TL;DNR = Too Late; Do Not Resuscitate

[NB: check the byline, thanks! / ~Rayne]

A friend sent me this tweet with an embedded TikTok clip late Friday night:

Yes, Idaho’s Department of Health and Welfare declared it was activating Crisis Standards of Care (CSC) effective September 6; the standard was reiterated on September 16. The “Universal DNR” referred to in the TikTok is on page 9 of the IDHW’s document, Patient Care Strategies for Scarce Resource Situations for use under CSC conditions.

Idaho has simply run out of ICU beds, ventilators, and personnel to support persons who either code in the hospital or arrive at the hospital in need of resuscitation.

Technically speaking, the guideline isn’t universal across all of Idaho; the IDHW noted in its September 16 statement,

… Although DHW has activated CSC, hospitals will implement as needed and according to their own CSC policies. However, not all hospitals will move to that standard of care. If they are managing under their current circumstances, they can continue to do so. …

But chances are good if the ICU beds are full in any Idaho hospital, patients are being transferred to other hospitals until their beds are full as well.

None of this had to happen.

In fact, this change in triage methodology could have been foreseen.

Last March we saw the first documented and publicly acknowledged “codice nero” conditions in northern Italy and then in Detroit, when hospitals were completely overwhelmed by the first surge of COVID-19 patients. While Italians may not have known about the implementation of code black, Detroit’s local news reported on the change in triage protocols after patients and their families were notified on admission that care would be allocated in order of patients’ likelihood of survival due to the limited resources available, from ICU beds to ventilators to qualified health care staff.

The swamping of hospitals in March 2020 could have been avoided had lock-downs and mask mandates been implemented by the end of February/first week of March, but there likely would have been a surge in hospitalizations simply because government and public alike still had not fully acknowledged the threat COVID-19 posed.

Idaho’s hospitals have been and are among the worst in the nation for crisis care preparedness. As of the third week of August, Idaho was number three behind Georgia and Texas among states that are least prepared for hospital capacity. At that time Idaho’s ICU beds were already 83% occupied.

The state had ample to adjust to a pandemic and prepare for the possibility of a surge in COVID-19 cases. They had plenty of examples of crisis level care across the country to shape their response.

But now, nineteen months after the first wave began, when multiple vaccines are freely available to the public? The ICU beds are beyond full if Idaho must declare the equivalent of a code black.

Unvaccinated Idahoans chose this. They willfully opted to court hospitalization, long-term disability, and death by COVID-19.

The worst part is what the unvaccinated are doing to those who chose otherwise — like those who arrive at the hospital with a gunshot wound or a heart attack or stroke, who may have been vaccinated but are likely to die because they will only receive palliative care instead of interventions to save their lives.

Trump’s death panels continue apace.

~ ~ ~

EDIT: 21-SEP-2021 — 1:50 AM —

To make it easier for folks who don’t want to open the IDHW’s document, Patient Care Strategies for Scarce Resource Situations for use under CSC conditions to read page 9, here’s a snapshot:

Note there is zero reference to COVID-19 on the entire page and the “Universal DNR Order” refers to all patients in cardiac arrest.

163 replies
  1. Rayne says:

    My reserves of empathy and sympathy are tapped out. Unless one has a health condition precluding vaccination, are suppressed in some way from getting the vaccine, or are too young for vaccines, they’ve made a choice.

      • BobCon says:

        The issue though is that it’s not any form of natural selection. It’s a bad analogy.

        “The worst part is what the unvaccinated are doing to those who chose otherwise — like those who arrive at the hospital with a gunshot wound or a heart attack or stroke, who may have been vaccinated but are likely to die because they will only receive palliative care instead of interventions to save their lives.”

        There’s a real danger of slipping into solipsistic thinking where we can just let this run its course among the unvaccinated and the responsible people will be better off than the others. You even see this assumption framing supposedly responsible commentary in the national press, with editors irresponsibly letting it go through unchallenged.

        An old school pseudo-Darwinian framework is nearly as bad as denialism, both in terms of description and prescription.

    • Frank Probst says:

      I think most reasonable people are at this point, which is why Biden’s announcement about vaccine mandates got so little pushback. Yes, a bunch of people are shrieking about them, but there hasn’t been much organized and serious opposition to them. A handful of people are threatening to quit their jobs rather than get vaccinated, and the general response is that they’re told not to let the door hit them in the ass on the way out.

      • P J Evans says:

        I’m tired of the vaxxed being expected to play nice with the unvaxxed so we don’t hurt their tender fee-fees. We know and understand that they want things to go back to “normal”, but that won’t happen until they also get vaxxed, which they won’t – or can’t – admit to themselves.

    • Ephraim says:

      I very much support EMPTY WHEEL but the info here appears extremely misleading. Directed to the IDHW doc, page 9, the text seems clearly to be referring to cardiac arrest in COVID patients (danger of aerosolization, et al), not gunshot wounds or other maladies. Unless EMPTY WHEEL can show otherwise, this seems like histrionic propaganda.

      • Rayne says:

        Oh hello, total stranger who appears to be commenting here for the first time. The word “COVID” appears five times in the IDHW’s Patient Care: Strategies for Scarce Resource Situations, version 3.0 dated January 2021, and nowhere on page 9.

        The entire document has been written to address STRATEGIES FOR SCARCE RESOURCE SITUATIONS under CRISIS STANDARDS OF CARE, of which COVID is but one situation. The “Universal DNR Order” text specifically says,

        Universal DNR Order
        Adult patients hospitalized during a public health emergency, when crisis standards of care have been declared (and a hospital is using the mechanical ventilation allocation framework due to demand for ventilators exceeding supply), should receive aggressive interventions; however, they should receive NO attempts at resuscitation (compressions, shocks or intubation if not yet intubated) in the event of cardiac arrest. The likelihood of survival after a cardiac arrest is extremely low for adult patients. As well, resuscitation poses significant risk to healthcare workers due to aerosolization of body fluids and uses large quantities of scarce resources such as staff time, personal protective equipment, and lifesaving medications, with minimal opportunity for benefit. This universal DNR order does not apply to pediatric patients; however, pediatric patients requiring a ventilator after resuscitation would enter the ventilator triage protocol after resuscitation, just like other patients needing ventilator access.

        Emphasis mine — nowhere in that clause does the order refer to COVID patients exclusively or ventilation alone.

        Here’s page 9, though — perhaps you’d like to look again at it more closely noting it clearly says “Strategies for Scarce Resource Situations”:

        Now go tell your story walking before I really go histrionic on your ass.

        • Ephraim says:

          Hi Rayne, yes this is my first (now second) response, and thanks for the warm welcome (not!). If you wish to point out that the document is unclear in its specificity, then yes, I can see your point. However, allow me to point out that some clarity is provided two sentences below the one you underlined: ‘As well, resuscitation poses significant risk to healthcare workers due to aerosolization of body fluids…’. Trained medical personnel would not expect to be placed in jeopardy when doing chest compressions on a gunshot victim or a stroke victim or a patient suffering from any other sort of trauma OTHER than COVID19. That simply makes no medical or scientific sense. You don’t need to be a brain surgeon to understand its directives IMPLY reference to COVID19 and not other conditions. For your own edification and personal growth ( I mean really, was the ad hominem necessary?) take a deep breath, step back, and look at the document in context. Context is what is lacking in so many of our discussions these days.

          • Rayne says:

            A “Universal DNR Order” is universal. What part of universal is difficult to comprehend?

            Once more, the order pointedly says, “Adult patients hospitalized during a public health emergency, when crisis standards of care have been declared” — there’s ZERO exclusion there, no mention whatsofuckingever of COVID or any other infectious respiratory agent which could also apply to other viruses and bacteria. There’s a specific reference to ADULT patients to differentiate from minors which are not subject to the order and that’s about all the criteria applied save needing resuscitation.

            As for the tone: don’t drop in here for the first time ever and drop a turd in the punch bowl by spouting about histrionics unless you want histrionics. Tell you what I’m going to do, though, since you’re not up to the reading level of this community and we don’t have time to spend on drive-by concern trolls — consider yourself liberated. Hasta pasta.

          • Nord Dakota says:

            The document is not covid-specific even though covid may have precipitated its creation. It’s intended to cover all kinds of public health crises, including human-made and natural disasters as well as diseases.

  2. Hika says:

    When it comes to assessment of “likelihood of survival”, one wonders what weighting may be given to having chosen to be unvaxed. As far as I know, these are judgment call decisions without any defined quantitative formula. Being unvaxed might be considered a relevant factor in how people are ranked in the queue for treatment.

    • Glen says:

      or ranked in the queue for anything, such as medicare, social security, etc.

      [Welcome to emptywheel. Please use a more differentiated username when you comment next as we have several community members named “Glen” or “Glenn.” Thanks. /~Rayne]

      • Spencer Dawkins says:

        “Maybe hospitals could offer DNR tattoos in the parking lot for the unvaxxed.”

        I’m sure that at least some militantly anti-vax people would take hospitals up on the offer, and I’m sure that including vaccine in the tattoo ink would violate all kinds of ethics and laws, but that would be an ironic contribution to fighting the pandemic …

    • LeeNLP says:

      There’s a long tradition – visible in the Geneva conventions and elsewhere – of ensuring that doctors consider only medical criteria in making triage decisions. Doctors are to be healers, not judges. However, since vaccination status directly impacts likelihood of survival, it seems doctors should be free to consider it when forced to decide who lives and who dies. Just as they do when considering prospective liver transplant patients’ use of alcohol when deciding who gets the next available liver.

      It’s unfortunate that not only do COVID-19 freeloaders take ICU beds they wouldn’t have needed had they done their civic duty in the first place, they tend to hold onto those resources for a long time. They refuse to lift a finger to protect their fellow citizens, then come hat-in-hand to those fellow citizens (seeking hospital support, taxpayer help with medical bills, GoFundMe to help with out-of-pocket expenses) when their poor choices catch up with them. And end up killing others along the way- collateral damage I guess along the way in their pursuit of “freedom”.

      I wonder does it occur to any of them that they’ve become parasites, stealing from others and giving nothing in return?

      • Bruce Olsen says:

        My gut agrees with the general sense of what you’re saying, but is there anything backing this up?
        I see plenty of folks on GoFundMe that aren’t COVID-related for example. It’s shameful that the health care system seems to force folks into begging in public (even though not all of them are legitimate needs), but I wonder if COVID is overrepresented.

      • Nord Dakota says:

        Vaccination status makes no difference when the person is ill to the point of requiring mechanical ventilation. I don’t have the cite but I read this recently, likely in an article explaining the reasons why vaccination status cannot be considered when allocating care, based on medical ethics.

        And I agree. There are many circumstances in which life choices contribute to someone presenting in an ER.

  3. klynn says:

    Tried to share the Mayo Clinic data on By-State By-Age vaccination rates but their site blocked sharing it.

    Sadly in the age group “under 18” only a few states come close to 30% vaccinated CT and MA. Everyone else is failing.

    • harpie says:

      I wonder if <18 includes children younger than 12 who can not yet be vaccinated…and if so, why the data is presented like that.

      If not, why not label it like the other columns, ie: Age 12 – 18?

      • klynn says:

        Glad you were able to get the link. Thank you! I had a security blocker come up three times so I stopped trying!

        There can be variations from their data and a state’s data. Some timing of data posting is usually the cause.

    • Sprout says:

      Something is not quite right with the Mayo data. For example, if you go to State of Hawaii Dept of Health website
      you will find vaccination rates of 59.4% completed and 73.0% initiated for the 12 – 17 age population. And 66.1% completed and 74.6% initiated for the population as a whole. Not sure where these things go wrong during data aggregation, but I’m fairly certain that Hawaii is not one of those states desperately trying to hide its COVID numbers.

      • PieIsDamnGood says:

        Hawaii state data shows better vaccination rates, correct?

        I suspect it is reporting lags to the CDC (Mayo’s source), and then time for CDC to aggregate rather than anything nefarious. Could be potential issue with the denominator as well, e.g. full population vs eligible population.

    • WilliamOckham says:

      I don’t trust the Mayo Clinic data. It says that 86.5% of Texans aged 65 and up are fully vaccinated. This is dangerously, woefully, and inexplicably wrong. The actual number according to the Texas Department of State Health Services is 78.45%. I suspect that even that number may be an overestimate due to a possible error in the denominator. It appears that the state hasn’t updated the age group population totals based on the 2020 Census. Texas grew much faster than predicted by the last Census estimate before the 2020 Census.

  4. Frank Probst says:

    Another problem that I’ve seen very few people address is the fact that this is burning out an entire generation of health care professionals (and teachers, for that matter). Every day, these workers are asking themselves, “Why am I risking my life for this?” The ones who end up quitting probably aren’t coming back. If you’re quitting your job because administrators are treating you like something disposable, you’re usually gone for good.

    • harpie says:

      Not only their own lives, but that of their families as well,
      especially those who cannot yet be vaccinated.

      And how many would like to quit, but can’t afford it?

      • Eureka says:

        Same, same as to anger and the affordability issues. Some (more) are going to be forced to “afford” it because it’s otherwise untenable to continue in their chosen profession for which they’ve invested however much time, cost, education — and society will lose their expertise. It’s going to (continue to) affect their whole families’ lives (housing, schooling, retirement / income / security in old age — just on the economic part — and with our great safety nets and compassionate culture to boot /s).

        In the now, in the in-between of keeping on or changing course, society’s helpers have little left for themselves and their families. That’s a big tragedy.

        People don’t get or GAF how far reaching this is, all the life-altering shit (beyond the immediate health gauntlets of the pan/endemic itself) because of other people’s sociopathic choices. How fucking sad.

    • rosalind says:

      THIS. I’ve been railing on my Reps about this for months. Need a Marshall Plan to re-build our Health Care personnel starting now.

      sitting in my elderly aunt’s hospital room this summer, i got to watch the nurses in action. they have voice activated pagers now (new to me since my parents’ last hospitalizations 15 years ago). as one nurse was busy treating my aunt she was paging others and coordinating care while others came into the room to consult and trade off tasks. it was remarkable how seamlessly they worked together, and so much more efficient than the past.

      and almost every one was born in the Phillippines or Dominican Republic.

      • Kevin R says:

        if only we could pass a big bill with a bunch of things that could be considered, in one way or another, as infrastructure. Then we could address many of these needs. Alas, I guess that’s not what this country is about.

    • posaune says:

      My nephew and his wife both graduated medical school june 2020 — right into covid residencies. She is anesthesiology (great at intubation now); he is pediatrics. I can’t imagine the stress of trying to fit into a residency during covid. They won’t quit — but I hope they don’t burn out. They are bright, humane, compassionate people from Iowa.

  5. bg says:

    I had someone who is apparently a legit case for non-vax try to tell me that the vaccine is causing people to rage. Who is beating up restaurant hostesses and store employees who are trying to enforce health and safety measures? I have seen people on line begging for help to find a hospital bed for someone in a medical crisis, and as you said, the beds are full and care rationing is to be had. I’m plenty mad at people who chose not to get the shot(s), but I’m very passive on their deaths. Dead can’t vote is just fine with me.

    • Rayne says:

      It’s not the vaccine causing them to rage. Trump took the leash off their nasty reptilian ids, gave them permission to act out. He modeled that behavior all the time even if we didn’t recognize it for what it was, ex. “Grab ’em by the pussy.”

      I suspect some of these ragers are also suffering from COVID sequelae, literally brain damage causing psychosis. They may have been asymptomatic, but the effects of neurological deficits may not become obvious until they are in a strange environment and stressed beyond what they could previously handle with more restraint. They regress to toddler-like behavior and have tantrums.

      • Hika says:

        I take your point about Covid having neurological effects, but a lot of these people had neurological deficits to start with and Covid-world has just acted as a catalyst to bring them to full flourish as the [expletive]s they were destined to be.

      • Leoghann says:

        Which leads me to wonder just how badly affected the Orange Leader is from covid sequelae. It seems like there have been more reports of his childish behavior, and reports of worse spells. But is that because of worse behavior or more accurate reporting?

        • Rayne says:

          I have often wondered how badly Trump’s suffered from additional neurological deficits after COVID. It bothered me to no end that the media didn’t make any effort to examine the possibility Trump was still suffering from COVID through the election, that he may have had long COVID, and that if he was barely competent before he was infected, he might not be competent after and thus ineligible for office.

          Reports of his tantrums sans any examination into the underlying physiological cause I couldn’t see as more accurate reporting.

          • Ginevra diBenci says:

            Rayne, I agree about coverage of DT’s Covid. He seemed so obviously high on dexamethazone for a long time after his release from WR, but was allowed to get away with the never-felt-better blather unchecked. I suspect that reporters were fearful of venturing into semi-charted medical territory at the time, but I have to wonder why all the “He was a lunatic” stories are coming out now, when he is putatively out of office.

            And welcome back. I’ve missed your voice and your perspective here. None of us can bring it like you do.

    • Rayne says:

      Worked for a jackass executive back in my corporate drone days to whom I’d said the same thing, that life wasn’t fair.

      He was surprisingly sagacious in response: “Life IS fair. Everybody’s heart gets broken.”

      That’s the one thing he said to me out of the years I worked for him which stuck. All of us are getting our hearts broken, one way or another. It’s just so goddamned sad to see people willingly choosing to break their own and others’ hearts along with theirs.

  6. OldTulsaDude says:

    This train is bound for Crazy, this train
    This train is bound for Crazy, this train
    This train is bound for Crazy
    The vaccine kills but Jesus saves me
    This train is bound for Crazy, this train.

    This train don’t believe in science, this train
    This train don’t believe in science, this train
    This train don’t believe in science
    only one book can give you guidance
    This train don’t believe in science, this train

    This train is dyin’ slowly, this train
    This train is dyin’ slowly, this train
    This train is dyin’ slowly
    The ticket’s one-way but we don’t know it
    This train is dyin’ slowly, this train

    • John Colvin says:

      This train don’t allow no passports, this train;
      This train don’t allow no passports, this train;
      This train don’t allow no passports,
      For bars, restaurants, or big league sports,
      This train don’t allow no passports. This train.

      This train don’t wear no masks, this train;
      This train don’t wear no masks, this train
      This train don’t wear no masks,
      To see your face is all we ask,
      This train don’t wear no masks. This train.

      This train treats with ivermectin, this train;
      This train treats with ivermectin, this train;
      This train treats with ivermectin,
      Hydroxychloroquine and betadine,
      This train treats with ivermectin. This train.

  7. Wajim says:

    I work in northern Idaho and during the first Covid wave quit my well-paying, public-facing day job for a poorly paying night job during which I hardly encounter anyone. While I have been fully vaccinated since April only about 40% of the faculty and students on the college campus where I work have been. The one co-worker I am regularly exposed to (who’s afraid of having a “bad reaction” to the jab) also refuses to mask on the job. Our two local hospitals are maxed-out with ICU beds full of Covid victims, yet only about 40% of the students and faculty wear masks, even in tightly packed classrooms and dorms, and the State refuses to mandate masks or vaccines because “Liberty!” even as cases are soaring around us and on campus. Many of my fellow Idahoans (including many highly educated folks) are either mindlessly complacent and/or simply in denial. Others (especially the Trump supporter crowd) seem blindly defiant so they can “own the Libs.” Hard to be “free” when you’re dead, I say. No other words but childish, foolish, ignorant, and simply insane

    • Rayne says:

      I feel for you. Even in states which are doing better like Michigan, it can still be very dicey trying to do fairly normal things.

      I went to a restaurant to celebrate a family member’s birthday last week; it was the first time I’d been indoors to dine since February 2020. Had it been in my county I wouldn’t have been as concerned but I was in a county that voted hard core GOP all the time — you just know in that neck of the woods most residents are Trumpers. I spent most of my uncomfortable meal faking happiness, trying not to think about the likelihood someone in that dining room was contagious and who might be hospitalized or dead within the next several weeks because they dined indoors. It’s not freedom even for those of us who are vaccinated to watch these fools killing themselves and their futures along with others who can’t consent.

      • Wajim says:

        Thanks. Asotin County, WA (where I live) and Nez Perce County, ID (where I work) are both hardcore Trump zones. “Trump 2020” flags and MAGA gear everywhere one looks, still, on houses, pickups, yard signs. I don’t talk much about being a Progressive Dem voter around here, except with some close friends from college days, as it can get hostile, even threatening, as we say here, “right quick.”

      • klynn says:

        I totally feel your pain of that restaurant moment.

        I had a doctor tell me on Friday that he was extremely disappointed in our local schools with the “opt out” of masks policy. He noted with all the hospitals near our community, a number of doctors live in the community and the number of high school students going maskless forces him to live out of his home’s 4-seasons room to remain separate from his kids receiving exposures. He’s a risk to them. They are now a risk to him. He says he has to test himself constantly and that is getting to be an emotional drain. Noted universal masking would keep doctors and responders and their families safer and slow down covid. We then talked about the stress on those who do their civic duty – vaccinate/mask/social distance – and yet are either denied access to care when they need it or have to censor activity based on the threat of other’s behavior.

        • Rayne says:

          Awful. I can’t imagine having to deal with that daily, hourly. I’ve had to be so careful because of my autoimmunity disorder, but it’s not like having to work with these wretched anti-vaxx nutbags everyday and worrying about children at the same time. Grueling.

          Our entire nation is in need of psychotherapy, with more than half of us living with folks who are essentially abusive personalities.

          • Leoghann says:

            A couple of friends and I were discussing last night that we need a natural unifier in high office, but that person, in order to be effective would have to serve as a national therapist as well. Then the discussion moved on to how long that process would take.

            • Rayne says:

              Such a person would have to have a personality which could appeal to the right-wing in this country, but the risk is that such a person would be a major risk in the White House, given power’s ability to corrupt. How would the left trust someone who would necessarily be a populist on the face of it?

              • Leoghann says:

                The appeal to the right wing pundits an”influencers” (ye gods, I hate that word) would be almost impossible, because they’re the ones driving the partisan division, for the most part. But appealing to the better instincts of many people who have come to follow those demagogues might be easier. You might notice I didn’t have any specific suggestions. Such a person may or may not exist.

                • Ginevra diBenci says:

                  That person does exist. He is president right now. No one who’s not an android could be more of an empathic unifier than Joe Biden. The problem doesn’t lie with the leader; it reflects a half-century program (triggered by 1960s civil rights gains and the women’s movement) with fathomless funding determined specifically to divide us against each other and reap the dividends of hatred and disunity.

                  The past twenty years did nothing to slow this machine, even when it seemed to recede during Obama’s administration. They are playing a long game. Trump proved an apotheosis–deepening and hardening the divisions but also repeatedly saying the quiet part out loud. I’m praying that their gamble on him fails, but I’m not convinced at all that it will.

          • Max404 says:

            It’s the cruelty that gobsmacks. So much cruelty. Such a polite, friendly people, sir, ma’am, and so cruel.

  8. Binky Pelegreene says:

    This sounds stupid, but I think it’s true. Trump played COVID as unimportant when it first appeared and he can’t tolerate any failings. Because of that, everyone(!) has to echo his position. Mass insanity.

    [Welcome back to emptywheel. Please use the same username each time you comment so that community members get to know you. This is your fourth user name. Pick from Terrence/Terry/Terrence Fuller and stick with it. Thanks. /~Rayne]

  9. bidrec says:

    Heidegger (German philosopher) says humans die but animals perish. That is, a human knows that his life will end. An animal does not. Maybe there are humans that do not have the distinction “death”.

  10. Terrapin says:

    My sympathies are for non-COVID patients who need ICU beds and won’t get them because of COVID patients who are taking them up when if they could had been vaccinated and avoided hospitalization. Some of these non-COVID patients will die needlessly and their deaths will be on the unvaccinated.

    Sometimes I think armed National Guard should be sent around with police and vaccination teams and the unvaccinated be forced to be jabbed–at gunpoint if necessary.

  11. ThomasH says:

    One of my former colleagues, an anesthesiologist, wrote to me in the late winter of 2020 when the SARS-CoV-2 was starting to ring all the healthcare alarm bells: “This will be unlike anything we’ve ever experienced” in modern times. So far, his prediction has been dead on.

  12. Rugger9 says:

    OT: I’ll see more of the Monday morning quarterbacking later, but the drone strike that GEN Milley copped to being a “tragic mistake” I do not think was completely avoidable. First, the target did nothing wrong nor did the other victims. However, there was doubtless a lot of pressure along the CENTCOM chain of command to do something to show how it was too dangerous to leave Afghanistan and for the “blob” that meant waxing some terrorists in a drone strike. However, just like many of the ones in Yemen they didn’t do their intel properly and killed innocents instead. Or, they didn’t care like Fahrenheit 451’s Mechanical Hound because they only needed a dead body to blame.

    Milley at the time of the strike was all over the place telling us how awesome it was that terrorists were being eliminated. He needs to resign for this, since his OK let this happen. Also, CENTCOM and the DoD section in charge of drone strikes need to go as well, since they clearly cannot tell the sheep from the goats, aka “demonstrated unreliability”.

    • bmaz says:

      That is the nature of drone striking though. Even if there were manned Tomcats or F-16s in the air, it would be no different,

    • Rayne says:

      I’ve been restraining myself from writing about the Afghanistan exit and Milley. Every single pundit complaining about what happened does NOT have all the intelligence — and neither do you. Nor have any of them ever questioned the intelligence the U.S. public has received about Afghanistan for the last five years. While Milley may say the drone strike was a “tragic mistake,” he may not be able to say anything more if there was questionable intelligence which drove the decision behind the strike because doing so might disclose means and methods.

      Further, there was a trolley problem: what should be done if there is ample intelligence indicating there will be yet another terrorist attack on the air base, some of the intelligence indicates a particular vehicle will be utilized, and doing anything which requires troops to be deployed to engage the threat directly on the ground when they are already short staffed will increase the attack surface?

      I don’t think Milley should resign. We’re fortunate he’s kept a cool head at the right times.

      • Savage Librarian says:

        Thanks for that, Rayne. My sentiments too. Life experiences are much more of an interlinking web of known and unknown circumstances. Participants, observers, and researchers have a variety of motivations for revealing what they do. Even in much smaller and simpler situations, events can be easily obscured…sometimes willfully and sometimes through indifference, ennui, or sloppiness.

        As an example, I recently came across an article written this year by an educator with a PhD. He mentioned me but he never once contacted me. It appears that he may have relied on very limited information and came to conclusions. It may not even have occurred to him that some of the sources he relied on could have been tainted with their own biases and backstories.

        He might even have thought he was doing something honest and honorable. And I’m pretty sure it hasn’t occurred to him he got significant things wrong. Chances are good that I wouldn’t have talked with him anyway. I just don’t think it would be a smart thing to do at this time.

        So, that’s why I’m giving Milley the benefit of the doubt. And I’m still very grateful for some of the heroic measures he has taken.

      • Rugger9 says:

        No, I may not have the current intel but I do have plenty of experience in how these types of decisions get made. Milley had the benefit of the knowledge of prior strikes that went sour and in his role should have demanded absolute certainty about the target, yet he did not and then he compounded that error by bragging about the hit until the truth filtered out.

        The target turned out to be one of our Afghan agents who was trying to get his kids out of country. That means he was actually well known to someone(s) in the IC and therefore should have never been targeted as he was. Where was the review process I know Milley on down should have demanded be there, especially in a charged situation like this one? This is called “planning” and is a central component of Milley’s and CENTCOM’s respective jobs. FWIW, I also have seen no career consequences now that the truth is out for any of the teams involved in this FUBAR, show me who got relieved of command / fired for this and I’ll lay off GEN Milley.

        I’ve seen officers’ careers ended with a thud for sins a lot less grievous than this one, but then again we also have the example that (IIRC) none of the senior Abu Ghraib officers were fired either (like the commanding general) so maybe the military has changed its standards. If so they will come to regret it.

        • Rayne says:

          “Afghan agents” is kind of loaded. You think the overwhelmed and certainly leery troops we had remaining on the ground were monitoring every single one of thousands of “Afghan agents” — including ones loading their car with container after container of fluid?

          And you say you “may not have the current intel” but the people over the horizon had to make a decision — confronted the trolley problem —- based on what intelligence they had and you have zero doubt that they made a bad decision rather than giving them the benefit of the doubt that they were deliberately fed bad intelligence they were likely unable to validate with HUMINT on a vehicle loaded with fluid.

          Jesus Christ, it’s as if the possibility we’ve been fucked with by other foreign entities to undermine U.S. credibility never enters anybody’s mind any more in spite of the numerous occasions where intelligence has been borked.

          • Rugger9 says:

            The point you seem to miss is that this person was known to us as one of ours. It could very well be that the left hand did not talk to the right hand here, but given the situation it was Milley’s duty as C-JCS to inform CENTCOM that the rules of engagement were changed to have JCS approve any strikes during the withdrawal. That also means no strikes unless confirmed by HUMINT, and those are decisions well within Milley’s ambit.

            Someone on our side knew this guy but allowed the strike anyway. The only statement that would support this strike was that he was behaving “suspiciously” in the mind of the drone team. Were there no checkpoints?

            • P J Evans says:

              I doubt that we track every “agent” all the time, and I suspect that from a distance it might be hard to tell who’s who and what they’re doing.

              • Rugger9 says:

                Well, since you seem to imply that you do, show me where I am wrong. DoD admitted they were wrong, in print and offered their regrets. That by itself is pretty significant since the military rarely admits errors in judgement (USS Iowa, USS Cole, Tailhook, Abu Ghraib, etc.), and it is quite probable that these hints of DoD intel are out there to cover their own arses. I’ve seen this before while in the service, and that’s why cynicism is a good characteristic to develop when getting fed information by someone that could be culpable themselves.

                As for “tracking every agent”, the USA handler actually does as part of his job in order to avoid loss due to friendly fire. Nice try.

      • e.a.f. says:

        Rayne, totally agree with your response about Milley. Sitting here in Canada all I can say is, thankfully the Americans have a General like him. Makes me feel safer he was there for all of what has transpired in the not so distant past.

        • Rugger9 says:

          Not saying GEN Milley’s always wrong, but he was very wrong here and he needs to go. Has GEN Milley fired anyone yet? I haven’t heard of any commanders being relieved for cause. That would tell me some accountability is being done, otherwise I keep getting this underlying vibe that “this guy deserved it because we thought so from our echo chamber discussion”.

            • Rugger9 says:

              Milley selected the team to make these decisions, and as politically charged as this situation was during the withdrawal, I have no doubt that Milley would have at the very least made sure any drone strike in the region is approved through him. He’s enough of a political animal to know the consequences, not least of which that the Taliban and future adversaries can point to this drone strike and tell anyone otherwise willing to help the USA that we’ll just kill them anyway when they’re not useful (not true, but it will happen). We won’t get the time of day after this.

              GEN Milley’s in command, and that means he owns what his people do because he put them there to follow his orders. Anyone who served knows that. There still doesn’t seem to be any firings either by Milley or by CENTCOM. Perhaps there is something being done but not yet in the press. At the very least we should get the rest of the family out since they’re in danger from the Taliban as collaborators.

              • Rugger9 says:

                The press reports are that the target (Ahmadi) was a military instructor. Definitely known to support our side. The only question is whether he changed sides, which given that he was trying to get the kids out says he did not. If he had changed sides DoD would have said “good riddance to bad rubbish” and not apologized. But, DoD did. And, the family remains in danger.


              • Rugger9 says:

                Schiff says there will be hearings, GEN McKenzie (CENTCOM) claimed “full responsibility” for the FUBAR, but as yet hasn’t resigned. Milley should have asked for McKenzie’s head as soon as it became clear within DoD what happened.

    • Bill Crowder says:

      Let’s not forget the many, many other “mistaken” killings in our War on Terror. Funny how all of a sudden people find only this latest horror unacceptable.

      • Rugger9 says:

        Not so, but this was probably the worst in a long time and perhaps the most clear-cut. This wasn’t a situation where human shields were used or the scene restaged by the local jihadis or there were legit reasons to think there could be a real threat here. And FWIW, many of the earlier ones were called out loudly in the press but under DJT in particular nothing would be changed.

        • russell penner says:

          Pretty good odds the intel source on this horrific mistake was under Taliban control. Who gained a significant propaganda advantage though the death of innocent children. In 20 years, it seems the military learned very little about jihadist mindset.

          • Savage Librarian says:

            I must admit that I’ve wondered about that too. Considering how difficult it has been for Americans to determine what is true and false in our own country, the horrendous confusion about facts must have been intensely magnified in Afghanistan during our final days there.

            I think someone shared this before, but I found it interesting;

            “What I Learned While Eavesdropping on the Taliban: I spent 600 hours listening in on the people who now run Afghanistan. It wasn’t until the end of my tour that I understood what they were telling me.” – Ian Fritz, 8/19/21


    • Molly Pitcher says:

      Rugger, you chastised me for grumbling about Milley and Lafayette Park. I have to say I am still on the fence about him. Rayne is right, there is a whole lot of intel we know nothing about. I would like to believe that our Intelligence is more accomplished than they appear from the outside view, but we don’t have the perspective to know for sure. This makes for great discomfort.

      BTW, Go Bears ! Good day in Strawberry Canyon. Gotta enjoy those victories when we get them. It’s going to be a long year I fear.

      • Rugger9 says:

        This one was worse for the reasons I have noted above. I was in the Gulf about six months after the USS Vincennes (CG-49) shot down Flight 290 that had been vectored by Iranian air traffic control over the US ship only recently engaged with Iranian gunboats, despite a still-active Notice to Airmen issued by the State Department after the USS Stark was hit in 1987. In short, airmen were warned that doing so would mean a shoot down, and the Airbus was warned at least twice with proposed course changes to proceed and ignored the warnings. The Iran-Iraq War had only recently ended so there were plenty of bad feelings in the area.

        There were plenty of mistakes on USS Vincennes, though, and Rogers’ information was that he had a Tomcat bearing down (remember that Bandar Abbas is both a civilian and a military airfield, like Honolulu is), and he protected his ship as he saw it. The USS Sides nearby had a different picture (for many reasons, including what radars were employed) and her CO went after CAPT Rogers who nonetheless remained in command, got a Legion of Merit medal for his time as CG-49’s CO and retired after another shore tour.

        As for the Bears I remain underwhelmed with excitement. Garbers missed too many open receivers and most of us in the stands were saying things like “he won’t get away with that against SC”. Incidentally, some order was restored (plane notwithstanding, or leaning…) by SC’s thrashing of the Cougars.

      • Ginevra diBenci says:

        The years are always long when you’re looking to the Bears to keep things moving. But I’m sure you know this, Molly Pitcher. When things go awry (and they will), I just replay memories of 1985-86. I know this reveals me to be 1) old, and 2) delusional, but growing up with Chicago parents does that.

  13. harpie says:

    Failure to vaccinate increases risk to others as much as drunk driving
    Sam Wang September 15th, 2021

    Today in the Washington Post, I join columnist Leana Wen in considering vaccination’s consequences – for other people. We argue that from the point of view of endangering other people, going unvaccinated is on a par with drunk driving. […]

    • e.a.f. says:


      Yes, we don’t get to drive drunk because we not only injure others but kill them. We drink and drive we are fined or sent to jail or have our driver’s licenses revoked. I’d suggest going around unvaccinated is the same thing. The unvaccinated can cause others injury and/or kill.

      Adults can be vaccinated but there are these other people, they’re called children and they don’t get vaccinated if they’re under 12. How dare these anti vaccers decide these children are expendable because they don’t want to be vaccinated or wear masks.

      No one is forcing them to be vaccinated, they just shouldn’t be able to go out in public. Living in British Columbia, Canada, our Premier and Chief Medical Officer have once again implemented protocols for public spaces–vaccinated, masked, etc. People who don’t want to be vaccinated don’t have to be, but they can’t enter a whole lot of places and indoor spaces everyone is required to wear a mask.

      Our neighbour, Alberta, their right wing Premier had other ideas and that didn’t turn out so well. Their hospitals are full, the Premier has sort of apologized, and Ontario is taking their over flow of patients. B.C. declined to “help out” the Alberta Premier saying we need to keep our extra available beds open incase things get worse here and for patients needing things such as surgery.

      People made choices, some times they’re the wrong ones and they die. Along the way theyt cause others to die and that just should not be on. of course it hasn’t helped that senior government officials, idiot politicians, have not understood science. some one ought to try charging them criminally. Yes, I know Bmaz is going to tell me that isn’t possible but if you give some one COVID and they die, in my opinion that is manslaughter.

      To those who don’t want to be vaccinated because they aren’t sure about the vaccines, the vaccines have been around long enough now that we know they aren’t going to kill you, well most of us. there has been the odd case where there was a bad reaction, but those cases are few and far between. Its like in Quebec, where women were being killed in domestic circumstances, The lock downs forced people to stay home and in some cases that was not a good thing and domestic abuse increased substantially. Had a look at the stats and women had a better chance of being killed by their spouse than by the vaccine. I would have taken the vaccine.

      Some times I think younger people aren’t being vaccinated because they have never lived in a time when diseases, besides cancer could kill a lot of people. As an aging baby boomer I remember people dying of polio or being left in an iron lung, or wheel chair. Got vaccinated as soon as I could.

      • bidrec says:

        Commenting on your last paragraph, my next door neighbor had polio and was in an iron lung. When the power went out it switched to a generator in the basement. The exhaust pipe was right under the parlor window—the iron lung and she were always in the parlor except for nice days when her husband carried her outdoors. There was also a telephone in every room which was unheard of in the ’60’s in case of an emergency.

        • P J Evans says:

          I know that the utility company I worked at knew who had medical needs, like a generator for emergencies.

          Kid next door had had polio and had braces on both legs, plus crutches. Cousin (a month younger than me) had polio also, was lucky to only have one leg “withered”.

  14. harpie says:

    Modeling The Pandemic: How Many Will Die?
    Cheryl Rofer 9/19/21

    […] The bottom line, expected deaths for the US, is close to 300,000, which will give a total close to a million dead from covid. That doesn’t count excess deaths from the overloading of the medical system. Combined immunities from illness and vaccination are not too different from the percent of vaccinations. The pandemic is far from over.

  15. RWood says:

    “…that care would be allocated in order of patients’ likelihood of survival…”

    Most have no idea what goes into those few words. For the doctors making these triage decisions, and despite the public insistence that it will not, the vaccination status of the patient WILL enter the equation. Other than battlefield conditions the closest I can think of, from my own personal experience, is organ recipient panels. Who is more deserving of this heart? Who has the best chance of being alive in five years? Sometimes the smallest of factors can sway that decision. I’ve seen people lose based on the condition of their teeth. (If you can’t take care of your teeth how can we expect you to take care of a heart?) Its a very blunt process.

    And yes, there will be some Keynesian/Utilitarian inner battles. I was ridiculed for this the other day here but I have zero doubt those thoughts will enter the minds of the doctors and hospital staff being forced to make these decisions.

    I don’t envy them. The next few weeks will likely be the worst of their careers.

    Good to see you again, Rayne.

    • Rugger9 says:

      Indeed, not only will they need to live with a decision about who to treat, but also the decision effects because new patients come in and not with COVID. There have been several of those in the news as well where these patients could have been saved but the bed was taken up by some anti-vaxxer COVID case and the patient died. I think it’s one of the reasons that most of us have had enough of anti-vaxxer tantrums which incidentally are not spilling out into open insurrection at school board meetings.

      e.a.f’s comment about the BC Premier (similar to USA governors) keeping capacity open also raises the question of how many beds for how long? Those decisions will also mean patients will be turned away. Combining all of these issues makes me wonder how long it will be before someone sues out of rage and grief when a loved one dies due to being denied care. In my opinion it’s only a matter of time before someone gets mad enough to lash out this way.

      Do they go after the hospital, the patients clogging the system after not being vaccinated, the ones like Faux, OANN, Newsmax, the bible-thumping “pastors” who tell them that getting the jabs means Satan / socialism / DNA alteration / etc. is just around the corner? Or, do they go after the ones like our Marin teacher who didn’t vaccinate and potentially/allegedly infected the class? With an incubation period up to two weeks cause and effect would be hard to prove without CRISPR / PCR analysis to trace a particular source even if the parties involved agreed to be tested (which I’m sure would be fought in court). Faux for their part demanded the jab, which makes their continued “merely asking questions” shtick more monstrous than usual.

      • Rugger9 says:

        I had forgotten about the anti-vaxxers affinity for, ahem, alternative medicine where a judge in OH (IIRC) ordered the doctors to use Ivermectin to treat someone’s husband and was later overturned by a different judge. So, we’ll get to see more of that kind of litigation as well, which can’t help on any level.

      • John Paul Jones says:

        B.C. is currently experiencing a steep rise in COVID cases, but they are almost all (90% or more) among the unvaccinated, and almost all in either remote northern areas or in the interior of the province, which area is much whiter and older than the major city (Vancouver). The interior of the province, in other words, is “red state” whereas the urban areas are more “blue state” and with a population that is much much more diverse.

        • Rugger9 says:

          We have that situation in CA as well, or in PA which my beloved (who is from there) describes as two big cities separated by Alabama.

        • MB says:

          Despite the described geographic balkanization (which is found almost everywhere), the new province-wide mandates in B.C. affect everybody. A friend of mine who lives in Nanaimo on Vancouver Island got surprised today when he attempted to pop into a local restaurant to get some take-out food, and he was refused entry because he didn’t have his vax card on him and so couldn’t prove to them he was a member in good standing of the sane and thoughtful Canadian citizen club. He’ll have a new habit tomorrow, I’m sure – no shirt, no shoes, no vax card – no service!

          I was up there 3 weeks ago and it was completely different then – about 25% of the people I saw in public were wearing masks, you could walk into a restaurant without a mask or a vax card and they would ask for your name and phone # for contact tracing purposes, but that was about it. Rising infection rates in a region (or whole province) can change things in a hurry, though…

  16. Raven Eye says:

    And the spin-off impacts just keep building…

    Mercy Flights is a non-profit that was the first civil air ambulance service in the U.S. They also provide ground ambulance service for most of Jackson County, OR — where they are based. Thousands in the region sign up for membership, and if you don’t use the service, that year’s membership fee is considered a donation. (

    And now I read in the paper: “Mercy Flights can’t keep up with requests for transport during COVID-19 surge”

    They have three Beech air ambulances (missions crewed by two pilots, one nurse, one paramedic) and one helicopter. It’s the fixed-wing services that are the busiest, which you can tell by looking up the tail numbers (N149MF & N121MF — N117MF appears to be out of service) on FlightAware. The hours on airframes and crew members just keep climbing, and eventually a company may need to start triaging their missions.

    One of the ironies is that there are a bunch of RMWJs in Oregon who want to split the red counties and become part of Greater Idaho. I’m sure they’ll want to spin this whole disaster with something like “See? At least Idaho knows how to defend our freedoms.”

  17. Molly Pitcher says:

    The graceless side of my personality would like to blow off those who have refused to get vaccinated and observe common sense protective measures, but the practical side says they are walking petri dishes of morphing variants we need to be protected from, and the spiritual side wags a warning finger of Karma. Every day is a battle with the rising gorge of schadenfreude.

    I am usually pretty good at seeing where things are going to end up, but I just cannot see how this all ends. January 2020 seems like years ago, but I don’t know where the days of the last year and a half have gone; they are mostly indistinguishable from each other. I want to say this can’t go on like this, but my real fear is that , yes, we could be stuck going on like this for a long time.

    • Rugger9 says:

      I think as long as the “willingly unvaxxed” percentage remains in the 30s herd immunity isn’t achievable which would be the prerequisite for “normal”. I think Rayne’s note above about the neurological change is apt and worth more investigation but we as a society still need to address the quality of information these resisters get and fix that. That means restoration of the old communications limits on station ownership that Bill Clinton signed out of law with the Communications Act. It will be harder now that most people get a significant part of their information from the Web, with all of the charlatans out there.

      • RWood says:

        Herd immunity will be reached, but there are two ways to get there.

        One is the vaccine in the arm of 80% of the population. The other is the virus killing off enough of that population so the remainder is 80% vaccinated. We won’t get there anytime soon with the Darwin variant, but maybe the next one, and we’re pretty much guaranteed a next one thanks to the anti-vaxxers.

        The anti-vaxxers are forcing us to go with option two, even though it’s them that are the ones dying. And frankly, like Rayne I’m out of fuck’s to give for them. Once the kids are vaccinated that’s going to get even easier.

        • Rugger9 says:

          If it were JUST the antivaxxers dying I wouldn’t have much irritation about this situation, but they are creating a lot of collateral damage as well from those who can’t vaccinate or are denied beds because of anti-vax mulishness and that is what makes me angry. They should go last in line and stay in quarantine until they are vaccinated.

    • Eureka says:

      He wentz to do his research (smart guy!) to figure out how to treat that ankle properly, build an MRI room… too bad NFL won’t agree to take that dead cap off our books towards his medical schooling. Like a scholarship!


      So you guys gonna trade out Kliff K for Dougy P next year? (This is his season of redemption, too, btw. Have never seen so many Colts fans yelling about Reich’s incompetent play calling.)

      But I had a big sad today over one of our dlinemen out for the season now: BG, Brandon Graham –heart of the team, others would recall him for the strip-sack of TB in LII. Injuries all suck but this hit different.

      • bmaz says:

        That is a hard question. Maybe. Give Pederson credit, he did win a SB with a backup QB. Can Kingsbury get AZ there? I do not think so. But a lot of the NFL is luck, so guess we shall see.

        • Eureka says:

          Kyler & co. (stacked roster — also you must have a great GM to have gotten those top Texans @ firesale) might be good enough to overcome those deficiencies you see in the coaching, or maybe Kingsbury’ll bring in some advisors.

          and to clarify 8:16 pm: “incompetent” re Reich is their fans’ new claim, not mine. Carson checked so much baggage to Indy that you could change the dates and hashtags and not be able to tell whether the excuses and complaints are Philly then or Indy now (“bad oline” “not enough good receivers” “poor playcalling”). This despite the exact opposite rhetoric peri-trade (he’ll have a better line and weapons, Reich).

          Some on the twitters have gently suggested that maybe it’s Wentz … but few want to hear that.

          • Rugger9 says:

            Most of the sports writers consider it more due to Texans’ front office incompetence, but AZ seized the opportunity.

            • Eureka says:

              Thanks- that both makes sense, and explains the rumors of them (nonsensically, IMO) playing hardball over trade terms for their troubled non-playing QB (though they may get their way yet if Tua is in trouble: Fins were rumored suitors).

      • Eureka says:

        Oh Bills won today too, so not necessarily recalling everyone the tree’s at least .500 on the day, plus WFT Thurs.

  18. may says:

    when all this started it was accurate to say that I could be infectious with the disease and not know it.
    so every one I came into contact with could also be infected.
    my family, my neighbors , the people at the local shop, any children, babies, old people
    and I, if uninfected, could be so by the same people.
    the idea that such reality could be ignored because of some sort of ideology is not valid.

    writhemouth republicans are cashing in?

    there must be money in it somewhere.
    but where?

    nature doesn’t do ideology.

    nature does consequences.

  19. harpie says:

    Covid-19 vaccine for 5- to 11-year-olds is safe and shows ‘robust’ antibody response, Pfizer says
    7:38 AM ET, Mon September 20, 2021

    In a highly anticipated announcement, Pfizer said on Monday a Phase 2/3 trial showed its Covid-19 vaccine was safe and generated a “robust” antibody response in children ages 5 to 11.

    These are the first such results released for this age group for a US Covid-19 vaccine, and the data has not yet been peer-reviewed or published. Pfizer said it plans to submit to the US Food and Drug Administration for emergency use authorization soon.

    The trial included 2,268 participants ages 5 to 11 and used a two-dose regimen of the vaccine administered 21 days apart. This trials used a 10-microgram dose — smaller than the 30-microgram dose that has been used for those 12 and older. […]

    Here’s the news release:
    Monday, September 20, 2021 – 06:45am

    Results are the first from a pivotal trial of any COVID-19 vaccine in children under 12 years of age
    In participants 5 to 11 years of age, the vaccine was safe, well tolerated and showed robust neutralizing antibody responses
    Companies plan to submit these data to the FDA, EMA and other regulatory agencies around the world as soon as possible
    Results in children under 5 years of age are expected as soon as later this year […]

      • Rayne says:

        Pfizer could be goosing their stock price, but they’re damned-if-you-damned-if-you-don’t as are the other major vaccine makers. How many times have we heard anti-vaxxers — the hesitant ones on the spectrum — complain they haven’t heard enough about the vaccine/know nothing about its effectiveness/haven’t heard any research results. I don’t see how Pfizer management can do anything but share data ASAP.

      • P J Evans says:

        Three of my brother’s five grandkids are in that 5-11 group. (One is over 11, and one well under five.) We’ll all breathe a sigh of relief when they get vaxxed.

  20. skua says:

    The use of CSC for a predicted situation that could reasonably been mitigated by preparation has Idaho not part of modern civilization.

    The failure to take basic steps to ensure a reasonable level of medical care to inhabitants makes the legitimacy of the Idaho state government questionable. If the governement can’t organise this then what is the point of it?

    • Leoghann says:

      “. . . [M]akes the legitimacy of the Idaho state government questionable.” Have you checked out the Idaho state government lately? Their governor is a right-wing Republican, who doesn’t dare leave the state because, when she does, the lieutenant governor, who is nuttier than 45, steps in and signs insane executive orders. And despite the fact that those orders are executed illegally, so far no one has attempted to charge or arrest her. It’s nuts up there.

      • Leoghann says:

        There’s a typo in my above comment that makes it a bit confusing. It should be “governor . . . he.” The governor is a man, and the Qhead lieutenant governor is a woman.

  21. Stephen Calhoun says:

    This evokes pictures of full NFL stadiums this weekend, all of which have semi-indoor food courts, swag and other vending areas, and, in the stands, lots of shouting.

    Superspreading is one of the terms we’re not as a society strongly associated with much anymore—in year two of the pandemic, (along with contact tracing, social distancing, and other terms.)

    • Rayne says:

      Oh, I thought “superspreader event” when I drove by a Stop-the-Steal Trumper rally two weeks ago where more than 100 assholes had gathered to party together here in my town. Flipped them off as I drove by, thinking of the burden on our ICUs if they got sick after their little pity party. Ignorant selfish fucks, the lot of them.

      ADDER: Goddamnit, it was definitely a superspreader event. Look at this chart – that spike is 10 days after their absurdist rally, and it dwarfs the spike in cases which happened after Trump’s campaign rally near here last autumn. I will be absolutely furious if they’ve killed anyone who isn’t a bloody Trumper.

      • Rugger9 says:

        I’m trying to locate where I ran across the chart of COVID cases at the county level versus Trump vote percentage and it was a very clear correlation that being a MAGA cult member is a factor to consider for risk of infection.

        Markos Moulitsas has been running the Anti-Vaxx Chronicles over at Daily Kos for a while now, and it’s clear these people don’t want to wise up. At least he’s classier about the reporting than the Herman Cain Awards or are.

        • Rayne says:

          Charles Gaba has been tracking that correlation for several months. Dr. Eric Ding shared one such graph recently.

        • Alan Charbonneau says:

          A Twitter post showed a map of Calif’s recall election by county and another with covid hot spots. There was a high correlation between the support of the recall & the severity of covid.

          I grew up in California and I know the geography reasonably well. Covid was a bigger problem just north of Los Angeles county in Kern, Kings, and Tulare counties. L.A., Orange, and San Diego counties have more than 15 times the population density than Kern, Kings, & Tulare but less of a covid problem.

          The covid mentality of people makes my head spin.
          Earlier this year, “Zoe” on Twitter posted
          “If lockdown works, explain the following:
          Deaths per 1 million population:
          Florida – 1591
          California – 1537

          Which state had draconian lockdown”
          8:05 AM · Apr 15, 2021

          So I updated the numbers and as if today (Sept 21, 2021) the figures look like this:
          Florida – 2,416 (ranked #10/50)
          Calif – 1,726 (ranked #33/t0)

          So, back in April, Florida had a deaths per million (dpm) of 1,591 out of a population of 21,477,737= 34,171 deaths. To get to a new dpm of 2,416 we need another 17,713 deaths.

          For California, we had 60,730 to get dpm of 1,537. Today, we need 68,185 to get a dpm of 1,726 – that’s an additional 7,455.

          In sum, Florida has had 17,713 deaths since mid-April with a pop of 21 mm and calif has 7,455 with a pop of 39 mm

          Trumpists point out that NY has a higher dpm rate, but almost all of the deaths were early in the pandemic with Manhattan being a perfect superspreader city. Lots of people commuting in to a hot spot and bringing the virus home with them. People always want an easy answer that supports their position.

  22. Drew says:

    Having grown up in Idaho, I paid attention to what was happening there since the very beginning of the pandemic. The earliest hotspot there was in Sun Valley/Ketchum which is substantially more liberal than most other areas of the state, stemming from being swamped with rich people from the big cities that identify as Democrat. They had a big “end of ski season” party around March 1 that was a superspreader event. During the early period they seemed to be working pretty hard to follow professional public health practices.

    I should mention here, that >50 years ago I attended Episcopalian church camp with the current governor. As popular rich kids went, he was kinder than most. We weren’t friends or anything, but he wasn’t among the bullies and assholes that abounded in middle school. (Being the scion of the largest sheep ranching family in Idaho is what counts out there as “old money”)

    It hardly surprised me that the kid I knew a little ended up a politician. And it was almost inevitable that he would end up a conservative Republican. But his instincts were mostly toward doing the right thing. Then his Lt. Governor, who is a real Q-Anon Queen decided to go with the extreme anti mask anti vax people. (Protests at the state capitol and all that shit) So somewhere in the summer of 2020 he buckled and policy became as permissive as all the other red states. And covid spiraled out of control as Trump mania ran crazy throughout the state.

    I kind of stopped following it closely after a while, not having much stomach for those antics. But my wife was researching some things and she pointed out this video from August 31. It basically is the first stage of rolling out this declaration.
    It’s not a profile in courage, but it’s reflective of what the not-insane Republicans would do if not overwhelmed by the Trumpian rhetoric. However, I’m pretty sure that Brad will be primaried if he runs again and they will get a right wing extremist as governor. He’s my age and I’m comfortably retired, so I wish him the best, but I’m very pessimistic about the state actually electing someone better.

  23. pdaly says:

    Wow! That is quite a spike!

    I wonder if those protesters live by the scientifically incoherent phrase I saw recently by my (now blocked) Facebook friend who was having a meltdown after Pfizer’s COVID19 vaccine achieved full FDA approval and word of workplace mandates to receive the COVID vaccine hit the news cycle:

    “Vaccines are for diseases, NOT viruses!”

    I am tempted to say this person is not paying attention, but that description misses the fact that this person is always listening, always parroting the latest misinformation, and ceaselessly following the programming, including, as soon as the programming demanded it, detouring ‘to save Dr. Seuss books’ or castigating minimum wage earners for ‘being too lazy on government subsidies to return to work.’

      • pdaly says:

        No doubt. But since “disease” seems to be a legitimate reason in their mind for a vaccine, I think I am going to explicitly say “COVID-19 disease” over and over when talking with any unvaccinated person.

  24. Leoghann says:

    I have a very good friend who is a county coroner in Idaho. These days, the best way to get a very long, very serious response from her is to ask (or declare) something along the lines of “but it can’t be all that bad, can it?” She’s been swamped with work, as you might imagine, and so much of it is heartbreaking–whole families dead, extremely conscientious public servants, the list goes on. As she put it, “we’re losing so many of the good guys.”

    She pointed thing out to me the other day, as I was grousing about covid patients taking up hospital beds needed by people who had been in accidents, had heart attacks, etc. The CSC being in effect also means that some people extremely sick with covid, who are unvaccinated almost without exception, will be the ones taken off ventilators and treated as DNRs, when some young, otherwise-healthy accident victim comes in. All those beds aren’t just sacrificed to covid patients.

  25. Rugger9 says:

    I wonder if TX Lt Gov Dan Patrick got himself vaccinated like the hypocrite he is. As I recall, his was one of the loudest voices early on about how it was noble for the old folks to clear the way for the young’uns by dying, to which I responded: “You first”.

  26. Nord Dakota says:

    To clarify–there is no universal DNR at this time.

    Hospitals may apply this if they do not have enough ventilators. So far they do and are ordering more as well as pulling old equipment out (the news media reports I found said nothing about what if there are not enough staff top use the ventilators).

    I suppose your ICU bed may be in the cafeteria . . . .

    • Rayne says:

      Right here:

      Adult patients hospitalized during a public health emergency, when crisis standards of care have been declared (and a hospital is using the mechanical ventilation allocation framework due to demand for ventilators exceeding supply), should receive aggressive interventions;

      There *is* a Universal DNR Order in place because the state remains in Crisis Standards of Care. But no cases of deaths due to lack of resuscitation have been made public likely because the hospitals are still using the mechanical ventilation allocation framework mentioned in the order; DNRs could have already happened but we may not know because of HIPAA.

      The question is when will the limit of supplies and staff to handle mechanical ventilation be reached? If Idaho is still under CSC, it could be any time.

      You can say there’s no universal DNR order when Idaho has left the CSC.

      • RWood says:

        If there are not enough vents just get some anti-vaxxers in there to manually bag them for hours on end.

        I’ve done it on long transports when the vent chose to stop working, as well as in some rather undesirable places around the world when the power failed or there were just no vents.

        Vents are a luxury, not a neccessity. Work the idiots in shifts until their hands can’t squeeze anymore. Then see what they think of the hoax.

        • Rayne says:

          I wish that would work but how many anti-vaxxer-baggers would arrive infected and spread it to others who weren’t infected? And then they’d continue to whine as they have that COVID patients are being denied hydroxychloroquine/ivermectine/betadine/snake-oil-du-jour, disrupting others’ care, while ranting it’s only the flu. ~sigh~

          Makes me think of the line in Jane Austen’s Pride and Prejudice in which Mrs. Bennet responds to her daughter Jane’s sudden illness, “Oh! I am not at all afraid of her dying. People do not die of little trifling colds. …” ~eye roll~

      • Nord Dakota says:

        So in theory, it is possible that a person who goes into cardiac arrest could be allowed to die. But first, three things must happen:

        Crisis standards of care must be declared. That happened statewide on Thursday.
        Hospitals operating under crisis standards would have to include this “universal DNR” in their own plans. St. Luke’s, which is Idaho’s largest hospital system, does not currently have a universal DNR in its plan to deal with the COVID-19 crisis.
        And this is the “important part,” says Johnson: A hospital must not have enough ventilators. The shortage must be significant enough for a hospital to be forced into using the “mechanical ventilation allocation framework.” Johnson said that applies to “nobody I know in the state” at this point. St. Luke’s still has enough ventilators, he said. Earlier this week, it was using 77 of 101 in its supply and recently placed orders for 20 more to arrive in the next couple of weeks, he said. “We’re limited in staff, for sure, we’re limited in space, for sure, but ventilators, we still have enough,” he said.

        This is not to minimize the seriousness, especially as (I am sure) they are juggling hospital beds.

        Here in ND, there have been some protests about school mask wearing (not all schools have mandates and we have a new statute that says the gov cannot mandate masks statewide (which he did with great reluctance last November when we had the world’s highest covid death rate, total 2020 deaths 20% over the average of the previous 3 years). Interestingly, the rate of increase has been dropping. July-August 1000 positives would be 1049 by the next day, 2 weeks ago that rate was down to 3.3 (from 4.9) and although I haven’t done the calculation I would put it at around 2.8 now.

        The adults under 40 are still majority unvaxxed, and the 30-39 year old set remains (as it has all along) the highest number of cases.

        • Rayne says:

          If a hospital doesn’t have enough trained health care personnel to intubate patients, unused ventilators are useless. If they don’t have enough personnel to mechanically bag patients, a default DNR will happen. To some extent the order isn’t an instruction, but a rationalization for what may happen when one of the key limiting factors is met and resuscitation isn’t possible.

          • skua says:

            I think it would also function as legal protection for staff forced to make a DNR decision.
            “I made the best decision possible in the context, a decision informed by and consistent with the activated official CSC.”

            • Rayne says:

              Yup — because the conditions in a crisis scenario are fluid. No knowing in advance what nurse-to-patient ratio will be, as one example, at any given moment, and that ratio matters deeply. It’s not the nurses’ fault; it’s a crisis.

              Just fucking galls me there’s more attention paid to whether it is/isn’t a universal DNR order, whether people have died/not died under the order, instead of the fact there’s a wholly preventable man-made existential crisis under way and so little energy aimed at stopping the underlying cause.

  27. Wm. Boyce says:

    Even here in the Bay Area, I know of one local hospital that’s filling up w/Covid cases from afar. I’m sure it’s not just one that this is happening in.

  28. Raven Eye says:

    This could be considered surrendering to the situation, or more positively, adapting to the reality:

    “Order of the Health Officer of Mendocino County to require posting of consumer notice of vaccination policies for patrons and workers where food and drink are provided indoors.”

    Scroll down to the last six pages in the link and you’ll see the placards that restaurants* are required to display as soon as possible, but no later than November 1, 2021.

    The placards are green, yellow, and red, indicating:

    Green: All employees are vaccinated or tested weekly. Vaccinated patrons welcome inside. All must wear masks inside except when actively eating/drinking. Patrons who are not vaccinated may only be seated outside or take out.

    Yellow: All employees are vaccinated or tested weekly. All patrons may be seated inside All must wear masks inside except while actively eating/drinking.

    Red: Employees are not required to vaccinate. Patrons are not required to vaccinate to eat inside. All must wear masks inside except when actively eating/drinking.

    * “…operators or hosts of establishments or events where food or drink is served indoors, including but not limited to, dining establishments, bars, clubs, theaters, and entertainment venues. For clarity, this does not include food or drink provided as part of a religious ceremony, (e.g., communion or Kiddush).”

    • Fran of the North says:

      Interesting. I wonder whether there will be differences in occupancy/spend based upon the color of the placard. I for one would turn on my heel if I was entering an establishment that posted a red placard.

      If enough difference exists, restaurateurs may change policies to improve their bottom lines.

      • Raven Eye says:

        I sent the link to my county Board of Commissioners (2 of the 3 are total idiots) and suggested they consider it. I also said it would make a difference in my COVID indoor dining choices (which have been zero up to this time). I would actively look for the green signs.

      • Tracy Lynn says:

        Or, they could do what a restaurant in my neighborhood did when our county first reopened — restaurants were supposed to open with half capacity only. So these this restaurant did so, opened at half capacity, but crammed most of the tables it normally has into that half of the restaurant so that patrons were practically sitting in the laps of strangers. It took a week or two, but the restaurant finally got called out and management took out half the tables.

  29. mospeck says:

    Half of my neighbors up here in the low Adirondacks just don’t trust the vax, nor the Feds, or the modern science, God forbid. You can talk until you’re blue. Still, you gotta love these hopeless Joes who are now getting measured up for their caskets (it’s like from some old Clint Eastwood movie). Yea, it’s depressing. Yea, it gets you to thinking that maybe it’s just our time for moving on, and time for the AIs.
    Meanwhile, United Russia won in the shocker of all mothermoosefucking unexpectedly shocking results with a resounding 49.8%, with the commies coming in 2nd at 20.1
    Just another good reason to root for the AIs.
    Rayne, yea, I listen to Coltrane, derail my own train, because it makes me happy

  30. Claudia says:

    Usually a reader not a commentator as not a lawyer – but AM a brain doctor.

    Ephraim: whether COVID 19 is implied or stated or whatever in the Idaho actions is irrelevant. Nobody knows if an acute stroke patient is aerosolizing the novel coronavirus at them – or potentially transmitting hepatitis viruses via that accidental needle stick – that’s why universal precautions are universal. Rayne is on the right track here: it’s not about whether the crisis rules specifically apply to COVID patients, its about how *all* patients hitting overwhelmed hospitals in northern Idaho are at risk for a radically reduced level of care and potentially at risk for preventable loss of life due to hospitals being swamped by COVID cases – in direct correlation to the low levels of vaccination in the area.

    The red-states-will-burn comments: totally agree w/ the red state/vaccination correlations. Unfortunately now we get to see how effective state-wide branding/tribalism campaigns are – currently hospitals are obligated to accept transfers from across state lines if it’s medically necessary, the resources are available, and the patient can’t get the care where they are – say, an overwhelmed place. Will that hold? I note Bay Area comment on high patient rates there thanks in part to transfers in. Hoping to catch up soon w/ a colleague just off an ICU work stint in that area, she wasn’t ready to talk earlier this week after processing “a lot of bad death”. I’m scared of the Idaho measures. I’ll be terrified if states try to start blocking transfers.

    For everybody putting their honest empathy/sympathy wipe-outs out there: I feel you. And my own feelings scare me, in part because that’s where blocking hospital transfers starts. However… I volunteered at a vaccine clinic in late August (midAtlantic, not Idaho). There was a steady trickle of patients all morning, not awesome but not nothing. One immunosuppressed person getting approved 3rd shot. Couple 12 year olds w/ calm parents. Mainly middle aged people getting initial shots. What struck me was how genuinely scared some of them were. One nearly had a panic attack in the post-shot waiting area so we held them for extra time and I checked up on them until they decided they were ready to leave. One said up front they were only there because their sister and cousin kept calling and calling about getting it done (nurse took a photo for patient’s sister – no more calls!). One was so scared she backed out of the appointment but then asked to just talk. She was more afraid of the vaccination than what a COVID illness would do to her given her lupus (!), based on a ton of terrible and mainly grossly inaccurate info that had really pushed all her normal human fear-of-particular-risks buttons. We talked for 15 minutes and she decided to do it but it was a near thing, then she apologized for taking up so much time.

    I thought I was all done w/ the unvaxxed – the dental students who were holding out at the mass vaccination site because they’d read about male infertility and the vaccines (their classmates were rather over them as well); the family members blocking my elderly patients from getting vaccinated because the whole thing is a liberal conspiracy; the patients who openly admitted they figure “everyone else” will get vaccinated so they can avoid the risks; the colleagues who are themselves vaccinated but don’t feel right about vaccinating their own kids because after all kids’ risks are so low w/ (non-delta!!!) COVID… I’m a scientist and a physician, and the lack of analytical thinking crossed with enormous selfishness made me bonkers.

    Now I’m OK with the individuals. I’ve talked to enough of them to understand where their fear is coming from, and have let go of the I’ll-always-be-a-selfish-idiot minority. Instead I’m all done with the misinformation spreaders. This includes the people who openly state (I almost said “concede”) that they and their family members are vaccinated but you know there’s all this uncertainty nudge nudge wink so there should be freedom for others to do otherwise. The “I don’t need to act to prevent people from dying because more votes and/or money for me is more important” set.

    It’s worth trying to direct the ire at those accelerating the madness, because vaxxed and unvaxxed are all suffering together in Idaho.

    Thanks for letting me screed it up on an initial comment.

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