Categories
Anthropology outbreaks shananapocalypse we know nothing

The Four Horsemen of the Apocalypse: A Few Observations Amidst COVID-19/CoronaVirus Response and Reactions

I dive into the four horsemen metaphor at the end of this post but I think it is worthwhile to read everything in order to get there.

This is all unfolding at a pace that would have seemed impossible or ridiculous just a few days ago. Tens of thousands of people (maybe hundreds of thousands or millions) have already lost their jobs, though most of them probably don’t know it yet.

Airlines and cruise lines are shutting down. Casinos are shutting down. Movie theaters, restaurants, and bars are shutting down. Hotels are shutting down. At the moment, these are all temporary – but let’s face it – most businesses can’t survive a month or more without income. From where I sit, I can’t imagine this all being solved in a month.

The governments are printing money and will be handing out money to keep people from freaking out – they have to.  That process is going to make all of the money worth less than it was before. Prices will rise – not just from gouging, but because the cost of production will go up.

It seems to me that pretty much everyone is going to be exposed to this virus in one way or another. Those who become symptomatic (which I have no idea about a number, no one does) will seek treatment and most likely, there will not be enough beds/doctors etc.

We can’t all hide in our homes forever – so we are going to have to come out and interact with each other on some level – work, school, foraging, or just mental health.

I have no idea where this all goes, but it leaves things radically different than they were before. At the moment, it seems like we are trying to race the virus- come up with a way to defeat it before it defeats us – that might work if we can overcome the bureaucratic red tape around vaccine development and deployment – but it won’t really change anything about how people are forced to weather this thing.

But, let’s say that we don’t come up with a cure or the virus adapts after we do. What does the new society that comes out of this look like?

It seems to me that nature is forcing us to group together in smaller numbers and limiting the way that we are able to interact with one another. Maybe on some level, nature decided that letting humans easily move about from place to place covering large distances is a bad idea. Maybe the bottom line of all of this is that essentially, we are learning that ‘travel isn’t a good thing’.

Maybe this plays out by a large number of people dying and then small communities with immunity or with the disease wiped out within local borders, closing their doors to newcomers that might bring this (0r any) virus.

Is it worth it to conquer or control territory that might bring you the disease?

Maybe we are entering the age where the superpower and mega state loses control of our destiny. Maybe we are entering an era of local autonomy.

I don’t know…I’m simply watching like everyone else – and trying to put the potential pieces together in a way that makes sense.

I don’t think we are all going to die.

I think our countries and economies might already be dead.

I think capitalism might have just been dealt a death blow.

I think we are going to see a lot of elderly, homeless, and ill people heading into the great beyond.

I think that travel, tourism, and mass entertainment (sport, cinema, etc) might have just been given a choice to evolve or die.

I think monetary policy is on the verge of complete failure.

I think human beings are being given a choice about which direction they want to go now – and the choices are 1) End as a species or 2) Change everything

If we are to look at the classical progression of the end of the world, we can look at the four horsemen of the apocalypse. Death, Famine, War, and Conquest.

Horseman #1: Death:

We have started with death. This virus will run it’s course.

Horseman #2 Famine:

The result will be famine – a general lack of everything – and it wouldn’t surprise me if mother nature throws severe climate, storms, earthquakes and disasters on top of that.

Horseman #3 War:

Unfortunately – war will almost certainly follow. Politicians use war to preserve their power, to save economies, and to control resources for ‘their’ people. War is coming. On what level – we can’t know.

Horseman #4 Conquest:

Superpowers and nation states will do what they do. Strongmen will rise up and do what they do. They will try to use us to fulfill their ambitions. Ultimately they will fail.

Is there a way out? I don’ think so. If there is, it is to take away power from the large and to empower the small. Maybe that is what the lamb is all about. Decentralizing, focusing on municipality, commune, neighborhood, town – not on state, country or nation.

Metaphorically, I think the four horsemen of the apocalypse work – but I also think there is a metaphor built into the prophecy that gives us a way out. The lamb.

I’m not a religious person, I’m not saying everyone needs to find Jesus – I don’t believe that. I’m saying that there is a way to short circuit the four horsemen.

We need to embody the qualities of the lamb and the flock. Care for one another, be gentle, not over-graze, and stick together. The society of the lamb is a small group of people, they range in their pasture, they are not aggressive, and generally, they cannot be used for aggression.

Categories
America outbreaks Politics shananapocalypse

A Complete and Total Societal Failure

We can’t say that we didn’t see it coming and yet here we are – totally and completely unprepared. From the top leadership to the ground zero forces – we are totally unprepared to deal with the current state of the world. And, unfortunately, it is likely to get worse – and we are unlikely to get better.

There are so many levels here – personal, local, city, state, federal, international. On the health level, school level, home level, or business level – there are failures stacking up in every realm. The one that people are noticing right now is the financial – but it’s just the tip of the iceberg. Still, it bears looking at.

I also failed. I knew how to prepare – or I thought I did, but then I lost the thread. For the past three years, I’ve been getting ready for the inevitable meltdown of the Trump economy.  One of the cornerstones of that was allocating a certain amount of my investments into volatility – for me it was TVIX – the Velocity Shares 2x VIX Short Term ETN. At one point late last year, I had over 200 shares – which for me was a big investment – but the constant infusions of cash into the economy by the Federal Reserve and the short sighted stimulus kept pumping the economy higher and higher – finally, in December, the TVIX was driven so low that there was a huge reverse split and I was left with  the process beginning again. This seemed like a good way to lose what little money I had – so I sold. And of course, today, at $350 each and I don’t have this particular hedge. So, like everyone – I am losing.

It turns out that there may not have been a good hedge, no place to hide out. Bitcoin and Gold are both tanking along with the markets today. Inflation is starting to reveal itself and that’s just going to get worse – so cash is nowhere to hide. Real estate is going to suffer along with everything else.

So, there is the financial end of things from my very tiny perspective. We should have known a pandemic would have this kind of effect – I mean, actually we did, but we ignored it. We should have known that ineffective leadership with temporary loyalist cabinet members and “Yes Sir” congress would lead to crisis – and I suppose we did, but here we are. All those baby boomers who kept loving their 401k growing under Trump’s grand manipulation of the economy, they probably don’t feel so good about him now, hiding out in their Boomer Bunkers with huge piles of toilet paper and soon to be dead spouses and call centers that keep telling them to call their PCP, the CDC, an Emergency Care Clinic, or someone else because no one knows how to take care of this.

Is this the end? Probably not. Let’s hope that it is the end of the disgusting capitalist ideology that got us here. There is a chance to change – that is the only real hedge – anything else is just like an injection of cash into the stock market by the inept and corrupt banking system or a new decree or ban from the inept and corrupt political leadership.

Categories
Alternative Medicine America outbreaks

Free Hand Sanitizer and Toilet Paper

Enough already with the hand sanitizer and toilet paper freaking out! And if you are tired of all this shit – maybe it’s time to give this a read. 

First of all – buy a bidet (we call it a butt washer) and learn how to properly clean your ass without paper. Here’s a link to a variety of cheap bidets that attack to your toilet. No more need for toilet paper – just wash yourself and use a towel after drip dry.

Second – Hand sanitizer is pretty easy to make – you can also just use alcohol or tea tree oil! My favorite recipe is thus:

  • 5-10 drops lavender essential oil
  • 30 drops tea tree essential oil
  • 3 ounces rubbing alcohol
  • 1 ounce pure aloe vera gel
  • ¼ teaspoon Vitamin E Oil (helps soften hands!)

Instructions

  1. Add essential oils and Vitamin E oil to a small glass bowl or container and swirl to mix.
  2. Add alcohol to the oils and swirl again.
  3. Combine this mixture with the aloe vera gel and mix well.
  4. Shake gently before each use. (Sanitizer should last several months with the addition of Vitamin E and alcohol to help preserve.)

Transfer hand sanitizer to small, clean squirt bottles. Also, use colored bottles so the essential oils in the recipe are not exposed to light. Finally, this recipe is perfect for throwing into a purse or a backpack!

Categories
America Economics Environment outbreaks shananapocalypse

The Shit is Really Hitting the Fan!

Wow. The stars are really lining up for massive change. Chaos at the Greek/Turkish border over the ‘catch and release’ of Syrian refugees into Europe from Turkey. Russia and Saudi Arabia getting into a gas price war that is going to screw American oil and shale extraction, North Korea launching something towards South Korea,  – plus the whole COVID-19 CoronaVirus mess. Bottom line is – get ready for some shit people. It’s hitting and it’s hitting all over all at once.

Crypto prices are tanking, stocks will most likely drop at record levels tomorrow, and who knows how many people were exposed to Covid-19 in DC, Seattle, Europe, and NYC.

But you know what – it’s spring. Maybe we need to start thinking about a good old fashioned May Day Celebration.

And you’ve gotta admit – it seems like maybe the Covid-19 virus is a conscious response from a conscious planet that has had enough of our bullshit. It seems to be targeting the main perpetrators. Yes, a May Day celebration is definitely in order with some good old fashioned Ring Around the Rosies, Pocket Full of Posies, Ashes, Ashes, We All Fall DOWN.

Here’s a little something to keep your soul cheerful.

Categories
outbreaks

CoronaVirus and You – COVID-19 and Hysterical Responses

I’m not an epidemiologist or a doctor, I don’t play one on TV. Pandemics and viruses are serious business – but it is my humble opinion that the current hysteria over the COVID-19 virus is waaaaaaaaay overblown. Yes, people are dying and more people will die – but looking at the numbers, this doesn’t seem to be all that deadly of a disease. As I write, 86,000 cases in a two month period – with nearly half of those having recovered and close to 3000 fatalities. That’s a 3.5% mortality rate – the vast majority of which contracted and died from the disease before there was any sort of understanding of what it was.

So, we have roughly 8 billion people on the planet – which means that if we lose 3% of them that still leaves way more than 7 billion people – sure 27 million could die by that calculation, but those are numbers. It seems that the majority of people who are dying are those who are a bit older – so they really probably only had a few more years to go.

Oops – sorry, forgot a zero. Actually it’s 227 million. But that still leaves 7 billion on Spaceship Earth. If the planet wants to get rid of us quickly she is going to have to become more virulent and more deadly – but let’s hope that doesn’t happen. As to people’s panic – if the reality comes out to anything like those numbers – maybe panic is warranted after all.

(Note a few days later: My friend John, who is a pretty rational guy just posted this – read it and put your head on straight. )

Categories
America assholes outbreaks shananapocalypse

The Fall of the USA Continues

Words just can’t express how far we’ve already fallen – and yet, the crash is going to be so much more incredibly painful when we hit the bottom. We still have a long way to go. With the exception of Mitt Romney, the entire Republican Senate essentially proved that they have already sold their souls with the vote on Donald Trump’s impeachment. They gave him a pass – for everything. This is only going to get worse.

The Democrats meanwhile are so hell bent on keeping their campaign funding and power that they choose to completely ignore the will of the people and willfully pervert voting institutions like the Iowa Caucuses. I’ve got no beef with Pete Buttigieg – he’s a warrior fighting for LGBTQ equality, he did his time in the service honorably, and by most accounts he’s tried his best to be a good mayor. The DNC though is pulling their usual tricks – here’s what happened – I have no proof, but it’s obvious if you look.

They expected a Biden victory. Middle America is so terrified of socialism that when they saw that Bernie Sanders was going to walk away with it – they began messing with the caucuses. Finally, some lily white genius who probably can’t program a remote control decided to release the results in such a way that it looked like Buttigieg won it. They let Pete know about this and he spilled the beans.

The only reason the Iowa caucuses have ever mattered was for bragging rights and they took those from Bernie Sanders and gave them to Buttigieg. Make no mistake, it was some illegal shenanigans going on there and it was either willfully done by Democrats or masterfully manipulated by Donald Trump.

At this point, we can’t get rid of Trump. There’s no candidates who will beat him and if they do, he will be able to call foul play on the elections and refuse to step down. This is going to get really painful for some. My advice is that we just step back and let it play out. When things that actually threaten lives, freedom, or existence take place – then we step up. We need to embrace jiu jitsu here and just let him run with his head.

There’s plenty of other stuff happening at the same time Wuhan Corona Virus continues to balloon, the stock markets continue to go up and up and up – just like a roller coaster that is pulling the car up to where the tracks stop before pushing everyone to their deaths. None of this really matters – the stock markets I mean. That wealth is ephemeral. We’re all going to die at some point and this whole system is reaching the point where all it can do is collapse.

It’s my hope that when these cataclysms happen – we, as people, can find a way to take care of each other – and more importantly to take care of each other’s children. Right now there are 50 million people locked into a quarantine zone with what seems to be a very contagious and deadly disease – think about that. At least a third of those fifty million are kids – probably more.

We are at a time when we need leadership in the world – but we don’t have it. Maybe this crisis will bring it to the fore. Maybe this crisis is what will bring about real change. God help us all.

Categories
America Antichrist 2020 outbreaks

Less than ‘Two Minutes to Midnight’ – Humanity on the Brink of Disaster – Wuhan, Nukes, Opiates, Propaganda

It would almost appear that Netflix was holding their ‘Pandemic’ series for an outbreak. We have one now – hopefully not as virulent as it appears and with a lower mortality rate than common flu. Mercenary move by Netflix.

Speaking of mercenaries, it seems that it wasn’t just me who saw that the opportunities for Trump and his gang to use the bully pulpit to make themselves richer in the stock market were ripe for the picking. Obviously the Trumps saw it – and now Vanity Fair and Salon have done some solid investigative reporting into just how much this administration’s corruption is making the Trump’s wealthier..

On another mercenary front, the tragic death of Kobe Bryant this morning was not wasted news on the vendors at the flea market. I walked through this morning and within minutes saw vendors tearing through their nearly worthless 1990s basketball cards looking for anything Kobe. You can’t blame them, since rookie cards quickly short up to $60, $6000, and even one card selling for $60,000 this morning on ebay.

Unfortunately – this is how we (the smartest beings in the universe that we know of) force each other to be.

Despite lots of looking – we still haven’t found life – nor intelligent life – which would probably come very much to the surprise of the authors of this Scientific American article from 1943 – we haven’t even found vegetation on Mars yet!

In the United States, we are spiraling towards dictatorship with the antiquated two-party system but it isn’t the only option (and radicals like me are no longer the only ones calling for change).

https://www.vox.com/2020/1/23/21075960/polarization-parties-ranked-choice-voting-proportional-representation

https://thebulletin.org/doomsday-clock/current-time/#

Categories
outbreaks Politics shananapocalypse

Signs of the apocolypse? Fallen arches and WW III.

Remember seeing the arches in arches national park when you visited there? Hopefully you do, because the main arch that is there collapsed.

Oh well, shit happens. And I will tell you that shit is happening in the world…this situation with Russia and Georgia seems to be building up. You know when the dick speaks (Dick Cheney) that things are getting out of control.

On Sunday, Vice President Dick Cheney told Georgia’s pro-American president that “Russian aggression must not go unanswered, and that its continuation would have serious consequences for its relations with the United States,

Bush when asked about Russia and Georgia said that he didn’t know the Bulldogs were competing in the olympics but expected them to win the gold for football although he said the Russians were getting better under their new coach.

The president was to end his weeklong Asia trip by attending a baseball game and other events Monday at the Beijing Olympics. The Beijing stay was mostly for fun and games, but the fast-moving conflict in Georgia has grabbed his attention even as he cheered from the stands as American Michael Phelps claimed the first of an expected string of gold medals by smashing his own world record in the 400-meter individual medley.
“God, what a thrill to cheer for you!” Bush told Phelps.


Meanwhile guess who is in charge back in the U.S….uh-oh! It’s the Dick. And he has no strange ideas about being best friends with good old Vlad. The aggression is spread out even as far as the United Nations between the cold war rivals.

“This is completely unacceptable and crosses a line,” said the U.S. ambassador to the U.N., Zalmay Khalilzad, who made the allegation.
In a crackling exchange of a type rarely seen since the end of the Cold War, Khalilzad asked Russian Ambassador Vitaly Churkin whether the Russians were seeking “regime change” in Georgia with the military operation they launched Friday.
In response, Churkin objected to the disclosure of a confidential phone call between top diplomats and said “regime change” was “an American expression.”

And in the meantime, allied Georgia troops are pulling out of Iraq where they are part of Bush’s coalition of the willing and heading back to fight the Russians…seems like it would be a little ungrateful to not help them out with a few weapons, some material support, maybe some troops, I mean after all, they have been helping the U.S. and even on the verge of joining NATO…

As the third largest contributor to coalition forces in Iraq after the United States and Britain, the departure of the Georgian troops entails adjustments for the US military.
“We had already been shuffling forces around in Wassit province before the recent events, so despite the loss of the Georgian units, although unexpected, we can and are accommodating the changes,” said Hall.
As a staunch ally of the United States the Georgians arrived in August 2003, about five months after the American-led invasion toppled Iraqi dictator Saddam Huessein.
The majority of Georgian soldiers were deployed near Kut, 175 kilometres (109 miles) south of Baghdad in the province of Wasit, a hotbed of smuggling near the Iranian border.
They have provided training to Iraq’s fledgling military, and manned border checkpoints.
The Georgian brigade has also faced powerful Shiite militias in the south and al-Qaeda forces in the Diyala region, northeast of Baghdad, regarded as the most dangerous area in Iraq.

Categories
Anthropology Art and Beauty assholes big screen, little screen, ipod Crime and Punishment energy Environment Food and Booze Oddities other worlds outbreaks

Questionable energy, expensive burgers, Rembrandt laughing, my herpes and 1/4 of New York's Herpes, the history of the human universe in 200 words, Joe Arpaio, whistle language, and Galileo's middle finger.

We’ve established that the universe is made up of nothing but energy in many different forms and that much of what we think we see is arguably illusion, however, that doesn’t change the fact that we are forced to live in this world of maya (illusion) and that we have to make the best choices that we can for the greatest good of our collective selves. That being said, we can begin to talk about questionable energy.
Sen. John McCain called Wednesday for the construction of 45 new nuclear reactors by 2030 and pledged $2 billion a year in federal funds “to make clean coal a reality,” measures designed to reduce dependence on foreign oil.
President George W Bush has called on Congress to end a 27-year ban on drilling for oil in US coastal waters, to reduce dependence on imports. Mr Bush said existing restrictions on offshore drilling were “outdated and counter-productive”.
These guys are trying to step backwards to a time when it was okay to have a barbecue with your favorite oil baron at your ranch in Texas.
While we are speaking of expensive choices, Burger King’s new Whopper includes Japanese-style Wagyu beef, Italian truffles, Spanish cured ham, aged balsamic vinegar and Champagne onions on a saffron- and truffle-dusted bun for just $200. Would you like fries with that?

Experts have confirmed “Rembrandt Laughing” — bought for a bargain price of $4.5 million at an English auction house in October — is a self-portrait by the Dutch master himself, depicted with his head tilted back in easygoing laughter.
William Noortman from Noortman Master Paintings, specializing in Dutch and Flemish masters, said it’s worth $30 million to $40 million.

I suspect Rembrandt was laughing because he has herpes and suspects that a quarter of adults living in New York City are infected with the genital herpes virus. This was somehow just shown to be true. Lots of us have herpes, it’s time to let go of the shame. Personally, I think the herpes are an intelligent organism that interact symbiotically with those of us lucky enough to have them and gives us incredible healing and mental powers. If you have them, you know what I mean. (Yes, I refer to them in the plural). If you don’t have them, well, you will eventually…if you get lucky.

The History of the Universe in 200 Words or Less

History_of_the_universe Quantum fluctuation. Inflation. Expansion. Strong nuclear interaction. Particle-antiparticle annihilation. Deuterium and helium production. Density perturbations. Recombination. Blackbody radiation. Local contraction. Cluster formation. Reionization? Violent relaxation. Virialization. Biased galaxy formation? Turbulent fragmentation. Contraction. Ionization. Compression. Opaque hydrogen. Massive star formation. Deuterium ignition. Hydrogen fusion. Hydrogen depletion. Core contraction. Envelope expansion. Helium fusion. Carbon, oxygen, and silicon fusion. Iron production. Implosion. Supernova explosion. Metals injection. Star formation. Supernova explosions. Star formation. Condensation. Planetesimal accretion. Planetary differentiation. Crust solidification. Volatile gas expulsion. Water condensation. Water dissociation. Ozone production. Ultraviolet absorption. Photosynthetic unicellular organisms. Oxidation. Mutation. Natural selection and evolution. Respiration. Cell differentiation. Sexual reproduction. Fossilization. Land exploration. Dinosaur extinction. Mammal expansion. Glaciation. Homo sapiens manifestation. Animal domestication. Food surplus production. Civilization! Innovation. Exploration. Religion. Warring nations. Empire creation and destruction. Exploration. Colonization. Taxation without representation. Revolution. Constitution. Election. Expansion. Industrialization. Rebellion. Emancipation Proclamation. Invention. Mass production. Urbanization. Immigration. World conflagration. League of Nations. Suffrage extension. Depression. World conflagration. Fission explosions. United Nations. Space exploration. Assassinations. Lunar excursions. Resignation. Computerization. World Trade Organization. Terrorism. Internet expansion. Reunification. Dissolution. World-Wide Web creation. Composition. Extrapolation?

This was composed by astronomer and science humorist Eric Schulman, a member of the editorial board of the Annals of Improbable Researc. He later expanded this piece into a book, A Briefer History of Time. So far as we know he is not the jogger listed below.
Lincoln police have a message for local joggers with exhibitionist tendencies: The thong is wrong. Police arrested a man on Saturday night for running on a Lincoln bike trail in his thong underwear.
And Sheriff Joe Arpaio is making headlines again in Maricopa County, Arizona.

Maricopa County was spending approx. $18 million dollars a year on stray animals, like cats and dogs.
Maricopa County Sheriff Joe Arpaio offered to take the department over, and the County Supervisors said okay.
The animal shelters are now all staffed and operated by prisoners. They feed and care for the strays. Every animal in his care is taken out and walked twice daily. He now has prisoners who are experts in animal nutrition and behavior. They give great classes for anyone who’d like to adopt an animal. He has literally taken stray dogs off the street, given them to the care of prisoners, and had them place in dog shows. The best part? His budget for the entire department is now under $3 million.
The prisoners get the benefit of about $0.28 an hour for working, but most would work for free, just to be out of their cells for the day. Most of his budget is for utilities, building maintenance, etc. He pays the prisoners out of the fees collected for adopted animals. I have long wondered when the rest of the country would take a look at the way he runs the jail system, and copy some of his ideas.
He has a huge farm, donated to the county years ago, where inmates can work, and they grow most of their own fresh vegetables and food, doing all the work and harvesting by hand. He has a pretty good sized hog farm, which provides meat, and fertilizer. It fertilizes the Christmas tree nursery, where prisoners work, and you can buy a living Christmas tree for $6 – $8 for the Holi days, and plant it later. He was reelected last year with 83% of the vote.

On the small mountainous island of La Gomera, one of the Canaries, the children speak to each other from miles apart using one of the most unusual languages in the world. Known as Silbo, the whistling language of Gomero Island has a vocabulary of over 4,000 words, and is used by “Silbadors” to send messages across the island’s deep valleys. Though Silbo was on the verge of extinction in the 1990s, the Gomerans have made a concerted effort to revive their language by adding it to the public school curriculum. Today 3,000 schoolchildren are in the process of learning it.

Of all five fingers, to choose that one. And to keep it in the manner of a saintly medieval relic… Today it seems a loud gesture. Galileo Galilei’s middle finger is preserved in the History of Science Museum in Florence, Italy. From Curious Expeditions:
It is a remarkable bit of irony, that finger. Venerated, kept in reliquary, subjected to the same treatment as a Saint. But this finger belonged to no Saint. It is the long bony finger of an enemy of the church, a heretic. A man so dangerous to the religious institution he was made a prisoner in his own home. It sits in a small glass egg atop an inscribed marble base in the Istituto e Museo di Storia della Scienza, or the History of Science Museum in Florence, Italy. … As with a fine wine, it took some years for Galileo’s finger to age into something worth snapping off his skeletal hand. The finger was removed by one Anton Francesco Gori on March 12, 1737, 95 years after Galileo’s death. Passed around for a couple hundred years it finally came to rest in the Florence History of Science Museum. Today is sits among lodestones and telescopes, the only human fragment in a museum devoted entirely to scientific instruments. It is hard to know how Galileo would have felt about the final resting place of his finger. Whether the finger points upwards to the sky, where Galileo glimpsed the glory of the universe and saw God in mathematics, or if it sits eternally defiant to the church that condemned him, is for the viewer to decide.

Categories
outbreaks

Doctors compose list of who to let die in pandemic

I would just like to add one group to the list: zombies…let them die already.
cd

Who should MDs let die in a pandemic? Report offers answers
By LINDSEY TANNER, AP Medical Writer
(AP) — Doctors know some patients needing lifesaving care won’t get it in a flu pandemic or other disaster. The gut-wrenching dilemma will be deciding who to let die.
Now, an influential group of physicians has drafted a grimly specific list of recommendations for which patients wouldn’t be treated. They include the very elderly, seriously hurt trauma victims, severely burned patients and those with severe dementia.
The suggested list was compiled by a task force whose members come from prestigious universities, medical groups, the military and government agencies. They include the Department of Homeland Security, the Centers for Disease Control and Prevention and the Department of Health and Human Services.
The proposed guidelines are designed to be a blueprint for hospitals “so that everybody will be thinking in the same way” when pandemic flu or another widespread health care disaster hits, said Dr. Asha Devereaux. She is a critical care specialist in San Diego and lead writer of the task force report.
The idea is to try to make sure that scarce resources – including ventilators, medicine and doctors and nurses – are used in a uniform, objective way, task force members said.
Their recommendations appear in a report appearing Monday in the May edition of Chest, the medical journal of the American College of Chest Physicians.
“If a mass casualty critical care event were to occur tomorrow, many people with clinical conditions that are survivable under usual health care system conditions may have to forgo life-sustaining interventions owing to deficiencies in supply or staffing,” the report states.
To prepare, hospitals should designate a triage team with the Godlike task of deciding who will and who won’t get lifesaving care, the task force wrote. Those out of luck are the people at high risk of death and a slim chance of long-term survival. But the recommendations get much more specific, and include:
-People older than 85.
-Those with severe trauma, which could include critical injuries from car crashes and shootings.
-Severely burned patients older than 60.
-Those with severe mental impairment, which could include advanced Alzheimer’s disease.
-Those with a severe chronic disease, such as advanced heart failure, lung disease or poorly controlled diabetes.
Dr. Kevin Yeskey, director of the preparedness and emergency operations office at the Department of Health and Human Services, was on the task force. He said the report would be among many the agency reviews as part of preparedness efforts.
Public health law expert Lawrence Gostin of Georgetown University called the report an important initiative but also “a political minefield and a legal minefield.”
The recommendations would probably violate federal laws against age discrimination and disability discrimination, said Gostin, who was not on the task force.
If followed to a tee, such rules could exclude care for the poorest, most disadvantaged citizens who suffer disproportionately from chronic disease and disability, he said. While health care rationing will be necessary in a mass disaster, “there are some real ethical concerns here.”
James Bentley, a senior vice president at American Hospital Association, said the report will give guidance to hospitals in shaping their own preparedness plans even if they don’t follow all the suggestions.
He said the proposals resemble a battlefield approach in which limited health care resources are reserved for those most likely to survive.
Bentley said it’s not the first time this type of approach has been recommended for a catastrophic pandemic, but that “this is the most detailed one I have seen from a professional group.”
While the notion of rationing health care is unpleasant, the report could help the public understand that it will be necessary, Bentley said.
Devereaux said compiling the list “was emotionally difficult for everyone.”
That’s partly because members believe it’s just a matter of time before such a health care disaster hits, she said.
“You never know,” Devereaux said. “SARS took a lot of folks by surprise. We didn’t even know it existed.”

On the Net:
CHEST: http://www.chestjournal.org
U.S. Govt.: http://www.pandemicflu.gov