July 10, 2020
What Dhaka Gets… That America Doesn’t
In ten days, my little brother is going back into the coronavirus fire.
He’s an attending physician at the emergency room of a big, urban public hospital in the southwest of the U.S. A normal day at the office for him has enough blood and guts and tears to fill an entire season of Grey’s Anatomy (“only no doctors are that good-looking,” he warns).
Back in March, my brother was in a self-imposed quarantine after he treated a patient with COVID-19.
Today, he says lots of people coming through the ER doors are coronavirus patients. There’s a special COVID-19 fast-track waiting room. His emergency room is nearly doubling patient capacity. Like other hospitals in the area, coronavirus patients are gradually taking over the entire hospital, floor by floor… like a virus.
Elective surgeries that are necessary but not immediately essential – from hip replacements to cataract extraction to tonsillectomies – are being delayed indefinitely, by wary would-be patients or by hospital administrators concerned about the availability of hospital beds.
One of the few signs of progress in the American war against the coronavirus is that now there’s plenty of personal protective equipment (“PPE”) to go around. “Before, we were re-using N95s, but now we have enough of them,” my brother told me.
However, just a few days ago, he said that the hospital announced that they have enough PPE “on hand” for just two weeks. And on Wednesday, the Associated Press said that PPE “in the U.S. is running low again as the virus resumes its rapid spread and the number of hospitalized patients climbs.” So much for progress…
(N95s are heavy-duty facemasks that the Centers for Disease Control and Prevention (“CDC”) does not recommend for the general public – not because they’re ineffective or dangerous… but so that there are enough of them for health care workers.)
Even better, my brother and his colleagues now usually wear P100s, which is the respirator mask you’d want if you were wandering through an understaffed preschool after a salmonella lunch. While seeing patients in the ER, he usually wears goggles, a P100, and a face shield. “It’s like we’re going jousting,” he told me.
All that body armor isn’t exactly a soft touch with patients, though. “In P100s, we have to scream to be heard,” my brother says.
Meanwhile, the United States has more than 3 million cases, and around 135,000 people have died of the coronavirus. Encouragingly, deaths are dropping – for now, at least.
My 5% Risk
And still, using facemasks – just the normal surgical kind that’s like a few tissues over your nose and mouth – is somehow still a matter of debate in much of the U.S… including in the stucco-and-cacti suburb of Phoenix, Arizona where my parents live. It’s home to one of the world’s highest fountains (“110 feet higher than the Great Pyramid of Cheops in Egypt,” the website brags) and lots of old people.
(Arizona, of course, is now one of the coronavirus hotspots of the world… with nearly 4,000 new reported infections every day.)
As we know well by now, old people are the demographic that’s by far the most susceptible to coronavirus decimation. My 80-year-old father and 74-year-old mother jog three miles every day, just a year ago were hiking Machu Picchu, and (until recently) spent half their time in Amsterdam. But since March, they haven’t seen anything but stucco, cacti, and each other – because they know that outside of quarantine, they’re red meat to the Tyrannosaurs Rex that is the coronavirus.
“If you’re over 75, catching COVID-19 can be like playing Russian roulette,” explains the MIT Technology Review. “Your odds of dying from COVID-19 depend on things like location, sex, and underlying health conditions. But the biggest factor is age. For someone… in the over-75 age bracket, the chance of death can range as high as 17%. That’s roughly 1 in 6, or the chance you’ll lose at Russian roulette.”
(See this website to calculate your odds of infection and of dying if you’re infected. I have an infection risk of 5%, and a mortality risk of 0.19%… and you?)
Beware the Rise of ‘Authoritarian Socialism’
My folks’ neighborhood is filled with oldsters more vulnerable than either of them. Nevertheless, two weeks ago, the local town council – swayed by arguments decrying “a rise of authoritarian socialism” – decided not to mandate residents to wear facemasks. (This part of the story has a happy ending: The county board of supervisors subsequently overrode braindead town councils, like that of Fountain Hills, to require facemasks throughout the county.)
If they’re lucky, the old people in the area who contract the coronavirus might have the option to go on remdesivir, an experimental antiviral drug that’s been found to reduce coronavirus patient hospital stays by four days. Gilead Sciences, the American pharma giant that produces remdesivir, charges $2,340 for a five-day prescription. (This is the drug that may have saved the life of my friend Bob after he barely escaped from Nigeria while desperately ill.)
In the U.S., that’s arguably a bargain – considering a one-night stay at the hospital costs around $4,000. (Of course, how much a night costs you depends on your condition and treatment – and how many hundreds of dollars your insurance company is charged for an aspirin.)
But compared to the $1 per dosage cost of production for remdesivir, it’s pretty steep.
It’s Cheaper in Dhaka
And (as you might guess), remdesivir is a lot cheaper in Bangladesh. In some less-developed countries, local drugmakers are allowed to ignore patents to (legally) produce treatment products for domestic consumption and for other poor countries. For example, Beximco, a big pharma producer in Bangladesh, is now making remdesivir and selling it to the government for around 20% of what Gilead charges in the U.S.
Last week, I checked in with my friend Rafi, who back in April told me that as the lockdown there began to bite, he’d never seen so many beggars on the streets of Dhaka, the capital of Bangladesh, where he lives.
Despite a partial lifting of the lockdown, and the overwhelming need for desperately poor people to work to put food on the table, Dhaka is strangely mellow now, Rafi told me, because people are afraid to go out. “Buses are driving around half empty, ” he told me.
Dhaka has three times as many people as Chicago. Bangladesh has around half the population of the U.S. – crammed into an area about the size of Florida. It’s one of the world’s most densely populated countries. A normal (non-pandemic) day in the capital is as chaotic as a riot bumping into a Guns N’ Roses concert just letting out. “Quiet Dhaka” is as much of an oxymoron as “government intelligence” or “if we stop testing, we’d have fewer cases.”
Officially, just over 2,000 people have died of the coronavirus in Bangladesh. The country says its deaths-per-million rate is just 3% that of the U.S.
But those figures don’t reflect reality. “A lot of people just aren’t getting any medical help. If they show symptoms, the hospitals won’t take them,” Rafi told me. In a country with an average daily wage around $5, most people don’t have spare cash for visits to the doctor anyway (to say nothing of hospital stays).
One thing that people are doing, though, is wearing masks. “Even the beggars are wearing them,” Rafi told me. “It’s really caught on. People don’t want to get sick.”
Here in Singapore, as I wrote last month, not wearing a mask can earn you front-page ridicule and prison time. Going to the grocery store at my local mall involves having your national ID scanned and your temperature taken – twice. In general, the government is in your business so much here that the intrusion of wearing a facemask is incidental.
The Pseudo-Libertarians Are Killing Us All
And there’s zero doubt – at least among people who understand that science traffics in fact, not opinion – that facemasks help. A few weeks ago, famed philosopher, mathematician, and investor Nassim Taleb – who in late-January warned about the dangers of the coronavirus – wrote about dumb mistakes people have made with respect to face covering.
“… Masks (and face shields) supplemented with constraints of superspreader events can save us trillions of dollars in future lockdowns (and lawsuits) and be potentially sufficient (under adequate compliance) to stem the pandemic,” he wrote.
One of the big mask mistakes, he says, is “ignoring the Non-Aggression Principle.” He wrote that…
“[Pseudo-libertarians] are resisting mask wearing on grounds that it constrains their freedom. Yet the entire concept of liberty lies in… the equivalent of the Silver Rule: do not harm others; they in turn should not harm you…
Note that by infecting another person you are not infecting just another person. You are infecting many, many more and causing systemic risk.
Wear a mask. For the sake of others.”
They understand this in Dhaka… and in Singapore… and in much else in the world. For the sake of my brother and his colleagues – not to mention my parents and their neighbors – I hope the United States starts to understand it, too.
May you find your way through the chaos.
Now here are some of the stories we’re reading…
U.S. hits 3 million cases, about a quarter of world total
The U.S. figure dwarfs the 85,000 cases in China, where the virus is thought to have originated. Even allowing for potential underreporting by Chinese authorities, China’s 1.4 billion people make its per capita infection rate one in 16,000. Here, one in every 110 Americans has tested positive for the virus.
Trump threatens federal funding for schools, says he disagrees with CDC over reopening guidelines
On Twitter, Trump said reopening guidelines from the Centers for Disease Control and Prevention are “very impractical” and that he would be meeting with the organization.
Prospect of chaos in November grows
The rickety, decentralized election system that has been a hallmark of American life is facing its most significant test yet under the combined pressure of a worsening coronavirus pandemic and President Donald Trump’s determination to undermine faith in the voting system.
‘Far Side’ Cartoonist Gary Larson Shares First New Work in 25 Years
In a note on his website, Mr. Larson thanked a clogged pen for pushing him to create digital cartoons on a tablet. “I’m just exploring, experimenting, and trying stuff,” he said. “New Stuff.”
And let us know what you’re reading at [email protected].
Chaos Chronicles Editor, American Consequences
With P.J. O’Rourke and the Editorial Staff
July 10, 2020