Once again, what's wrong with these people?

This morning we begin to get reports of the shitshow MAGA and RFK Jr are making of the American health complex. It's bad. It will be a few days before the newsmedia suss out the full catastrophe.

But this morning we get The Bulwark's new healthcare writer Jonathan Cohn taking up what those of us who live in the reality-based universe frequently find ourselves reverting to these day: why are these lunatics tearing down the country we have known? What motivates them? I found this summary helpful:

THE WRECKAGE FROM TUESDAY’S CUTS ONCE MORE raised the question of why, instead of undertaking a more carefully calibrated set of staff reductions, the Trump administration cut so crudely and destructively.

Most likely, multiple motives are at work, coming from different parts of the Trump coalition. For ideologues like Russ Vought, the Project 2025 participant who now leads the Office of Management and Budget, this is a chance to cut the federal government down to their preferred size—and to wipe out all the supposedly left-wing activists they believe have burrowed into the bureaucracy.

For Elon Musk and the DOGE team, quite possibly, there’s an element of techno-arrogance at work. And for Trump himself, the cuts would seem to fit in neatly with his agenda of attacking the “deep state” he believes thwarted him during his first term.

That leaves Kennedy, the secretary, who if so inclined could have pushed back on these reductions or at least demanded they proceed in a more deliberate way. There are no signs that happened. Instead, the one hallmark of Kennedy’s tenure so far has been a disregard—some would say disdain—for the department’s veterans and the way they do things.

You can see it in the expertise that the Trump administration cavalierly dispatched on Tuesday. You can see it, also, in how RFK Jr. is dealing with real-world challenges the department currently faces.

Right now the United States is confronting two serious threats that fall under HHS jurisdiction: the measles outbreak that started in Texas and has now spread to three other states, and the strands of avian flu decimating poultry flocks. ...

Photo from 2009. Will these Unitarian Universalists have to come back to the fray?

Jonathan Cohn is long time student of our health care morass who was one of my go-tos during the Obamacare passage wars.  Definitely someone worth following as MAGA tries to unravel decades of health accomplishments.

Trials of techno-medicine

Provision of medical services has become more and more sliced and diced to provide maximum profit for corporate providers, or so it appears to me.

Last week I accompanied an older friend to an appointment for a prescribed blood draw. The office was in a nondescript strip mall building. The entrance issued on a waiting room with rows of chairs -- and no human attendant. Just chairs and a large wall screen that flashed a series of messages.

A printed sign pointed to another small screen on a podium at waist level and called upon patients to "check in here." This screen asked for an appointment number -- a number which appeared nowhere on the paper notice provided by my friend's doctor. Dauntlessly, my friend ventured down a hall way and around a partition to find a human. That worker offered, resignedly, "just enter your phone number." Seemed she might have been interrupted by this question before.

After a bit of poking around on several confusingly designed screens, we found a place to enter that number and my friend managed to call up a notice of her appointment, offer her ID to be scanned, and also enter some of her insurance information. She never quite finished that part of the process, but eventually her name appeared in the left hand white column on the big wall screen, indicating that the office understood she was there for her appointment.

So we sat in one of the rows of chairs, all of which faced the big wall screen. And there was nothing to fix on except that screen, which flashed a series of messages promoting this for-profit facility. We especially appreciated the one above. So helpful to patients ...

Meanwhile, bloodcurdling screams issued from the back offices -- we'd seen a mother lead a reluctant child down the hall. This was not so much pain, we hoped, but terror. But it was completely unsettling. When they exited, the mother -- in the midst of reassuring the child -- looked around the waiting room shamefacedly. I tried to offer her some comfort.

Finally a human appeared to call my friend to come behind for her needle stick. She was taken to the same room from which the child-patient had been leaving. She reported she still felt the swirl of psychic fear in this antiseptic place. The tech was business-like; her blood draw was quickly accomplished. And then he pushed on to the next waiting patient.

There's no health in a setting like this; we're just profit points for someone. Would hiring a receptionist really hurt the bottom line so much?

Got a cold?

Does it seem as if every second person you know has flu, or cold, or perhaps COVID? That's because they do.

Click to enlarge

At least that's true in the more southerly parts of the country. 

I am glad to have received all my recommended shots -- most of us have not, so it's virus time.

Lying low today

Before the doc wrenched out my dead monster molar yesterday morning, I asked whether the idea I'd heard that redheads are particularly subject to dental pain was true.

"Maybe 50 percent of the time," he offered.

I used to be a redhead, so perhaps that's why I have such troublesome teeth?

The dead tooth wasn't as large as this, but it was large.

Thank you, Google, here's a 2009 New York Times report on red hair and teeth. It exactly describes how I approached dental visits for many years -- I didn't!

A growing body of research shows that people with red hair need larger doses of anesthesia and often are resistant to local pain blockers like Novocaine. As a result, redheads tend to be particularly nervous about dental procedures and are twice as likely to avoid going to the dentist as people with other hair colors, according to new research published in The Journal of the American Dental Association.

Researchers believe redheads are more sensitive to pain because of a mutation in a gene that affects hair color. ...

... People with the MC1R gene variant had more dental care–related anxiety and fear of dental pain than those without the gene variant. And they were more than twice as likely to avoid dental care. ...

... “Because they’re resistant, many redheads have had bad experiences,” Dr. Sessler said. “If they go to the dentist or have a cut sutured, they’ll need more local anesthetic than other people.” 

That's me. Or at least it used to be. Of late dentists have become more believing about this and dental visits have become mostly just expensive, not agonizing ...

The virus, precautions, and our biases

The current, and most likely continuing, risk profile of coronavirus infections is an invitation to ageism. And since ageism is an unspoken reality of our lives, it's influence cannot be discounted as we learn to live with the virus.

According to S. Matthew Liao, a professor of bioethics, philosophy and public health at New York University: 

“There’s a bit of ageism, so to speak, attached to it,” he said, adding, “People, even if they are older, they still have as much claim to live as me.”

The ageism in our understanding of the coronavirus isn't just prejudice, though both how we understand evidence and how we respond to risks will necessarily reflect out prejudices. The virus is more deadly to us old folks.

Unlike flu, which impacts both the very young and the very old, the coronavirus appears to put mostly older people at higher risk of severe disease and death. The proportion of deaths among those 65 or older has fluctuated from eight out of 10 in the first few months of the pandemic, to a low of 6 out of 10 when the delta wave struck in the summer of 2021, to a high of 9 out of 10 today.

Last month, people 85 and older represented 41.4 percent of deaths, those 75 to 84 were 30 percent of deaths, and those 65 to 74 were 17.5 percent of deaths, according to a Post analysis. All told, the 65-plus age group accounted for nearly 90 percent of covid deaths in the United States despite being only 16 percent of the population.

The only individual solution is to get fully vaxxed, take precautions that make us comfortable, and stay current with the best information we can find. And it doesn't hurt to advocate and agitate for stronger efforts to protect vulnerable old people who may not have the choices the more privileged among us enjoy.

• • • 

I write this coming off a season of serving as the "COVID officer" to a campaign involving nearly one hundred canvassers. Only one of these people contracted the coronavirus while working with each other every day, and that on the day after the election. We were determined to keep the crew as safe as possible -- for the well-being of individuals, of course, but also because an outbreak could have derailed our program.

UniteHERE can be proud that it chose to do what needed to be done to keep us COVID-free. All of us were required to be vaccinated and boosted. We wore masks indoors, though not religiously. Moreover, material safety precautions included housing everyone in separate units (no roommates on this campaign!) and renting cars for each driver, both expensive expedients which might not have been implemented with no pandemic. 

Being the COVID officer meant receiving the electronic forms everyone had to fill out each day which sought to alert folks if they had any suspicious symptoms. I spent a lot of time talking with canvassers who were plagued by allergic snuffles and providing antigen tests if they wanted them. Also providing fever thermometers.

Despite the precautions, I still think we got lucky. There's still a pandemic going on.

And we weren't all young. We had a canvasser who is 82 ...

When necessary medical care is denied ...

This is a little longer than clips I usually share here -- but a necessary reminder of what it means health interventions are made a criminal offense.

Eighteen weeks into her pregnancy, Amanda Zurawski felt something was "wrong"—and learned from doctors that her fetus could not survive. Miscarriage was inevitable—"but what happened next was not," she says. Under Texas's sweeping abortion ban, doctors could not provide her with care, starting a medical nightmare that put her in the ICU fighting a life-threatening infection. In this exclusive video, she and her husband sat down with the doctors behind Obstetricians for Reproductive Justice and The Meteor to share what happened.

H/t All in Her Head.

While getting a flu shot ...

Today we ventured out to get the shots -- and while dealing with the helpful CVS pharmacy technician, I felt as if I were watching what's described here in front of my face.

The New Omicron Booster and Flu Season Have Pushed Pharmacy Workers to Their Limit

... “We were told Thursday that week would be the earliest,” she said. “Suddenly we received a shipment of two boxes that Monday.”

The first day wasn’t so bad—only one patient realized the new vaccine was available. But the following day, “chaos ensued,” she said. Shots were scheduled every 15 minutes from 9:30 a.m. to 6:15 p.m., with no breaks. “That first day, we didn’t even know how many milliliters the patient was to receive in the shot,” she said. “We didn’t know if it was OK to give with a flu vaccine. We didn’t know if it had any side effects. We didn’t even know how to properly post the vaccine to our inventory system.”

Pharmacists also felt the pressure in the early days of the new vaccine rollout. As Matt, a pharmacist and manager at a retail pharmacy near Tucson, Arizona, said, “As the new omicron boosters roll out, the extreme anxiety has returned”—worsened by his company’s requirement that pharmacies accommodate walk-ins at all hours of the day.

Making matters more dire, the new vaccine rollout coincides with flu season, typically the busiest time of year at the pharmacy. ...

Today our CVS pharmacy tech fielded three phone calls which trying to process our out-of-state medical and insurance records. Her work space was jammed with crates and boxes. She explained they were dealing with twice the volume of incoming drug packages and three times the number of requests they usually see -- all with a reduced staff because it's so hard to hire at present. 

She was surprisingly cheerful about it, though reporting that she found herself working 14 hour days without stopping to eat.

Corporate capitalism is not about efficiency -- it's about getting the most out of nice people who take pride in their work. That sucks.

We need national health insurance!

 

Usually I write that we need Medicare for All. And we do. But today's little insurance-compelled jaunt reminded me that's not all we need.

As readers here know, I'm living in Reno temporarily. So today, in order for my Kaiser insurance to provide a urinalysis, I had to take a 220 mile round trip to Roseville, California. Two hundred twenty miles to pee in a cup. Kaiser insurance doesn't reach me in Nevada. 

That's nuts. Just glad I could do it.

Exceptional indeed

 

Well, that's happened. Today, life expectancy at birth is lower in the United States than in China. Or, for that matter, in much of the world.

Economist Adam Tooze writes:

... it is not only China that has overtaken the United States based on this metric. In 2021 Cuba has a higher life expectancy than the US. So does Albania.

Why? Well, the United States did a uniquely bad job of containing COVID. And we're afflicted by an opioid epidemic. But in addition, we're a society where some people are more equal than others.

A life expectancy of 66.7 means that Black men in the United States have, at birth, the same life expectancy as men in Pakistan, a country which ranks #150 out of 193 on the global list. In 2021, a boy born in an African success story like Rwanda has a longer life expectancy than a Black boy born in the United States. Men in India, Laos and North Korea have a higher life expectancy than Black men in America.

The most disadvantaged populations of all are Native Americans. In 2021, according to the CDC, Native American men have a life expectancy that puts them on a par with low-income Sub-Saharan African countries such as Togo or Burkina Faso, some of the poorest countries in the world.

Tooze calls these statistics "shameful" -- and he's right.

Picture of the day

Overcoming many predictions, women in Kansas have preserved abortion rights by popular vote. Along with their menfolk, of course.

See rejoicing!

The GOP is killing its own base among old people

This isn't about vaccine-rejection and anti-masking hysteria. This was pre-COVID:

In this national analysis [from the BMJ - a peer reviewed publication from the trade union of the British Medical Association], we found that Americans living in counties that voted Democratic during presidential elections from 2000 to 2016 experienced lower age adjusted mortality rates (AAMRs) than residents of counties that voted for a Republican candidate, and these patterns were consistent across subgroups (sex, race and ethnicity, urban-rural location). The gap in overall AAMR between Democratic and Republican counties increased more than sixfold from 2001 to 2019, driven primarily by changes in deaths due to heart disease, cancer, lower respiratory tract diseases, unintentional injuries, and suicide.

Click to enlarge

 "Unintentional injuries" is a euphemism for opioid deaths.

It's not so much that old Republicans were dying of different causes than old Democrats -- both were mostly afflicted by heart disease, cancer, and cardio-vascular ailments. But Democratic counties did a better job of reducing mortality among their old people, based on such factors as Medicaid expansion (access to health insurance coverage), stronger tobacco and gun control, and more generous social welfare systems in general.

It does seem counter-productive -- no, ghoulish -- for a political party to cooperate in killing off its supporters.

H/t commenters at Emptywheel.

A necessary break

So I checked this off Wednesday. And, unlike previous rounds, this shot left me a little woozy. 

Imagine I'll be back Friday.

No line, by the way, just the usual Kaiser efficiency.

Why doesn't California have this?

Of perhaps we do and I just don't know it. (I get my health care in the closed Kaiser system, so I enjoy the advantages of that.)

Because of having worked on elections in Nevada, I scan the news from the Silver State and was delighted to see that Governor Steve Sisolak has managed to launch a prescription drug cost savings program.

According to the Nevada Independent: 

Gov. Steve Sisolak announced that Nevada will join Oregon and Washington in the Northwest Prescription Drug Consortium, a partnership that allows residents to use drug discount cards to purchase prescription drugs at lower costs.

... Data shared by the state using examples from Oregon and Washington offer an example of potential cost savings for consumers. The retail chain cash price for 30 counts of 20 mg Atorvastatin, a medication widely used to lower cholesterol, is $127, but through the program, the cost could be reduced to just $6.14. Similarly, five 3 ml Lantus Solostar insulin pens can cost $530 at a retail chain, but the program can lower the cost to approximately $418.

... All residents of Nevada are free to enroll regardless of their private insurance. Slamowitz said consumers can choose to use the ArrayRx Card, that can be used at 65,000 locations nationwide or use their pharmacy benefit, depending on whichever provides a better price. 

Drug companies can just run over individuals. Harnessing the power our numbers is what government should be doing. If the feds can't get it done, states should get on with it. 

Bravo Nevada Democrats!

Another timely jab

It's flu shot time. The nice nursing student who did the job wasn't into the aesthetics of bandaids.

It's a big world

Maybe if our right wing nitwits got out and about more, they wouldn't be so stupid. This week they are whining about "vaccine passports" -- some, not yet extant, proof that people might use to show that they've gotten their shots against the coronavirus. 

Representative Marjorie Taylor Green insists any such instrument is "Biden's Mark of the Beast." This despite the fact that the administration is leaving the development of such a thing to private actors. Well, Greene is the Congresswoman from QAnon ...

For the last two decades, I've traveled with one of these tucked in my passport. 

Sometimes border authorities glance at it; other times not. There are still countries that want to be darn sure that visitors aren't bringing some dangerous germ along with them.  I think the original purpose was to combat smallpox. Hey, that worked.

I can't remember which country it was whose demand led to my getting one. Judging by the dates inside, probably Tanzania ... I'm not sure.

And I certainly don't feel oppressed by being expected to produce it ... It has too often been the case that we here forget that other countries get to run their own borders.

COVID-19 doesn't do borders. We must vaccinate the world.

Over the weekend, I was talking with a friend in Nicaragua. Several of us on the call reported that we had received our vaccinations. We asked, "how's it going there?"

He replied that there didn't seem to be any organized effort from the state to get people shots -- maybe the country of 6 million had inoculated 3000 people. He didn't know where they'd been getting the vaccine -- it was a discussion that was so remote from his reality that he seemed not to have much thought about it.

What came to my mind immediately was that, if Nicaragua and other poor Latin American countries were ever going to get vaccines, they would probably be looking to Cuba. Cuba has historically shared medical resources with Nicaragua. The Caribbean island has a developed biotech industry and a history of assisting other impoverished nations.

And so I wasn't surprised to run across this from the Washington Post:

Cuban leader Fidel Castro vowed to build a biotech juggernaut in the Caribbean, advancing the idea in the early 1980s with six researchers in a tiny Havana lab. Forty years later, the communist island nation could be on the cusp of a singular breakthrough: Becoming the world’s smallest country to develop not just one, but multiple coronavirus vaccines. 

... Cuban officials say they’re developing cheap and easy-to-store serums. They are able to last at room temperature for weeks, and in long-term storage as high as 46.4 degrees, potentially making them a viable option for low-income, tropical countries that have been pushed aside by bigger, wealthier nations in the international scrum for coronavirus vaccines. 

They could also make Cuba the pharmacist for nations lumped by Washington into the “Axis of Evil” and “Troika of Tyranny.” Iran and Venezuela have inked vaccine deals with Havana. Iran has agreed to host a Phase 3 trial of one of Cuba’s most promising candidates — Soberana 2 — as part of a technology transfer agreement that could see millions of doses manufactured in Iran. ...

This article treats Cuba as an unreconstructed authoritarian hell-hole. Now there's certainly plenty wrong with Cuba for Cubans. But let's credit the Cuban project with understanding that health care is a right, not a commodity. We in the United States have nothing to brag about while we defend the patents held by rich world pharmaceutical companies against the international effort to make life-saving shots cheap and accessible around the world. 

Meanwhile scientists with a big picture view warn that rich world indifference and corporate greed might mean that mutations render the first wave of coronavirus vaccines obsolete within a year if we're too cheap to make sure protection reaches everyone, everywhere.

The grim forecast of a year or less comes from two-thirds of respondents, according to the People’s Vaccine Alliance, a coalition of organisations including Amnesty International, Oxfam, and UNAIDS, who carried out the survey of 77 scientists from 28 countries. Nearly one-third of the respondents indicated that the time-frame was likely nine months or less. 

Persistent low vaccine coverage in many countries would make it more likely for vaccine-resistant mutations to appear, said 88% of the respondents, who work across illustrious institutions such as Johns Hopkins, Yale, Imperial College, London School of Hygiene & Tropical Medicine and the University of Edinburgh. 

“New mutations arise every day. Sometimes they find a niche that makes them more fit than their predecessors. These lucky variants could transmit more efficiently and potentially evade immune responses to previous strains,” said Gregg Gonsalves, associate professor of epidemiology at Yale University, in a statement. 

“Unless we vaccinate the world, we leave the playing field open to more and more mutations, which could churn out variants that could evade our current vaccines and require booster shots to deal with them.”

Generosity

A decade ago, diligent journalistic digging brought to light the hidden story of how researchers at John Hopkins University had appropriated unusual cancer cells taken from a poor Black Baltimore woman, Henrietta Lacks. They used these in cancer and other studies, without meaningful consent or compensation to Lacks or her surviving family. She died of her disease; her cells, named HeLa by the doctors, lived on in medical research.

The story of this unexamined appropriation of a woman's body parts for science and profit raised up profound failures of scientific and medical ethics. Lacks' descendants eventually won some compensation; the journalist, Rebecca Skloot, founded the Henrietta Lacks Foundation which has used its funds to provide grants to poor people of color who are survivors of medical exploitation.

The Foundation mission statement:

to promote public discourse concerning the role that contributions of biological materials play in scientific research and disease prevention, as well as issues related to consent, and disparities in access to health care and research benefits, particularly for minorities and underserved communities.

In this time of coronavirus threat, the Lacks family has stepped out to encourage vaccinations, despite their own history with medical exploitation. Nobody knows better that doctors sometimes aren't your friends -- and nobody knows better that if medical help becomes available, it's good to get some.

Prediction: health care will again move to center in the election

Remember the seemingly endless Democratic presidential primary season that ended with Joe Biden suddenly wiping out all the others? Probably not. Between COVID-19 and the filmed murder of George Floyd, most feeling people have had so much run over us that the memory is indistinct.

But at least one development of the last week should remind of us of what that long intraparty squabble was ostensibly about. Presidential aspirants argued and proposed and postured for months about how they would ensure everybody had access to health care. Today millions of people are out of work in a country that ties access to medical services to having a job -- in the midst of a pandemic. And it looks like voters do still care, even in states that seem less than obvious.

Dylan Scott at Vox surveyed social scientists about a recent, seemingly unlikely, development:

"For the second time this summer, voters in a solidly Republican state have decided now is the moment to expand Medicaid coverage through the Affordable Care Act.

"Missouri voters passed a ballot initiative to expand Medicaid during Tuesday’s primary elections; 53 percent of voters supported the measure and 47 percent opposed it. That vote comes about a month after Oklahoma voters also decided to expand Medicaid via ballot referendum by less than 1 percentage point. 

"... Crises have a way of changing political attitudes. ... right now, disapproval of the Affordable Care Act is at a low ebb, with just 36 percent of Americans saying they have an unfavorable view of the law in the Kaiser Family Foundation’s July 2020 poll.  

"It is too soon to say whether any shift in the public’s policy preferences will be permanent. But we shouldn’t be surprised if a crisis as disruptive as the coronavirus pandemic leaves a long-lasting mark on our politics."

In the Los Angeles Times, David Lauter points out the advantage which Democrats gain by responding to the public's health care fears and hopes.

"Democrats have learned over the past decade that complex efforts at market-based solutions to expanding healthcare, like the Affordable Care Act’s subsidized marketplaces for low- and middle-income families who lack job-based coverage, don’t work politically on two levels: They fail to win over the Republicans they were designed to attract and they aren’t as popular with voters as straightforward expansions of public programs. 

"Biden opposes Medicare for All, but if he wins in November, some form of Medicaid for Many — a public option built around further expansion of the program — will likely form a key part of his administration’s program. 

"... if the spread of the virus slows, which President Trump‘s campaign strategists hope will allow him to start a comeback, he will still face a host of issues on which he was vulnerable long before the pandemic began. His efforts to repeal healthcare coverage for millions of Americans remain high on the list."

This is not the terrain on which Donald Trump wants to fight this election. He'll try to distract. He'll promise a “tremendous healthcare plan,” as he did just two weeks ago, a fantasy solution. He'll claim to protect people with pre-existing conditions, such as having been infected by COVID -- but legislators of his party has voted to repeal these protections over and over. And Trump supports a lawsuit to kill off all of Obamacare. Trump's magic health care fix will never happen. 

If Dems are smart, they'll keep hammering on a promise to make certain all of us can go to doctors. People need and want assurance of health care access; the virus keeps the need fresh in our minds.

It's on all of us to make sure Trump does not escape his failures -- his failure against the coronavirus, his failure to deliver on delusional promises.

Dangerous drivel

Notoriously, the pathological toddler in the White House has again been hyping the unproven and dangerous drug hydroxychloroquine as a treatment for the coronavirus. On Monday, his dopey son tweeted an endorsement; Twitter scrubbed the lie and locked Jr.'s account for 12 hours. So Daddy started passing around the same phony medical endorsement.

A friend, a doctor "too exhausted actually taking care of sick COVID patients to type it out," passed on this rebuttal to the Trumps from yet another working doctor.

"Even doctors can spread misinformation, and despite the claims, there are numerous studies showing lack of efficacy even when used early on. That's why we created a process to sift good information from the bad in an objective manner.

"You can always find outliers. What do the MAJORITY of credible doctors and scientists say. Just b/c the far right trots out a handful of scientists who deny global warming doesn't mean we aren't all in a slow cooker.

"Also, if a doctor says he knows his cures work bc others doctors tried it and told him so, then scoffs at double blinded randomized studies, rest assured you are not getting good information. Anecdotal evidence is as useful as a monkey's fart.

"Just because your great aunt Tandy once plastered onion to your 3rd cousins feet and cured his syphylis does not mean everyone needs to run out and buy onion flip flops. There are doctors going around claiming they are curing covid with hydroxychloroquine, zinc and azithromycin.

"Please remember MOST people will get better with nothing, just like MOST people recover from the flu. The fact that you drank a tequila and wheat grass shot 3 times a day does not mean it was a "cure" for the flu."

The Daily Beast reveals some background on Trump's new favorite source of medical misinformation.

"Before Trump and his supporters embrace [Dr. Stella] Immanuel’s medical expertise, though, they should consider other medical claims Immanuel has made—including those about alien DNA and the physical effects of having sex with witches and demons in your dreams. ...

"She alleges alien DNA is currently used in medical treatments, and that scientists are cooking up a vaccine to prevent people from being religious. And, despite appearing in Washington, D.C. to lobby Congress on Monday, she has said that the government is run in part not by humans but by “reptilians” and other aliens."

Just the sort of quackery you'd expect Trump to embrace. No wonder he has been worse than useless to the people of his country as we endure preventable sickness and death. He's bored with COVID.

Good news: so far, the epidemic has not exploded at Laguna Honda

In the early days of the pandemic I walked (with careful distancing) the neighborhoods adjacent to San Francisco's mammoth public nursing home, Laguna Honda Hospital. Was a catastrophic death toll about to happen in that huge facility? As I read reports from Washington State and New York, mass infections and horror seemed inevitable.

But this hasn't happened. The San Francisco Chronicle reports:

Now, four months into the pandemic, not one Laguna Honda resident or worker has died of COVID-19, public health officials say. Of the 721 people living there, 19 have become infected. And of more than 1,800 employees, 50 have tested positive.

What went so right when so many other nursing homes became death traps?

• The city received useful help from the CDC in training staff in effective handwashing and how to wear masks and gowns.
• The city somehow got hold of enough PPE so workers could follow safety rules without having to worry they would run out.
• There was enough space to create a separate COVID area so infected patients could be quarantined for 28 days.
• Testing was slow to ramp up, for lack of tests and equipment, but eventually all residents and staff were put on a two week  regular testing schedule.
• When workers did develop symptoms, the local public health department devoted personnel to contact tracing.

I'm not often a fan of our mayor, but the article highlights another reason Laguna Honda was the recipient of this smart, careful assistance: London Breed's own grandmother had been a resident there. It's not every mayor who has had relatives in a public hospital and that almost certainly made a difference in the attention directed at Laguna Honda.

The article fails to mention another unusual facet of why Laguna Hospital has been able to beat back infection, at least for now. The workers there are union members, accustomed to stick up for themselves through their own organizations. Worker power can save lives.

Let's hope San Francisco's public hospital can keep up this effective response to the public health crisis.

The experience points to the two clear lessons of this plague time: mass death was preventable and mass death is averted when organized people work together.