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John Livingston

Accountability and Perspective

The after-action reports and the Monday morning quarterbacking have yet to take place regarding our State’s Covid response. Maybe we are waiting until after the November general elections. Historically in the medical and nursing professions every death and every bad outcome is reviewed at the clinical level giving context to the analysis done at the Public Health level. It is obvious that this context will not be forthcoming regarding the Covid-19 pandemic. I do believe that giving proper context to the Covid numbers is important, but this will have to be done regarding data at the Macro level.

“Every Battle is Won before it is ever fought” Sun Tzu. The Covid War was lost before it was ever fought because of the economic incentives and the clinical initiatives that were accelerated by the Affordable Care Act. Even before “Obama Care” a public health model was replacing a patient centric model in health care. After all the analysis we probably may never get to the bottom and the truth regarding how the medical and nursing professions measured up and responded to the crises. I do believe the response was hindered by hospital administrators and their boards, government bureaucrats, and a reliance on “experts” and not on doctors and nurses who were at the bedside taking care of sick patients. Why wasn’t a clinician (doctor or nurse) on the governor’s advisory team? Instead, he allowed himself to be directed by lobbyists and corporate executives. Over 50% of health care in our country is paid for by government. Medicare, Medicaid, VA, and Tri-Care. The incentives for transfers from the government coffers to the private and non-profit sectors over the past 15 years resulted in a 15% reduction in total hospital beds—20% of acute care beds prior to the presentation of the pandemic.

In the end, the integrity and respect for the nursing and medical professions will be what has suffered the most from the pandemic. Corporate branding and a communal public health ethic replaced the doctor-patient relationship. Patients and families know this. So do doctors and nurses who have seen the code of ethics and the implied morality of their professions be replaced by a business model with Boards of Directors of large health care institutions giving bonuses to CEOs and top executives based on corporate balance sheets and profit and loss statements and cash flow projections—not on clinical results. Not on patient care. How else could St. Luke’s justify a $10 million salary to their CEO his last year of service when at the same time they were dismantling corporate achievement ladders and pay inducements for their most senior nurses? Despite being given a 20-year advance notice about planning for pandemics and mass casualty situations our corporate leaders, their titular Boards and government bureaucrats were asleep at the switch. For confirmation of my argument in this regard access the link below—an interview with two outstanding St. Luke’s nurses presented by the Idaho Dispatch’s Gregg Pruitt. The bottom line is that it is doctors and nurses that bring value to a hospital not CEOs making $10 million/yr.

So here is some perspective working from the top down comparing pre-Covid numbers to 2021—the most recent CDC analysis available.

2019:

  1. Life Expectancy 78.8 years
  2. Death rate—All Case Fatality Rate 723.6/100,000.
  3. Total Deaths2,854,838

2021:

  1. Life Expectancy 77.0 years
  2. Death rate—All Case Fatality Rate 1027.0/100,000
  3. Total Deaths 3,383,726

In both years heart disease and Cancer were the primary causes of death. In 2019 influenza and pneumonia were number 7 on the list as causes of death—my mother died the year before of influenza. In 2021 influenza and pneumonia was number three on the list. Both cancer deaths and heart disease numbers increased significantly during that year—why?

Comparing the two years the overall death rates increased by 15.6%. Remember hospital bed availability decreased over 15 years 15/20%—total and acute. Remember that the major causes of death (heart disease and cancer) increased significantly over those two years and remained at the top of the list. Also remember and we may never find out, how many people died from Covid and how many people died with Covid? Why?

In the 15,000 year history of the modern world an air-borne upper respiratory tract virus has never been able to be “conquered”; a promise made by “experts” at the local, State and Federal levels. Doctors and nurses working at the bedside knew that only a properly fitted N-95 mask was appropriate. Bedside protection and institutional mitigation should have been left to the discernment and knowledge of the doctors and nurses who were in the line of fire, not designed by public health specialists who had never taken care of a patient. Not defined by a directive promulgated by CMS or CDC, that if institutions didn’t conform, they wouldn’t have additional Covid funding made available to them via a Governor’s Emergency order. Same could be said for treatment algorithms that limited clinicians’ options when treating real patients in real time. In the history of modern medicine, except for smallpox, no virus has been able to be eradicated by vaccination. I am vaxxed and boosted for my own personal reasons, and in appropriate settings I used N-95 masks. These are personal decisions. I also swam a mile 6 days a week and lost 65 pounds. Not everybody had that kind of access to exercise and for that access I am grateful. The average adult in our country gained 15lbs during the pandemic. Outside of age (70% of people who died were over the age of 70), and immune compromised status—like my daughter-in-law who underwent chemotherapy and a splenectomy at the beginning of the pandemic and who made her own appropriate mitigation strategies and got on with life), obesity was a primary risk factor. Will we be hurt more when we are inevitably hit by the next pandemic, because of mass isolation strategies used in this pandemic? Was this “unintended consequence” ever considered by the experts? What will be its’ cost?

Doctors and nurses know best how to take care of sick patients—not hospital administrators or government bureaucrats. And isn’t it interesting that it was they who gave themselves front-of-the-line access when vaccines became available—ahead of patients and those working near patients. My daughter-in-law and family members living in the same home had to wait three months to get vaccinated. A situation pointed out to me by a St. Luke’s Board member who was appalled by the privilege. I guess when somebody is making millions of dollars per year, they are important! At least in their own eyes.

Individuals and families know best how to mitigate their risks in pandemics or any situation. Public Health and government experts never know what is best for us living in our homes and working where we work, or where we go to shop, or out to eat, or go to church or school.

Doctors and nurses—your doctors and your nurses didn’t fail you. The people they work for did. Hospital CEOs, Boards of Directors, Government bureaucrats, failed miserably—in Idaho and in the USA. And therein lies the problem. Health care professionals no longer work for you. They work for large institutions who are run by people who subscribe to a corporate ethic. If that doesn’t change the next pandemic could be worse than the last one—which wasn’t as bad as our government officials and the media have led us to believe. Heck, prior to 2007 the World Health Organization (WHO) definition of a pandemic was 5% of the population dying—that would have been over 17 million people, not one million as we have now experienced. The number in Idaho would have been over 100,000, not the 6000 we have experienced. Any death is sad and tragic. My mother dying from seasonal flu is just as tragic as the captain of my college football team dying from Covid. We all mourn the deaths of those we love. We should all celebrate and love life, and not fear death. Covid mitigation strategies were unfortunately rooted in fear and resulted in “mass hysteria”—not in a love and respect for the wonder of life.

The purpose of an out-brief is to help us do better in the future. It is best done from the bottom up, but the bureaucrats and statisticians have too much to lose—especially in an election year. I have tried to help move the process along.

2 replies on “Accountability and Perspective”

In June 2nd, 2022, Wall Street Journal—Letters to the Editor
Our healthcare system is off the rails. Primary-care appointments set for 2023 are the norm. Disrupted supply chains are creating shortages in everything from local anesthetics to cancer treatments. And the solution? Add oil to the fire by expanding already misguided Obama Care subsidies (“When ‘Temporary’ Subsidies Are Forever,” Review & Outlook, May 31).

It’s time to tell the truth. Middlemen make up an astonishing 73% of healthcare spending—one-third of every tax dollar. GPOs and PBMs, in collusion with insurers, raise prices but restrict access. They are protected by a 1987 safe-harbor law that exempts them from oversight.

The voter has the right to know where the money is going. Do you want to pay for treatment or pay for a complex bureaucracy designed in the 1960s to deny care? Our system is archaic. Patients, not insurers, are more than capable of authorizing their own care.

Price transparency is federal law. Let’s stop rewarding injurious behavior, especially when it disproportionately affects those with the most limited resources. It really isn’t difficult to solve this problem.

I couldn’t have said it better myself. When will the People Wake Up?

Paula Muto, M.D.

Founder and CEO, Uberdoc

There are so very many factors that have contributed to the clear and compelling reality that the public health response to the global SARS-CoV-2 outbreak has been one of the greatest failures in public policy in modern history. But chief among those has been the grossly overestimated modeling projections of likely disease and death due to the virus.

From The Imperial College in London

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