Friday, July 3, 2020

Q&A Covid Time

I think this is worth reading to understand how those "in the know" handle Covid. Inconsistent on some issues and on others quite so.  That said you can see that even "experts" are not truly cohesive on their reasoning or behaviors, just like everyone else.  Comforting on some level and some not, only showing me that they know as much as we know which is not much.

Fauci, 5 other health specialists deal with covid-19 risks in their everyday lives

By Marlene Cimons
The Washington Post
July 3, 2020

As Americans learn to live with the coronavirus, many are struggling with decisions about which practices are safe or risky for them. The Washington Post asked six public health/infectious diseases specialists about their own behavior choices.

Q: When and where do you wear a mask?

Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases: It dominates everything I do. The only time I don’t wear one is when I am alone, when I am home with my wife, or when I am speaking in public — provided there is 6 feet between me and the people to whom I am speaking, as was the case when I answered questions at the recent Congressional hearings.

Elizabeth Connick, chief of the infectious diseases division and professor of medicine and immunobiology at the University of Arizona: I walk in the morning and never wear a mask walking around in my neighborhood. Even if you see somebody, you can keep your distance. But I do wear it otherwise. I don’t wear one inside my own office, but I do wear one in the general office area. I wasn’t wearing one before, but now everyone is masking because we have more covid spread [in Arizona].

Paul A. Volberding, professor of medicine and emeritus professor of epidemiology and biostatistics at the University of California at San Francisco: I wear a mask most of the time, although not inside the house or sitting outside on my second-floor deck. I think people are crazy not to be wearing masks. The evidence that they are effective is pretty strong. I’ve noticed in recent weeks that the number of people wearing them seems to be decreasing, which concerns me. There is no shame in wearing a mask.

Linda Bell, South Carolina’s state epidemiologist: I wear one in public whenever possible, in stores, office settings, if I encounter groups of people that I can’t distance myself from and during press conferences when I’m not speaking.

Barry Bloom, Jacobson research professor and former dean of the Harvard T.H. Chan School of Public Health: Every time I leave the house, inside and outside, and certainly when I shop.

David Satcher, former U.S. surgeon general, former director of the Centers for Disease Control and Prevention, and, most recently, founder of the Satcher Health Leadership Institute at the Morehouse School of Medicine: All the time. Even when I’m in the office, I keep it on, since people are always coming in and out. The only time I don’t is when I am home.

Q: Besides family, do you allow anyone else inside your home, such as cleaners or service people for repairs?

Fauci: The only person who comes into the house besides (my wife) Christine and me is the woman who cleans the house once every two weeks. She wears a mask and gloves at all times while in the house.

Connick: I pay someone to clean house. She was very afraid at first, and didn’t come for six weeks, but I paid her anyway. Then she decided she was comfortable and came back. I’m not here when she cleans, and she’s gone when I come home. So I am not breathing her air. I do have a pest control guy come. He’s quick, and I stay far away from him.

Volberding: We have cleaners who come once a week. They text me when they are nearly here, and (my wife) Molly and I close ourselves into a room on the top floor study and don’t interact with them at all. They text when they are leaving. They are good about disinfecting. As for the room we stay in, it’s my chore to keep it clean.

Bell: I allow repair workers in the home and don’t make them wear a mask while they’re working, but I do when I have contact with them, and I keep my distance.

Bloom: Yes, but only people I know, and we keep our distance and often wear masks.

Satcher: Yes, probably more than I should. My daughter is upset at the number of people I let in who don’t wear masks, although I wear one.

Q: Do you shop in grocery stores, or order online? Do you wash the items off or disinfect the outside of packages once you get home?

Fauci: I do physically go to the grocery store, but I wear a mask and keep my distance. I usually go at odd times. I spend half the day alone in my office, and I’m part-time at the White House. In the late afternoon or evening, when I’m finished with the White House, I go shopping for groceries, or to drugstores. I don’t disinfect the bags. In general, I will take the materials out of the bags, then wash my hands with soap and water, and then use Purell, and let everything sit for a day.

Connick: I wear a mask when I shop, and stay away from people while in the store. I try to minimize my trips. As infections become more widespread, I think I will be more conscientious about making only one visit a week. I don’t wash the packages. I did that for about a week, then decided there would be more cases if the virus was transmitted that way. I don’t think there is a lot of virus hanging around on those packages. But I do wash my hands.

Volberding: We have wonderful stores in our neighborhood that really enforce everything. They don’t let you get close to anyone else and everyone wears a mask. I don’t disinfect or wash anything. I don’t think the evidence for surface contamination is real. I don’t wear gloves in the store, but I wash my hands before I go and when I come back.

Bell: I shop in grocery stores and order online. I don’t disinfect packages that I bring into my home.
Bloom: I shop at grocery stores, and also have them shipped. I don’t wash them, but usually let them sit for a day before I use them. The bug dies pretty quickly.

Satcher: I shop in grocery stores and I wear a mask. I do the handwashing thing. I’m compulsive about that. I don’t wash or disinfect the packages, but I do wash my hands after touching them.

Q: Would you dine inside a restaurant? Outside? Do you get takeout?

Fauci: We don’t do anything inside. I don’t eat in restaurants. We do get takeout.

Connick: No, no restaurants. I avoid any closed space with a lot of people, particularly when it’s people whose risk I don’t know. I think the biggest risk is being in a closed space and breathing the same air that other people are breathing, and also not wearing masks. I wouldn’t go even if they were wearing masks. I might consider dining outside, although I would rather not. I think being outside is much safer. Takeout, yes. I would die if I didn’t do takeout.

Volberding: I wouldn’t feel comfortable yet with indoor seating, but I’d feel comfortable outside, with distances between the tables. We haven’t gone yet. We’ve gotten takeout a couple of times. We are cooking a ton, and love it.

Bell: I would not dine in a restaurant, but I would dine outside if the restaurant had a safe set up. I do get takeout.

Bloom: I would not dine inside now. I would dine outside. I’m a big believer in outside, that it’s safer outside.

Satcher: I have not dined inside a restaurant in a long time, and I used to do it a lot. I have not dined outside, but I would if I could be six feet away from other people. I do sometimes get takeout.

Q: Do you take any precautions with your mail or packages?

Fauci: I used to, but now I just bring the mail in, wash my hands, then let it lie around for a day or two before I open it.

Connick: I’m just not that interested in my mail. It’s in a locked box across the street from my driveway, and I only pick it up once a week. If there is any virus on those letters, it gets cooked off. I don’t think a virus is living on my mail, and I’m really not worried about it. I don’t worry about packages. I open them.

Volberding: I don’t take any precautions with my mail. As for packages, there is no contact with the delivery person. I don’t leave them outside — they’d be stolen if I did.

Bell: No.

Bloom: I let them sit for a day. That’s probably irrational, but I do it that way.

Satcher: I’m so compulsive about mail that I’m reading it before I get it into my house. But I do wash my hands afterwards.

Q: Do you go to friends' homes for dinner, or have friends to your house, or see them in other ways?

Fauci: On the rare occasion when we have people over, we have them out on the deck, six feet apart, and we never have more than two people, and they are people who themselves are locked in. We wear masks, unless we are eating. We don’t share anything. There are no common bowls. Each person has his or her own receptacle. Some people even bring their own glasses. We always do takeout and I tell the takeout people that I want the food in four separate plastic containers, so no one has to touch anyone else’s food. Everyone’s food is self-contained. Also, we always stay outside. We don’t do anything inside. If it’s too hot, or rainy, we cancel it.

Connick: There are a few friends I see for dinner. In Tucson, you can sit outside to eat. I’ve had a few people over to dinner and we eat outside. I don’t have many people over. The people I have over have been quarantining. We don’t wear masks. We sit outside at a good distance. I think if you are outside at a good distance the risk is very small. I invite over people who are very circumspect in their behavior. No one comes over to my house who goes to restaurants or bars.

Volberding: Except for seeing immediate family, the only thing we have done was to go to a birthday celebration for a friend in Golden Gate Park. Everything was widely spread out, and everyone was wearing masks. Everyone brought their own blanket and food. We haven’t been in anyone else’s house, and no one has been in ours, except our kids, and only once in a while.

Bell: I don’t go to friends’ homes for dinner at this time. I do see friends by practicing physical distancing and using masks if we have to be closer than six feet for longer than a few minutes. I allow friends in the home whose practices I’m confident in.

Bloom: I have only seen friends once, to dine outside, which was very nice. I am very keen on the outside and dispersion of aerosols sitting in the open air, but concerned about them in closed settings.
Satcher: I have not been to anybody’s house for dinner since this started. My son and his family came over for the day, and my daughter was over once to help me with a Zoom presentation.

Q: Are you getting your hair cut?

Fauci: I usually get it cut every five weeks, but I didn’t go for a long while. By the 11th week, it was looking really bad. So I asked the woman who cuts my hair if I could come in really early in the morning, at 7 a.m., and we arranged to do that. No one else was there. She wore a mask and I wore a mask.

Connick: I do not go to the hair salon. I pay my hairdresser to come to my house. The first time he did it, he said: “It’s on me, thanks for being a health-care worker.” The second time, I insisted. He did it outside the first time, the second time, inside. He comes once a month. No mask for my hairdresser or me in the past. However, now that salons are open, I will have to ask him how much time he has spent at the salon. If he is spending a lot of time, I may ask him to mask. We will definitely do hair outside next time. The pandemic is unfortunately ramping up in Arizona, and everyone’s risk is greater now than it was two months ago when he first cut my hair.

Volberding: [laughs] I am quite bald. I have a little hair on the sides and I buzz that off myself. I know Molly would love to get to the hair salon. She took some kitchen shears a couple of weeks ago and whacked off her hair. I understand the urge to get back to some of those personal services, but I haven’t been inclined at all.

Bell: I have not, but I would go if the business only allowed one client at a time in the general area, there was no waiting with other clients and the use of masks by all employees was required.

Bloom: Nope, I haven’t in three months, but that’s because the barbers were closed down. Now you have to make an appointment, and I haven’t had the time. Everybody wears a mask, so it would be fine.
Satcher: I haven’t been to the barber since this started. I cut my own hair now, just like I did when I was in college.

Q: Are you willing to fly? What about bus, train, subway?

Fauci: I’m 79 years old. I am not getting on a plane. I have been on flights where I’ve been seated near people who were sneezing and coughing, and then three days later, I’ve got it. So, no chance. No Metro, no public transportation. I’m in a high risk group, and I don’t want to play around.

Connick: I would only fly if I had to, for an emergency. I would not fly now for pleasure or work. I have a family reunion that happens every year, and I’m not going. But if I had to fly, I would wear an N95 mask.

Volberding: I haven’t flown, and I’m not eager to. I don’t like the idea of being in an enclosed space, especially when the airplanes are full. I’ve only ridden BART (Bay Area Rapid Transit) once because we were in the East Bay to see our new granddaughter, and a Black Lives Matter protest took over the Bay Bridge. There was no way to get back except by BART. Normally, I wouldn’t have done it, but it wasn’t very crowded.

Bell: No. With the current disease activity in the country, I don’t know when I’ll fly again while airlines don’t require physical distancing and masks required for all. No [buses or trains], but public transport isn’t widely used in my community.

Bloom: No, none of them, not until the numbers of cases are down to much lower levels than they are at the moment.

Satcher: I am willing, but I haven’t flown recently. If someone invites me to speak, and I can speak by Zoom, I do it. If someone said they really needed me somewhere, I would go, but I would wear a mask all the way. I have not been on the subway since this started, but Atlanta isn’t as big on subways as New York or other places. I just usually drive my car.

Q: Would you visit your kids/grandkids?

Fauci: My middle daughter, who teaches school in New Orleans, drove up here after they closed the schools. She could teach online from here, so she thought: Why not come home and see her parents? When she got here she went straight through the back entrance into the basement. She stayed in our basement, which has a room with a bed, a shower, electricity, and she did not come upstairs for 14 days. My wife brought food down to her on paper dishes. She lives in a very high risk city, and she wouldn’t let us near her. I wanted to hug her when she arrived, but she said: “No way, dad.” She came upstairs after 14 days, and then stayed with us for several months.

Connick: I’m not going to go visit him [a son, 22, who lives in New York City] because of the flying. Besides, who wants to go to New York when you can’t go anywhere? Also, I wouldn’t take the bus or subway there. Those are enclosed spaces where you share air, and I avoid them.

Volberding: Not very often. At first, we didn’t at all. We have family cocktail hour Zooms twice a week. We talk a lot about covid, and everyone is being super safe. I held my granddaughter — I couldn’t help that — but I don’t hug my kids or their partners.

Bloom: I have a brand new grandson, 2 months old, who lives in Los Angeles. He’s the cutest kid in the world. I would love to fly there and see him, but I won’t.

Satcher: I’ve visited my son and daughter-in-law once or twice. They needed me to sign some papers, so I went over. We were social distancing in the garage area and wearing masks, and my grandkids were wearing masks. We also do family Zoom meetings every other week on Sundays which include my two brothers and sister and their children.

Q: What would you tell your kids or grandkids who wanted to join a protest march or go to a political rally?

Fauci: My daughters feel very strongly about social injustice, but would not likely want to do that. They are very careful with their health. They stay away from crowds.

Connick: I’d be so proud of him. I would tell him to wear a mask. He’s young and doesn’t have any health conditions. Nothing is risk free. If that’s what he wanted to do, I’d ask him to wear a mask.

Volberding: We are a pretty political family, and believe in these protests. But I haven’t been to a rally. I’m old enough that it’s probably more serious for me. They are young enough that it’s probably less serious for them. But I would tell them to stay to the side and wear masks all the time, and that being in the mosh pit of a crowd is a pretty bad idea.

Bell: I would advise them that the risk for exposure is high, and that they should wear a mask at all times, and make every attempt to distance themselves from people without masks.

Bloom: The answer would be yes, but wear a mask and try to stay [six to eight] feet away from everybody. I wouldn’t do it because I am at high risk.

Satcher: I was quite active in the civil rights movement when I was a student at Morehouse. I went to jail at least five times. What bothers me about today’s protests is that they aren’t as organized as we were. You don’t know who you are marching with. You don’t want to find out when you get there that someone is going to throw a rock or start a fire.

Q: Would you go work out at a gym? Swim in a pool? Run? Walk?

Fauci: I wouldn’t go to a gym. I need to be so careful. I don’t want to take a chance. I have a pool at home, so I swim in that. I do power-walking with Chris. I was running until about a year ago, but every time I went running, my back would tighten up the next morning. So now I walk the same distance. It just takes longer. We go every day with few exceptions, 3.5 miles per day during the week, four miles over the weekend. Prior to covid-19, I did it at lunch alone in the parks near NIH. Now, I do it in the evening with Chris around the neighborhood. On the weekends, Chris and I do it together on the C&O canal.

Connick: I wouldn’t go to a gym. I’d go to an outdoor pool, which is much safer than an indoor pool, since everything dissipates in the air, although I wouldn’t go to a crowded outdoor pool.

Volberding: I had a gym built in my house before this and it has everything, so I have no need to go to a gym. But I wouldn’t go eagerly. They can’t disinfect everything all of the time. As for pools, if anything, outdoors yes, indoors no. The swimmers would need to be far enough apart. There is a lot of heavy breathing, so even if they are in the next lane, I don’t think it’s fully safe. I try to get out and walk most days.

Bell: Of these I would only run, walk or hike where there were few other people, making it easy to avoid close contact

Bloom: I’m on the treadmill every other day at my house. I belong to a gym, but don’t believe gyms are the safest place to be until the numbers go down. Swimming outside itself is pretty safe — but stay out of the locker rooms.

Satcher: I’m not a gym person, even when there is no pandemic. I have to be outside. Being outside is good for you. I still run and walk, although I walk more than I run. I go about three or four miles most mornings. I would swim, since there is no evidence it is spread in water. I would only swim outside, since I am not an indoor swimmer.

Q: Are you making routine trips to the doctor or dentist?

Fauci: No, not yet, although I might check in within the next few weeks with my physician to get some soothing meds for my throat since I have a hoarse voice from so many briefings and interviews. He will probably take a look and say: “Just stop talking so much.”

Connick: Fortunately, I had my doctor checkup just before the shutdown, but I probably would not. As for the dentist, I probably wouldn’t go unless I had an emergency. I wouldn’t go for a routine cleaning.

Volberding: Nope. I had one doctor’s appointment done by video. I haven’t been to the dentist, although the problem with dentists is not my health, but theirs. I feel sorry for them.

Bell: No.

Bloom: No. I’m still nervous about infection control. If I had a major dental or medical emergency, I would go. The medical people take good precautions, but I am concerned with other patients going in and out.

Satcher: I haven’t seen a dentist since this started, but probably will go in soon. I’ve seen a physician once or twice for routine appointments, and I was comfortable with the way they handled the visits.

Q: What about mammograms? Would you get a routine mammogram/advise your wife/daughter to get one?

Fauci: If routine, I’d probably tell her to wait.

Connick: I am going to do it because I am a year overdue for mine, and want to get it done, otherwise I probably wouldn’t.

Volberding: Not yet.

Bell: Yes.

Bloom: Probably not.

Satcher: There is breast cancer history in the family, so yes.

Q: What kinds of questions would you ask a doctor's office before going for a routine appointment — and what are "acceptable risk" answers?

Connick: I would ask if they practice universal masking and whether they are seeing sick patients in their office.

Volberding: I would ask about disinfection, masks and face shields, and — for the dentist — whether they are using tools that generate a lot of aerosols.

Bell: I would ask if they separate sick patients from others, whether they keep a physical distance between patients, whether they require the use of masks for all employees and patients in common areas, do they screen health-care providers for symptoms, and exclude those who are ill.

Satcher: I have not interrogated the doctors, because I trust them, and I haven’t been disappointed.

Q: Are you working in your office? What precautions do you take?

Fauci: I don’t wear a mask when I’m alone in my office, but I slap one on if I walk out into the hall and could pass someone, like my assistant, who also wears one.

Connick: In our infectious diseases clinic, if anyone is sick, they are sent home. They are screened outside and talked to on phone, and asked if they are sick. We see people for HIV or other chronic infectious diseases and they are asked not to come if they have a fever or upper respiratory tract symptoms. Also, everyone must wear a surgical mask or we won’t see them. I wear an N95 mask if I am seeing covid patients, as well as goggles and a shield.

Volberding: I still have AIDS patients I do by phone. I went into clinic once a few weeks ago, but stayed only a brief period of time. I’m still not too eager to get back to the clinic. I do most work from home.
Bell: I primarily telework, but I wear a mask in group meetings when I’m in the office.

Bloom: Until recently, school has been closed and locked. I have permission to go in, but no particular reason to do so. I live by Zoom, and it’s fantastic.

Satcher: I go in about twice a week and wear a mask all the time, which is the rule. Also, everyone gets temperature checked.

Q: Will you ever shake hands again? Hug/kiss someone?

Fauci: I think it’s going to be a while. The infection rate will have to be extremely low or nonexistent, or we have to have a vaccine. Right now, I don’t even think about doing it.

Connick: I don’t know if people will ever shake hands again. Not until this thing is gone. Not until this is over. If my son came to visit, I’d hug him, but I’m generally not hugging people.

Volberding: It’s been a long time since I have shaken a hand. Maybe I will again once there is a vaccine. I grew up in Minnesota where hugging is not common, but since I’ve been out here, I’ve wanted to hug people, and love it. Once there is a vaccine, I want to get back to hugging. It just feels normal.

Bell: Yes [to shaking hands], followed by practicing good hand hygiene. Yes [to hugging and kissing.]
Bloom: I’d try to avoid it. I think it’s a bad idea. But I would rub elbows.

Satcher: I forget upon occasion and reach out my hand. I’m supposed to set an example, but I don’t always remember. Handshakes have always been a big thing at Morehouse, a firm handshake was one of the things they recommended when I was a student. I do the elbow bump thing, and I’m now a stickler for social distance. I don’t hug or kiss anyone.

Q: If you had young kids, would you send them back to school in the fall?

Fauci: It really depends on where you live.

Connick: I think that’s a very difficult question. I’m very glad I don’t have to make that decision. If they got sick, they may be fine but they could give it to me. As a doctor, I feel obligated to not get sick. It would be very difficult [to] have children who were in the school system.

Volberding: Oh boy, that’s a hard question. It’s such a challenge. The data I’ve heard about suggest that the really young kids are not much of an infection reservoir, so I think it might be okay for preschool, day care and elementary school. The question gets to be harder in high school and college. I think the schools probably will have shifts, morning and afternoon, and limited hours. They might consider teaching in cohorts — small groups of students, so if one get infected, they can quarantine that one group to keep it from spreading. I don’t think you can replace direct interaction with Zoom.

Bell: Yes.

Bloom: Yes. I believe that the process of socialization is really important, and that long-term deprivation of that is probably going to do more harm than the occasional child becoming infected. We also need to liberate parents and get them back to work, but as carefully as we can. I think kids need schooling and socialization.

Satcher: It would depend on what arrangements the school made to protect their health.

Q: Have you been tested for the coronavirus?

Fauci: Yes, every time I go to the White House.

Connick: I have not been tested. I’ve had no symptoms, so I see no reason to get tested.

Volberding: No. I am asymptomatic. I take my temperature every day and I have a spray bottle of fragrance that I spray into the air every day to make sure I haven’t lost my sense of smell. I’m in my house almost all the time except for walks in the neighborhood and trips to grocery stores.

Bell: No.

Bloom: No. But I have no symptoms.

Satcher: Yes, Morehouse requires it before we can come back. I actually took two different tests, the nasal swab and an antibody test because I was curious. I didn’t have any symptoms. Both were negative.

Q: What is your best guess about when a vaccine will be available?

Fauci: We have multiple candidates, and my hope is that we will have more than one, probably by the end of this year or the beginning of 2021.

Connick: Hopefully in six months. That would be a dream.

Volberding: The challenge isn’t making a vaccine, it’s in testing it for efficacy in large numbers of people. It’s got to be placebo controlled to know it’s working, and done on enough people with exposure risk. If everyone is staying at home, you won’t know. It also depends on how the epidemic goes. If, unfortunately, it is blasting along, you’ll be able to test it. It will take longer if there is a pandemic lull. I’m not expecting anything for at least a year from now.

Bell: Based on previous vaccine development, and the expectation that safety and efficacy were well tested, a complete guess would be late 2021.

Bloom: It’s unlikely we will have one that is 100 percent effective. But it would be terrific to have one that’s 50 percent effective, which is in the ballpark for flu. You need about 30,000 people to test and I don’t think 30,000 people are going to volunteer for each trial. So how many to know it’s safe and effective? My guess, though, is that we could have something by the first quarter of 2021.

Satcher: I wish I could say we will have one by the end of this year, but I can’t. We may have one in 2021, but I think it’s a long shot. Vaccines are not easy to develop, and this virus gives us some real challenges.

The experts

  • Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases.
  • Barry Bloom, Jacobson research professor and former dean of the Harvard T.H. Chan School of Public Health.
  • Paul A. Volberding, professor of medicine and emeritus professor of epidemiology and biostatistics at the University of California at San Francisco.
  • Elizabeth Connick, chief of the infectious diseases division and professor of medicine and immunobiology at the University of Arizona.
  • Linda Bell, South Carolina’s state epidemiologist.
  • David Satcher, former U.S. surgeon general, former director of the Centers for Disease Control and Prevention and most recently founder of the Satcher Health Leadership Institute at the Morehouse School of Medicine.

Back to School

The Fourth of July is normally the mid point of summer, with families scheduling vacations around this date and the hot days of this month are marked by summer camps and other extracurriculars that have kids still socializing and experiencing some type of emotional and intellectual stimulation if not growth.  Right, that is if you have money and access.  Few if any programs exist other than local community centers that like the rest of the services for the great unwashed are quite limited.  Needless to say the antiquated notion of school running for nine months a year with the summer off might have to go the way with the rest of our former ideas on how to manage and operate the United States. Let's face it folks, when Grocery Store workers, delivery drivers, public transportation operators and those others without degrees or established professional identities (think cooks, cleaners and other lower elements to the totem pole) are considered "essential" then we have a lot to rethink.  They were lumped in with Doctors and other medical professionals or "front line workers" who were there to basically do their job in surreal circumstances, and again those circumstances are the same with the kids going to camp, academy's and the like during summer break, the staff that work at wealthy hospitals that serve wealthy families.  I have already put up the story about New York's crisis with regards to how patients were treated, no, handled in public hospitals when they landed there for treatment.  If they were lucky they were shoved to the naval ship or the Javitz Center or the religious tent in Central Park but those numbers were few and far between and many never made it out of the hospital in anything but a body bag.

Yes American medical care is exceptional in that it has two classes of patients - the have and the have nots.  I am 99.9% sure that is why Harborview Hospital mistreated me in 2012 as they did not verify my insurance until after I was dismissed and in turn the damage was already done.  Anyone setting foot in that shithole well good luck to you, its only a miracle I did not die from their mistreatment and I suspect many have been now and no one will ever know as they don't have a massive newspaper with resources to cover this story as most other cities do either so those stories will go untold and the bodies dumped in the potter's field or thrown into storage trucks parked on roadsides as they are here.

**and for the record the local presses have been very active in uncovering major scandals.. It was the Keating 5 that came out of local press and the story about Boeing from The Seattle Times and there are many many more, The Boston Herald as the Priest scandal that without their local investigative journalism many stories like these would go unknown and the culprits on with their lives, like now but without a good movie. ****

In fact many of the unclaimed belongings are lost in the halls, closets or trash bins never to find a home or place to rest as well. Again if you think that staff aren't stealing some of these things, think again. Drug theft is the most common (and that includes Doctors as well)  but they take whatever is not locked down if you don't believe me,  ask this Nurse. I find it a miracle that I walked out with any jewelry or belongings from my incident.  Nurses are two bit cunts, and many others who work inside are lowly paid persons who frankly are largely ignored exploited workers, so they likely steal to use it to pawn.  I suspect why they have not raided that cookie jar is largely due to the fact that everyone is so bloody scared of Covid they aren't touching that shit but what they can take, they will.  Again its hard to think of these "heroes" doing such a thing, yeah remember when you felt that way about Cops?

Here is the next casualty on the horizon, public schools and universities.  The reality is that States are driven by the budget crisis to cut everything from everything. So if you think public health and education are already cut to the bone, think again.  This is an irony on top of a crisis as now more than ever how schools and hospitals go forward will be a demanding if not expensive operation for decades to come. And in fact should be the norm as to ensure that parity and equity are finally achieved for all those who don't have the privileges afforded them for being just essential workers.  I do find that hilarious that the dude who poured my coffee everyday and the other who brought my food had bigger role than my Accountant and Attorney whom I have not spoken to since this began is something that doesn't surprise me, as I rarely did and they are both new having fired the last Accountant and had just contacted the Attorney to set up some business trust and get my estate in order.  Again more irony.   I have no idea if we ever will meet or I will find someone else as I never wrote a check or followed up after the quarantine went down.  So much for essential.

I don't think any public teacher wants to set foot in any classroom without heavy duty protections in place, the same go with College Professors.  The reality is that the two cohorts who have the most problem following instructions and complying with order are kids, regardless of age.  I actually think of all kids, High Schoolers, would be the most easiest to work with as they are just of an age to rationalize what this means, the worst middle schoolers.  Then of course those in the first year or two of College are equally disrespectful as they have entitlement tattooed on their forehead as they are convinced their entrance means they are special, like everyone else.  What.ever.  So after binge drinking, pledging a Fraternity and then drugging some girl up to rape behind a dumpster I am sure they have no problem monitoring their health, wearing a mask and following social distance protocols.

This is what current Academics are saying with regards to returning to campus. And this will also be the guidelines for those in K-12 as who do you think are telling the White Daddies what to do. This is the "brain trust" who come up with these ideas, then go "Fuck this is not working out." Because trying to tell people how to behave and guide human behavior when they won't listen, don't care, assume its a game, political, fraud, made up, will go away, the fault of some Chinese person or whatever other bullshit falls out of the mouth of Trump, tells you everything you need to know in why this shit is hitting the fan.  Then you have a media whose sole job is to not actually ask questions, seek varying opinions and follow stories that have the ability to fact check and substantiate, you got more problems. As I have read repeatedly stories that contradict, stories that have odd blank or missing facts without any critical analysis offered.   We have seen opinion pieces and ads published without editorial oversight and more importantly, actual scientific reports printed only to be retracted days and weeks later without any real warning noted at print time advising  that this may not be all that and a bag of chips has instead become the daily Covid Caller.   And these are from the papers that have serious reputations that over the years despite their own roles in major fuckups, (Iran, that one was bad there NYT) (oh and the Post you ain't innocent either)  they are still considered the bellwether; so, when they screw it up we are screwed. Folks, most people are idiots, just ask the bleach drinkers.

And these same bleach drinkers breed, right there a problem, but do you honestly expect their children to be these compliant, well behaved individuals intent on following instructions and monitoring their behavior? Have you ever been to a public school?  They barely managed online learning, disrupting those classes when and if they ever showed.  So again, what about school?

Just ask these Teachers in Texas, hot bed for Covid 20 which seems worse than Covid 19. And of course the fish stinks from the head and so the White Daddies are putting this all on local districts without any guidance, let alone actual facts on how to do this, so I think this is like hospitals. The rich get all the goodies and the poor, well they can do what they always do, sink or swim.  Oh don't know how to swim? Well yeah that costs extra and we don't have any extra sauce for you kid.  Oh shit, (pun intended)  it is like Chipolte.  From parking lot fights to gun toting crazies if there is not another reason to set foot in that fast food dump there it is.  That place was a hot bed of norovirus numerous times,  you know like Covid, but less deadly.  So again if you think all these fights and furies are bad now, just wait.

Texas Teachers Consider Leaving The Classroom Over COVID-19 Fears

The Association of Texas Professional Educators recently surveyed some 4,200 educators. About 60% said they were concerned about their health and safety heading into the 2020-21 school year.

Laura Isensee | Posted on June 30, 2020,

For 40 years, Robin Stauffer has taught high school English in seven different school districts in three different states. Most recently, Advanced Placement English in Katy, where she says working with kids has kept her young and lighthearted.

But since the pandemic hit, a question has nagged at her: Is it time to retire?

“I was very upset and sad. I was torn. I went back and forth,” Stauffer said.

On the one hand, she isn’t ready to leave the classroom. She’s still passionate about why she joined the profession in the first place: “To be the type of teacher that I wish I would have had when I was in public school, to kind of right the wrongs that I experienced.”

On the other hand, she knows how hard it is to maintain a campus with thousands of students. Before COVID-19, district administrators in Katy reduced their custodial staff, and it was often up to teachers to clean their own rooms.

“They don’t supply hand sanitizer. They don’t supply wipes. None of these supplies were ever given to us. You just used what you had or what teachers themselves purchased,” she said.

Stauffer waited for the Katy Independent School District to release safety plans for back-to-school. Instead, she’s seen what she called a “back-to-normal” attitude.

And then she had to consider her health: She’s 66 years old, has diabetes and a family history of heart disease, all making her more vulnerable to the coronavirus.

“I just don’t trust the school district to safeguard my health during this pandemic,” she said.

Like Stauffer, many Texas teachers are on edge and considering leaving the profession even as the state’s education commissioner has declared it “safe for Texas public school students, teachers, and staff to return to school campuses for in-person instruction this fall.”

As many as one in five U.S. educators say they’re unlikely to return to the classroom because of the coronavirus, according to a national survey conducted before Texas indicated its light-handed approach to reopening schools.

“There are people that have already made the decision to quit,” said Zeph Capo, president of the Texas American Federation of Teachers. “There’s certainly a lot of people that are considering it. I’ve heard from others as well, too. They’re single parents and they don’t have a lot of choice.”

“So they’re depending on us,” Capo said, “to help make sure that they are afforded as much safety as possible in doing that. So that’s what keeps me moving.”

Higher risk

Nearly one-third of U.S. teachers are 50 years or older, according to federal data. That puts them at higher risk of becoming seriously ill from the virus. And the publication Education Week has identified more than 300 school staff and former educators who’ve died from COVID-19.

“There’s obviously a lot of fear because there are so many unanswered questions,” said Noel Candelaria, president of the Texas State Teachers Association.

He says school staff with underlying health conditions are also concerned. Consider his own family: Candelaria is married to Patty, who is a dyslexia therapist and has had three surgeries to fix a congenital heart defect.

“There are educators, like my wife, who if the districts do not provide an alternative method for them to do their job from home without exposing themselves, (they) are seriously considering a medical leave,” Candelaria said.

Texas public school districts are still waiting for safety and health guidelines from the Texas Education Agency. They were scheduled to be released last week, but were delayed after the Texas Tribune published draft rules indicating few mandatory safety measures.

That has weighed on many teachers.

“We can’t just talk about student health and safety without talking about educator health and safety, because they’re sharing the same space,” Candelaria said.

The Association of Texas Professional Educators recently surveyed some 4,200 educators. About 60% said they were concerned about their health and safety heading into the 2020-21 school year.

Sso far, however, that concern hasn’t translated into an increase in retirements. Nearly 22,000 teachers and state employees have retired this fiscal year, compared to about 25,000 last year, according to the Teacher Retirement System.

Few mandates

Gov. Greg Abbott has said districts will have some flexiblity in implementing safety protocols, and allowing families to continue remote learning.

“The state has already made allocations and is prepared to continue allocations of masks for schools, allowing, I think, for a level of flexibility at the local school district level to make the best determinations for the schools in that district about what the mask requirement should be,” Abbott told KBTX-TV in a recent interview.

But, the Republican governor has told state lawmakers Texas won’t mandate schools to require face coverings or test for COVID-19 symptoms.

“It was really shocking because it seems like nobody cares what’s going to happen in the schools,” said Kristen McClintock, who’s taught special education for six years at a large Houston high school.

She has a newborn and a toddler at home and doesn’t want to expose them to the virus. Nor does she want to expose her students with disabilities, whom she says she misses a lot.

“We’re almost like a family,” McClintock said. “So it’s been really hard to not be able to see them for months. I want to see some of them graduate next year”

But every night she and her husband discuss if they can afford for her to quit and rely on his income as an online tutor.

“It would cut our finances in half,” she said. “We would have to lean on support probably from family to try and get by.”

No choice

McClintock is still deciding. First, she wants to see more health data and detailed plans from the Houston Independent School District.

But veteran educator Stauffer has made up her mind. She turned in her resignation in May.

“All my life, I’ve been a teacher,” Stauffer said. “That is who I am. And to give up my identity, it will be challenging, but I don’t feel like I had another choice.”

She cleaned out her classroom, said goodbye to students over Zoom and didn’t have any real celebration.

That is, until some of her colleagues surprised her with a car parade, waving signs and balloons as they drove by — a fitting end to a 40-year career, in the age of COVID-19.

Thursday, July 2, 2020

Enter at your own risk

Once again reading the paper I had to put it down to compose myself.  Not that I was surprised by the article, in fact I was anything but; however, when you read the facts and the truths in black and white confirming what you believed was true given what you know about how the medical industrial complex operates (pun intended) in the best of time, I knew that in the worst it would be more of the same only in fact even worse.   I have never understood the hero worship nor the giving or donating anything to these hospitals unless they are publicly owned and managed as they actually needed it. But they are also largely mismanaged, poorly maintained and have few advocates who give one flying fuck.  This article only again confirms this.   Enter at your own risk as they don't give a shit.

This article once again proves the failings by the great white Daddies who held daily meetings, announced the lottery numbers without one clear plan, without knowledge or even the ability to communicate coherently and truthfully about how Covid was a dangerous deadly virus, they did not know what to do and they were going to try anything and everything to make this somehow work but whatever the public at large could do to stop this would be welcome, appreciated and necessary and that may evolve over time but with support and cooperation this may not fully go away but it will be manageable with many sacrifices on all our parts to do so.  Nope, here in New Jersey we were called knuckleheads, and each city in the region came up with  its own bullshit with no logic and even less communication, all of it via Facebook. They too had no real idea what they were doing but they were going to do it nonetheless.  Funny California was considered a model and then not so there you go.  Meanwhile the Governors who were acclaimed, DeWine, Cuomo and Inslee had no clue but they were telegenic, competent sounding and of course had visual aids and the appropriate staff standing by to scold, reprimand and remind everyone to be afraid, be very afraid.

From testing fiasco's to the old folks homes to just overall neglect and failure to actually address the day to day, from homeless in the subways to the overgrowing pockets of Covid in poor and largely minority communities as after thought was just another day in the park of Covid.  It was clear that the President and his "Covid" geniuses had no fucking clue, the CDC was a farce of inconsistency so why not just say that and tell people they are on their own and that they have little to go on but faith.  But nope.  And Cuomo was the figure that many turned to for no other reasons that he was there but once you look at the failures of the hospitals in New York you can only say fuck you asshole this is all on you.  This is where the division of New York is clear and that is literally life and death.  If anyone votes for this fucking asshole they have blood on their hands.  There was no White Knight, no Calvary to the rescue there was just chaos and bullshit.

Why Surviving the Virus Might Come Down to Which Hospital Admits You

In New York cities poor neighborhoods, some patients have languished in understaffed hospitals, with substandard equipment.  It was a different story in Manhattan's private medical centers.

July 1, 2020

In Queens, the borough with the most coronavirus cases and the fewest hospital beds per capita, hundreds of patients languished in understaffed wards, often unwatched by nurses or doctors. Some died after removing oxygen masks to go to the bathroom.

In hospitals in impoverished neighborhoods around the boroughs, some critically ill patients were put on ventilator machines lacking key settings, and others pleaded for experimental drugs, only to be told that there were none available.

It was another story at the private medical centers in Manhattan, which have billions of dollars in endowments and cater largely to wealthy people with insurance. Patients there got access to heart-lung bypass machines and specialized drugs like remdesivir, even as those in the city’s community hospitals were denied more basic treatments like continuous dialysis.

In its first four months in New York, the coronavirus tore through low-income neighborhoods, infected immigrants and essential workers unable to stay home and disproportionately killed Black and Latino people, especially those with underlying health conditions.

Now, evidence is emerging of another inequality affecting low-income city residents: disparities in hospital care.

While the pandemic continues, it is not possible to determine exactly how much the gaps in hospital care have hurt patients. Many factors affect who recovers from the coronavirus and who does not. Hospitals treat vastly different patient populations, and experts have hesitated to criticize any hospital while workers valiantly fight the outbreak.

Still, mortality data from three dozen hospitals obtained by The New York Times indicates that the likelihood of survival may depend in part on where a patient is treated. At the peak of the pandemic in April, the data suggests, patients at some community hospitals were three times more likely to die as patients at medical centers in the wealthiest parts of the city.

Underfunded hospitals in the neighborhoods hit the hardest often had lower staffing, worse equipment and less access to drug trials and advanced treatments at the height of the crisis than the private, well-financed academic medical centers in wealthy parts of Manhattan, according to interviews with workers at all 47 of the city’s general hospitals.

“If we had proper staffing and proper equipment, we could have saved much more lives,” said Dr. Alexander Andreev, a medical resident and union representative at Brookdale University Hospital and Medical Center, a struggling independent hospital in Brooklyn. “Out of 10 deaths, I think at least two or three could have been saved.”

Inequality did not arrive with the virus; the divide between the haves and the have-nots has long been a part of the web of hospitals in the city.

Manhattan is home to several of the world’s most prestigious medical centers, a constellation of academic institutions that attract wealthy residents with private health insurance. The other boroughs are served by a patchwork of satellite campuses, city-run public hospitals and independent facilities, all of which treat more residents on Medicaid or Medicare, or without insurance.

The pandemic exposed and amplified the inequities, especially during the peak, according to doctors, nurses and other workers.

Overall, more than 17,500 people have been confirmed to have died in New York City of Covid-19, the illness caused by the coronavirus. More than 11,500 lived in ZIP codes with median household incomes below the city median, according to city data.

Deaths have slowed, but with the possibility of a second surge looming, doctors are examining the disparities.

At the NewYork-Presbyterian Hospital, the city’s largest private hospital network, 20 doctors drafted a letter in April warning leadership about inequalities, according to a copy obtained by The Times. The doctors had found that the mortality rate at an understaffed satellite was more than twice as high as at a flagship center, despite not treating sicker patients.

At NYU Langone Health, another large network, 43 medical residents wrote their own letter to the chief medical officer expressing concerns about disparities in hospital care.

Both networks said in statements that they deliver the same level of care at all their locations.

Gov. Andrew M. Cuomo and Mayor Bill de Blasio have spoken throughout the pandemic of adding hospital beds across the city, transferring patients and sending supplies and workers to community hospitals, implying that they have ensured all New Yorkers with Covid-19 receive the same quality care.

“We are one health care system,” Mr. Cuomo said on March 31. The same day, he described the coronavirus as “the great equalizer.”

In interviews, doctors scoffed at that notion, noting, among other issues, that government reinforcements were slowed by bureaucratic hurdles and mostly arrived after the peak.

“There was no cavalry,” said Dr. Ralph Madeb, surgery director at the independent New York Community Hospital in Brooklyn. “Everything we did was on our own.”

In a statement, Dani Lever, the governor’s communications director, said Mr. Cuomo has repeatedly pointed out inequalities in health care. The state worked during the peak to transfer patients so everybody could at least access care, she said.

“The governor said Covid was the ‘great equalizer’ in that it infected anyone regardless of race, age, etc. — not that everyone would receive the same the level of health care,” she said. “The governor said we are one health system in terms of ensuring that everyone who needed it had access to a hospital.”

A spokeswoman for Mr. de Blasio, Avery Cohen, said the mayor agreed that the pandemic had exposed inequalities, and the city had worked to address disparities.

“From nearly tripling hospital capacity at the virus’ peak, to creating a massive testing apparatus from the ground-up, we have channeled every possible resource into helping our most vulnerable and remain undeterred in doing so,” she said.

New York has never had a unified hospital system. It has several different hospital systems, and in recent years, they have consolidated and contracted, through mergers and more than a dozen hospital closures.

Today, most beds in the city are in hospitals in five private networks. NewYork-Presbyterian, which has Weill Cornell Medical Center and Columbia University Irving Medical Center; NYU Langone; the Mount Sinai Health System; Northwell Health; and the Montefiore Medical Center.

Most of the private networks are based at expansive campuses in Manhattan, as are some of the public hospitals. (Montefiore is based in the Bronx; many of Northwell’s hospitals are outside of New York City.)

The hospital closures have largely been outside of Manhattan, including three beloved safety-net hospitals in Queens in just a few months in 2008 and 2009.

There are now five hospital beds for every 1,000 residents in Manhattan, while only 1.8 per 1,000 residents in Queens, 2.2 in Brooue reading the main story

These networks are wealthy nonprofits aided by decades of government policies that have steered money to them. They also rake in revenue because, on average, two-thirds of their patients are on Medicare or have commercial insurance, through their employer or purchased privately.

Collectively, they annually spend $150 million on advertising and pay their chief executives $30 million, records show. They also pay their doctors the most, and score the highest marks on industry ratings regarding safety, mortality and patient satisfaction.

The city has 11 public hospitals. This is the city’s safety net, along with the private networks’ satellite campuses and a shrinking number of smaller independent hospitals, which have been financially struggling for years.

At the safety-net hospitals, only 10 percent of patients have private insurance. The hospitals provide all the basic serviceklyn and 2.4 in the Bronx, according to government data.

Yet in a cruel twist, the coronavirus has mostly clobbered areas outside of Manhattan.

Manhattan has only had 16 confirmed cases for every 1,000 residents, while there have been 28 per 1,000 residents in Queens, 23 in Brooklyn and 33 in the Bronx, the latest count shows.

These areas have lower median incomes — $38,000 in the Bronx versus $82,000 in Manhattan — and are filled with residents whose jobs have put them at higher risk of infection.

“Certain hospitals are located in the heart of a pandemic that hit on top of an epidemic of poverty and stress and pollution and segregation and racism,” said Dr. Carol Horowitz, director of the Institute for Health Equity Research at Mount Sinai.

At the pandemic’s peak, ambulances generally took patients to the nearest hospital — not the one with the most capacity. That contributed to crushing surges in hospitals in areas with high infection rates, overwhelming some hospitals and reducing their ability to care for patients.

In Manhattan, where many residents fled the city, hospitals also found patient release valves. Mount Sinai sent hundreds to a Central Park tent hospital. NewYork-Presbyterian sent 150 to the Hospital for Special Surgery.

In all, the census at some emergency rooms actually declined.

At Lenox Hill Hospital, a private hospital on the Upper East Side, Dr. Andrew Bauerschmidt said on April 8 — near the city’s peak in cases — that the hospital had more patients than usual, but not by much.

“Nothing dire is going on here, like the stories we’ve heard at other hospitals,” he said.

After weeks battling the virus at the Elmhurst Hospital Center, a public hospital in Queens that was overwhelmed by Covid-19 deaths, Dr. Ravi Katari took a shift at the Mount Sinai Hospital.

When he arrived at the towering campus just east of Central Park, he was surprised to see fewer patients and more workers than at Elmhurst, and a sense of calm.

Dr. Katari was a fourth-year emergency medicine resident in a program run by Mount Sinai that rotates residents through different hospitals, to give them varied experiences.

In interviews, seven of these residents described vast disparities during the pandemic — especially in staffing levels.

At the height of the crisis, doctors and nurses at every hospital had to care for more patients than normal. But at the safety-net hospitals, which could not deploy large numbers of specialists or students, or quickly hire workers, patient-to-staff ratios spiraled out of control.

In the emergency room, where best practices call for a maximum of four patients per nurse, the ratio hit 23 to 1 at Queens Hospital Center and 15 to 1 at Jacobi Medical Center in the Bronx, both public hospitals, and 20 to 1 at Kingsbrook Jewish Medical Center, an independent facility in Brooklyn, workers said.

“We could not care for the number of the patients we had,” said Feyoneisha McGrath, a nurse at Kingsbrook. “I worked 16 hours a day, and then I got in my car and cried.”

In intensive-care units, where patients require such close monitoring that the standard ratio is just two patients per nurse, ratios quadrupled at some hospitals, including at Interfaith Medical Center in Brooklyn, an independent facility, and at NewYork-Presbyterian’s satellite in Queens, workers said.

The city’s public hospital system disputed those ratios cited by workers. It added that during the pandemic, it recruited thousands of nurses and streamlined monitoring, including by opening doors to patient rooms. The chief executive of Kingsbrook and Interfaith also disputed the ratios at those hospitals.

Research has shown that staffing levels affect mortality, and that may be even more true during this pandemic because many Covid-19 patients quickly deteriorate without warning.

At Brookdale, the independent hospital, three doctors said that many patients on ventilators had to remain for days or weeks in understaffed wards because the intensive-care unit was full. Amid shortages in sedatives, some patients awoke from comas alone and, in a reflexive response, removed the tubes in their airways that were keeping them breathing. Alarms rang, and staff rushed to reintubate the patients. But they all eventually died, the doctors said.

A hospital spokesman, Khari Edwards, said, “Protocols for sedation of intubated patients are in place and are monitored by our quality improvement processes.”

Similar episodes occurred at Kingsbrook, the Queens Hospital Center and the Allen Hospital, a NewYork-Presbyterian hospital in Northern Manhattan, according to workers.

Dr. Dawn Maldonado, a resident doctor at Elmhurst, described a worrisome pattern of deaths on its understaffed general medicine floors. She said at least four patients collapsed after removing their oxygen masks to try to walk to the bathroom. Workers discovered their bodies later — in one case, as much as 45 minutes later — in the bathroom or nearby.

“We’d call them bathroom codes,” Dr. Maldonado said.

As the coronavirus raged, Lincoln Medical and Mental Health Center in the Bronx kept running into problems with ventilators.

Lincoln, a public hospital, had a limited number, and it could not acquire many more, so it had to increasingly use portable ventilators sent by the state. The machines did not have some settings to adjust to patients’ breathing, including a high-pressure mode called “airway pressure release ventilation.”

Virtually every hospital had to use some old ventilators. But at hospitals like Lincoln, almost all patients received emergency machines, doctors said.

Safety-net hospitals also ran low on dialysis machines, for patients with kidney damage. Many independent hospitals could not provide continuous dialysis even before the pandemic. At the peak, some facilities like St. John’s Episcopal Hospital in Queens had to restrict dialysis even further, providing only a couple hours at a time or not providing any to some patients.

While many interventions for Covid-19 are routine, like supplying oxygen through masks, safety-net hospital patients also have not had much access to advanced treatments, including a heart-lung bypass called extracorporeal membrane oxygenation, or E.C.M.O.

For weeks, many independent hospitals did not have remdesivir, the experimental anti-viral drug that has been used to treat Covid-19.

“We are not anybody’s priority,” said Dr. Josh Rosenberg of the Brooklyn Hospital Center, a 175-year-old independent facility that took longer than others to gain entry to a clinical trial that provided access to the drug.

Historically, safety-net hospitals have not been chosen for many drug trials.

Dr. Mangala Narasimhan, a regional director of critical care at Northwell, said just participating in a trial affects outcomes, regardless of whether the drug works.

“You’re super attentive to those patients,” she said. “That is an effect in itself.”

Some low-income patients have even missed the most basic of treatment strategies, like being turned onto their stomach. The technique, called proning, has helped many patients breathe, but because it requires several workers to keep IV lines untangled, some safety-net hospitals have been unable to provide it.

Many private centers have beds that automatically turn.

Near the corner of 1st Avenue and East 30th Street in Manhattan sit two hospital campuses that illustrate the disparities on the most tragic of measures: mortality rate.

One is NYU Langone’s flagship hospital. So far, about 11 percent of its coronavirus patients have died, according to data obtained by The Times. The other is Bellevue Hospital Center, the city’s most renowned public hospital, where about 22 percent of virus patients have died.

In other parts of the city, the gaps are even wider.

Overall, about one in five coronavirus patients in New York City hospitals has died, according to a Times data analysis. At some prestigious medical centers, it has been as low as one in 10. At some community hospitals outside Manhattan, it has been one in three, or worse.

Many factors have affected those numbers, including the severity of the patients’ illnesses, the extent of their exposure to the virus, their underlying conditions, how long they waited to go to the hospital and whether their hospital transferred healthier patients, or sicker patients.

Still, experts and doctors agreed that disparities in hospital care have played a role, too.

“It’s hard to look at the data and come to any other conclusion,” said Mary T. Bassett, who led the New York City Department of Health and Mental Hygiene from 2014 until 2018 before joining Harvard University’s School of Public Health. “We’ve known for a long time that these institutions are under-resourced. The answer should be to give them more resources.”

The data was obtained from a number of sources, including government agencies and the individual hospital systems.

Many of the sharpest disparities have occurred between hospitals in the same network.

At Mount Sinai, about 17 percent of patients at its flagship Manhattan hospital have died, a much lower rate than at its campuses in Brooklyn (34 percent) and Queens (33 percent).

Dr. David Reich, chief executive at the Mount Sinai Hospital and the Queens site, said the satellites were located near nursing homes and transferred out some of their healthy patients, making their numbers look worse. But he added that he was not surprised that large hospitals with more specialists had better mortality rates.

There have even been differences within the public system, where most hospitals have had mortality rates far higher than Bellevue’s.

At the Coney Island Hospital, 363 patients have died — 41 percent of those admitted.

In an interview, Dr. Mitchell H. Katz, the head of the public system, strenuously objected to the use of raw mortality data, saying it was meaningless if not adjusted for patient conditions. He agreed public hospitals needed more resources, but he defended their performance in the pandemic.

“I’m not going to say that the quality of care that people got at my 11 hospitals wasn’t as good or better as what people got at other hospitals,” he said. “Our hospitals worked heroically to keep people alive.”

On April 17, NYU Langone employees received an email that quoted President Trump praising the network’s response to Covid-19: “I’ve heard that you guys at NYU Langone are doing really great things.”

The email, from Dr. Fritz Fran├žois, the network’s chief medical officer, infuriated residents who had worked at both NYU Langone and Bellevue. They believed that if the private network was doing great, it was because of donors and government policies letting it get more funding.

“When given the ear of the arguably most powerful man in the world — who has control over essential allocation of resources and government funding — it is a physician’s duty to take this opportunity and to advocate for the resources that all patients need,” they responded.

At the same time, another conversation was happening. It began in late March, when doctors at the Lower Manhattan Hospital concluded their mortality rate for Covid-19 patients was more than twice the rate at Weill Cornell, a prestigious hospital in its same network, NewYork-Presbyterian.

The doctors saw an alarming potential explanation. In a draft letter dated April 11, they said their nurses cared for up to five critically ill patients, while Weill Cornell nurses had two or three. They also noted staffing shortages at the Allen Hospital and NewYork-Presbyterian Queens.

“What hospital a patient goes to (or that E.M.S. takes them to) should not be a choice that increases adverse outcomes, including mortality,” the draft letter said.

It is unclear if the doctors sent the letter. But in mid April, network leaders sent more staff to the Lower Manhattan Hospital, and that gap narrowed.

Another group of network doctors undertook a deeper study and found that some of the gap was explained by differences in the ages of patients and their health conditions. But even after controlling for those issues, they found a disparity, and they vowed to study it further.

In a statement, the network denied that any nurses had to monitor five critically ill patients. “Short-term, raw data snapshots do not show an accurate or full picture of the entire crisis,” it said.

Still, one doctor who works at both hospitals said he was disturbed by one episode during the peak at the Lower Manhattan Hospital.

The doctor, who spoke on condition of anonymity because he had been warned against talking to reporters, recalled he had three patients who needed to be intubated. When he called the intensive-care unit, he was told there was only space for one.

One man was in his mid-40s, younger than the other two, who were both over 70.

“Everyone looked bad, but he had the best chance,” the doctor said. “The others had to wait.”

The doctor said he did not know what happened to the patients after he left work. Given the high mortality rate at the hospital, he said he was reluctant to look it up.

“What good is it going to do me, to know what happened?” he said.

Streets of Blood

To truly understand the South you would have to be a combined Anthropologist, Sociologist, Theologian and Economist.  The South post Civil War failed at Reconstruction and in turn faced a series of economic boycotts over the years that began with the great migration by many Southern Black faces to the North that promised work.  The South remained largely agrarian  and in turn lost significant power over time Legislatively but thanks to the sheer numbers of folks who have remained has made the region one of political import.  But what is more important is that if one recalls the South was the site of many battles in the American Revolution, which residents of South Carolina never fail to mention, that civil war thing yes, but that history of their role in securing American's independence is something that of which they are resolutely proud of.  The Citadel sits in Charleston and is the school of legacy and in turn demonstrates that while the northern schools, such as West Point, get the attention the reality is that the South has been driven economically by their large numbers enlisted in the military.  It is the most significant institution next to schools of which again the South take great pride in, and they do that through college sports.  And it is not without its own history of abuse and scandal. But hey that is what makes you tough right.  Police, Warrior, Cop.

After time the South started to invite foreign businesses to set up shop, they created right to work laws, like their endless pursuit of religious freedom attests that is the most significant ways the South has come to rise again in America.  The Southern migration of many Black elite to rebuild and rebrand Atlanta gave the area a cache that had been largely resigned to the trash heap of Hee Haw and the Beverly Hillbillies and then came Medea.  Part satire, part honorarium, it brought the new money to the new faces of color that had for decades known how to put assess in seats and find white audiences to black theaters. And then of course sports.  You know the great equalizer until that black fist is raised or a knee bent.  But the greatest equalizer was and frankly is the Military.  One can note all the significant faces whoop I mean face of color in Colin Powell who attained one of the most respected places at the table of the White House until a young man named Obama took the next higher seat.  And again that was a way for everyone to say, "See we are not racist."  What.ever.

Meanwhile the South did not change, did not evolve at all in fact it doubled down on the hate laws. They carefully took voting rights away, re-examined civil rights and directed it towards another group, the Gay community and in turn under religious freedom ensured that hospitals or Planned Parenthood would be denied access and availability to any and all options when it came to family planning. They did the same for education, embracing charters and testing and other means to break any concept of public and equal education established in Brown, a color that is not just one in the Crayola box.  The South still had statues, markers and other symbols scattered throughout the cities and towns that were somehow equal notes about people, places and things that demonstrated growth and evolution. What.ever. Meanwhile the oppressive laws and legislative acts say otherwise

I toured the South and spoke and visited many sites of note.  I elected to avoid Alabama given their current attempt to destroy women's right to choose but I am still planning to go.  As a result of my "boycott" I  have not seen the Lynching Memorial in Montgomery and we know now it is about 1,000 names light as to number actually killed during that time. But then again the South numbers are not their best suit.   It is like today when we speak of George Floyd we are forgetting the seventy or more that in the prior year said variations of "I can't breathe."  They too were smothered to death at the hands of the Police, another protected class under the new name, "First Responders" that give cache and honor to a job that includes murder.  For anyone who chokes the life out of someone and does so with deliberation is a murderer.  Hard words but we give a pass to those who wear a uniform for they do so to save our country, to protect and serve and whatever other bullshit we like to say when we excuse the accuser.

So in the last decade the South rose again, the schools, the football, the basketball and their endless parade of flags to note that every single elected official were largely white men with dubious histories regarding civil rights and often relegated as public jokes. But meanwhile they made powerful allies and friends and they stay very much elected in office without issue or scandal.  Well some get busted and yet they are back again and again as the South is tribal, forgiving their own and seeing the "other" the "outsider" with suspicion and doubt. Well that is until a check is offered be it at the fund raiser or the church plate it is in that God We Trust.

Today Mississippi, the poorest state in the Southern union finally a century later removed the Confederate flag from their state flag. Tennessee which has resisted any call to remove the head of the KKK, Nathan Bedford Forest, statue from the Capital may do so. In fact, the Tennessee state Legislature passed a law when the City of Memphis sold a park with another absurd Confederate statue to a private investor who promptly removed the work of "art" and then deeded the land back to the city as a gift. The white powers that be immediately made that illegal and the statues stayed in place all of this after a young white woman, Heather Heyer, died in  Charlottesville against others fought those wanting to remove one from public land.   They were not residents from there, but they felt that vested in a statue that has nothing to do with their own history other that being one of a racist white man, they were willing to kill people to do so.   And finally Facebook today says, whoops sorry about giving them a forum.  How many deaths in the streets does it take?

Speaking of Facebook.... how many Russian trolls will it take to topple it? NONE.

This week it has been revealed that Russia was paying bounties to the Taliban to kill American soldiers, and that this might have been going on during the Obama Administration is not a message lost on me, as Obama reneged on that promise to get us out and failed to.   But given what you will read later on it makes sense.  But then again unlike the idiot in the White House I read.  This war was about rage and honor and I get it as I can walk out my door and see in my backyard the tower that replaced the two ripped out of the skies.  I can see memorial after memorial here in Jersey City and in NYC about that day.  There is no way to ever explain that rage and loss that included many "first responders" many whom did not need to die had they had better communication and linked lines that would have allowed them to know what was coming.  And again that lays as the hands and feet of another idiot in the Trump orbit and yet in those days he was America's Mayor.  Wow we could not do worse.  More deaths in streets and yet the powerful still go on being powerful.  His best friend, Bernard Kerik, was recently pardoned by Trump, and Trumps pardons go on to those who least deserve them but then again the powerful never get justice in the same way the rest do.

Another Trump pardon was an Army Sergeant who committed murder, or what we call War Crimes. War crimes that have been going on since WWII and we have spent much of history trying to call to Justice those in power who perpetuated them.  Sometimes it works but then again Stalin never faced a Jury nor will Putin.  Nor will any Saudi Prince for their own crimes against America that fateful day nor for any in the most recent day.  They will go on with life as usual as blood washes away quit easily when you have the money to make it so.

This is the link to the story of Sergeant Lorance ,who had been in command of 1st Platoon for only three days in Afghanistan; however,  in that short span of time he averaged a war crime a day.  Remember Police kill an average of 3 a day in America.  a military jury found.  The day before he was dismissed, he ordered his troops to open fire on three Afghan men standing by a motorcycle on the side of the road who he said posed a threat. His actions led to a 19-year prison sentence.  He served six years and then Trump made him a hero.  Well Chauvin may end up with the same if Trump remains in office, just a thought.

What I want to remind anyone is that no one acts alone.  That Police have accomplices and they are partners in crime and they too walk away or not as again this act on Mr. Floyd was not the first and certainly not the last until it is.  The reality is that for those who choose to not or find themselves unwitting aids to one who has the power and authority to damage their lives if not actually enable their lives to end, it is a precarious journey.  And I urge you to read the stories of the men who now see their former colleague walk free as if nothing he did wrong. The same goes for those who were victims of crimes, of sexual assaults and other serious matters where the laws seem to favor the accused and in turn enable them to walk out the door, if they ever even get inside in the first place.

In my case I hold two men responsible for what happened to me, two white men, two Lawyers, Ted Vosk and Kevin Trombold, as the ones who did more damage to me than my date Char ever did as he never finished the job, but they did their best to do so. To the massive staff at Harborview Hospital, their role cannot be ignored as they allowed me to wander the streets for a week without anyone caring for me putting me further at risk and perhaps even allowing me to invite the maniac back into my home. To them I wish them a special place in hell.  And this also goes to the ones who have done this to others, the professionals with whom we entrust to serve, to protect, to heal, to make a life better and as this pandemic has proven they are not capable nor truly able to do so. This is America, in God We Trust, and by that I mean the God of the word on the dollar.  We trust and respect no other and those uniforms that are worn be it of Police, Military, Fire, EMT, Doctor, Nurse or the Robes in court they are not there for the citizens of the country they are there for their own self interest.  They can go fuck themselves.   We have the power in number and we refuse for whatever reason or belief to vote, to engage, to read, and to know. And because of that our streets run with blood.

Tuesday, June 30, 2020

Take a Breath

I have said repeatedly you don't know me until you know me and then let me know what you think, be honest, be frank and be kind.  Any criticism should come from love and from that comes growth but not in America we just shame, blame, scold and walk away. Working out great.

As I wrote about the recent comments from two women about what it is like to be a face of color be in business or education there is a long road ahead for equity and parity both in gender and race.  But again there is a massive rainbow here and we have not done well finding the pot of gold for any of those who travel along it.  Dorothy may have clicked her heels three times to find her home over the rainbow but for the woman who played her she never made it home in one piece, we do that, kill or be killed; Survival of the fittest, only the strongest survive.  We get it, we really do.

When I gave a friend, who is black, Radley Balko's articles and books on Warrior Cops and the racism endemic in the criminal justice system he was amazed.  He had no idea that over 1,000 people a year die at the hands of police, George Floyd only one of them.  His Mother is a 911 Operator and she has never discussed her job or her role in how these calls literally are the life and death of many who are the first responders on the other end. But you are right, I am White and should not teach anyone of any color other than my own about my own experience in said system, nor hear of others and in turn share that in any way that is to inform, educate and bring change.  Thank you.  And guess what? I won't.  I have finally realized sitting in house arrest about how I mocked Nashville and its racism and poverty and values that seemed resistant to growth, to change, to be less religious and more open and then I sat down and realized how Seattle, the good white liberal town was not much different, white privilege is well for the privileged. And by that we mean never had a bad thing ever happen to them ever.  Not all white people are so fortunate but our color at times makes us invisible to those in power until they choose to see it.   And we can choose at any time to see color and just add that to the list of things we note and then we can choose to know them. Fuck that its hard I just want to be with the people who get me and my people. Thanks I am stupid and privileged. Oh how fragile I am!!

In public education, most of the schools are run by faces of color, many Teachers are faces of color, much of the staff are also very much a reflection of the school's population.  And this varies by district and in each district each neighborhood they too add  color or lack thereof but that is about segregation in another way, economic and the taxes and costs of home that legally separate the have's from the have nots.  To overcome that since Seattle had ended Affirmative Action which required quotas and numbers, we created a false culture of education. There were/are or have been schools that existed to reach any face and all types of learners, schools that were African American Academy's, Interagency' Academy's and their focus on the kids who needed alternative support, the American Indian Academy, the Seahawks Academy, the Center School, the varying high schools with Academic Achievement, International Baccalaureate Programs, the World School of multicultural languages, and on and on with all kinds of methods and concepts to show how progressive, liberal and good they were.  They have the same in Nashville and they are all dumpsters, and the kids garbage bags. Some are better quality and are compostable and recyclable and are largely white with high achieving faces of color to round out the program. The focus on Sports and the never ending bullshit that makes it the leveler of equality by enabling boys to believe that sports will open the door to a better life.  Yes, been to an NFL Draft?  It is a slave auction just without whips.  There are no professions apparently open to faces of color other than entertainment and athletics, good to know says, Dr. Neil DeGrasse Tyson.

We have good Teachers, we have bad. We have good Administrators, we have bad, but we have one thing in common, nothing is good about public education as it stands today. Sorry but they are all just shitty as hell, from the politics to the course work they are horrific.   I have had conversations with a young black girl who works in my coffee shop, she is lovely. She never heard of the 4 Girls in the Church of Alabama or of Emmett Till. So much for Jersey City schools being quality that answered all I need to know before I ever set foot in one.

  The endless amount of faces of color who have seemingly never heard of many things until pop culture embraces it never ceases to amaze me. And much of that goes for other faces less of color. We live a me me world.    It is as if intellectual curiousity is for freaks of nature who don't deserve respect or attention and that is when I realized why people hate me.  In the last 10 years in schools I have been accused of slapping a kid because he was black, he later retracted it but after putting me through hell and massive legal bills and I am not alone.  I have been called racist more times than I can count, had money stolen, been verbally abused and had shit thrown out me while kids laughed.  And like a true Masochist I went back for no reason other than I could and thought it will be different next time.  I recall when a Principal came in and said I was reading racist material to a class, it was an editorial by Bob Herbert in the New York Times and the importance of children of color getting into higher education; he has written a book on the subject, and that when I showed him both the article and the photo of Mr. Herbert it was snatched from my hand and never heard about it again. This a class that the former Teacher had quit, the long term sub also quit as the children were having sex in the classroom. Yes, in the classroom; It was a portable and there was a room divider and they would go behind that and have sex.  They were 7th graders.  And there were more stories like this in Seattle, the circle jerk film that circulated in another middle school leading the Police to come and the boys returning to class.  The boys in a high school raping a special needs girl in a toilet, the boy in a high achieving high school raping a student on a field trip and having done it another middle school the year before.  Do I need to add that all of these are children of color and yet you keep hoping and trying that maybe one voice will reach them.  Apparently it was because none did? No face of color seemingly did either and they were there, so explain that to me,  I can wait.

Now I have many horror stories about other kids not black but largely they share one thing in common, they are poor, they are angry and they are in public schools.

The ending of public schools began when the President Voodoo Reagan began to cut funding in his smaller Government concept that has dominated the GOP playbook for decades, it masks classism, racism, arrogance, ignorance and general disregard for the concept of Democracy.  It is not just fueled in racism but it is the biggest burner in the stove.  So when I read books calling all white people fragile and therefore racist I want to say, "You don't know me and you generalize, you know like if I said all Black kids are crazy."  Given my experience I could say it's valid,  but you see I actually vest and talk and try to connect and try to learn and teach simultaneously.  So when you hear the phrase, "I can't breathe." Know that many before and after have said the same, at the hands of law enforcement. This white teacher reads and actually wants this to stop and has for years.  I have seen the affects of the broken families, the crime, the pain on the faces of children and I want that to stop too.  But instead I will stop teaching, I will do something white, whatever the fuck that is.

Three Words. 70 Cases. The Tragic History of ‘I Can’t Breathe.’
The deaths of Eric Garner in New York and George Floyd in Minnesota created national outrage over the use of deadly police restraints. There were many others you didn’t hear about.

By Mike Baker, Jennifer Valentino-DeVries, Manny Fernandez and Michael LaForgia
The New York Times
June 29, 2020

As the sun began to rise on a sweltering summer morning in Las Vegas last year, a police officer spotted Byron Williams bicycling along a road west of downtown.

The bike did not have a light on it, so officers flipped on their siren and shouted for him to stop. Mr. Williams fled through a vacant lot and over a wall before complying with orders to drop face down in the dirt, where officers used their hands and knees to pin him down. “I can’t breathe,” he gasped. He repeated it 17 times before he later lapsed into unconsciousness and died.

Eric Garner, another black man, had said the same three anguished words in 2014 after a police officer who had stopped him for selling untaxed cigarettes held him in a chokehold on a New York sidewalk. “I can’t breathe,” George Floyd pleaded in May, appealing to the Minneapolis police officer who responded to reports of a phony $20 bill and planted a knee in the back of his neck until his life had slipped away.

Mr. Floyd’s dying words have prompted a national outcry over law enforcement’s deadly toll on African-American people, and they have united much of the country in a sense of outrage that a police officer would not heed a man’s appeal for something as basic as air.

But while the cases of Mr. Garner and Mr. Floyd shocked the nation, dozens of other incidents with a remarkable common denominator have gone widely unacknowledged. Over the past decade, The New York Times found, at least 70 people have died in law enforcement custody after saying the same words — “I can’t breathe.” The dead ranged in age from 19 to 65. The majority of them had been stopped or held over nonviolent infractions, 911 calls about suspicious behavior, or concerns about their mental health. More than half were black.

Dozens of videos, court documents, autopsies and police reports reviewed in these cases — involving a range of people who died in confrontations with officers on the street, in local jails or in their homes — show a pattern of aggressive tactics that ignored prevailing safety precautions while embracing dubious science that suggested that people pleading for air do not need urgent intervention.

In some of the “I can’t breathe” cases, officers restrained detainees by the neck, hogtied them, Tased them multiple times or covered their heads with mesh hoods designed to prevent spitting or biting. Most frequently, officers pushed them face down on the ground and held them prone with their body weight.

Not all of the cases involved police restraints. Some were deaths that occurred after detainees’ protests that they could not breathe — perhaps because of a medical problem or drug intoxication — were discounted or ignored. Some people pleaded for hours for help before they died.

Among those who died after declaring “I can’t breathe” were a chemical engineer in Mississippi, a former real estate agent in California, a meat salesman in Florida and a drummer at a church in Washington State. One was an active-duty soldier who had survived two tours in Iraq. One was a registered nurse. One was a doctor.

In nearly half of the cases The Times reviewed, the people who died after being restrained, including Mr. Williams, were already at risk as a result of drug intoxication. Others were having a mental health episode or medical issues such as pneumonia or heart failure. Some of them presented a significant challenge to officers, fleeing or fighting.

Departments across the United States have banned some of the most dangerous restraint techniques, such as hogtying, and restricted the use of others, including chokeholds, to only the most extreme circumstances — those moments when officers are in fear for their lives. They have for years warned officers about the risks of moves such as facedown compression holds. But the restraints continue to be used as a result of poor training, gaps in policies or the reality that officers sometimes struggle with people who fight hard and threaten to overpower them.

Many of the cases suggest a widespread belief that persists in departments across the country that a person being detained who says “I can’t breathe” is lying or exaggerating, even if multiple officers are using pressure to restrain the person. Police officers, who for generations have been taught that a person who can talk can also breathe, regularly cited that bit of conventional wisdom to dismiss complaints of arrestees who were dying in front of them, records and interviews show.

That dubious claim was photocopied and posted on a bulletin board at the Montgomery County Jail in Dayton, Ohio, in 2018. “If you can talk then you obviously can [expletive] breathe,” the sign said.

Federal officials have long warned about factors that can cause suffocations in custody, and for the past five years, a federal law has required local police agencies to report all in-custody deaths to the Justice Department or face the loss of federal law enforcement funding.

But the Justice Department, under both President Barack Obama and President Trump, has been slow to enforce the law, the agency’s inspector general found in a 2018 report. Though there has been only scattershot reporting by departments, not a single dollar has been withheld.

Autopsies have repeatedly identified links between the actions of officers and the deaths of detainees who struggled for air, even when other medical issues such as heart disease and drug use were contributing or primary factors. But government investigations often found that the detainees were acting erratically or aggressively and that the officers were therefore justified in their actions.

Only a small fraction of officers have faced criminal charges, and almost none have been convicted.

In the case of Mr. Williams in Las Vegas last year, Police Department investigators determined that the officers did not violate the law. But the death triggered immediate changes, said Lt. Erik Lloyd of the Las Vegas Metropolitan Police Department’s force investigations team.

Officers are not medical doctors and may believe that someone who says “I can’t breathe” may be trying to escape, he said.

To alleviate potential dangers, officers are told now to promptly get detainees off their stomachs and onto their sides — or up to a sitting or standing position. They are also told to call for medical help if someone has distressed breathing.

“Since the death of Mr. Williams, our department has been extremely aware of someone saying, ‘I can’t breathe,’” Lieutenant Lloyd said. “We have changed the attitude of patrol officers.”

For the relatives of many of the men and women who died under similar circumstances in police custody, watching the video of Mr. Floyd’s arrest in Minneapolis has felt painfully familiar. Silvia Soto’s husband, Marshall Miles, died in 2018 in Sacramento County, Calif., after being pinned down by sheriff’s deputies at a jail. She said she had been feeling both heartbroken and comforted amid the national outrage.

“I don’t feel alone anymore,” Ms. Soto said.
‘You want to kill me?’

While there have been dozens of “I can’t breathe” deaths over the past decade, the emergence of body cameras and surveillance footage has eliminated the invisibility that once shrouded many of these deaths.

Videos from Mr. Garner’s death galvanized changes in neck restraint policies around the country, but problematic techniques for restraining people did not go away. In the six years since then, more than 40 people have died after warning, “I can’t breathe.”

Less than three months after Mr. Garner died, police officers went out to a tidy stucco home near Glendale, Ariz., to investigate a report of a couple arguing.

The officers found Balantine Mbegbu seated in a leather chair with his dinner. Both Mr. Mbegbu and his wife assured them that no argument had taken place. According to police reports, Mr. Mbegbu became indignant when they refused to leave.

“Why are you guys here?” he said, his voice rising. “You want to kill me?”

When he tried to stand, the officers slammed him to the floor, punched him in the head and shot him with a Taser. With Mr. Mbegbu on his stomach, officers put knees on his back and neck.

As his wife, Ngozi Mbegbu, watched them pile on top of her husband, she heard him say, “I can’t breathe. I’m dying,” according to a sworn statement she made. Records show he vomited, began foaming at the mouth, stopped breathing and was pronounced dead.

The county prosecutor’s office determined that “the officers did not commit any act that warrants criminal prosecution.”

Cases in which detainees protested that they could not breathe, before dying, continued to occur. Their words could be heard on audio or video recordings, or were otherwise documented in official witness statements or reports.

In 2015, Calvon Reid died in Coconut Creek, Fla., after officers fired 10 shots at him with a Taser.

In 2016, Fermin Vincent Valenzuela was asphyxiated after police officers in Anaheim, Calif., put him in a neck hold while trying to arrest him. His family won a $13 million jury verdict.

In 2017, Hector Arreola died in Columbus, Ga., after officers forced him to the ground, cuffed his hands behind him and leaned on his back, with one officer brushing off his complaints: “He’s fine,” he said.

In 2018, Cristobal Solano was arrested in Tustin, Calif., and then died after at least seven deputies worked together to subdue him on the floor of a holding cell, some with their knees on his back.

In 2019, Vicente Villela died in an Albuquerque jail after telling guards who were holding him down with their knees that he could not breathe. “Right, because they’re having to hold you down,” one of the guards said.

Then last week, the Police Department in Tucson, Ariz., released video of an encounter on April 21 with Carlos Ingram Lopez, who was naked and behaving erratically when officers forced him to lie face down on the floor of a garage with his hands handcuffed behind his back. Part of the time, Mr. Lopez’s head was covered with a blanket and a hood. He was held down for 12 minutes, crying for air, for water and for his grandmother. Then he, too, died.
‘If you can talk you can breathe’

One of the reasons such cases keep occurring may be the persistent belief on the part of police officers that a detainee who is complaining that he cannot breathe is breathing enough to talk.

Edward Flynn, the former police chief in Milwaukee, said in a deposition in 2014 that this idea was once part of training for officers there and persisted as a “common understanding” even if it was wrong. Other departments have told their officers the same thing, records show, and the notion shows up often in interactions with detainees.

“If you’re talking, you’re breathing — I don’t want to hear it,” a sheriff’s deputy told Willie Ray Banks, who was struggling for air after officers in Granite Shoals, Texas, restrained and Tased him in 2011.

But the medical facts are more complicated. While it may technically be true that someone speaking is passing air through the windpipe, Dr. Carl Wigren, an independent pathologist, said that even someone able to mutter a phrase such as “I can’t breathe” may not be able to take the full breaths needed to take in sufficient oxygen to maintain life.

The “if you can talk” notion has persisted even in places like the jail in Montgomery County, Ohio, which had to pay a $3.5 million settlement last year in connection with the 2012 death of an inmate named Robert Richardson, who had been jailed for failing to show up for a child support hearing.

A fellow inmate called for help after Mr. Richardson, 28, had what was described as a possible seizure. Sheriff’s deputies cuffed his hands behind his back and restrained him face down on the floor, pushing on his back and shoulders, and eventually on his head and neck, according to court documents.

Witnesses said Mr. Richardson repeatedly told deputies he could not breathe, until, after 22 minutes, he stopped moving. He was pronounced dead less than an hour later.

It was that jail facility where, six years later, the photocopied sign about being able to breathe if you could talk was posted on the bulletin board.
‘We literally had to sit there and watch my brother die’

Police officers often failed to seek prompt medical attention when a detainee expressed problems breathing, and that has proved to be a factor in several deaths. In some of these cases, the person in custody had recently been Tased or restrained, but other times they were suffering from acute disorders, such as lung infections, and languished for hours. Often, this appeared to be because officers did not take the detainees’ claims seriously.

When 40-year-old Rodney Brown told police officers in Cleveland he could not breathe after being Tased multiple times during a struggle in 2010, one of them responded: “So? Who gives a [expletive]?”

One of the police officers radioed for paramedics but later said he did so only because it was a required procedure when someone had been Tased; he did not convey that Mr. Brown had claimed he could not breathe.

A lawyer for the city in that case told a panel of judges that the officers did not have the medical expertise to know when someone was in a medical crisis or simply exhausted from a vigorous fight, according to an audio recording.

Another troubling case occurred in March 2019 when the police in Montebello, Calif., were called to the home of David Minassian, 39, a former vice president at a property management firm who had suffered a heroin overdose.

His older sister, Maro Minassian, a certified emergency medical technician, had given her brother a dose of naloxone, a medication that reverses the effects of opiate overdoses. He jolted awake but still appeared to have fluid in his lungs, and she dialed 911, anxious to get him to a hospital.

But it was the police, not paramedics, who arrived next. Ms. Minassian said three Montebello officers entered her family’s home as her brother was flailing on the floor.

At least two of the officers slammed him to the ground and put their knees into his back as they tried to cuff him, Ms. Minassian said, and remained on top of him until he stopped talking. “I told them, ‘My brother can’t breathe,’” Ms. Minassian said through tears. “We literally had to sit there and watch my brother die.”
‘Please take the mask off’

Despite years of concerns about some of the potentially dangerous techniques used to subdue people in custody, law enforcement agents have continued to use them.

In the 2018 case involving Ms. Soto’s husband, Marshall Miles, officers struggled to get him into jail after arresting him on suspicion of vandalism and public intoxication.

The Sheriff’s Department had produced training materials as early as 2004 warning about the dangers of suffocation when people were restrained face down or hogtied with their hands and feet linked behind their backs.

But those warnings apparently went unheeded. Mr. Miles, 36, was hogtied while being brought in by the California Highway Patrol, even though the Sheriff’s Department, which runs the jail, no longer allowed the restraint. Deputies removed him from the hogtie but held him face down for more than 15 minutes as he repeatedly said, “I can’t breathe.” They then carried him handcuffed and shackled to a cell, where at least three deputies put their weight on his facedown body while he groaned ever more faintly. About two minutes later, he fell silent and then stopped breathing, according to video of the death.

An autopsy concluded that he died from a combination of physical exertion, mixed drug intoxication and restraint by law enforcement. Hogtie restraints were used in four other deaths over the past decade that were examined by The Times.

Another technique used in a series of cases with fatal outcomes, including at least two this year, has been the use of hoods or masks designed to prevent people from spitting on or biting officers. Law enforcement agencies around the world have grappled with whether to use them to protect officers despite concerns about whether the masks are safe.

Video from 2012 shows how one of the masks was used on James W. Brown, an Army sergeant stationed at Fort Bliss in El Paso who had a diagnosis of post-traumatic stress disorder. Sergeant Brown, 26, was supposed to serve a two-day sentence at the county jail for a drunken-driving conviction, but officials said he became aggressive after learning he would be jailed longer.

With his hands cuffed behind him, Sergeant Brown can be seen in a video seated in a chair, surrounded by guards in riot gear holding him down. Deputies had placed a mesh-style mask over the lower half of his face, and he wore it for more than five minutes before telling the guards and a medical worker that he could not breathe.

“Please take the mask off,” Sergeant Brown pleads. “I cannot breathe. Please!”

He passed out shortly afterward, and he was pronounced dead the next day. A county autopsy ruled that his death was caused by a sickle-cell crisis — natural causes — but a forensic pathologist later hired by the county concluded that his blood condition had been exacerbated by the restraint procedures.

Sergeant Brown’s relatives sued El Paso County, the jail and 10 officers for wrongful death and other claims. The case was later settled.

“I feel like they treated him like he was less than an animal,” said Sergeant Brown’s mother, Dinetta Scott. “Who treats somebody like that?”