Monday, May 4, 2020

Fast Ball, Slow Curve

Its the Ninth.  We are in the end of the final inning with two outs, players on each base and the next hitter is the ninth man, the last at bat who is older in the game, has had an amazing career with home runs and yet this may be the last he makes before he retires and this is the game that ends all games.  So how does he play it? What will the Pitcher do to ensure that this is the third strike and the game ends with the winners coming in from the field to take the Series?  Will he play it slow, throw a curve or a fast ball.  To know is to know his opponent, his weaknesses, the stats and yet all of those knowns may not matter for there is no predictable outcome when the known is not always as one predicts and believes.  The opponent, the old player at bat could swing wide, he could hit is hard and it fly into the air beyond reach and allow all the players to make it home and the game is his to lose and his to win and yet all the variables, from wind, to the Pitcher, to the Players on the field and those on base and a ball that may not in fact fly that far or be carried by the wind to allow the outcome to favor the man at bat.  That is Covid, too many variables to predict the outcome other than it is highly contagious, highly deadly and is a new player at bat with no history on which to know how to throw.

I used to love Baseball and it has been a long time since I went as we have since learned that being a powerful player meant studying the game, building strength, learning to read the pitch, hit the bat and run like hell, all while knowing how to watch a ball fly through the air to catch it in one hand and/or throw it equally as fast to stop the runner and the game in their tracks.  But then drugs and the ability to enhance performance and the ability to spy on your opponents during practice, to bribe and pay Players to cheat and fail or to alter the outcome are all variables that change the games composition.

Models are created using the stats, the knowledge gleaned from past games, watching Players,knowing their history, using that data to predict the way to play the game from the roles they play and their position on the field. To have top Coaches and Owners  that worked in sync  to ensure they had the training, the plans and the money needed to build a team and do whatever it takes to win.  Sometimes chance played the game and players can change the outcome by having a good day, having a bad day, when injuries rule or when someone crosses the line and in turn penalties are made.  All of the game with the best of intention is planned, organized, strategized and then it plays out and the ending, the outcome was not what was expected.  Where have we heard that before?

Like Baseball we have endless models, strategies and theories that are to stop the spread, eliminate the number of new cases, end the hospitalizations or end the deaths,  Each day the number of innings played changes just like the league playing them -major, minor or little. And that not all innings are played matters just like Covid as you need not have all the symptoms to be the loser there.    The same with the tools used from bats to balls to even the mitts. The players can change and that too can affect the game and all of it hinges on how a man sees the play and if the player is out or in matters.   Ah yes the power of a man to make the decisions that affects the outcome.  Even the rules change dependent upon the league and where one plays.. All of this ends up with games that change on the toss of a coin and it all ends up with decisions made and a game played that could ultimately mean life or death.  What a metaphor.

And we are there now.  There is no end in sight and frankly the fear factor is duly in place and there are those who are trying to cope, the hyper mania ones who are sure we are all going to die,  those utterly confused and trying just to manage,  and then we have the utterly oblivious or ignorant.   I am, depending upon the day, trying to cope and just managing.   Today fell into coping until I again felt I had to school people on a multitude of subjects, from taxes, to payroll to of course the virus. WHAT THE FLYING FUCK?  Is this not the age of information and you cannot look some of this shit up?  But this is the Age of Covid and all logic and sense goes out the window when it comes to this disease.  And why? LACK.OF.LEADERSHIP.

If there was ever a need for a qualified skilled Umpire this is it.  Right now we are just hitting balls randomly and hoping that they land, don't, get caught, don't hit someone in the head and that if we run fast enough we won't be out.  Its going well so far, well no we are in the end of the 1st inning and the Umps are just throwing mitts into the air and walking off the field. A whole new kind of strike.

I got home this afternoon from doing my essential business and of course grabbed a coffee and did my usual co-parenting then came home just again to an email from the Yoga teacher wanting a Zoom session of tea and comfort for those who need to touch base. Uh no thanks I don't know you and that will not change once quarantine is lifted.  You were and are a service provider I will take the online Yoga classes and then those in real life when they return and when my membership expires I will move onto the next studio and start anew.  That Covid allowed me to hit my reset button is one thing that is a positive out of this.  I sure as fuck don't want to test positive for Covid thanks.

Then of course came the warning that this will be with us for another year and to that I go, thanks I know.  We will not fully get of quarantine before Covid Version 2.0 for 20.. as well that is the year as that is why it is Covid 19.. the year it arrived with a bang, returns.  So we have flu vaccines that will be utterly useless and I still will get mine and update my winter wardrobe to include fleece face masks and by then have a version of flu paranoia full in place.  In other words limited contact although I hope to go back to Substituting with full social and physical distance in place, my dream classroom as it is what I always did.  I discouraged kids from touching me or anything, the faux shaking of hands also loathsome and in turn they will have to stay at least six feet away so hey not bad.  That works for me.  I never set foot in Teacher's Lounges, Lunchroom and went to the bathroom was utterly paranoid and touched everything with paper towels and washed hands constantly. Kids are disgusting.  How was I ever a Teacher?   Again, I want to point out it is very different as a Sub versus a full time Teacher so I approach it very differently and exactly what it is - a Gig Worker.   There for the time assigned and then I leave running literally for the door to avoid as many kids as possible.

But while I am very proactive with my physical health I am less so right now with my emotional health and I need to talk to someone sooner versus later.  I am not doing well with the endless demands on my time and even when I volunteer I realize that it is because I cannot stand the misinformation and confusion it goes against my better nature.  Oh yeah I was clearly a Teacher.  But right now I would love one person to actually ask how I am? To talk to me for a few minutes or an hour and actually give a flying fuck about me.  I am in the middle of trying to figure out the next few months and what will happen from worst case scenario to the at least some middle ground of reason and that seems to be next to near impossible and it almost seems that "they" want it that way.  And it is the "they" that I worry about as I have no idea who "they" are.

When my friend told me about his hospitalization for depression at age 18 while denying to me that he had ever experienced trauma, I thought: Well if that ain't it what is?  Clearly I have a short leash when it comes to mental health.  And this is going to be the leash from hell as much like our bootstraps this one is pulled past its breaking point.

That said I note they are not discussing homicides, violence, sexual and physical assaults and of course other mental health breaks including animal abuse from the rising tides of folks adopting pets and of course the costs that have that built in. And lastly child abuse.  That one will be through the roof too.

So what have we learned? Wash.your.fucking.hands. Stay home when sick. Don't travel when sick. Get medical attention immediately versus treating it with OTC medicine. Take personal responsibility for your health and well being and save lives that way rather than giving it to everyone else.  Try that one.

The coronavirus pandemic is pushing America into a mental health crisis
Anxiety and depression are rising. The U.S. is ill-prepared, with some clinics already on the brink of collapse.

By William Wan
The Washington Post
May 4, 2020 at 12:57 p.m. EDT

Three months into the coronavirus pandemic, America is on the verge of another health crisis, with daily doses of death, isolation and fear generating widespread psychological trauma.

Federal agencies and experts warn that a historic wave of mental health problems is approaching: depression, substance abuse, post-traumatic stress disorder and suicide.

Just as the initial coronavirus outbreak caught hospitals unprepared, the country’s mental health system — vastly underfunded, fragmented and difficult to access before the pandemic — is even less prepared to handle this coming surge.

“That’s what is keeping me up at night,” said Susan Borja, who leads the traumatic stress research program at the National Institute of Mental Health. “I worry about the people the system just won’t absorb or won’t reach. I worry about the suffering that’s going to go untreated on such a large scale.”

Data show depression and anxiety are already roiling the nation.

Nearly half of Americans report the coronavirus crisis is harming their mental health, according to a Kaiser Family Foundation poll. A federal emergency hotline for people in emotional distress registered a more than 1,000 percent increase in April compared with the same time last year. Roughly 20,000 people texted that hotline, run by the Substance Abuse and Mental Health Services Administration, last month.

Online therapy company Talkspace reported a 65 percent jump in clients since mid-February. Text messages and transcribed therapy sessions collected anonymously by the company show coronavirus-related anxiety dominating patients’ concerns.

“People are really afraid,” Talkspace co-founder and CEO Oren Frank said. The increasing demand for services, he said, follows almost exactly the geographic march of the virus across the United States. “What’s shocking to me is how little leaders are talking about this. There are no White House briefings about it. There is no plan.”The suicides of two New York health-care workers highlight the risks, especially to those combating the pandemic. Lorna Breen, a top New York emergency room doctor, had spent weeks contending with coronavirus patients flooding her hospital and sometimes dying before they could be removed from ambulances. She had no history of mental illness, her relatives have said in interviews, but struggled increasingly with the emotional weight of the outbreak before she died. Days later, reports emerged that a Bronx EMT also killed himself.

Researchers have created models — based on data collected after natural disasters, terrorist attacks and economic downturns — that show a likely increase in suicides, overdose deaths and substance use disorders. **great more models more theories more bullshit covered in hysteria***

And yet, out of the trillions of dollars Congress passed in emergency coronavirus funding, only a tiny portion is allocated for mental health. At the same time, therapists have struggled to bring their practices online and to reach vulnerable groups because of restrictions on licensing and reimbursement. Community behavioral health centers — which treat populations most at risk — are struggling to stay financially solvent and have begun closing programs.

“If we don’t do something about it now, people are going to be suffering from these mental health impacts for years to come,” said Paul Gionfriddo, president of the advocacy group Mental Health America. That could further harm the economy as stress and anxiety debilitate some workers and further strain the medical system as people go to emergency rooms with panic attacks, overdoses and depression, he said.

Just as the country took drastic steps to prevent hospitals from being overwhelmed by infections, experts say, it needs to brace for the coming wave of behavioral health needs by providing widespread mental health screenings, better access to services through telehealth, and a sizable infusion of federal dollars.

Dire warnings in data

When diseases strike, experts say, they cast a shadow pandemic of psychological and societal injuries. The shadow often trails the disease by weeks, months, even years. And it receives scant attention compared with the disease, even though it, too, wreaks carnage, devastates families, harms and kills.

Mental health experts are especially worried about the ongoing economic devastation. Research has established a strong link between economic upheaval and suicide and substance use. A study of the Great Recession that began in late 2007 found that for every percentage point increase in the unemployment rate, there was about a 1.6 percent increase in the suicide rate.

Using such estimations, a Texas nonprofit — Meadows Mental Health Policy Institute — created models that suggest if unemployment amid the coronavirus pandemic ends up rising 5 percentage points to a level similar to the Great Recession, an additional 4,000 people could die from suicide and an additional 4,800 from drug overdoses.

But if unemployment rises by 20 percentage points — to levels recorded during the 1930s Great Depression — suicides could increase by 18,000 and overdose deaths by more than 22,000, according to Meadows.

“These projections are not intended to question the necessity of virus mitigation efforts,” cautioned authors of the Meadows report, “but rather to inform health system planning.”

Suicide experts and prevention groups have deliberately refrained from discussing too widely death projections such as those from the Meadows Institute. Experts say reporting excessively or sensationally on suicide can lead to increases in suicide attempts, an effect known as contagion. And the factors involved in any suicide are often complex, they point out.

“Could the numbers go up? Yes, but it isn’t inevitable. We know suicide is preventable,” said Christine Moutier, chief medical officer for the American Foundation for Suicide Prevention.

Research has shown interventions make a marked difference, such as limiting access to guns and lethal drugs, screening patients for suicidal thoughts, treating underlying mental conditions and ensuring access to therapy and crisis lines to call and text. “That’s why we need to act now,” Moutier said.

On Wednesday, a coalition representing more than 250 mental health groups announced it was convening a national response to the problem of pandemic suicide — an effort that will include at least one federal agency, the National Institute for Mental Health.

‘Poisonous fire hydrant’

Front-line workers — health-care providers, grocery store workers, delivery people — are especially vulnerable to the coming storm of mental health problems.

“We’re used to dealing with sick people and seeing terrible things, but what’s devastating with covid is the sheer volume. It’s like drinking from a poisonous fire hydrant,” said Flavia Nobay, an emergency room doctor.

As infections soared in March in New York, Nobay took leave from her duties at the University of Rochester Medical Center to volunteer as an ER doctor in Queens.

Weeks later, the experience still haunts her: Watching families crumple in the ambulance bay knowing they may never see relatives again. Hearing the relentless alerts every few minutes of crashing patients and respiratory arrest. Sending patients home because they weren’t quite sick enough, knowing they may be coming right back. Or even worse, the chance they may not make it back.

“It chips away at your soul,” Nobay said. “You have to hold on to the positive and how you’re helping in the ways you can. That hope is like medicine. It’s as important and tangible as Tylenol.”

A study of 1,257 doctors and nurses in China during that country’s coronavirus peak found that half reported depression, 45 percent anxiety and 34 percent insomnia.

Pre-pandemic, doctors and nurses were already acutely prone to burnout, research shows, because of the workload, pressure, chaos and increasingly dysfunctional health-care system.

“We’re now hitting a period of uncertainty where a lot of people are asking themselves how long they can keep it up,” said Liselotte Dyrbye, a Mayo Clinic doctor and leading researcher on burnout. “The teapot can only boil for so long."

Could therapy ease your coronavirus stress? How to decide, what to expect and where to find it.
A broken system when it’s needed the most

This approaching wave of mental injuries will be met in coming months by a severely broken system.

In the United States, 1 in 5 adults endure the consequences of mental illness each year. Yet less than half receive treatment, federal statistics show. As suicide rates have fallen around the world, the rate in the United States has climbed every year since 1999, increasing 33 percent in the past two decades.

Part of the problem, experts say, is the markedly different way the United States treats mental illness compared to physical illness.

In normal times, a heart attack patient rarely has trouble securing a cardiologist, operating table and hospital bed. But patients in mental crises, studies show, consistently struggle to get their insurance to pay for care. Even with insurance, they struggle to find therapists and psychiatrists willing to take that payment. Those who can afford it often end up paying out of pocket.

Experts warn that such parity and access problems may only worsen with the pandemic, which has upended the functions of hospitals, insurance companies and mental health centers.

In a joint letter Wednesday, leaders in mental health and substance abuse treatment pleaded for the Trump administration’s help. The letter — signed by the American Psychological Association, the American Psychiatric Association, the National Alliance on Mental Illness and 12 other organizations — asked federal officials to save community mental health centers facing financial collapse.

The letter also asked the government to lift reimbursement restrictions that have prevented therapists from using phone calls to treat patients. On Thursday, the Trump administration indicated it would do so.

A survey of local mental health and drug addiction centers showed the pandemic has already left many on the brink of financial collapse, preventing them from providing services that generate much of their reimbursement revenue. More than 60 percent said they would run out of funding in less than three months and had already closed some programs.

In a letter to Congress in early April, mental health organizations estimated that $38.5 billion is needed to save treatment providers and centers and that $10 billion more is needed to respond to the coronavirus pandemic. On Friday, the federal substance abuse and mental health agency said it had been allocated less than 1 percent of the amount advocated by mental health groups — $425 million in emergency funding — and has awarded $375 million to states and local organizations.

While Congress recently authorized $100 billion in emergency funds for hospitals and medical providers, very little will go to mental health and addiction service providers because they mainly receive funding through Medicaid. And most of the emergency provider money is being distributed through Medicare.

There are glimmers of hope, experts say, amid the gloomy outlook.

The sudden push into telemedicine could make services more accessible in years to come. And the national mental health crisis could spark reforms and movement toward better treatment.

And while almost everyone is experiencing increased stress, the effect for many will be transient — trouble sleeping, shorter fuses.

The difficulty is identifying and treating those who develop deeper, worrisome mental problems such as post-traumatic stress disorder and severe depression.

“To control the virus, it’s all about testing, testing, testing. And for the mental health problems ahead, it’s gonna be all about screening, screening, screening,” said Gionfriddo of Mental Health America.

For years, Gionfriddo’s nonprofit has offered questionnaires on its website — widely used in medicine — to help people screen themselves for mental health problems. Since the pandemic began, those daily screenings have jumped 60 to 70 percent. And since February, the number of people screening positive for moderate to severe anxiety and depression has jumped by an additional 18,000 people compared with January.

Speaking from her parents’ home in Pittsburgh, Ananya Cleetus said she has felt the increased strain.

First came the closure of her school, the University of Illinois at Urbana-Champaign, bringing to an end her ambitious plans for the semester in computer engineering. Then came the loss of her therapist, forbidden by licensing rules from treating her across state lines. And social media didn’t help — all those posts of people baking bread and living their best #quarantinelife, making hers feel all the more pitiful.  **ya think, or the impending scolding and hysteria... neither good**

It was getting increasingly hard to get out of bed, said Cleetus, 23, who has a bipolar disorder and helps lead a student advocacy group.

“It took me a few weeks and talking to friends to finally realize this wasn’t just something wrong with me,” Cleetus said. Since then, she has poured her energies into creating a daily routine and an online guide for fellow students struggling with the pandemic and mental health.

“This virus is messing with everyone. The anxiety, isolation, uncertainty,” she said. “Everyone’s struggling with it in one way or another.”

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