Unsanitized: The COVID-19 Report for Aug. 4, 2020

The Virus Heads to Where Hospital Beds Are Scarce
Plus, small business collapse,
and breaking the post office backfires

 

A makeshift isolation area at the rural, 24-bed Kearny County Hospital
in Lakin, Kansas. (Charlie Riedel/AP Photo)

First Response

Sunday and Monday are the typical slow days for counting coronavirus
cases, hospitalizations, and deaths. We will have to brace for today's
results for the full trend. But based on current data
(which, as I've said repeatedly, is a
lot like the blind man feeling an elephant, though it can show trends),
cases and hospitalizations are trending down. Deaths you would expect to
have another week or so of increases before they start to trend down as
well.

The Trump Veep sketch
was
embarrassing, but near the end he does mention that deaths were going
down in Arizona , Florida
, and Texas
. It's better to say that
these states have plateaued on deaths and seen a sustained drop in cases
(though testing is also lower) and hospitalizations, but in general
there is a softening in the data. These trends could be reversed, but
they hold for a lot of states with major outbreaks, like California
. The death rise will
likely continue for a little while but with hospitalizations falling,
official deaths are probably going to fall as well.

If this wave does top out at a high of 1,500 or so deaths per day, that
is a significant reduction from the 2,000-2,500 we saw in April. That
does suggest better medical care has saved lives, which is a good thing,
though obviously there are a host of bad outcomes from coronavirus that
fall short of immediate death.

Of course, the whole country cannot breathe more easily now. It's
wrong to look at national cases in a country this vast, with different
outbreak timelines. We are sadly likely to have these waves of hot spots
and cold spots until there's a vaccine in widespread use. For example,
Ohio
,
Tennessee
,
Georgia , Oklahoma
, and Kentucky

are in a plateau at a high level; Idaho
and Arkansas
hospitalizations are
rising without end; Alabama
and Mississippi
have raised concerns
.

All of these states have large rural areas, and that's where the trend
of improved medical care could reverse itself. And as this study in
Health Affairs

shows, it's a story about inequality.

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The study concerns intensive care unit (ICU) beds, a critical part of
COVID-19 care. If you have a secure facility to administer to a patient,
there's a better chance of survival. But because America is America,
there's a critical shortage of ICU beds in precisely the places that
need them the most right now; poor rural communities that are often too
far from wealthy areas to transfer patients. According to the Health
Affairs study, "49 percent of the lowest-income communities had no ICU
beds... whereas only 3 percent of the highest-income communities had no
ICU beds." And this disparity was even sharper in rural areas, which
again don't have a richer community next door to which they can
offload patients.

We're seeing this in the Rio Grande Valley

in Texas, home to 1.3 million residents and no public hospital. Starr
County is one of the only in America to have to resort to triage,
choosing who to care for and who to send home to die. The conversion of
hospital facilities into ICUs is ongoing but often too late.

Rural hospitals, of course, are in total crisis in the U.S., with 19
closures last year

and 120 since 2010. As hospital networks consolidate and strive for
ever-greater profits, rural hospitals that fail to bring in the
necessary revenue fall away.

This is where the virus is headed, into areas that are utterly
unprepared for a crisis of this nature. That's because America remains
a place where your medical care is a function of your socio-economic
status. This essential inhumanity should have been remedied long ago,
but the crisis makes it impossible to look away. We have the greatest
health system in the world if you can afford it. That's a moral crime.
Single-payer supporters are often derided as "unrealistic," but
it's actually unrealistic to expect that Americans will blandly accept
their bank accounts being a factor in their mortality. This must change.

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One-Third

That's the percentage of small businesses in New York City that could
close up shop due to the pandemic, according to the Partnership for New
York City
.
That's 80,000 businesses in New York City alone. The working number
I've seen for closures so far is 100,000... for the whole country. I
don't have similar numbers for my hometown in Los Angeles, but
here's a long and updating list

of closed restaurants. I've been told that downtown Washington, near
the Prospect offices, is a ghost town.

It's in many ways not surprising that a small business program that
provided eight weeks of payroll didn't last in a crisis well into its
fifth month, and by "in many ways" I mean in every way. This is
another example of the temporary benefits of the CARES Act
,
set against the effectively permanent bailout authority for large
corporations. There was certainly a way to have the corporate credit
facilities run by the Fed expire on the same date that unemployment
benefits and all the other pieces expired; that way there would be
incentive on all sides to extend them. I don't support the Fed
facilities but at least that would be a politically balanced way to
ensure a stake in the outcome on all sides. Now you have Mitch McConnell
lamenting

that 20 of his Senators will never vote for anything, and a party simply
disinvested in desperately needed relief.

So if you're asked why everything's a Taco Bell or Amazon Go store
in 20 years, remember this aspect of it.

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Oh God

The disruption of mail service across the country, as the new Postmaster
General bans overtime and instructs postal workers to leave behind mail,
is coming so close to a presidential election that
will have a heavy vote-by-mail element that you can't help but assume
that this is the ultimate goal. I would say it's a happy by-product of
a bid to delegitimize the post office and warm the public mood toward
privatization. The USPS had high marks for service and trust before now,
making it the DMV of conservative fever dreams makes it easier to kill,
and the pandemic provided the opportunity.

Now, seeing Trump assert that mail-in voting can't be done

now that he broke the post office certainly suggests opportunism. But
the immediate impact of that will evaporate the traditional Republican
advantage

on mail-in voting. It will make things worse for him and his party. And
the Postmaster General serves at the pleasure of the president, so the
next one can throw out the Trump donor currently running the USPS into
the ground. Just another thing to do on day one.

Days Without a Bailout Oversight Chair

130
.
Although maybe the chair is superfluous. The Congressional Oversight
Commission is actually holding a hearing on Friday about the Main Street
Lending Program. Maybe it will cover how the Fed changed the program

to support the oil and gas industry. The hearing should stream at its
new website, coc.senate.gov , which is
sadly... not operative yet.

We Can't Do This Without You

Today I Learned

* Quick Monopolized news, I did a long interview with Teddy Downey of
The Capitol Forum, which is normally paywalled but you can access the
interview here .
(The Capitol Forum)

* I think "upbeat" here means that the screaming has died down in
coronavirus relief negotiations
.
(Wall Street Journal)

* Some ideas about unilateral executive action are foolish, but the
proper agencies probably could do an eviction moratorium
.
(Politico)

* Airline industry workers looking for another lifeline
.
(CNBC)

* Health care industry and particularly insurance profits

are booming in the pandemic. (Axios)

* California might add millionaire tax brackets

to deal with its pandemic-caused budget crisis. (Sacramento Bee)

* The St. Louis Cardinals are the second pro baseball team

with a major outbreak among its players. The season is just a war of
attrition. (USA Today)

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