a hospital in the Cayman Islands was shuttered for two weeks after a 68-year-old Italian man who suffered a stroke was evacuated from the Costa Luminosa ship on Feb. 29 and later tested positive for the coronavirus.

More than 40 health-care workers who came into contact with the man and their families were quarantined, and the nation’s limited testing capabilities were used to test nurses and other patients in the hospital, according to a spokesperson for Health City Cayman Islands, where the passenger was treated. The hospital reported six positive cases connected to the passenger, including four health-care workers.

On the Costa Luminosa’s next sail around the Caribbean, the ship dropped off an Italian couple in Puerto Rico on March 8 after the woman was experiencing flu-like symptoms.

Carmen Cruz, who owns the ambulance company that transported her to a hospital, said the dispatcher told local medical personnel that the woman possibly had pneumonia — but that covid-19 was not suspected.

“As soon as they described the symptoms, we said, ‘This is covid-19,’ ” Cruz said. “They described it saying ‘No, that this was pneumonia, and she had a history of respiratory issues.’ ” At the time, Puerto Rico had no other confirmed cases of the illness.

The woman and her husband tested positive for the coronavirus on March 13. She died eight days later.

“The cruise line needed to have been more direct and transparent with us because it could put our island in danger,” said Cruz, noting that the woman’s symptoms were clearly consistent with the coronavirus. “A rooster could not sing more loudly.”

A representative of the dispatcher said that the company facilitates communications between a ship’s medical staff and the local hospital, but that those parties discuss the particulars of a medical case.

Costa Cruises disputed the idea that ship officials had dismissed the possibility of the virus, saying that before the sick woman disembarked, the ship’s doctor requested that she be tested for the coronavirus in Puerto Rico, even though the hospital said it was not likely a covid-19 case, according to the company.

“Costa Cruises’ main concern has always been and remains to safeguard the health and safety of our guests, our crew members and the communities in the destinations we visit,” the company said.

While the woman was still in the hospital, Luminosa officials isolated those who were in close contact with her, and then took further measures when it got the results of her test, quarantining all guests and performing daily temperature checks, according to the company.

Still, signs of sickness spread as the ship traveled across the Atlantic and into the Mediterranean, where it struggled for days to find a port that would accept its passengers.

Finally, 350 Americans and Canadians disembarked March 19 in Marseille, France. The group was crowded together on buses and then an airplane to Atlanta, where the CDC allowed many to enter the terminal and then board commercial airliners home.

It would take more than two more weeks for the CDC to change its guidelines about disembarking passengers from stricken ships, barring even those without symptoms from further commercial travel.

Cetron, the CDC’s head of global migration and quarantine, said the agency shifted courses after fully realizing the implications of asymptomatic transmission.

“Not only is this virus fast moving in terms of its spread and transmission and stealth, it’s also teaching us every day something new," he said.

As of April 20, at least 145 crew members and 48 passengers who were aboard the Luminosa have tested positive for the coronavirus, according to Costa Cruises. Former passengers who have started a Facebook page to track their experiences have reported accounts of at least seven deaths.

Among them was Tom Sheehan, 68, who flew from Atlanta to his home in Sarasota, Fla., before being hospitalized the next day. He died March 28, his four adult children barred from his hospital room, able to say goodbye only via video.

“My dad had said multiple times if the cruise had let them know there was a possible covid case, they would have just gotten off in Puerto Rico and flown home,” said Sheehan’s son, Kevin. “They were more worried about keeping people on the boat and spending money.”

Costa Cruises said it communicated information to passengers as soon as it received it and noted that it voluntarily paused new cruises on March 13, the same day it said it received notice that the first passenger had tested positive. At that point, the ship struggled to find a port. The company said it expressed “its deepest grief and condolences to the families of those guests who have lost their lives due to this invisible enemy.”

One of the ‘safest places in the world’

Aboard the Celebrity Eclipse and Coral Princess, the vicious virus seemed a world away as the ships headed in early March toward Cape Horn at the tip of South America — a bucket list trip for many cruisers.

“There were whales and penguins and glaciers. You name it, we saw it,” said Tom Sachs, 66, a retired federal worker from Franconia, Va., who was on the Eclipse.

Then countries began barring ships from docking. Off the west coast of South America, Chile prohibited the Eclipse from scheduled stops there. On the other side of the continent, Uruguay and Argentina did the same to the Coral Princess.

There was confusion on both ships, where passengers initially believed their days at sea had kept them walled-off from the coronavirus.

150 coronavirus cases and 6 deaths have been reported among passengers of the Coral Princess and Celebrity Eclipse ships.

On the Coral Princess, passengers received a letter March 20 from the senior physician assuring them that the risk of the ship’s exposure was “near negligible.”

“Rest assured that, relatively speaking, Coral Princess is probably one of the safest places in the world to be at this time,” read the letter obtained by The Post.

Gill Morgan, 66, who works with the National Health Service in the United Kingdom, said that Coral Princess passengers continued to enjoy music, films on the deck and guest-organized tai chi classes and line dancing sessions.

By late March, both ships were headed toward the United States, where they could finally disembark — California for the Eclipse and Florida for the Coral Princess.

On March 21, Eclipse passenger Vivian Miller, 77, said the captain gathered people around the pool to celebrate health-care workers. “We cheered and applauded,” she said.

Days later, hundreds partied again at a special ceremony to mark the ship’s passage of the equator. The ship’s theater hosted daily events. “They actually made more activities, to keep people occupied,” Miller said.

On the Coral Princess, the March 26 celebration of health-care workers drew a large crowd.

“The ship is virus free, so we can move around as normal with no social isolation,” British passenger Sara Roberts, who posted a video of the applause, told The Post via email on March 27.

But soon, people were getting sick on both ships. Several passengers aboard the Celebrity Eclipse, including Miller, said in interviews that they sought assistance from the onboard medical clinic for flu-like symptoms starting early in the cruise, only to be told they likely had colds or the flu.

On the Coral Princess, Long Island residents Peter and Grace Nahm went to the medical center March 28 after their health had been deteriorating. After a nose swab, both were diagnosed with the flu, said their son, Paul Nahm, 39, of Fort Lee, N.J.

Meanwhile, Coral Princess passengers continued to sunbathe, swim and socialize in what was “glorious weather,” Roberts recalled later.

As the ship sailed toward Barbados on March 30, where a stop the next day was planned, the cruise line released a public statement at 6 p.m. Eastern that said in part: “There remains no known risk of COVID-19 onboard.”

Nearly 19 hours later, there was suddenly a different message. After a “higher-than-normal number of people presenting influenza-like symptoms,” all passengers were being confined to their rooms, the company announced March 31.

By then, those aboard had been freely socializing for 26 days.

That night, the Coral Princess stopped in Barbados, where a sick passenger was taken off the ship. There, the company also collected coronavirus test samples and sent them to the island.

Two days later, on April 2, ship officials said 13 people had been tested; 12 were positive for the coronavirus. That number included Peter Nahm, his son said.

By the time the ship finally reached land in Miami on April 4, two people aboard had died. Six were brought to hospitals in Florida the day the ship arrived, and a dozen more the next day, according to county officials.

The Nahms were hospitalized a day apart; both have tested positive for the coronavirus, Paul Nahm said. His mother has since recovered and returned to New York on a medical evacuation flight; his father remained in a Miami-area hospital.

Paul Nahm said the trip should have been canceled before it started or should have tried to find a port to disembark passengers earlier. And, he argued, the cruise line should have better managed the situation once anyone was aware of illness.

“Once people are sick on board and there’s cases of flu-like symptoms, they should have immediately locked down,” he said.

Princess Cruises spokeswoman Alivia Owyoung Ender did not address specific questions about how the Coral Princess handled the situation, but said in an email that the company has followed the guidance and direction of health authorities, including the CDC.

“During this entire unprecedented time, Princess has done everything possible to be open, honest and transparent, and to provide for the health and well-being of our guests and crew in the most earnest and compassionate way possible,” she said.

Zeiger of Royal Caribbean Cruises said the Eclipse did not experience an abnormally high number of people with flu-like symptoms for a ship carrying more than 3,000 passengers, adding that the crew did not believe the coronavirus was aboard. He noted that the ship ultimately spent five days off the coast of Chile while trying to dock and another 10 days sailing to San Diego, keeping it out at sea longer than the virus’s typical incubation period.

Still, he said of the cruise industry’s experience with the coronavirus, “You don’t come through something like this without learning some lessons. You better be more humble than that.”

Now in San Diego, David Nystrom said he believes the Eclipse’s medical staff genuinely did not believe his wife had covid-19 — they treated her for days without masks, potentially endangering their own health, he noted.

She was the first off the ship when it docked March 30, transported from the Eclipse to a hospital by ambulance, where Nystrom said she tested positive for the coronavirus within 10 hours and then spent 22 days on a ventilator before beginning a slow recovery.

“What happened was terrible and my life might be changed forever,” he said in an email. “But since coronavirus was still new when we got on the cruise on March 1, did the medical staff just not realize what was happening?”

Earlier this month, after more than 14 days in quarantine, David Nystrom developed a dry cough. His test result: positive.