Fire away…

Electoral College is voting now. Vermont was first, with three electors voting for Biden and for Harris. (They have to submit separate ballots for each candidate on the ticket). Bunch of paperwork they have to fill out…copies for VP of the US, one copy for archives, one for the state house, etc.

List of electors is in wikipedia: https://en.wikipedia.org/wiki/List_of_2020_United_States_presidential_electors

CNN reports that electors in Pennsylvania and Michigan have police escorts due to security concerns.

Should hospitals reuse medical supplies? A new study says yes.

When it comes to the tools doctors use to poke, prod, test, and treat us with, human safety, not the safety of the planet, is paramount.

But the two aren’t always in conflict, according to a paper in the December issue of Health Affairs — the first-ever issue on the intersection of climate and health. There’s a way to cut down on medical waste and the emissions produced by manufacturing new medical supplies, according to the analysis, which notes that the supply chain is responsible for 80 percent of the emissions from healthcare sources in the U.S. The solution is called medical device reprocessing.

Medical device reprocessing, a little-known industry in the global health care sector that cleans, inspects, and repackages used hospital equipment, has doubled in size every year for the past 20 years, the Association of Medical Reprocessors says. In 2018, medical device reprocessing diverted 15 million pounds of medical waste from landfills and saved healthcare institutions an estimated $470 million.

This industry isn’t in the business of reprocessing things like syringes, catheters, and needles — the authors of the study recommend recycling those products for their base materials instead of reprocessing them. The study, a review of previous research published last Monday, focuses on “mid-range complexity” medical devices, equipment like ultrasound probes, blood pressure cuffs, some kinds of forceps, and laparoscopic tools, all of which can be cleaned and reused. The analysis was funded by the Association of Medical Device Reprocessors, an industry group, and was conducted by professors working in medical schools at a number of top universities around the world.

“There are opportunities to reduce emissions without sacrificing health care quality,” Jodi D. Sherman, an associate professor of anesthesiology in the Yale School of Medicine and a member of the research team that worked on the study said at a press conference last week. Not to mention, investing in systems that encourage reusing products will help avoid the kind of system-wide shortages hospitals experienced this year during the COVID-19 pandemic. For example, it’s possible to safely decontaminate and recirculate N95 masks, a crucial piece of personal protective equipment that has been in short supply throughout the pandemic. But a couple of obstacles stand in the way of reducing waste and emissions from the medical supply chain.

For one thing, manufacturers of original equipment have found ways to undercut the reprocessing industry by doing things like slapping single-use labels on devices that can safely be reused, slashing the “best before” dates on products to shorten their shelf life, designing flimsy products that won’t last long, putting unnecessary holes in devices to make them more difficult to clean, and even covering “critical pieces of the device in glue to prevent disassembly,” the study says.

And the Food and Drug Administration (FDA) and the Centers for Disease Control the two federal organizations that set the regulatory protocols for safety and sanitation in hospitals, make it easier for manufacturers to produce single-use rather than reusable devices. The FDA requires marketers of products that can be reused to prove that the device in question can be safely reprocessed. Companies that market devices as single-use don’t have to meet that requirement. “This creates a regulatory incentive for manufacturers to label devices as single use to avoid the time and financial resources required to validate a reprocessing protocol,” the study says.

Dr. Lori A. Hoepner, an associate professor at SUNY Downstate’s Health Sciences University School of Public Health who was not involved in the paper, told Grist that the study takes a rather broad look at the waste coming out of health care institutions and doesn’t fully account for the downstream costs of reprocessing. For example, one of the studies this new study relies on only assessed disposable wipes as a method of cleaning reusable blood pressure cuffs, which in turn creates its own environmental burden. One thing the study could have done, Hoepner said, is “explore more environmentally friendly decontamination methods.” It also could have acknowledged that “the methods we use to sanitize medical devices can lead to adverse health effects that may impact the economy from the burden of costs associated with illness,” Hoepner said.

Doctors and governments have an incentive to cut down on greenhouse gas emissions — more and more research shows that climate change threatens health outcomes and life expectancy around the world. Just last week, a landmark report in the medical journal The Lancet showed that rising temperatures and other consequences of burning fossil fuels threaten to undo the past 50 years of gains in public health. “If you work in health care, there is a role in not just responding and adapting but preventing the emissions that lead to climate change,” Alan Weil, editor in chief of Health Affairs, said on Tuesday.

In order to reduce emissions from medical equipment, the Health Affairs study says that we need to transform the linear health care economy, the current raw-material-to-landfill pipeline in many hospitals, into a circular one instead. That means designing durable products, teaching various industries within the health care sector to use one another’s used materials, finding new ways to use old materials, and, perhaps most importantly, writing new regulations that actually encourage manufacturers to make reusable products.

As NY becomes the first state to obtain the vaccine today, Juan Cole offers some food for thought.

The reason for the difference is that no one could make any money on mitigating the deaths from the pandemic, and the United States has been reformed since the 1970s by Neoliberal orthodoxy, which exalts markets and profits over human considerations. Since dealing effectively with the coronavirus epidemic actually cost money in the form of closures of businesses like restaurants and bars, the Trump administration actively resisted a long shutdown. Trump wanted to keep the stock market high, even if it meant killing off the equivalent of the entire state of Wyoming.

If we compare the American track record on limiting deaths to other countries with a similar age structure and with lots of big cities, like South Korea and Germany, we can see that they have a different form of government. It is common to speak of the U.S., South Korea and Germany as “industrialized democracies.” But there are varieties of the later. The US is less democratic than the other two, and more impervious to the pain of the population. They have managed capitalism. In the US, capitalism manages us.

The over-all US death rate per 100K is 91. Canada is 36. Germany’s rate is about 26. South Korea’s is 1.12. Taiwan is .03 (yes!) The US has a similar failure rate to that of Mexico, Argentina and Brazil, the first two fragile states and the third gripped by a form of fascism.

There are countries with apparently low death rates because they don’t have comprehensive medical systems that could diagnose and tabulate deaths. There are countries with low death rates because their populations are very young. You can’t compare the US to them. But Germany and South Korea are in the same club as we are. We failed. Big time. And South Korea showed that with a robust government with a robust health infrastructure that cares about its people, you didn’t even need to close businesses on the whole.

The US is no longer a superpower, but a stumbling giant unable to protect its people from mass death. Some 3,000 are being killed a day. Trump and his acolytes are pretending it isn’t even happening.

Neoliberal governors such as Rick DeSantis in Florida not only refused to close up but actually forbade the mayor of Miami and other cities from doing so.
Florida is a warm state where people could stay outdoors this fall and winter, and its population density is much less than more urbanized areas like New York and Southern California. But Florida’s rate of COVID-19 deaths per 100,000 population is 91. That is significantly higher than Minnesota, which is essentially a frigid city-state; most people live in Minneapolis-St. Paul and it is so cold they have skywalks between buildings downtown so shoppers don’t have to go outside in the winter. But they had a proper state government that encouraged mask-wearing and social distancing.

Florida did so badly because DeSantis cared more about business and property than he did about human life. North and South Dakota are lightly populated but militantly capitalist and Trumpie. The low population density could not outweigh the superspreader events encouraged by the governors and the shade they threw on mask-wearing. North Dakota had 146 deaths per 100K population. South Dakato has 133 deaths per 100K population. California, despite being dense and urban in some parts of the state, kept the rate to 52 with government policy. If policies had actually been implemented, the rate would be less still.

This massive failure will likely cost the US some 600,000 lives by the time it is all over, rivaling deaths from the Spanish Flu in 1918. The cost in lives did not trouble the Trump administration nor did it trouble most states.

States that swung into action kept cases and deaths low.

In contrast to mitigation, the vaccine was an enormous success, though not a particularly American one. The breakthrough for Pfizer came in a German subsidiary headed by a Turkish-Germany biologist. Pfizer was not part of Trump’s Operation Warp Speed. Pfizer’s CEO, Albert Bourla of Greece, was willing to put $1.5 billion into the vaccine. Bourla seems an admirable person, and you have to admire the science and the rapidity with which Pfizer worked. But after all there is a lot of money to be made in this vaccine.

Monopoly capitalism is very, very good at doing things that make money.

The US hopes to innoculate 100 million people by March 31, just a little over a year after the pandemic began in the US. Given the rate of transmission (R0 or R-naught) of the novel coronavirus, the World Health Organization estimates that we need to immunize about 70 percent of the population to achieve herd immunity. That would be roughly 230 million Americans. If things go really well, we could maybe reach that goal by the beginning of September.

When 70% of the population has immunity, the rate of transmission begin rapidly falling, since the chance that an infectious person will come into contact with a person without immunity falls dramatically. If you can keep the rate of transmission under 1, that is, each infected person on average transmits it to less than one other person, then you get a reverse snowball effect and the rate of coronavirus infections will spiral on down. The reason the death toll annually from influenza is a fraction of what we’ve seen from COVID-19 is that most people have some immunity. Nearly 300,000 are dead of the coronavirus in the US this year, and likely it is about a third more because a lot of old poor people just die in their beds without being diagnosed. Flu deaths range from 12,000 a year to a high of 60,000 a year.

But this vaccine victory is bittersweet. We have lost so many Americans to the virus, who didn’t have to die. Many of them died because of stubbornly pro-capitalist public policy.

Monopoly capitalism advertises itself as a trade-off. The public acquiesces in inequality and inefficiency in return for rising standards of living. Monopoly capitalism isn’t giving us that.