Notes on a Nightmare #2: Suffering and Politics

Why this is so terrifying and how the existing political response is failing us.

I imagine you might have been doing what I’ve been doing: worrying that every little unusual thing your body does could be a sign you have the Disease. A few days ago, something felt a little odd in the back of my throat. Perhaps it was the Cough coming. But it wasn’t. Last night, I felt hot. I took my temperature. 99.2. Oh God: Was this the beginning of the Fever? This morning it was perfectly fine.

Just because you’re paranoid doesn’t mean the disease isn’t after you, and while I know I am overreacting to every little sign that my body might be doing something abnormal and I know I am possibly imagining things (“My lungs—do they feel… heavy? They do! They’re too heavy! Oh God.”), the disease is scary. Sometimes it is like the flu, sometimes it is entirely asymptomatic, but sometimes it’s truly horrific. A recent ProPublica interview with a New Orleans respiratory therapist is enough to make you want to socially distance yourself very far away for a very long time:

[WARNING: disturbing graphic descriptions of disease to follow]

“[W]e deal with the flu every year so I was thinking: Well, it’s probably not that much worse than the flu. But seeing patients with COVID-19 completely changed my perspective, and it’s a lot more frightening. I have patients in their early 40s and, yeah, I was kind of shocked. I’m seeing people who look relatively healthy with a minimal health history, and they are completely wiped out, like they’ve been hit by a truck. This is knocking out what should be perfectly fit, healthy people. Patients will be on minimal support, on a little bit of oxygen, and then all of a sudden, they go into complete respiratory arrest, shut down and can’t breathe at all…  what happens to a lot of these patients [is, t]hey suddenly become unresponsive or go into respiratory failure… the lungs are filled with fluid… With our coronavirus patients, once they’re on ventilators, most need about the highest settings that we can do… [It] is nearly as high as I’ve ever seen. The level we’re at means we are running out of options. I’ve never seen a microorganism or an infectious process cause such acute damage to the lungs so rapidly.”

“It first struck me how different it was when I saw my first coronavirus patient go bad. I was like, Holy shit, this is not the flu. Watching this relatively young guy, gasping for air, pink frothy secretions coming out of his tube and out of his mouth. The ventilator should have been doing the work of breathing but he was still gasping for air, moving his mouth, moving his body, struggling. We had to restrain him. With all the coronavirus patients, we’ve had to restrain them. They really hyperventilate, really struggle to breathe. When you’re in that mindstate of struggling to breathe and delirious with fever, you don’t know when someone is trying to help you, so you’ll try to rip the breathing tube out because you feel it is choking you, but you are drowning… They are essentially drowning in their own blood and fluids because their lungs are so full… Before this, [w]e were all joking: I want to get the coronavirus because then I get a paid vacation from work. And once I saw these patients with it, I was like, Holy shit, I do not want to catch this and I don’t want anyone I know to catch this.

I quote him at length, even though it’s extremely upsetting stuff, because every person needs to understand what they are potentially exposing others to if they do not follow the absolute strictest safety protocols. Death from this disease is agonizing in the most extreme possible way. This is not peacefully passing in your sleep. This is a long slow process of trying desperately to breathe and finding yourself drowning on the inside. I can’t really think of many worse ways to go, to be honest. 

As I say, the majority of cases do not go like this. But the number that do is far too high for anyone to be comfortable. This is why Italy cannot even keep up with burying dead people fast enough, with coffins piling up. Nearly 800 people in the country died in this horrific fashion in a single day in the country, mothers, fathers, grandmothers, uncles. 

Furthermore, while young people are assuming that this is an older person’s disease, what shocked the New Orleans respiratory therapist was how healthy, younger people could be hit just as hard. A 39-year old New Orleans woman took a coronavirus test on Monday after feeling the symptoms of a cold. By Friday she was dead in her kitchen. And even the supposedly “mild cases” that young people get may still be worse than the worst illnesses they have ever had before. As former CDC director Tom Frieden writes for CNN: 

It’s not just older people with underlying conditions who become very ill and can die. Younger adults, previously healthy people and some children develop viral pneumonia. Although prior reports suggested that 80% of people got only mild disease, it now appears that about half of these people, despite not needing hospital admission, have moderately severe pneumonia, which can take weeks or longer to recover from.

All of this is why, even though I recently returned to my Florida hometown to be near my parents, I am staying the fuck away from them right now, even though I do not have symptoms of coronavirus. We do not actually know how long an asymptomatic carrier may be infectious, and even if the risk was low (which it might not be, given how contagious this thing has been so far), any chance at all of inflicting the above-described fate on a beloved family member is not worth taking. When we look at the death statistics tick up slowly, we are talking about people watching their family members die so, so horribly. In fact, they don’t even get to be near their family, they can’t even touch them in their last moments. 

The New Orleans respiratory therapist also talks about how overwhelmed the system already is by the comparatively few patients it has. They are already rationing masks, before the worst has begun, and the point at which they run out of ventilators (which can be excruciating to be on, and can also damage the lungs), is fast approaching.

I am sorry. I know I have probably made you even more afraid than you already were. But it’s critical to understanding why, in a choice between “preventing coronavirus deaths in the millions” and “preventing the U.S. economy from tanking,” we have had to let the economy fall completely to shit. Mere numerical death statistics simply do not capture the level of suffering we are talking about, and you may not see most of it, because it will happen behind tightly closed doors.

* * * *

It is deeply unfortunate that during what is possibly going to be the biggest economic and social crisis of my lifetime, the country is being led by a reality TV star who thinks “saying you’ve fixed a problem” is the same as “having actually fixed the problem.” But perhaps even worse, we’re also sorely lacking a strong Democratic opposition right now. Unfortunately, just as this crisis was unfolding, Joe Biden was achieving a virtually insurmountable lead for the Democratic presidential nomination. Because at the very moment the country needs an FDR figure, someone to step in and take command of the problem, we have a guy who can’t even organize a livestream. Biden has been completely AWOL, with Politico reporting that he “has made no public appearances or statements” since winning the primaries in Florida, Illinois, and Arizona on Tuesday. Biden even apparently held back from criticizing Trump early on, because he felt it would seem “too political,” even though as Ryan Cooper documents, “it is almost impossible to exaggerate how badly Trump has botched the epidemic response.” If our political leaders are worrying about being political they should pursue a different career.

The economic and public health calamity that has befallen us is going to require drastic federal action. Unfortunately, for the past two decades, both the Democratic and Republican parties have coalesced around a philosophy of government austerity: the state should not make things and do things itself, but should mostly only intervene by regulating markets (or “nudging” people gently this way and that). This is what Larry Summers, the former director of President Obama’s National Economic Council, meant when he said that Democrats are “all Friedmanites” now. 

Republicans will never be able to respond to a public health crisis effectively, because the problems are literally impossible to comprehend on a Republican worldview. Ronald Reagan said that the scariest words in the English language were “I’m from the government, and I’m here to help.” In fact, some of the scariest words in the English language are “You’ve got coronavirus,” and it would actually be a blessing if someone from the government was here to help. Do you think the Republican party is ever going to seize control of industries in order to make them produce necessary medical supplies to help poor patients for free? Are they going to want to pay poor people large sums of money not to work? Are they going to start building giant free public hospitals? Are they going to free prisoners and give them money, or build public housing so that homeless people don’t get sick? You must be joking. If you want to see how a conservative government responds to a collective crisis, look at Hurricane Katrina. In fact, what we’ll probably see from Republicans is little more than an attempt to make sure rich people don’t lose too much money in the stock market, and maybe a barely useful pittance of a check that will immediately be spent on rent. 

But Democrats have also been failing, with Nancy Pelosi’s original plan so feeble that even a hard right-winger like Tom Cotton was able to say it didn’t go far enough. Do you remember back when Kamala Harris proposed a student debt relief plan that promised to forgive loans for “Pell Grant recipients who start a business that operates for three years in disadvantaged communities”? She was rightly mocked, but this has been the dominant Democratic approach for some time now: push a watered down proposal that will become even more watered down over the course of negotiations to the point where it barely does anything for anyone. Joe Biden, the presumptive Democratic presidential nominee, embraces this approach; his healthcare plan, even in its most ambitious form, leaves millions of people uninsured. As if coronavirus was not enough of a nightmare in itself, being uninsured in the time of coronavirus adds misery to insult to injury. 

I think right now you are seeing something strange: For a long time, members of both parties have only pretended to govern. They haven’t actually taken the steps necessary to fix social problems, they’ve just introduced legislation that sounds good without really addressing systemic causes. Now we are in a situation where it’s no longer possible to pretend to govern. But Democrats are ideologically opposed to doing the things we need. A new Great Depression requires a new New Deal, but the institutional Democratic party has just spent all of its energy trying to crush the candidacy of a social democrat who promised exactly that. After saying that we need moderation and restraint rather than bold and unprecedented action, they have suddenly been plunged into a situation that demands bold and unprecedented action. Expect Democrats to dither. All they can do is dither, because even ideas like “building new public housing” and “having free public hospitals” have been considered dangerous radicalism for so long, and slow, incremental steps inherently better than big things done quickly. 

Healthcare must be free at the point of use. How much clearer can this be? My God, with coronavirus ravaging the population are we really going to have insurance companies arguing with patients over what’s covered and what isn’t? Are there really going to be people whose full-time job it is to deny people’s claims? And lest you think, like Joe Biden, that we can limit free care to coronavirus patients, remember: This virus makes everything else worse. It means that people’s other conditions aren’t being treated, and are worsening, and are therefore costing them more. If limited protective masks are being used solely in the coronavirus ward, they’re not being used elsewhere. Coronavirus isn’t the only reason people require ventilators. The lost employment from coronavirus is going to mean lost insurance, which is going to mean sicker people. 

Current Affairs will have more on what policy responses are required in the face of this unprecedented crisis. For now, have a look at the plans from Bernie Sanders, Matt Bruenig, and Doug Henwood to see the bare minimum we should be doing. I wonder how long it will take before it becomes disturbingly clear that we cannot get through this with the usual Democratic compromised half-measures and Republican “strangle the government in the bathtub” policymaking. The response to the crisis so far has been: everybody stay at home, let’s impose a state of quasi-martial law, and maybe we’ll give you a small fraction of the income from your lost job somewhere down the line. The toll of this will be immense.

* * * *

Everybody knows that pestilences have a way of recurring in the world; yet somehow we find it hard to believe in ones that crash down on our heads from a blue sky. There have been as many plagues as wars in history; yet always plagues and wars take people equally by surprise. — Albert Camus, The Plague, 1947 

We are in a time of terrible uncertainty. I do not want to leave you feeling hopeless. It is incredibly surprising to have this come upon us, but we are not the first people to whom something like this has happened and we will probably not be the last. Let us do everything we can to support each other in dark times. Suddenly, overnight, the inequality and unfairness that was already here has multiplied by an order of magnitude. It is hard to even process this. I still wake up thinking that this must all be some terrible dream. If only. But even with harsh social distancing measures in place, we must make sure not to let each other get too isolated. I am also of the opinion that it’s perfectly okay to shame people who do risky things for no good reason. Every new infection is a potential tragedy, so let’s act accordingly, hopefully without in the process inviting martial law and the vast further expansion of the surveillance state. 

Stay safe out there. 

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