Charlie Riedel/AP Photo
Unsanitized-080420
A makeshift isolation area at the rural, 24-bed Kearny County Hospital in Lakin, Kansas.
First Response
Sunday and Monday are the typical slow days for counting coronavirus cases, hospitalizations, and deaths. We will have to brace for today’s results for the full trend. But based on current data (which, as I’ve said repeatedly, is a lot like the blind man feeling an elephant, though it can show trends), cases and hospitalizations are trending down. Deaths you would expect to have another week or so of increases before they start to trend down as well.
The Trump Veep sketch was embarrassing, but near the end he does mention that deaths were going down in Arizona, Florida, and Texas. It’s better to say that these states have plateaued on deaths and seen a sustained drop in cases (though testing is also lower) and hospitalizations, but in general there is a softening in the data. These trends could be reversed, but they hold for a lot of states with major outbreaks, like California. The death rise will likely continue for a little while but with hospitalizations falling, official deaths are probably going to fall as well.
If this wave does top out at a high of 1,500 or so deaths per day, that is a significant reduction from the 2,000-2,500 we saw in April. That does suggest better medical care has saved lives, which is a good thing, though obviously there are a host of bad outcomes from coronavirus that fall short of immediate death.
Of course, the whole country cannot breathe more easily now. It’s wrong to look at national cases in a country this vast, with different outbreak timelines. We are sadly likely to have these waves of hot spots and cold spots until there’s a vaccine in widespread use. For example, Ohio, Tennessee, Georgia, Oklahoma, and Kentucky are in a plateau at a high level; Idaho and Arkansas hospitalizations are rising without end; Alabama and Mississippi have raised concerns.
All of these states have large rural areas, and that’s where the trend of improved medical care could reverse itself. And as this study in Health Affairs shows, it’s a story about inequality.
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The study concerns intensive care unit (ICU) beds, a critical part of COVID-19 care. If you have a secure facility to administer to a patient, there’s a better chance of survival. But because America is America, there’s a critical shortage of ICU beds in precisely the places that need them the most right now; poor rural communities that are often too far from wealthy areas to transfer patients. According to the Health Affairs study, “49 percent of the lowest-income communities had no ICU beds… whereas only 3 percent of the highest-income communities had no ICU beds.” And this disparity was even sharper in rural areas, which again don’t have a richer community next door to which they can offload patients.
We’re seeing this in the Rio Grande Valley in Texas, home to 1.3 million residents and no public hospital. Starr County is one of the only in America to have to resort to triage, choosing who to care for and who to send home to die. The conversion of hospital facilities into ICUs is ongoing but often too late.
Rural hospitals, of course, are in total crisis in the U.S., with 19 closures last year and 120 since 2010. As hospital networks consolidate and strive for ever-greater profits, rural hospitals that fail to bring in the necessary revenue fall away.
This is where the virus is headed, into areas that are utterly unprepared for a crisis of this nature. That’s because America remains a place where your medical care is a function of your socio-economic status. This essential inhumanity should have been remedied long ago, but the crisis makes it impossible to look away. We have the greatest health system in the world if you can afford it. That’s a moral crime. Single-payer supporters are often derided as “unrealistic,” but it’s actually unrealistic to expect that Americans will blandly accept their bank accounts being a factor in their mortality. This must change.
One-Third
That’s the percentage of small businesses in New York City that could close up shop due to the pandemic, according to the Partnership for New York City. That’s 80,000 businesses in New York City alone. The working number I’ve seen for closures so far is 100,000… for the whole country. I don’t have similar numbers for my hometown in Los Angeles, but here’s a long and updating list of closed restaurants. I’ve been told that downtown Washington, near the Prospect offices, is a ghost town.
It’s in many ways not surprising that a small business program that provided eight weeks of payroll didn’t last in a crisis well into its fifth month, and by “in many ways” I mean in every way. This is another example of the temporary benefits of the CARES Act, set against the effectively permanent bailout authority for large corporations. There was certainly a way to have the corporate credit facilities run by the Fed expire on the same date that unemployment benefits and all the other pieces expired; that way there would be incentive on all sides to extend them. I don’t support the Fed facilities but at least that would be a politically balanced way to ensure a stake in the outcome on all sides. Now you have Mitch McConnell lamenting that 20 of his Senators will never vote for anything, and a party simply disinvested in desperately needed relief.
So if you’re asked why everything’s a Taco Bell or Amazon Go store in 20 years, remember this aspect of it.
Mail-In Blowback
The disruption of mail service across the country, as the new Postmaster General bans overtime and instructs postal workers to leave behind mail, is coming so close to a presidential election that will have a heavy vote-by-mail element that you can’t help but assume that this is the ultimate goal. I would say it’s a happy by-product of a bid to delegitimize the post office and warm the public mood toward privatization. The USPS had high marks for service and trust before now, making it the DMV of conservative fever dreams makes it easier to kill, and the pandemic provided the opportunity.
Now, seeing Trump assert that mail-in voting can’t be done now that he broke the post office certainly suggests opportunism. But the immediate impact of that will evaporate the traditional Republican advantage on mail-in voting. It will make things worse for him and his party. And the Postmaster General serves at the pleasure of the president, so the next one can throw out the Trump donor currently running the USPS into the ground. Just another thing to do on day one.
Days Without a Bailout Oversight Chair
130. Although maybe the chair is superfluous. The Congressional Oversight Commission is actually holding a hearing on Friday about the Main Street Lending Program. Maybe it will cover how the Fed changed the program to support the oil and gas industry. The hearing should stream at its new website, coc.senate.gov, which is sadly… not operative yet.
Today I Learned
- Quick Monopolized news, I did a long interview with Teddy Downey of The Capitol Forum, which is normally paywalled but you can access the interview here. (The Capitol Forum)
- I think “upbeat” here means that the screaming has died down in coronavirus relief negotiations. (Wall Street Journal)
- Some ideas about unilateral executive action are foolish, but the proper agencies probably could do an eviction moratorium. (Politico)
- Airline industry workers looking for another lifeline. (CNBC)
- Health care industry and particularly insurance profits are booming in the pandemic. (Axios)
- California might add millionaire tax brackets to deal with its pandemic-caused budget crisis. (Sacramento Bee)
- The St. Louis Cardinals are the second pro baseball team with a major outbreak among its players. The season is just a war of attrition. (USA Today)
