Rod Dreher's Blog, page 165
March 11, 2020
Life During Coronavirus Wartime
A thread by the Johns Hopkins political scientist Yascha Mounk:
The Italian College of Anesthesia, Analgesia, Resuscitation and Intensive Care just published the most extraordinary medical document I’ve ever seen.
To help people from Germany to America understand what we’re about to face, I am publishing translated extracts here.
Background:
A week ago, Italy had so few cases of corona that it could give each stricken patient high-quality care.
Today, some hospitals are so overwhelmed that they simply cannot treat every patient. They are starting to do wartime triage.
Here’s the guidance for that.
“It may be necessary to establish criteria of access to intensive care not just on the basis of clinical appropriateness but inspired by the most consensual criteria regarding distributive justice and the appropriate allocation of limited health resources.”
“This scenario is substantially comparable to the field of ‘catastrophe medicine,’ for which ethical reflection has over time stipulated many concrete guidelines for doctors and nurses facing difficult choices.”
“In a context of grave shortage of medical resources, the allocation criteria need to guarantee that those patients with the highest chance of therapeutic success will retain access to intensive care.
It’s a matter of giving priority to ‘the highest hope of life and survival.'”
Recommendations:
1)
The extraordinary criteria of admission and discharge are flexible and can be adapted in accordance with the local availability of resources.
These criteria apply to all patients in intensive care, not just those infected with CoVid-19.
2)
“Allocation is a very complex and delicate choice. […]
The foreseeable increase in mortality for clinical conditions not linked to the current epidemic due to the reduction of chirurgical activity and the scarcity of resources needs to be taken into consideration.”
3)
“It may become necessary to establish an age limit for access to intensive care.
This is not a value judgments but a way to provide extremely scarce resources to those who have the highest likelihood of survival and could enjoy the largest number of life-years saved.”
“This is informed by the principle of maximizing benefits for the largest number.
In case of a total saturation of resources, maintaining the criterion of ‘first come, first served’ would amount to a decision to exclude late-arriving patients from access to intensive care.”
4)
“In addition to age, the presence of comorbidities needs to be carefully evaluated. It is conceivable that what might be a relatively short treatment course in healthier people could be longer and more resource-consuming in the case of older or more fragile patients.”
“For patients for whom access to intensive care is judged inappropriate, the decision to posit a ceiling of care nevertheless needs to be explained, communicated, and documented.”
I spent many years sitting in seminar rooms thinking about questions of distributive justice.
Let me be honest: It’s left me not one bit wiser about what to do in these kinds of dramatic circumstances. So I don’t don’t mean to pass judgment on the contents of this document.
BUT here’s the point I do want everyone to take away from this:
Doctors in America will likely be faced with similarly heartbreaking dilemmas very soon.
But we can avoid that if we:.
* Start engaging in extreme forms of social distancing
* Radically expand ICU capacities
The moral choices involved in figuring out who gets care when hospitals do not have the resources to treat all critical patients are heart-breaking.
But the moral choices involved in doing what we can today to avert that situation are straightforward.
Cancel everything now.
Here is the full document.
(Undoubtedly imperfect) translation of it is by me.
[End.]
Here’s a link to the paper in Italian.
Keep in mind that even if you avoid getting sick from coronavirus, your life may still be at risk:
While too much of mainstream media *and* Trump administration focused on the case fatality rate debates, one key fact got overlooked. The risk is systemic. There is no fixed fatality rate. Once your hospitals are overrun, mortality from everything will rise. As now, in Italy.
— zeynep tufekci (@zeynep) March 11, 2020
The time for shrugging this off, or assuming the best, is gone. Right now, make sure you have at least two weeks’ supply of nonperishable food and medicine, and start practicing social distancing.
The post Life During Coronavirus Wartime appeared first on The American Conservative.
The Virus Doesn’t Care About Your Narrative
Good afternoon. Lots of information this morning, in my in-box, very little of it shareable, because I’m being told off the record. The message, though, is the same one that I’ve been banging on about for a while in this space: Prepare. I’ve been told by a medical source I trust that authorities in at least one major East Coast city is preparing to announce a lockdown any day now. I would not be surprised if there were more cities planning to do this. The point is, we are all running out of time to get supplies for a quarantine or isolation situation. If you haven’t done it yet, go now, this afternoon or evening. Do not put it off another day. Without warning, you may not be able to get out of your place.
Rush Limbaugh today told his listeners not to worry about coronavirus:
But I’m telling you, folks, I have — there’s so many red flags about things happening out there. This coronavirus, they’re just — all of this panic is just not warranted. This, I’m telling you, when I tell you — when I’ve told you that this virus is the common cold. When I said that, it was based on the number of cases. It’s also based on the kind of virus this is. Why do you think this is “COVID-19”? This is the 19th coronavirus. They’re not uncommon. Coronaviruses are respiratory cold and flu viruses. There is nothing about this, except where it came from, and the itinerant media panic that — you can’t blame people reacting the way they’re reacting, if they pay any, even scant attention to the media.
If you read just two or three media headlines a day — pick one, pick two, pick three at random — you’re going to think that if you leave your home you’ve got a good chance of dying — and you don’t. But I can’t — there’s no way we here can stop a panic. There’s no way we can talk sense into a panic. I wouldn’t even try. But I’m telling you, just — to me, this is just a gigantic series of question marks and red flags, all this stuff that is — it’s just the timing of it, the objective — the gleeful, gleeful attitudes in the media about this, the gleeful attitudes that Democrat leaders have about this.
I’ll tell you what’s really more scary than anything, is how the American people — some Americans, I don’t know how many it is, seem to be okay with being told they can’t do this, and they can’t go there and you’ve got to stay here, and we’re gonna quarantine you there, and we’re gonna wrap you up over there, we’re gonna put you in this cocoon here, and you can’t leave and you — “Okay, okay, fine with me!” No, not okay.
Meanwhile:
‘Heck Of A Job, Trumpy’
The nation is on the verge of a pandemic unlike anything it has faced in over 100 years, and this is what the President of the United States is thinking about tonight:
Pocahontas, working in conjunction with the Democrat Party, totally destroyed the campaign of Bernie Sanders. If she would have quit 3 days earlier, Sanders would have beaten Biden in a route, it wouldn’t even have been close. They also got two other losers to support Sleepy Joe!
— Donald J. Trump (@realDonaldTrump) March 11, 2020
What a disgraceful boob. You regular readers know how much I fear for religious liberty in the coming soft totalitarianism, so I don’t say this lightly. There is something worse than having a Democratic president appoint judges for four years, and that’s having a man-child in charge of the federal government during a national crisis unprecedented in living memory. The unseriousness of this man, in this time, is utterly infuriating, and demoralizing.
Here’s the thing, though: after we get through this thing, the temptation is going to be to scapegoat Trump for all the failures of the federal government to plan for coronavirus response. It’s not just Trump at fault. Here’s an appalling story from The New York Times about how the US public health bureaucracy botched the coronavirus response early on. Here is how it begins:
Dr. Helen Y. Chu, an infectious disease expert in Seattle, knew that the United States did not have much time.
In late January, the first confirmed American case of the coronavirus had landed in her area. Critical questions needed answers: Had the man infected anyone else? Was the deadly virus already lurking in other communities and spreading?
As luck would have it, Dr. Chu had a way to monitor the region. For months, as part of a research project into the flu, she and a team of researchers had been collecting nasal swabs from residents experiencing symptoms throughout the Puget Sound region.
To repurpose the tests for monitoring the coronavirus, they would need the support of state and federal officials. But nearly everywhere Dr. Chu turned, officials repeatedly rejected the idea, interviews and emails show, even as weeks crawled by and outbreaks emerged in countries outside of China, where the infection began.
By Feb. 25, Dr. Chu and her colleagues could not bear to wait any longer. They began performing coronavirus tests, without government approval.
What came back confirmed their worst fear. They quickly had a positive test from a local teenager with no recent travel history. The coronavirus had already established itself on American soil without anybody realizing it.
“It must have been here this entire time,” Dr. Chu recalled thinking with dread. “It’s just everywhere already.”
In fact, officials would later discover through testing, the virus had already contributed to the deaths of two people, and it would go on to kill 20 more in the Seattle region over the following days.
Federal and state officials said the flu study could not be repurposed because it did not have explicit permission from research subjects; the labs were also not certified for clinical work. While acknowledging the ethical questions, Dr. Chu and others argued there should be more flexibility in an emergency during which so many lives could be lost. On Monday night, state regulators told them to stop testing altogether.
The failure to tap into the flu study, detailed here for the first time, was just one in a series of missed chances by the federal government to ensure more widespread testing during the early days of the outbreak, when containment would have been easier. Instead, local officials across the country were left to work blindly as the crisis grew undetected and exponentially.
The story goes on to explain in detail how scientists in Seattle spent the month of February desperately trying to convince the CDC and the FDA to allow them to test for coronavirus — and were shot down because of rule-following. More:
Looking back, Dr. Chu said she understood why the regulations that stymied the flu study’s efforts for weeks existed. “Those protections are in place for a reason,” she said. “You want to protect human subjects. You want to do things in an ethical way.”
The frustration, she said, was how long it took to cut through red tape to try to save lives in an outbreak that had the potential to explode in Washington State and spread in many other regions. “I don’t think people knew that back then,” she said. “We know it now.”
Seattle scientists would have known far earlier that coronavirus was already here had the feds allowed them to test the samples they already had. Think about that. The country would have known a month earlier that there was no keeping coronavirus out of America, because it was already well established.
It is not Trump’s fault that the FDA and the CDC insisted on sticking by rules that dramatically hampered response to a fast-emerging public health crisis. However, this is exactly the kind of bureaucratic logjam that an engaged White House could have broken through. We still do not know how bad the outbreak is in this country, because we do not have the resources to do full testing. The system failed. And look at this:
As health department officials worked quickly to negotiate an emergency funding package to fight the spreading coronavirus outbreak on Feb. 23, they came to a frustrating realization: Their email system had crashed.
The outage in the Health and Human Services secretary’s office stretched on much of the day, with some messages delayed up to 11 hours, creating frustration and slowing the Trump administration’s coronavirus response.
The HHS officials soon discovered the culprit: An email test conducted by the team at the Centers for Medicare and Medicaid Services, a branch of the health department that hadn’t briefed HHS leaders or alerted the department’s chief information officer before sending thousands of messages through their shared system. Although it was a Sunday, top officials were negotiating with the White House over a soon-to-be-announced coronavirus funding plan and tackling other urgent decisions — which were interrupted by the email outage.
The problem, as the story details, is the managerial incompetence of Seema Verma, the Pence ally who heads the Medicare/Medicaid office. Last year, she was faulted for spending millions of taxpayer dollars on GOP consultants to manage her brand. In December, she tried to charge the taxpayer $47,000 to replace stolen Ivanka Trump brand jewelry, cosmetics, and other luggage she left in her car in San Francisco, where it was stolen.
Remember the good old days, when FEMA’s bungled initial response to Katrina brought unwanted attention to Michael Brown, the inexperienced Republican hack George W. Bush put in charge of the federal emergency management agency? “Brownie, you’re doing a heck of a job,” the president said at the time. Brownie may be gone, but his spirit thrives in this Republican administration.
Should the Democrats throw the Republicans out of the White House and even the Senate this fall, remember all this. But after the crisis passes, there should also be Congressional hearings about why the federal bureaucracy was so slow to react to this mounting crisis, despite all the evidence. This is not entirely Trump’s fault.
The post ‘Heck Of A Job, Trumpy’ appeared first on The American Conservative.
March 10, 2020
Coronavirus Diary
There’s an old brain teaser that goes like this: You have a pond of a certain size, and upon that pond, a single lilypad. This particular species of lily pad reproduces once a day, so that on day two, you have two lily pads. On day three, you have four, and so on.
Now the teaser. “If it takes the lily pads 48 days to cover the pond completely, how long will it take for the pond to be covered halfway?”
The answer is 47 days. Moreover, at day 40, you’ll barely know the lily pads are there.
That grim math explains why so many people — including me — are worried about the novel coronavirus, which causes a disease known as covid-19. And why so many other people think we are panicking over nothing.
She said scoffers are fond of saying that more people have died from the seasonal flu, etc.
But go back to those lily pads: When something dangerous is growing exponentially, everything looks fine until it doesn’t. In the early days of the Wuhan epidemic, when no one was taking precautions, the number of cases appears to have doubled every four to five days.
Read it all. It’s going to be invisible to most of us … until seemingly overnight, it isn’t.
The Wall Street Journal has the chilling tale of Marc Thibault, 48, an American who caught coronavirus in Europe, fell ill back home in America, and was so sick that a priest came to the hospital to give him last rites. What’s so chilling about it is that Thibault is not an old man, and he says he exercises regularly, and rarely gets sick. And yet:
He says the virus now hit him “like a hurricane.” He was weak and had trouble breathing. The hospital whisked him into the ICU, where nurses donned hazmat-style suits to enter his room.
They inserted a breathing tube, and put another tube down his throat for medicine to deal with pneumonia that developed in his lungs, he said.
Gagging and coughing, Mr. Thibault said he felt scared. His lungs would fill with saliva and nurses would dash in and clear them out, only to have to do it again two hours later.
“The feeling of choking. That was the worst part,” he said. “You feel like you’re asphyxiating, and you’re panicking because you can’t breathe.”
The agony went on for days.
He very nearly died. As the Journal reporter points out, four out of five infected people will have only mild to moderate symptoms. Those who get very sick are disproportionately aged 60 and older. But relative youth is no guarantee that this will leave you unscathed.
Some people find comfort in the fact that other European nations have much lower numbers of infected than Italy — the thought being that there is something particular to Italy that makes it so bad there. That does not seem quite sound. German Chancellor Angela Merkel said today that 60 to 70 percent of Germans will eventually be infected. And:
France recorded a 70 per cent rise in cases over Monday night, with more than 1,200 patients now known to have caught the deadly infection.
Here, from Worldometer, is a chart tracking the French outbreak:
Same chart for the US, from the same source. Keep in mind that these are only the cases that we know about. Widespread testing is still not available:
In other coronavirus news today, some regional leaders in Lombardy, the hardest-hit Italian province, are calling for a total Wuhan-like curfew there to save the hospitals.
Here’s an excellent Spiegel interview with Harvard epidemiologist Marc Lipsitch. Excerpts:
DER SPIEGEL: You predict that up to 60 percent of adults could become infected with the novel coronavirus. Isn’t that alarmist?
Lipsitch: I don’t think so. It’s of course a projection and, like any projection, it could be wrong. But if you have a reproductive number of an infectious disease of around two, which seems to be the estimates that we’re getting right now (Eds: meaning that, on average, each infected person transmits the disease to two other people), then at a minimum, half the adult population needs to become infected before the spread can stop permanently. This is not an ungrounded estimation, but simply the basic math of epidemics.
More:
DER SPIEGEL: Japan closed schools nationwide, Italy closed its universities. Is that a good public health measure?
Lipsitch: It’s really hard to know. We have never dealt with an epidemic where the role of children was so unclear. Most infected kids don’t show symptoms, but we don’t know if they are still infectious. Closing schools countrywide even where there aren’t a lot of cases seems to be a measure that is hard to sustain. But in places where we saw community spread, it definitely makes sense.
DER SPIEGEL: You did extensive research on the influenza pandemic between 1918 and 1920, which killed more than 650,000 people in the United States alone. What did we learn from the flu pandemic?
Lipsitch: American cities reacted quite differently then. Philadelphia didn’t respond until two weeks after the first influenza case when it closed schools and canceled public events. St. Louis, on the contrary, put in interventions early on, after two days. The peak death rate in Saint Louis was only one-eighth that of Philadelphia. The study showed that if cities intervened early and implemented aggressive social distancing, the epidemic slowed down and was less deadly in general.
The Washington Post has a really informative story on why “social distancing” is such an important disease-fighting strategy. Excerpt:
Disrupting everyday life is more easily said than done, with effects that will ripple through individual families and the global economy. Much to the consternation of health officials, it is already creating dissonance and conflicting messages, starting at the very top. President Trump argued on Twitter on Monday that even though the flu killed 37,000 people last year, “Nothing is shut down, life & the economy go on. At this moment there are 546 confirmed cases of CoronaVirus, with 22 deaths. Think about that!”
Particularly for people who are young and healthy, disruptions may seem to be excessive — alarmist restrictions. But graphics comparing the speed of spread of epidemics with and without social distancing provide a powerful visual illustration of the importance of what experts call “flattening the curve.” It’s the difference between a viral outbreak that has the profile of Mount Everest, exploding vertically, vs. one that unfolds over time — a long, low hill.
“The idea is that the sooner you stop that transmission chain, you are actually limiting an exponential growth,” said Yvonne Maldonado, an infectious-disease epidemiologist at Stanford University. “That’s really important, because instead of preventing 1,000 cases, you might be preventing 100,000 cases — and a matter of days can make a difference.”
An early study, not yet peer-reviewed, of two cities in China suggested the potential difference. The Wuhan outbreak reached its peak quickly, and a similar growth curve “would fill our ICU” beds with coronavirus cases for the United States, tweeted Marc Lipsitch, a Harvard epidemiologist.
Guangzhou, which intervened in the epidemic earlier than Wuhan did in its own case, had a smaller peak of hospitalizations.
On the excellent coronavirus subreddit, an anonymous UK infectious disease critical care doctor caring for COVID19 patients — his identity was verified by Reddit admins; he has to be anonymous per NHS regulations — answered some reader questions. Link to the thread is here. The first one was about whether or not the UK would see an Italy-style outbreak, or whether the virus was contained in Britain. The doctor answered:
The consensus amongst my colleagues in general is yes, it will get much worse, and it is likely to reach Italy levels. We are preparing for such but there is only so much we can do from within a hospital.
As a health system, the UK runs at or over capacity. It is worth remembering that the background population of critically ill does not decrease in an outbreak.
There was a feeling a week or two ago, when we started seeing community clusters, that population measures needed to be taken. The feedback we have gotten from colleagues in public health or those involved in government advisory positions has been that there is a question of balancing short term economic burden against a predicted mortality.
I personally think this government response has been short-sighted.
We have very good case-studies, in Italy, showing what is likely to happen if delaying measures are not taken early; vis-a-vis South Korea showing what can happen when strict measures are taken in a timely fashion. The key is to prevent healthcare demand from being overwhelmed. This is the point where mortality rises.
Again, my personal opinion, is there is a problem in the UK amongst decision makers with denial, and concern about the political optics of early population measures that affect the economy. The problem is, with outbreaks like this, you won’t see that you are about to be overwhelmed until the day before, and you needed to have taken action at least two weeks before that. Lessons from China, from South Korea, and current lessons from Italy and Iran are not being listened to.
A reader sends this in from Dr. Ellen Eaton, an infectious disease specialist:
Close the schools now — flatten the curve!
Meanwhile, a National Review editorial quite reasonably faulted Trump’s handling of the coronavirus crisis. Excerpt:
In a serious public-health crisis, the public has the right to expect the government’s chief executive to lead in a number of crucial ways: by prioritizing the problem properly, by deferring to subject-matter experts when appropriate while making key decisions in informed and sensible ways, by providing honest and careful information to the country, by calming fears and setting expectations, and by addressing mistakes and setbacks.
Trump so far hasn’t passed muster on any of these metrics. He resisted making the response to the epidemic a priority for as long as he could — refusing briefings, downplaying the problem, and wasting precious time. He has failed to properly empower his subordinates and refused to trust the information they provided him — often offering up unsubstantiated claims and figures from cable television instead. He has spoken about the crisis in crude political and personal terms. He has stood in the way of public understanding of the plausible course of the epidemic, trafficking instead in dismissive clichés. He has denied his administration’s missteps, making it more difficult to address them.
This presidential behavior is all too familiar. It is how he has gotten through scandals and fiascos for more than three years in office. But those were all essentially political in nature, and most were self-created. The country has been lucky in the Trump era, largely avoiding the sorts of major, unforeseen crises that make the greatest demands of the modern presidency. That luck has now run out, and this demands a new level of seriousness from the president and those around him.
I was talking today with a political scientist, who agreed that Trump has been terrible in this thing, but who also said that this is a Chernobyl for the US public health system, which was not ready for the pandemic. Trump has to bear a big share of the blame, but a failure of this magnitude is systemic. I told him that my concern is that after this is all over, a lot of people who failed will be eager to scapegoat Trump — who will certainly deserve intense criticism — as a way of offloading their own faults.
Finally, I heard from a reader who talked about how people where he lives are starting to lose jobs as the economy slows down because of coronavirus. He mentioned two individuals he knows, one who is being laid off because the local tourism economy has crashed because of the outbreak, and the other losing his job as a truck driver, because the goods he normally transports are either sitting on a dock in China, or weren’t made in the first place. The reader writes:
Trump is being a complete imbecile about this. This is an economic dislocation, and is not going to be easily fixed. Constantly yelling at the Fed for monetary intervention is really stupid, as it will do nothing at this time. The problem is people are not buying anything. They are either in lockdown, or the things they would have bought are not here because they are stuck in China. The big layoffs are right around the corner.
The feast of consequences is on the way, and there are still many many people in this country who think this is all being made up. They will not know what hit them.
He adds that the two people he knows are both the sole breadwinner in their families. Not sure how the president’s proposed payroll tax cut is going to help those who are no longer on a payroll.
Best unemployment numbers in the history of our Country. Best employment number EVER, almost 160 million people working right now. Vote Republican, unless you want to see these numbers obliterated!
— Donald J. Trump (@realDonaldTrump) March 10, 2020
UPDATE: A reader posted this from Sunday. The man in the video is the pastor of an Evangelical megachurch in Cincinnati. His message is: “Chill out about the virus. American middle-class life will not be affected. Let’s make fun of this thing.”
Coronavirus is the latest thing in culture that has us paralyzed with fear. As @BrianTome explains, we are commanded not to fear, but to keep moving. #coronavirus pic.twitter.com/ADBYBh3q5H
— Crossroads (@crdschurch) March 9, 2020
The post Coronavirus Diary appeared first on The American Conservative.
Christ & Coronavirus
A friend of mine who is Orthodox mentioned to an Evangelical friend of his that he (Orthodox guy) is scaling back his participation in group activities out of concern for coronavirus spread.
“Well, I don’t want to be judgmental,” said the Evangelical, “but I guess that’s fine if you want to live in fear rather than trusting in the Lord.”
Boy, that chaps me — but I bet it’s common in some circles now, Christians shaming other Christians for coronavirus caution. As if being concerned, and taking serious steps to prepare, and to live out public health guidelines, is somehow evidence of a weak commitment to God.
If a Christian chooses not to swim in shark-infested waters, or pick up a poisonous snake, does that show weakness in faith? Of course not; it shows that you have a brain in your head. God’s promise to us is that He will always be with us, not that He will protect us from getting sick from viruses, or otherwise harmed in our bodies. A Christian doctor serves sick patients not because he expects God to place a magic force field around him to keep him from catching their disease, but because he knows that even if he gets sick, that God will be with him through his own suffering, and reward him for his loving self-sacrifice.
It angers me to think that there might be pastors or other church leaders out there now teaching their congregations not to pay attention to what the CDC and others are saying, because the Lord is going to take care of us all. I think of little old church ladies, especially. I think about the old joke about the Christian who refuses several offers to be rescued from a flood, telling his rescuers that God is going to save him. When the water overtakes him, he drowns, and gets to heaven, he says, “Lord, I trusted that you were going to take care of me. And you let me die!” God says, “But I sent my servants to help you three times, and you sent them away.”
I wonder, though, where we religious believers — Christian, Jewish, Muslim, and otherwise — should draw lines in thinking about our physical safety, and our religious faith. In the film Of Gods And Men, about the real-life story of the Catholic monks who died in Algeria, they all chose to stay in the country and serve despite the threat that they would be killed by Islamic terrorists. They did not believe that God would keep them from being kidnapped or killed; rather, they trusted that whatever happened, God would be there with them. That’s a different thing, isn’t it?
Abandonment to divine providence surely does not mean being heedless about one’s personal safety at all times. All of us lock our doors at night, do we not? Does that reflect a lack of faith in God, or does it reflect the use of the common sense God gave us?
I would like to know what you readers who are religious believers think about this topic. Let’s be respectful of those who disagree. What got my nose out of joint when my friend told me this story is the judgment that prudence in response to coronavirus is a vice.
UPDATE: A reader posted this from Sunday. The man in the video is the pastor of an Evangelical megachurch in Cincinnati. His message is: “Chill out about the virus. American middle-class life will not be affected. Let’s make fun of this thing.”
Coronavirus is the latest thing in culture that has us paralyzed with fear. As @BrianTome explains, we are commanded not to fear, but to keep moving. #coronavirus pic.twitter.com/ADBYBh3q5H
— Crossroads (@crdschurch) March 9, 2020
The post Christ & Coronavirus appeared first on The American Conservative.
What’s In Jean Vanier’s Name?
J.D. Flynn is head of the Catholic News Agency, and a canon lawyer. He and his wife Kate adopted two Down syndrome babies. Later, Kate gave birth to a child they conceived naturally. They named him Daniel Vanier Flynn — after Jean Vanier, the Catholic founder of L’Arche, the ministry that defends and celebrates the dignity of mentally disabled people. As parents of Down syndrome children, the Flynns really cherished Vanier and his witness.
The Flynns recently learned, along with the rest of the world, that Jean Vanier, who died last year, was almost certainly a sex abuser (of non-disabled adult women he manipulated). I wrote about that here. Kate immediately wanted to change their little boy’s name. J.D. ponders this out loud in this heart-rending essay. Excerpts:
It is possible he struggled, I think to myself. That he didn’t want to do what he did. That he was trying, for decades, to get away from it. That he was ashamed, and he didn’t know how to stop.
But he grievously misrepresented himself.
He wrote and spoke of relatively benign flaws with the appearance of great humility, while concealing his criminal abuse. He pretended not to know about the abusive practices of his spiritual mentor — even while they mirrored his own. He left women scarred and hopeless, he blasphemed God himself, and he never owned up to any of it.
People thought he was a kind of spiritual master, and even while he rebuffed them, he knew they kept thinking it. And, in one way or another, with books and lectures and documentaries and appearances, he let them.
All of that has led me to something like a crisis of faith. At its worst, it becomes nearly a kind of epistemic despair.
Of course, that feels like a cliche. It is a cliche. But it is no less true for its banality. I thought this man was holy, and he wasn’t. And now I am surprised to find myself wondering if holiness is real.
If he wasn’t holy, I thought to myself those first few days, was anyone? If he spent a lifetime meeting the peculiar demands of loving people with disabilities, and wasn’t transformed in holiness, can I be? Is no one really freed from sin?
McCarrick made me angry, but he never made me question the Christian proposition. I never expected that he was holy. That someone I already thought lukewarm turned out to be wicked was no real surprise. Other bishops too, who have proven to be wicked, have evoked in me no emotional response. I’ve known too many bishops, as men of flesh and blood, vice and virtue, to expect them to be any particular thing.
More:
I know this is why God gives us the Church. I know that the Church, in her wisdom, and through the test of time, carefully discerns men and women of heroic virtue — saints worth imitating and venerating. But the Vatican’s saint-making department is an office full of sinners, some of them facing criminal investigations. Believing that God works through those guys to help people know who was really holy takes faith. I know it’s true, but in the days after the Vanier news, I found myself plagued by doubt.
The apologetic answer I have at the ready is not yet a consolation. I laugh, because I’ve offered it before to suffering friends, and no one has told me how hollow it sounds.
Read it all. I strongly urge you to. It feels like it’s written in blood from an open wound.
I appreciate very much the final graf I quoted above, about how the apologetic answer is not (yet) a consolation. That is something very hard for religious people who have not gone through this kind of ordeal to understand. I never experienced a betrayal within my faith of the intensity or kind that the Flynns have, but me being me, I identified so profoundly with those who did — victims and their families — that it might as well have happened to me, given the effect it had on my faith. What Flynn writes about is deeply familiar to me. As I recall from those days, I just wanted to slap people who were quick to deploy lines like “well, churches are full of sinners,” and lines like that. They may have been, and may be, true, but yeah, nobody tells you how hollow it sounds when you’ve lived through, or seen up close, the effects of sexual abuse and betrayal within the Church.
Did you ever read All Quiet On The Western Front? There’s a chapter in that novel in which the soldiers are back from the World War I front on rest and relaxation, and go out for a beer. All the people back home congratulate them for their courage, for their patriotism, and so forth. They thank them for their service. But the soldiers feel so alienated from all that. These well-meaning people know nothing about what it’s like to be in the trenches, day in and day out. To kill, and to see your comrades die. To know suffering intimately.
The hollowness that J.D. Flynn talks about, when well-meaning Catholic apologists offer comfort with apologetics — it’s the same kind of thing. As I recall, what you want to say is, “Just shut up. Stop it, right now. It sounds like you are trying to comfort yourself, not me. I need you to sit with me and feel the shock and the pain that I’m feeling, and accompany me through it. We can talk about apologetics later.”
Is this anything you’ve experienced?
Do you think the Flynns should change their child’s name? I do. I didn’t at first, but the more I think about it, the more I think it should be done. He’s only two. He will never know.
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‘Suddenly, the ER Is Collapsing’
Another devastating account coming from a physician on the ground in Italy. Americans, wake up from your sleep. This is coming, and coming fast:
1/ I may be repeating myself, but I want to fight this sense of security that I see outside of the epicenters, as if nothing was going to happen “here”. The media in Europe are reassuring, politicians are reassuring, while there’s little to be reassured of. #COVID19 #coronavirus
2/ This is the English translation of a post of another ICU physician in Bergamo, Dr. Daniele Macchini. Read until the end “After much thought about whether and what to write about what is happening to us, I felt that silence was not responsible.
3/ I will therefore try to convey to people far from our reality what we are living in Bergamo in these days of Covid-19 pandemic. I understand the need not to create panic, but when the message of the dangerousness of what is happening does not reach people I shudder.
4/ I myself watched with some amazement the reorganization of the entire hospital in the past week, when our current enemy was still in the shadows: the wards slowly “emptied”, elective activities were interrupted, intensive care were freed up to create as many beds as possible.
5/ All this rapid transformation brought an atmosphere of silence and surreal emptiness to the corridors of the hospital that we did not yet understand, waiting for a war that was yet to begin and that many (including me) were not so sure would ever come with such ferocity.
6/ I still remember my night call a week ago when I was waiting for the results of a swab. When I think about it, my anxiety over one possible case seems almost ridiculous and unjustified, now that I’ve seen what’s happening. Well, the situation now is dramatic to say the least.
7/ The war has literally exploded and battles are uninterrupted day and night. But now that need for beds has arrived in all its drama. One after the other the departments that had been emptied fill up at an impressive pace.
8/ The boards with the names of the patients, of different colours depending on the operating unit, are now all red and instead of surgery you see the diagnosis, which is always the damned same: bilateral interstitial pneumonia.
9/ Now, explain to me which flu virus causes such a rapid drama. [post continues comparing covid19 to flu, link below]. And while there are still people who boast of not being afraid by ignoring directions, protesting because their normal routine is”temporarily” put in crisis,
10/ the epidemiological disaster is taking place. And there are no more surgeons, urologists, orthopedists, we are only doctors who suddenly become part of a single team to face this tsunami that has overwhelmed us.
11/ Cases are multiplying, we arrive at a rate of 15-20 admissions per day all for the same reason. The results of the swabs now come one after the other: positive, positive, positive. Suddenly the E.R. is collapsing.
12/ Reasons for the access always the same: fever and breathing difficulties, fever and cough, respiratory failure. Radiology reports always the same: bilateral interstitial pneumonia, bilateral interstitial pneumonia, bilateral interstitial pneumonia. All to be hospitalized.
13/ Someone already to be intubated and go to intensive care. For others it’s too late… Every ventilator becomes like gold: those in operating theatres that have now suspended their non-urgent activity become intensive care places that did not exist before.
14/ The staff is exhausted. I saw the tiredness on faces that didn’t know what it was despite the already exhausting workloads they had. I saw a solidarity of all of us, who never failed to go to our internist colleagues to ask “what can I do for you now?”
15/ Doctors who move beds and transfer patients, who administer therapies instead of nurses. Nurses with tears in their eyes because we can’t save everyone, and the vital parameters of several patients at the same time reveal an already marked destiny.
16/ There are no more shifts, no more hours. Social life is suspended for us. We no longer see our families for fear of infecting them. Some of us have already become infected despite the protocols.
17/ Some of our colleagues who are infected also have infected relatives and some of their relatives are already struggling between life and death. So be patient, you can’t go to the theatre, museums or the gym. Try to have pity on the myriad of old people you could exterminate.
18/ We just try to make ourselves useful. You should do the same: we influence the life and death of a few dozen people. You with yours, many more. Please share this message. We must spread the word to prevent what is happening here from happening all over Italy.”
20/ I finish by saying that I really don’t understand this war on panic. The only reason I see is mask shortages, but there’s no mask on sale anymore. We don’t have a lot of studies, but is it panic really worse than neglect and carelessness during an epidemic of this sort?
19/ Full post here, you can DeepL:
«Con le nostre azioni influenziamo la vita e la morte di molte persone»
Con un lungo post su Facebook, il dottor Daniele Macchini, medico dell’Humanitas Gavazzeni, racconta la sua vita in prima linea per contrastare il coronavirus. È una testimonianza da brividi, da legg…
https://www.ecodibergamo.it/stories/bergamo-citta/con-le-nostre-azioni-influenziamola-vita-e-la-morte-di-molte-persone_1344030_11/
I heard yesterday from one of this blog’s readers, a physician who met with his parish council after Sunday services, to beg them to devise and implement a COVID19 protocol. They decided instead to wait and see what happens, to avoid panic.
Reader Giuseppe Scalas, who lives in the northern Italian epicenter, posted last night that when the outbreak first appeared there, politicians fell all over themselves to warn Italians against having a racist reaction. Giuseppe says that this probably aided the spread of the coronavirus there, because right-thinking Italians were on guard not to take it too seriously, lest they be guilty of racism.
There is blindness on the left and the right about this thing. And it is going to get a lot of people killed.
Late last night, a friend in Tehran retweeted this. Translation below:
The post ‘Suddenly, the ER Is Collapsing’ appeared first on The American Conservative.
March 9, 2020
Tucker Carlson Tells The Hard Truth
This is a hugely important opening monologue from Tucker Carlson tonight — especially for conservatives, but actually for everybody. And most of all, for that Fox News watcher in the White House. Straight-up truth-telling right here:
He criticizes unnamed “leaders” for downplaying the virus’s seriousness, but we all know he’s talking about Donald Trump. Look at this: same administration, same day:
— Ross Douthat (@DouthatNYT) March 9, 2020
It is so great to hear an influential media conservative lay it all out like that, especially to complacent conservatives who want to believe the president’s phony messaging about how it’s all the fault of the Democrats and the media. Tucker points out that the situation that has brought Italy to a standstill tonight could well be coming here within a couple of weeks. A strong leader prepares his country for that possibility, not drugs them with false optimism.
At the end of the segment, Tucker quoted from a statement released a few days ago by Xinhua, the official Chinese state media. He drew from this passage from a Xinhua editorial:
If China retaliates against the United States at this time, in addition to announcing a travel ban on the United States, it will also announce strategic control over medical products and ban exports to the United States. Then the United States will be caught in the ocean of new coronaviruses.
According to the US CDC officials, most masks in the United States are made in China and imported from China. If China bans the export of masks to the United States, the United States will fall into a mask shortage, and the most basic measures to prevent the novel coronavirus can’t do it.
Also according to the US CDC officials, most of the drugs in the United States are imported, and some drugs are imported from Europe. However, Europe also places the production base of these drugs in China, so more than 90% of the US imported drugs are related to China. The implication is that at this time, as long as China announces that its drugs are for domestic use and banned exports, the United States will fall into the hell of the novel coronavirus epidemic.
Here’s what Tucker said about that:
He’s right. If this pandemic teaches us anything, it’s that we cannot be so strategically entangled with China. And when it comes to manufacturing pharmaceuticals and essential medical supplies, we must mandate by law that this is done domestically, as a matter of national security. That is something that all Republicans and Democrats ought to be able to pass.
As a step-off, here is a good thread by Oxford University data researcher Max C. Roser, on why he’s taking this crisis so seriously. He points out that the death rate is not the most important statistic; rather, the most important statistic is the rate of infection. Here’s why:
6/ Early in an outbreak, containment is key.
Slowing the rate of infection means that the number of people who are sick at the *same time* does not exceed the capacity of the health system.
[I wish more people understood the intention of containment.] pic.twitter.com/eBOW5nMpLS
— Max Roser (@MaxCRoser) March 9, 2020
We ought to be closing schools and banning or limiting public gatherings now. Two weeks ago, Italy was a very different country than it is tonight. Two weeks from tonight, America probably will be too. How different depends in large part on how we act right now. This week. Tomorrow.
You might not want to believe it when it comes from CNN or The New York Times. Will you believe it when it comes from Tucker Carlson?
UPDATE: This is a Twitter thread sent out tonight by anesthesiologist Dr. Jason Van Schoor of University College, London:
From a well respected friend and intensivist/A&E consultant who is currently in northern Italy:
1/ ‘I feel the pressure to give you a quick personal update about what is happening in Italy, and also give some quick direct advice about what you should do.
2/ First, Lumbardy is the most developed region in Italy and it has a extraordinary good healthcare, I have worked in Italy, UK and Aus and don’t make the mistake to think that what is happening is happening in a 3rd world country.
3/ The current situation is difficult to imagine and numbers do not explain things at all. Our hospitals are overwhelmed by Covid-19, they are running 200% capacity
4/ We’ve stopped all routine, all ORs have been converted to ITUs and they are now diverting or not treating all other emergencies like trauma or strokes. There are hundreds of pts with severe resp failure and many of them do not have access to anything above a reservoir mask.
5/ Patients above 65 or younger with comorbidities are not even assessed by ITU, I am not saying not tubed, I’m saying not assessed and no ITU staff attends when they arrest. Staff are working as much as they can but they are starting to get sick and are emotionally overwhelmed.
6/ My friends call me in tears because they see people dying in front of them and they con only offer some oxygen. Ortho and pathologists are being given a leaflet and sent to see patients on NIV. PLEASE STOP, READ THIS AGAIN AND THINK.
7/ We have seen the same pattern in different areas a week apart, and there is no reason that in a few weeks it won’t be the same everywhere, this is the pattern:
8/ 1)A few positive cases, first mild measures, people are told to avoid ED but still hang out in groups, everyone says not to panick
2)Some moderate resp failures and a few severe ones that need tube, but regular access to ED is significantly reduced so everything looks great
9/ 3)Tons of patients with moderate resp failure, that overtime deteriorate to saturate ICUs first, then NIVs, then CPAP hoods, then even O2.
4)Staff gets sick so it gets difficult to cover for shifts, mortality spikes also from all other causes that can’t be treated properly.
10/ Everything about how to treat them is online but the only things that will make a difference are: do not be afraid of massively strict measures to keep people safe,
11/ if governments won’t do this at least keep your family safe, your loved ones with history of cancer or diabetes or any transplant will not be tubed if they need it even if they are young. By safe I mean YOU do not attend them and YOU decide who does and YOU teach them how to.
12/ Another typical attitude is read and listen to people saying things like this and think “that’s bad dude” and then go out for dinner because you think you’ll be safe.
13/ We have seen it, you won’t be if you don’t take it seriously. I really hope it won’t be as bad as here but prepare.
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Wokeness In A Time Of Pandemic
Just saw the news that the entire nation of Italy has been placed into quarantine by its government. Italians are compelled by law to stay home, except for work or emergencies.
An entire nation has chosen to destroy its economy to save the lives of its people, and its public health system. Y’all denialists keep right on saying that this is just a version of the flu.
Please, please guys. Here in northern #Italy we made one big mistake. Everybody kept saying “It’s just flu” and now our intensive care units are collapsing. Everybody kept going outside like nothing happened and now our grandparents and parents are dying.#coronavirus is not #flu
— Zìbora
‘The Plague’ Book Club.3
This is the third entry in this blog’s book club reading of Albert Camus’s 1947 novel, “The Plague.”
I’m heavily moderating the comments section to exclude those who have neither read nor are reading the book. This is to prevent the discussion from veering too far from the text. I encourage discussion relating the novel to the current coronavirus situation — that’s why we’re reading it — but I don’t want the discussion to be too tangential. I may approve some comments by people who indicate by their remarks that they haven’t read and aren’t reading the book, but mostly I won’t.
Today’s discussion will cover Chapters 11 through 14.
In Chapter 11, Father Paneloux, the respected Jesuit priest, delivers a rousing homily to the townspeople. He offers a traditional Christian interpretation of plague. It’s important to note that the Narrator describes him as a scholar of history and antiquity; this priest is not a wild-eyed street preacher. The Narrator says that one Sunday during the plague, an overflow crowd came to the cathedral to hear Father Paneloux preach.
He has a powerful, rather emotional delivery, which carried to a great distance, and when he launched at the congregation his opening phrase in clear emphatic tones: “Calamity has come on you, my brethren, and, my brethren, you deserved it,” there was a flutter that extended to the crowd massed in the rain outside the porch.
Yeah, that’s quite an opening line. It announces the theme of the priest’s homily. He cites Scripture to talk about how God allowed plagues to come upon on pharaohs and peoples in the past to humble the proud and to call them to repentance.
“Yet this calamity was not willed by God. Too long this world of ours has connived at evil, too long has it counted on the divine mercy, on God’s forgiveness. Repentance was enough, men though; nothing was forbidden. Everyone felt comfortably assured; when the day came, he would surely turn from his sins and repent. Pending that day, the easiest course was to surrender all along the line; divine compassion would do the rest.”
The priest is speaking in the voice of a Biblical prophet here. He is telling the people that they were complacent, and did not take their lives seriously, because they always figured that they would have time to say they were sorry for their sins, and anyway, God is a kind gentleman who would never judge them harshly. He says that God has withdrawn His protection from the town.
Paneloux speaks with incredibly vivid words, trying to put the fear of God, literally, into his hearers, to drive them back to God. “Now, at last, you know the hour has struck to bend your thoughts to first and last things,” he thunders. And:
“Today the truth is a command. It is a red spear sternly pointing to the narrow path, the one way of salvation. And thus, my brothers, at last it is revealed to you, the divine compassion which has ordained good and evil in everything; wrath and pity; the plague and your salvation. This same pestilence which is slaying you works for your good and points your path.”
Father Paneloux concludes by saying that he hopes when the faithful leave church, that they will not only be aware of the wrath of God, but also take away a message “of comfort for your hearts.”
Well. I doubt one would ever hear a sermon like that today, away from the pulpits of snake-handlers. I don’t think this is to our credit, if I’m honest. I wouldn’t preach with such fire and brimstone, but it may come as a shock to Christians used to hearing mewly pap from contemporary pulpits to learn that Father Paneloux’s sermon is historically a theologically correct Christian response to traumas like the plague. Christians are supposed to see all things as working for our salvation. That is to say, we are supposed to react to all things as an opportunity to grow closer to God.
When I first became Orthodox nearly 14 years ago, I knew a priest who would react to bad things that happened to him by saying some version of, “I wonder what the blessing is in this?” He was serious. I thought that was weird. But now that I’m older, and have been practicing the Orthodox faith, I see his point. This really came home to me in this past year, reading the accounts of Christians thrown in prison and even tortured for their faith. What strengthened them and held them together through their trial was learning to regard this suffering as an opportunity to deepen their relationship with God. It might sound like a cliche to you, but I’m telling you, reading the words of the late Dr. Silvester Krcmery makes it real. Here is his reflection on his early days in prison:
Even though this was my first experience with this level of violent physical assault, I actually did not feel anything. Perhaps I was in such a state of shock that I was not fully conscious of the pain.
I considered the whole thing a very valuable ordeal. For hours I repeated, “Lord you didn’t disappoint us. You always promised that you would be with us, that you would never abandon us. What could I now possibly bring you as a sacrifice? nothing hurt me. I really have nothing to offer you as a sacrifice.”
Despite everything, in a sense I cherished those wounds. This was after all the only tangible, although insignificant evidence I had that I had offered Christ something.
After this interrogation I found that I had two broken ribs. I was not allowed to see a doctor but in the course of three or four weeks they healed, apparently without consequences.
The Soviet dissident Alexander Ogorodnikov, in my interview with him in Moscow last fall, said the same thing. He said that it was only when God showed him in his cell that he, Ogorodnikov, had been allowed to suffer in that way for the salvation of other souls, did he reconcile himself to the pain. Solzhenitsyn, as many know, famously wrote, “Bless you, prison” — because it was what saved his soul.
This is the point that Father Paneloux is trying to make to his congregation. He might have done it with more gentleness — his sermon reminded me of the priest’s in Joyce’s Portrait of the Artist As a Young Man, or, comically, of Amos Starkadder’s butter-based jeremiad in “Cold Comfort Farm.” Still, the priest is correct. He is imposing a Christian narrative onto the plague (I would say “finding the truth in the meaning of the plague”), and you have to ask yourself: do you have a better idea of how to respond to suffering that cannot be avoided?
The people of Oran do, according to the next chapter. Or rather, people got out of it what they brought to it. Some thought Father Paneloux was right; others thought that the priest simply highlighted the injustice of their fate; “there were others who rebelled and whose one idea now was to break loose from the prison-house.”
The Narrator tells us that this Sunday — “the Sunday of the sermon” — “marked the beginning of something like a widespread panic in the town, and it took so deep a hold as to lead one to suspect that only now had the true nature of their situation dawned on our townspeople.”
Dr. Rieux meets Grand, who invites him home to see the manuscript that he, Grand, has been working on for so long, and with such passion. Being able to articulate his vision in print has become the telos of the sad, lonely, toothless civil servant’s life. It is the thing that gives him purpose and dignity. When Rieux reads the opening lines, they are hopelessly banal. Rieux sees that poor Grand lives with the illusion that he is hard at work on a literary masterpiece — and he does not puncture the man’s illusion. Why should he? What would the purpose be? It would not make Grand’s life any easier, plague or no plague.
It’s interesting that Camus seems to juxtapose Father Paneloux’s sermon with a chapter about the story Grand is writing. What does this tell us about the importance of living by stories? Stories — narratives that we accept as true, as truly true, not just true for ourselves — as a way to make suffering bearable.
The next chapter is about the journalist Rambert’s struggle. He believes that if he can just make his case to the right official, that he will be able to work the system and get out of Oran, and back to his true love in Paris. It turns out that Rambert’s epic journey through the French colonial bureaucracy really did do what Dr. Rieux suggested his quarantine in Oran might do for him earlier in the book: give him important journalistic insights. Rambert is learning how bureaucracies work, or fail to work.
We learn that Rambert tries to keep his mind off his predicament by walking around the city and noticing things. He thought about certain scenes of life in Paris, and how much he missed the city, where his true love awaits him. “Rieux felt fairly sure [Rambert] was identifying these scenes with memories of his love.”
So here we have three ways of responding to the catastrophic suffering of the plague: Religious (Paneloux), Aesthetic (Grand), and Sentimental (Rambert).
In the final chapter we’re considering today, the Narrator discusses how the plague changed the sense of life in the town. Summer arrives in Oran, with its oppressive heat. People can’t go to the beach to escape the heat, either. The townspeople strain to bear up under the heat, the monotony, and the fear. Tarrou, the visitor to the town who keeps a diary, reflects that rhetoric Father Paneloux used “is not displeasing.”
“At the beginning of a pestilence and when it ends, there’s always a propensity for rhetoric. In the first case, habits have not yet been lost; in the second, they’re returning. It is in the thick of a calamity that one gets hardened to the truth — in other words, to silence. So let’s wait.”
That’s powerful. He’s saying that painful events at last make one realize that there are no words capable of imposing order onto the immensity of suffering.
The rest of this chapter is Tarrou detailing the habits the townspeople keep to for the sake of disciplining themselves. There’s the unintentionally comic behavior of the old man who spends his days in bed counting out chickpeas, and who has pretty much lived his life that way. Tarrou writes about the more ordinary habits of the other townspeople, whose habits form a kind of liturgy of their daily lives. That is, their daily deeds are the story they live, and it gives a sort of structure within which to shelter psychologically under the quotidian torment of threatened doom.
The final lines of this chapter are Tarrou’s:
“In the early days, when they thought this epidemic was much like other epidemics, religion held its ground. But once these people realized their instant peril, they gave their thoughts to pleasure. And all the hideous fears that stamp their faces in the daytime are transformed in the fiery, dusty nightfall into a sort of hectic exaltation, an unkempt freedom fevering their blood.
“And I, too, I’m no different. But what matter? Death means nothing to men like me. It’s the event that proves them right.”
Did you know that in the Black Death, some medieval Europeans had orgies in cemeteries, as a way of defying death? This really happened.
I wonder if we will see any of that here?
I just saw that the first case of coronavirus in Louisiana has been reported. I wonder if that will make it real to my mom. I’m struggling with my frustration, bordering on anger with her. I told you last week that she’s a 76-year-old heavy smoker with COPD. I thought I had her in a good place in terms of taking the threat to her health seriously, and staying at home, where she’s got a well-stocked larder. Last night when I called to check on her, she was so excited that she had had company all day long. Lots of people coming by to visit her.
After I let her finish, I told her that having people in and out of the house defeats the purpose of staying home. She did not want to hear that. She said frostily, “Well, I’m sure that I won’t get it” — the virus, she means.
“You can’t know that!” I said, exasperated. “If you get it, you’re going to be very sick, and there might not be a bed for you at the hospital!”
“I’m sure that I won’t get it,” she repeated.
This is the narrative she lives by in these days. We all have one. Is yours sound?
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