The Walls Come Down: No Travel Betwen US and Europe for 30 Days

[loomer]

Settler communities includes all settler communities, Broomstick, not just remote and rural ones.

You keep talking about a government's duty towards its citizens. What I still don't think you grasp is that the duty or right to healthcare does not exist in the US. You only have a right to healthcare if you have insurance.

<snip>

I have made no suggestion to the contrary. I have stated only - accurately - that there is a special fiduciary duty owed to the tribes, which extends to ensuring the survival of them as both units and as individual members. Accordingly I feel no need to engage with the rest since it's arguing against something I haven't claimed.

This is also why I am unsympathetic to your claims that your working hours keep you from answering my questions. You seem to have the time to argue against things I haven't claimed, and perhaps that time might be better spent responding to things I have or, if you really don't have the time, resting and recovering. So, let me make it clear: I have no interest in discussion with you unless and until you are prepared to answer my questions and actually engage in a good faith discussion. This bullshit of dancing around it and then trying to get in the odd strawman victory is uninteresting to me, unwelcome, and part of a history of behaviour on your part that makes me more inclined to view you as posting in bad faith.

[mr friendly guy]

Another "victim" of the coronavirus, Fox host Trish Regan who was fired, er I mean parted ways with Fox after calling coronavirus a "scam"
https://variety.com/2020/tv/news/fox-bu ... 203547558/

Trish Regan, who gained notice on Fox Business Network for a primetime program that developed a specialty for heated political talk, is leaving the network, just days after the show was removed from its schedule.

Regan’s show was taken off the air earlier this month in a bid to devote more newsgathering staff to coronavirus coverage. Several other programs have been trimmed as well, but Regan had captured attention for a vociferous segment that aired earlier in March suggesting liberals were overstating the effects of the spread of coronavirus to discredit President Donald Trump. A graphic that accompanied one segment that aired read “Coronavirus Impeachment Scam.”

“Fox Business has parted ways with Trish Regan – we thank her for her contributions to the network over the years and wish her continued success in her future endeavors,” the network said in a statement. “We will continue our reduced live primetime schedule for the foreseeable future in an effort to allocate staff resources to continuous breaking news coverage on the Coronavirus crisis.”

<snip>

Man, Trish Regan had that really irritating smirk when she was doing her interviews. I hope she practices as much social distancing from people as she does from reality, in which case she will be hiding in Antarctica.

[Jub]

I have made no suggestion to the contrary. I have stated only - accurately - that there is a special fiduciary duty owed to the tribes, which extends to ensuring the survival of them as both units and as individual members. Accordingly I feel no need to engage with the rest since it's arguing against something I haven't claimed.

You're literally calling to be first among equals and saying that cases that would be triaged and palliated in other communities be treated in First Nations communities. This is complete garbage and should be called out as such. If these groups are so fragile that losing a single member is a deathblow to their culture, it was already dead anyway. If its an issue that they haven't appointed the next leader, shaman, healer, etc. yet and the old one is at risk that's on them to deal with.

[loomer]

I have made no suggestion to the contrary. I have stated only - accurately - that there is a special fiduciary duty owed to the tribes, which extends to ensuring the survival of them as both units and as individual members. Accordingly I feel no need to engage with the rest since it's arguing against something I haven't claimed.

You're literally calling to be first among equals and saying that cases that would be triaged and palliated in other communities be treated in First Nations communities. This is complete garbage and should be called out as such. If these groups are so fragile that losing a single member is a deathblow to their culture, it was already dead anyway. If its an issue that they haven't appointed the next leader, shaman, healer, etc. yet and the old one is at risk that's on them to deal with.

I'm literally calling for the prioritization of specially vulnerable communities during a pandemic, Jub. Also, this isn't a danger of just one death - the initiatic line example is just an intensely vivid and possible one - destroying a culture, but the disproportionate deaths of elders who function as keepers of culture.

If you want to call it out - do. But be prepared to defend your position and prove why sending more aid to, and adopting a culturally appropriate standard in, specially vulnerable communities is wrong. Don't, as Broomstick has just done, invent a strawman that I've been talking about a generic duty to provide healthcare.

EDIT:
Incidentally, under such a prioritization scheme I wouldn't be first among equals even if that was an accurate summary. I'm not part of a specially vulnerable Indigenous community. I'm a whitefella living in a predominantly settler community.

[Jub]

I'm literally calling for the prioritization of specially vulnerable communities during a pandemic, Jub. Also, this isn't a danger of just one death - the initiatic line example is just an intensely vivid and possible one - destroying a culture, but the disproportionate deaths of elders who function as keepers of culture.

Shouldn't these elders be passing the knowledge down so that their demise doesn't doom an entire culture? Why isn't the rest of their nation helping them record it all? What happens in this same dude gets hit by a truck?

If you want to call it out - do. But be prepared to defend your position and prove why sending more aid to, and adopting a culturally appropriate standard in, specially vulnerable communities is wrong. Don't, as Broomstick has just done, invent a strawman that I've been talking about a generic duty to provide healthcare.

When you can't properly defend relatively healthy communities that are well served by local hospitals, it doesn't make sense to divert those resources to communities that could easily be wiped out in spite of your best efforts. At-risk communities should be triaged until there are resources to deal with them. It's shitty, but now isn't the time to try to fix the issues of neglect and deliberate underfunding that have made first nations communities vulnerable.

[loomer]

I'm literally calling for the prioritization of specially vulnerable communities during a pandemic, Jub. Also, this isn't a danger of just one death - the initiatic line example is just an intensely vivid and possible one - destroying a culture, but the disproportionate deaths of elders who function as keepers of culture.

Shouldn't these elders be passing the knowledge down so that their demise doesn't doom an entire culture? Why isn't the rest of their nation helping them record it all? What happens in this same dude gets hit by a truck?

The knowledge often is being passed down, but is either expansive and still being disseminated and recorded, or subject to ritual and law that restrict the way and times it can be disseminated. EDIT: You need to understand that in many cases, passing this knowledge down was subject to strict punishment by the governments of CANZUS until very recently. There are generations of systematic cultural destruction to try and overcome, which is why we've wound up with a situation where only a handful of people are initiated men and women of many old traditions, the majority of them old and at high risk.

If you want to call it out - do. But be prepared to defend your position and prove why sending more aid to, and adopting a culturally appropriate standard in, specially vulnerable communities is wrong. Don't, as Broomstick has just done, invent a strawman that I've been talking about a generic duty to provide healthcare.

When you can't properly defend relatively healthy communities that are well served by local hospitals, it doesn't make sense to divert those resources to communities that could easily be wiped out in spite of your best efforts. At-risk communities should be triaged until there are resources to deal with them. It's shitty, but now isn't the time to try to fix the issues of neglect and deliberate underfunding that have made first nations communities vulnerable.

I see. So your position, to be clear, is that we should leave the most vulnerable to fend for themselves without the extra resources that might keep an outbreak from devastating them, even if they will suffer highly disproportionate deaths? And we should do so in order to prioritize less vulnerable communities, who will not suffer the same kind of losses even if they receive less resources?

[Jub]

The knowledge often is being passed down, but is either expansive and still being disseminated and recorded, or subject to ritual and law that restrict the way and times it can be disseminated.

If you can't pass on knowledge due to rituals and tribal law that's on you.

EDIT: You need to understand that in many cases, passing this knowledge down was subject to strict punishment by the governments of CANZUS until very recently. There are generations of systematic cultural destruction to try and overcome, which is why we've wound up with a situation where only a handful of people are initiated men and women of many old traditions, the majority of them old and at high risk.

I also get this, but how is Covid-19 any different than any number of things that could kill or otherwise incapacitate these old and high-risk individuals? These cultures are on thin ice, in many cases because of the CANZUS governments, but we can't go back and change that now.

I see. So your position, to be clear, is that we should leave the most vulnerable to fend for themselves without the extra resources that might keep an outbreak from devastating them, even if they will suffer highly disproportionate deaths? And we should do so in order to prioritize less vulnerable communities, who will not suffer the same kind of losses even if they receive less resources?

I'm saying that the resources should go to high-density urban areas first because if those fail you get situations like New York or Italy. Lower density areas are more isolated already and should hunker down, close ranks, and avoid the disease as much as possible. To my eyes lives are lives and I'd rather save more lives than less.

[loomer]

The knowledge often is being passed down, but is either expansive and still being disseminated and recorded, or subject to ritual and law that restrict the way and times it can be disseminated.

If you can't pass on knowledge due to rituals and tribal law that's on you.

EDIT: You need to understand that in many cases, passing this knowledge down was subject to strict punishment by the governments of CANZUS until very recently. There are generations of systematic cultural destruction to try and overcome, which is why we've wound up with a situation where only a handful of people are initiated men and women of many old traditions, the majority of them old and at high risk.

I also get this, but how is Covid-19 any different than any number of things that could kill or otherwise incapacitate these old and high-risk individuals? These cultures are on thin ice, in many cases because of the CANZUS governments, but we can't go back and change that now.

No, we can't go back and change it. But we can take precautions to try and avoid special vulnerabilities from influencing things unduly. As for how COVID-19 is any different from anything else? It isn't, except that it's a highly communicable, highly lethal virus that elders are extremely vulnerable to and an ongoing crisis situation that is actively threatening these communities. I think that rather puts in a different category from most of those other things, which aren't actively threatening these communities, don't you?

I see. So your position, to be clear, is that we should leave the most vulnerable to fend for themselves without the extra resources that might keep an outbreak from devastating them, even if they will suffer highly disproportionate deaths? And we should do so in order to prioritize less vulnerable communities, who will not suffer the same kind of losses even if they receive less resources?

I'm saying that the resources should go to high-density urban areas first because if those fail you get situations like New York or Italy. Lower density areas are more isolated already and should hunker down, close ranks, and avoid the disease as much as possible. To my eyes lives are lives and I'd rather save more lives than less.

Okay. But let's take a moment.

The communities we're talking about are isolated, but are still having cases occur. The average member of the community is in worse health than the average New Yorker, with much higher rates of the specific diseases and disabilities that make COVID-19 especially lethal. They are also much smaller than New York, and often don't have access to running water for the sanitation practices necessary, and have a much higher percentage of 'overpopulated' multi-generational houses, where you wind up with ten or twenty people in a home that might, in a settler community, house five. Distributing a week's worth of PPE and other supplies to this smaller community (the Navajo Nation, for instance, has a grand total of about 250 hospital beds - NYC has about 23,000. There's roughly 1 hospital bed for every 365 people in NYC, and 1:1,500 or so for the Nation, with concomittant staffing) is a drop in the bucket for the needs of a much larger community, but given these factors, could potentially save more lives per unit than if you sent it to the larger community.

This is so because of two things. First, the average individual in these communities is at higher risk. Second, the potential for community-driven transmission is much higher because even if each house does hunker down, a case in one is more likely to infect ten or twenty people than the two to five it might infect in other communities. These communities also need additional aid to make 'well, just avoid the disease' feasible - they need supplies, they need infrastructure, and they need the authority to deter intruders. This is why they're actively calling for more aid to do exactly that - to avoid the disease getting in in the first place.

So, let's consider two hypotheticals I used earlier. You have a hypothetical happy urban community of healthy people who will suffer a .5% death toll from an uncontrolled outbreak. Then you have a regional community of unhealthy people who will suffer a 10% death toll from an uncontrolled outbreak. Both areas will wind up with the same final number of deaths, but one community is disproportionately impacted by these deaths, which could be prevented with more supply, the provision of additional staff, and aid in preventing community transmission. A life, as you say, is a life - so areas where the loss of life will be proportionately higher need more support, not less, because even if they come out even in the total number of deaths, the impact on the community is far more severe.

[Jub]

No, we can't go back and change it. But we can take precautions to try and avoid special vulnerabilities from influencing things unduly. As for how COVID-19 is any different from anything else? It isn't, except that it's a highly communicable, highly lethal virus that elders are extremely vulnerable to. I think that rather puts in a different category from most of those other things, don't you?

No more so than any other vulnerable person or community.

Okay. But let's take a moment.

The communities we're talking about are isolated, but are still having cases occur. The average member of the community is in worse health than the average New Yorker, with much higher rates of the specific diseases and disabilities that make COVID-19 especially lethal. They are also much smaller than New York, and often don't have access to running water for the sanitation practices necessary, and have a much higher percentage of 'overpopulated' multi-generational houses, where you wind up with ten or twenty people in a home that might, in a settler community, house five. Distributing a week's worth of PPE and other supplies to this smaller community (the Navajo Nation, for instance, has a grand total of about 250 hospital beds - NYC has about 23,000. There's roughly 1 hospital bed for every 365 people in NYC, and 1:1,500 or so for the Nation, with concomittant staffing) is a drop in the bucket for the needs of a much larger community, but given these factors, could potentially save more lives per unit than if you sent it to the larger community.

Livers per unit is an interesting stat, but I'd much rather focus resources on saving those most likely to make a recovery.

This is so because of two things. First, the average individual in these communities is at higher risk. Second, the potential for community-driven transmission is much higher because even if each house does hunker down, a case in one is more likely to infect ten or twenty people than the two to five it might infect in other communities. These communities also need additional aid to make 'well, just avoid the disease' feasible - they need supplies, they need infrastructure, and they need the authority to deter intruders. This is why they're actively calling for more aid to do exactly that - to avoid the disease getting in in the first place.

Realistically the US not going to be able to drop a load of new houses, hospitals, water treatment centers, etc. right now. So why throw good supplies into a place where they may not work due to other issues?

So, let's consider two hypotheticals I used earlier. You have a hypothetical happy urban community of healthy people who will suffer a .5% death toll from an uncontrolled outbreak. Then you have a regional community of unhealthy people who will suffer a 10% death toll from an uncontrolled outbreak. Both areas will wind up with the same final number of deaths, but one community is disproportionately impacted by these deaths, which could be prevented with more supply, the provision of additional staff, and aid in preventing community transmission. A life, as you say, is a life - so areas where the loss of life will be proportionately higher need more support, not less, because even if they come out even in the total number of deaths, the impact on the community is far more severe.

If we were certain those percentages would hold I might agree with you, but if that urban area rises to even 0.75% going your way has cost lives. You need to prove that diverting these resources will be a net benefit rather than asserting that it will be.

[loomer]

No, we can't go back and change it. But we can take precautions to try and avoid special vulnerabilities from influencing things unduly. As for how COVID-19 is any different from anything else? It isn't, except that it's a highly communicable, highly lethal virus that elders are extremely vulnerable to. I think that rather puts in a different category from most of those other things, don't you?

No more so than any other vulnerable person or community.

Yes. Which is why this is focused on supporting vulnerable communities. That's kind of my whole point: More vulnerable communities need additional aid to reduce the impact of COVID-19, above and beyond those of the general population.

Okay. But let's take a moment.

The communities we're talking about are isolated, but are still having cases occur. The average member of the community is in worse health than the average New Yorker, with much higher rates of the specific diseases and disabilities that make COVID-19 especially lethal. They are also much smaller than New York, and often don't have access to running water for the sanitation practices necessary, and have a much higher percentage of 'overpopulated' multi-generational houses, where you wind up with ten or twenty people in a home that might, in a settler community, house five. Distributing a week's worth of PPE and other supplies to this smaller community (the Navajo Nation, for instance, has a grand total of about 250 hospital beds - NYC has about 23,000. There's roughly 1 hospital bed for every 365 people in NYC, and 1:1,500 or so for the Nation, with concomittant staffing) is a drop in the bucket for the needs of a much larger community, but given these factors, could potentially save more lives per unit than if you sent it to the larger community.

Livers per unit is an interesting stat, but I'd much rather focus resources on saving those most likely to make a recovery.

Those most likely to make a recovery need the least additional resources. The average healthy 21-year old woman who contracts the coronavirus has a below 1% risk of death. Resources need to be pooled not where people are most likely to recover, but where they will produce the most improvement in the odds of recovery and in lowering death rates. The effectiveness of this distribution - our hypothetical lives per unit - is a crucial part of this.

To illustrate: You have ten people with COVID-19 who present to a hospital that can treat only 5. One will definitively survive without intervention, 3 probably will, 4 probably won't but will survive with it, 1 definitely won't and might still die with it, and 1 will die no matter what you do. Obviously, the situation isn't actually this clear cut - the resources are scarcer, the patient loads are higher, and who will live or die is never so obvious as this - but for illustrative purpose, it will serve. Treating the one who will definitely survive is a complete waste of resources, while treating those who have good odds of recovery without intervention means you eat into the capacity to treat those who will almost certainly survive with it - a situation that would raise the overall odds of survival for the entire cohort.

A model that emphasises treating only those most likely to survive, as you propose, actually wastes resources that could make a difference for others on those who don't need them. This is the point of triage - not to allocate resources to the fittest, but to try and find the best use for limited supplies to boost the overall survival rate. If we aren't looking at the effectiveness of distribution - at lives per unit - then we aren't actually doing triage. We're just deciding only the strong deserve to live.

And again, it needs to be emphasized that the relative size of these communities is important. A week's supply for small communities might last an hour in the densest hotspots, so it's not a choice between, say, nothing for New York and everything for the Navajo. It's a choice of say, 10% for New York vs 10% for the Navajo, or 9% for New York versus 100% for the Navajo.

This is so because of two things. First, the average individual in these communities is at higher risk. Second, the potential for community-driven transmission is much higher because even if each house does hunker down, a case in one is more likely to infect ten or twenty people than the two to five it might infect in other communities. These communities also need additional aid to make 'well, just avoid the disease' feasible - they need supplies, they need infrastructure, and they need the authority to deter intruders. This is why they're actively calling for more aid to do exactly that - to avoid the disease getting in in the first place.

Realistically the US not going to be able to drop a load of new houses, hospitals, water treatment centers, etc. right now. So why throw good supplies into a place where they may not work due to other issues?

Who said anything about new houses, hospitals, or water treatment centers? We're talking about reducing the rate of transmission by boosting community capacities, which can be done without those things (send more PPE, some nurses, and food and water tankers, for instance), and reducing the fatality rates for those who do become infected.

So, let's consider two hypotheticals I used earlier. You have a hypothetical happy urban community of healthy people who will suffer a .5% death toll from an uncontrolled outbreak. Then you have a regional community of unhealthy people who will suffer a 10% death toll from an uncontrolled outbreak. Both areas will wind up with the same final number of deaths, but one community is disproportionately impacted by these deaths, which could be prevented with more supply, the provision of additional staff, and aid in preventing community transmission. A life, as you say, is a life - so areas where the loss of life will be proportionately higher need more support, not less, because even if they come out even in the total number of deaths, the impact on the community is far more severe.

If we were certain those percentages would hold I might agree with you, but if that urban area rises to even 0.75% going your way has cost lives. You need to prove that diverting these resources will be a net benefit rather than asserting that it will be.

For the sake of the hypothetical, the percentages are set - it is not a rigorous model, but purely a hypothetical to illustrate the danger of looking at total deaths and not per capita deaths by community and category. As for proof of the general principle that these resources will help prevent disproportionate deaths in Indigenous communities, being as I am not an epidemiologist or virologist, I'll yield to the experts like the NIHB and AIDA who are calling for more supplies and supports to Indigenous communities because of the heightened risks of lethality and severe community transmission. Do you have any proof that their position is mistaken, and those supplies will make no difference?

[Tribble]

Yes. Which is why this is focused on supporting vulnerable communities. That's kind of my whole point: More vulnerable communities need additional aid to reduce the impact of COVID-19, above and beyond those of the general population.

However, you seem to be limiting the definition of "vulnerable community" to indigenous populations while implying that everyone else is just the "general population," "settlers" etc.

As others have pointed out there are plenty of areas that could qualify as "vulnerable communities" but the sense I am getting is that since they are not the culture / ethnicity that you are looking to preserve, they should not be prioritised.

Even if you are absolutely right in that approach and have the best of intentions, I hope you realize that's a hell of a slippery slope you are standing on.

[loomer]

Yes. Which is why this is focused on supporting vulnerable communities. That's kind of my whole point: More vulnerable communities need additional aid to reduce the impact of COVID-19, above and beyond those of the general population.

However, you seem to be limiting the definition of "vulnerable community" to indigenous populations while implying that everyone else is just the "general population," "settlers" etc.

As others have pointed out there are plenty of areas that could qualify as "vulnerable communities" but the sense I am getting is that since they are not the culture / ethnicity that you are looking to preserve, they should not be prioritised.

Even if you are absolutely right in that approach and have the best of intentions, I hope you realize that's a hell of a slippery slope you are standing on.

Except I'm not. This is a conversation specifically about Indigenous communities (if you recall, it's started specifically because I was posting news about Indigenous communities not receiving adequate supply), which is why I reserve my remarks for that context. I haven't said that other vulnerable communities shouldn't receive additional aid, and the comparison between Indigenous communities and settler populations is a standard one because, barring certain outliers (some extremely impoverished rural settler communities and other marginalized communities), Indigenous peoples are more vulnerable both as an average and in any other category they may fit into - e.g., the outcomes for disabled Indigenous peoples are worse than for disabled non-Indigenous peoples, the outcomes for queer Indigenous people are worse than for non-Indigenous queer people, and so on, in addition to the special cultural vulnerabilities that have resulted from attempted genocides. If you like, we can discuss the broader principle of prioritizing vulnerable communities too, but the reason it hasn't been a factor is because it's a different conversation.

[Jub]

Yes. Which is why this is focused on supporting vulnerable communities. That's kind of my whole point: More vulnerable communities need additional aid to reduce the impact of COVID-19, above and beyond those of the general population.

How do you define a vulnerable community? I ask because there are probably more vulnerable people in New York than there are people in the entire Navajo nation, so by that metric NYC is the community with a greater need.

Those most likely to make a recovery need the least additional resources. The average healthy 21-year old woman who contracts the coronavirus has a below 1% risk of death. Resources need to be pooled not where people are most likely to recover, but where they will produce the most improvement in the odds of recovery and in lowering death rates. The effectiveness of this distribution - our hypothetical lives per unit - is a crucial part of this.

To illustrate: You have ten people with COVID-19 who present to a hospital that can treat only 5. One will definitively survive without intervention, 3 probably will, 4 probably won't but will survive with it, 1 definitely won't and might still die with it, and 1 will die no matter what you do. Obviously, the situation isn't actually this clear cut - the resources are scarcer, the patient loads are higher, and who will live or die is never so obvious as this - but for illustrative purpose, it will serve. Treating the one who will definitely survive is a complete waste of resources, while treating those who have good odds of recovery without intervention means you eat into the capacity to treat those who will almost certainly survive with it - a situation that would raise the overall odds of survival for the entire cohort.

A model that emphasises treating only those most likely to survive, as you propose, actually wastes resources that could make a difference for others on those who don't need them. This is the point of triage - not to allocate resources to the fittest, but to try and find the best use for limited supplies to boost the overall survival rate. If we aren't looking at the effectiveness of distribution - at lives per unit - then we aren't actually doing triage. We're just deciding only the strong deserve to live.

And again, it needs to be emphasized that the relative size of these communities is important. A week's supply for small communities might last an hour in the densest hotspots, so it's not a choice between, say, nothing for New York and everything for the Navajo. It's a choice of say, 10% for New York vs 10% for the Navajo, or 9% for New York versus 100% for the Navajo.

You need to prove that diverting the supplies you want to have diverted will actually make that difference. If these communities are as bad off as you make it seem we could send these resources and still see massive casualty rates and thus will have wasted our efforts on the doomed.

Who said anything about new houses, hospitals, or water treatment centers? We're talking about reducing the rate of transmission by boosting community capacities, which can be done without those things (send more PPE, some nurses, and food and water tankers, for instance), and reducing the fatality rates for those who do become infected.

You brought up infrastructure and overcrowding. I brought up the issues I did because if things are as bad as you say, it's likely that these communities are already beyond and we're throwing needed resources at a lost cause.

For the sake of the hypothetical, the percentages are set - it is not a rigorous model, but purely a hypothetical to illustrate the danger of looking at total deaths and not per capita deaths by community and category. As for proof of the general principle that these resources will help prevent disproportionate deaths in Indigenous communities, being as I am not an epidemiologist or virologist, I'll yield to the experts like the NIHB and AIDA who are calling for more supplies and supports to Indigenous communities because of the heightened risks of lethality and severe community transmission. Do you have any proof that their position is mistaken, and those supplies will make no difference?

I can't prove that something won't make a difference and you well know that. It would also help if the IHS didn't have issues like "poor medical care, untrained staff, leadership turnover and, more recently, an investigation over reports that it failed to prevent a pediatrician from sexually assaulting young patients despite repeated warnings." and weren't "[W]orking out of a hole that is so deep it’s really kind of unfathomable,”. These issues should be fixed and shouldn't be allowed to continue, but is now the time to start pretending the US cares about these populations?

[loomer]

Yes. Which is why this is focused on supporting vulnerable communities. That's kind of my whole point: More vulnerable communities need additional aid to reduce the impact of COVID-19, above and beyond those of the general population.

How do you define a vulnerable community? I ask because there are probably more vulnerable people in New York than there are people in the entire Navajo nation, so by that metric NYC is the community with a greater need.

By the relative rates of disease, poverty, and access to infrastructure across that community, coupled with the likely impacts and ease of transmission of an outbreak, dude. This isn't complex or unprecedented stuff. Do you have any evidence that New York's population is more vulnerable than that of remote and regional Indigenous communities?

Those most likely to make a recovery need the least additional resources. The average healthy 21-year old woman who contracts the coronavirus has a below 1% risk of death. Resources need to be pooled not where people are most likely to recover, but where they will produce the most improvement in the odds of recovery and in lowering death rates. The effectiveness of this distribution - our hypothetical lives per unit - is a crucial part of this.

To illustrate: You have ten people with COVID-19 who present to a hospital that can treat only 5. One will definitively survive without intervention, 3 probably will, 4 probably won't but will survive with it, 1 definitely won't and might still die with it, and 1 will die no matter what you do. Obviously, the situation isn't actually this clear cut - the resources are scarcer, the patient loads are higher, and who will live or die is never so obvious as this - but for illustrative purpose, it will serve. Treating the one who will definitely survive is a complete waste of resources, while treating those who have good odds of recovery without intervention means you eat into the capacity to treat those who will almost certainly survive with it - a situation that would raise the overall odds of survival for the entire cohort.

A model that emphasises treating only those most likely to survive, as you propose, actually wastes resources that could make a difference for others on those who don't need them. This is the point of triage - not to allocate resources to the fittest, but to try and find the best use for limited supplies to boost the overall survival rate. If we aren't looking at the effectiveness of distribution - at lives per unit - then we aren't actually doing triage. We're just deciding only the strong deserve to live.

And again, it needs to be emphasized that the relative size of these communities is important. A week's supply for small communities might last an hour in the densest hotspots, so it's not a choice between, say, nothing for New York and everything for the Navajo. It's a choice of say, 10% for New York vs 10% for the Navajo, or 9% for New York versus 100% for the Navajo.

You need to prove that diverting the supplies you want to have diverted will actually make that difference. If these communities are as bad off as you make it seem we could send these resources and still see massive casualty rates and thus will have wasted our efforts on the doomed.

Again, I'm not a virologist or an epidemiologist. I'm listening to people who are, who are saying that sending this aid will have an impact. Can you show why they're mistaken?

Who said anything about new houses, hospitals, or water treatment centers? We're talking about reducing the rate of transmission by boosting community capacities, which can be done without those things (send more PPE, some nurses, and food and water tankers, for instance), and reducing the fatality rates for those who do become infected.

You brought up infrastructure and overcrowding. I brought up the issues I did because if things are as bad as you say, it's likely that these communities are already beyond and we're throwing needed resources at a lost cause.

I did, because they're factors in the increased vulnerability of Indigenous communities - but the immediate solution to these issues is not an impossible rollout of infrastructure but aid to what already exists. Now, you want to say they're beyond help - prove it. Show why the experts calling for aid are wrong. Show why sending PPE, nurses, and other resources (even something as simple as tents) is a lost cause.

For the sake of the hypothetical, the percentages are set - it is not a rigorous model, but purely a hypothetical to illustrate the danger of looking at total deaths and not per capita deaths by community and category. As for proof of the general principle that these resources will help prevent disproportionate deaths in Indigenous communities, being as I am not an epidemiologist or virologist, I'll yield to the experts like the NIHB and AIDA who are calling for more supplies and supports to Indigenous communities because of the heightened risks of lethality and severe community transmission. Do you have any proof that their position is mistaken, and those supplies will make no difference?

I can't prove that something won't make a difference and you well know that. It would also help if the IHS didn't have issues like "poor medical care, untrained staff, leadership turnover and, more recently, an investigation over reports that it failed to prevent a pediatrician from sexually assaulting young patients despite repeated warnings." and weren't "[W]orking out of a hole that is so deep it’s really kind of unfathomable,”. These issues should be fixed and shouldn't be allowed to continue, but is now the time to start pretending the US cares about these populations?

No, now is the time to start caring, and the simplest way to do that is to, you know, send the supplies and resources they need during this crisis, dude. You're taking the tack that because there's a pre-existing deficit, we shouldn't take extra measures to try and mitigate its impacts on vulnerable populations - an action that does nothing but perpetuate that deficit and stake out the most vulnerable to die. You understand that, right?

You started by insisting I should be called out for the 'complete garbage' view that Indigenous communities need more aid. You aren't showing me that it's complete garbage - you're showing me that you feel communities that are at special risk should be left to fend for themselves while resources are prioritized to those who are at less risk. You're showing me, when you make this argument that because there's a pre-existing deficit the community shouldn't get extra aid to try and overcome that deficit during a potentially devastating outbreak, that despite your 'a life is a life' rhetoric, you value the lives of those who haven't been systematically marginalized over the lives of those who have.

If all lives have equal value, Jub, then those that have been put at special risk deserve special protection. To do the opposite - to look at those who are at special risk and say 'hey, too bad, but you're fucked anyway' - is to value the lives of the fortunate and privileged more than the unfortunate and the dispossessed. It is the precise opposite of the view you espouse.

[mr friendly guy]

More fallout from Trump's chloroquine speech. Now people who actually have hydroxychloroquine for their medical conditions can't get it.
https://www.buzzfeednews.com/article/ta ... hloroquine

A Woman With Lupus Said Her Health Care Provider Is Stopping Her Chloroquine Prescription And Thanked Her For The “Sacrifice”
"The fact that they thanked me for my 'sacrifice' is disturbing," she told BuzzFeed News. "I never agreed to sacrifice my health and possibly my life and cannot believe that I am being forced to do so."


Posted on March 25, 2020, at 1:10 p.m. ET

A 45-year-old woman with systemic lupus erythematosus (SLE) said she received an online message from her health care provider stating it will no longer refill her vital hydroxychloroquine prescriptions because that drug is being used to treat the "critically ill with COVID-19," the disease caused by the novel coronavirus. The letter thanked her for her "sacrifice."

Dale, who lives in the Los Angeles area and asked to only be identified by her first name, told BuzzFeed News she "started crying" upon receiving the message from her doctor's office on Tuesday. She had previously called Kaiser Permanente, a major health care network based in Oakland, about why her prescription was being denied.


Dale said she's been taking the medication for a decade, and she's scared about possible consequences to her own health during the coronavirus pandemic if she's forced to stop taking hydroxychloroquine.

"I am already immunocompromised, and not taking this medication with likely put me into a lupus flare, making serious complications from COVID more likely," she said.

"The fact that they thanked me for my 'sacrifice' is disturbing," she then added. "I never agreed to sacrifice my health and possibly my life and cannot believe that I am being forced to do so."

In the message Kaiser sent to her about its decision to withhold the medication, it wrote, "Please do not contact your physician about an exception process to get a refill, as prescriptions will not be filled even if written by your physician. Hydroxychloroquine does build up a level in the system that stays in the body for an average of 40 days even after the last dose is taken. If you do run out of medication and feel your condition is significantly worsening, please contact your doctor to discuss alternative treatments."

"Thank you for the sacrifice you will be making for the sake of those that are critically ill; your sacrifice may actually save lives," the message said.

In a statement provided to BuzzFeed News, Kaiser Permanente confirmed that it was no longer filling routine prescriptions for chloroquine.

"As we face the real possibility of running out of the drug for everybody if we don’t take steps to mitigate the shortage, Kaiser Permanente, like other health care organizations across the country, has had to take steps to control the outflow of the medication to ensure access to severely sick patients, including both COVID-19 and those with acute lupus," said Nancy Gin, regional medical director of Quality and Clinical Analysis at Kaiser Permanente, Southern California, which has 4.6 million members.

"Extensive experience and research show that hydroxychloroquine builds up in the body and continues to work for an average of 40 days even after the last dose is taken. By then, we expect the drug manufacturers to have ramped up production to meet the increased demand. Until then, we are no longer refilling routine prescriptions to ensure we have adequate supply to care for our sickest patients," Gin said.

"Kaiser Permanente physicians and pharmacists are also working together on an evidence-based approach to identify alternative therapies for patients with lupus," Gin added in a follow-up statement.

Dale said she immediately called her doctor and has been scheduled for a phone call next week.


Anna Valdez, Ph.D., RN
@drannamvaldez
Please do not misuse hydroxychloroquine. This med is critical for people who have SLE, like me. I was told today that my prescription cannot be filled because the suppliers are completely out. Now I do not have the meds I actually need for an incurable disease I actually have. https://twitter.com/RyanMarino/status/1 ... 8520791044 …

Ryan Marino
@RyanMarino
Please. No. We are supposed to be better than this. https://twitter.com/ml_barnett/status/1 ... 1404357633 …

5,295
12:00 PM - Mar 21, 2020
Twitter Ads info and privacy
2,542 people are talking about this
Despite thin evidence for the drug’s effectiveness against coronavirus infections, shortages of chloroquine have erupted since Trump called it a “game changer” at a White House news conference late last week. The drug, a derivative of an antimalarial drug, has been added to the regimen for treating COVID-19 infections in China and South Korea and is being tested in clinical trials in the US.

However, experts on drug testing have been skeptical of the evidence for its benefits. A frequently cited French study of 20 patients saw several drop out of the trial to instead go into intensive care.

An Arizona man died on Monday after self-medicating with a related drug, chloroquine phosphate, where chloroquine was also touted at White House news conferences.

“For many people with lupus there are no alternatives to these medications,” the Lupus Foundation of America said in a statement on Monday, warning of shortages. “Hydroxychloroquine or chloroquine are the only methods of preventing inflammation and disease activity that can lead to pain, disability, organ damage, and other serious illness.”

Dale, who's been calling multiple pharmacies in her local area, said, "I have learned that all area pharmacies are completely out of hydroxychloroquine."


"In their mission statement, Kaiser says that they aim 'to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve,'" Dale said. "How is denying medication for a chronically ill, immunocompromised patient during a pandemic improving my health?"

"I want Kaiser to follow their own mission statement and reverse the decision to withhold my medication."

[aerius]

More fallout from Trump's chloroquine speech. Now people who actually have hydroxychloroquine for their medical conditions can't get it.

To be honest, I'm not sure if that's a Trump problem or a US healthcare industry are a bunch of total fucking shitbags problem. I wouldn't be surprised if someone in the industry did the math and realized that they could make a much fatter profit by jacking up the price of chloroquine and selling it exclusively to covid-19 patients.

[loomer]

I'm not so sure, since there are similar issues here and in the UK.

[mr friendly guy]

More fallout from Trump's chloroquine speech. Now people who actually have hydroxychloroquine for their medical conditions can't get it.

To be honest, I'm not sure if that's a Trump problem or a US healthcare industry are a bunch of total fucking shitbags problem. I wouldn't be surprised if someone in the industry did the math and realized that they could make a much fatter profit by jacking up the price of chloroquine and selling it exclusively to covid-19 patients.

That was what I was thinking too. Someone realised that dummies are going to believe what Trump says whether its true or not and decided to sell them to people concerned about covid 19. I wouldn't blame Trump for all of it. He was just the match that lit the room full of gunpowder.

[Jub]

By the relative rates of disease, poverty, and access to infrastructure across that community, coupled with the likely impacts and ease of transmission of an outbreak, dude. This isn't complex or unprecedented stuff. Do you have any evidence that New York's population is more vulnerable than that of remote and regional Indigenous communities?

Yes, look at the deaths in NYC, they have more deaths than the Navajo nation has confirmed cases while having a number of confirmed infected which number more than 12% of that entire nation's population.

Again, I'm not a virologist or an epidemiologist. I'm listening to people who are, who are saying that sending this aid will have an impact. Can you show why they're mistaken?

Obviously the aid will have some impact, of course it will. Will it have enough of one to justify taking any aid from places that are already pushed to their limit when for example, the Navajo nation could still contain their outbreak and not wind up needing the aid that would be diverted to them?

I did, because they're factors in the increased vulnerability of Indigenous communities - but the immediate solution to these issues is not an impossible rollout of infrastructure but aid to what already exists. Now, you want to say they're beyond help - prove it. Show why the experts calling for aid are wrong. Show why sending PPE, nurses, and other resources (even something as simple as tents) is a lost cause.

Perhaps because there's already a massive deficit of PPE and test kits and most health care workers are needed where they are? If there was an excess of supplies to go around we wouldn't be having this discussion.

No, now is the time to start caring, and the simplest way to do that is to, you know, send the supplies and resources they need during this crisis, dude. You're taking the tack that because there's a pre-existing deficit, we shouldn't take extra measures to try and mitigate its impacts on vulnerable populations - an action that does nothing but perpetuate that deficit and stake out the most vulnerable to die. You understand that, right?

People are already dying in the areas where we're not at such a deficit to begin with. Show me that the limited supplies you're saying will help will have enough of an impact to justify diverting them from other places that are currently wheeling bodies into trailers.

You started by insisting I should be called out for the 'complete garbage' view that Indigenous communities need more aid.

Everywhere needs more aid, that's the issue.

You aren't showing me that it's complete garbage - you're showing me that you feel communities that are at special risk should be left to fend for themselves while resources are prioritized to those who are at less risk. You're showing me, when you make this argument that because there's a pre-existing deficit the community shouldn't get extra aid to try and overcome that deficit during a potentially devastating outbreak, that despite your 'a life is a life' rhetoric, you value the lives of those who haven't been systematically marginalized over the lives of those who have.

If all lives have equal value, Jub, then those that have been put at special risk deserve special protection. To do the opposite - to look at those who are at special risk and say 'hey, too bad, but you're fucked anyway' - is to value the lives of the fortunate and privileged more than the unfortunate and the dispossessed. It is the precise opposite of the view you espouse.

You're asking for aid above and beyond what other areas are getting and have yet to prove that it will make enough of an impact to be worth prioritizing. None of your articles are showing the value prospect of sending aid to the IHS versus keeping it with the CDC and sending to to regions they cover.

[loomer]

By the relative rates of disease, poverty, and access to infrastructure across that community, coupled with the likely impacts and ease of transmission of an outbreak, dude. This isn't complex or unprecedented stuff. Do you have any evidence that New York's population is more vulnerable than that of remote and regional Indigenous communities?

Yes, look at the deaths in NYC, they have more deaths than the Navajo nation has confirmed cases while having a number of confirmed infected which number more than 12% of that entire nation's population.

That's not what a vulnerable population means. Again, you wish to argue NYC is as vulnerable as Indigenous communities - prove it. To do so, you'll need to show that they have similar rates of chronic illness and socioeconomic factors that make Indigenous communities as vulnerable as they are and inflate the potential risk factor.

Or you can admit that you don't actually think NYC as a whole is more vulnerable, and that you just think resources must be concentrated on larger populations and outbreak hotspots regardless of relative vulnerability.

Again, I'm not a virologist or an epidemiologist. I'm listening to people who are, who are saying that sending this aid will have an impact. Can you show why they're mistaken?

Obviously the aid will have some impact, of course it will. Will it have enough of one to justify taking any aid from places that are already pushed to their limit when for example, the Navajo nation could still contain their outbreak and not wind up needing the aid that would be diverted to them?

I don't know, and neither do you. But the experts seem to think it will - so why shouldn't we listen to them?

I did, because they're factors in the increased vulnerability of Indigenous communities - but the immediate solution to these issues is not an impossible rollout of infrastructure but aid to what already exists. Now, you want to say they're beyond help - prove it. Show why the experts calling for aid are wrong. Show why sending PPE, nurses, and other resources (even something as simple as tents) is a lost cause.

Perhaps because there's already a massive deficit of PPE and test kits and most health care workers are needed where they are? If there was an excess of supplies to go around we wouldn't be having this discussion.

I see. So it's a lost cause because there isn't enough to go around and therefore discussions on where it should go are... a lost cause? Is that the logic here? Because I'm struggling to see how that explains why it's a lost cause to send the relatively small amounts of aid requested to Indigenous communities.

No, now is the time to start caring, and the simplest way to do that is to, you know, send the supplies and resources they need during this crisis, dude. You're taking the tack that because there's a pre-existing deficit, we shouldn't take extra measures to try and mitigate its impacts on vulnerable populations - an action that does nothing but perpetuate that deficit and stake out the most vulnerable to die. You understand that, right?

People are already dying in the areas where we're not at such a deficit to begin with. Show me that the limited supplies you're saying will help will have enough of an impact to justify diverting them from other places that are currently wheeling bodies into trailers.

Again, I can't do that, and you can't show that they won't. But the experts in the field all seem to agree that the resources are especially needed in Indigenous communities because they're especially vulnerable. Why shouldn't we listen to that advice?

You started by insisting I should be called out for the 'complete garbage' view that Indigenous communities need more aid.

Everywhere needs more aid, that's the issue.

Yes. And that's why the discussion about where that aid should go is important. 'Well, there's not enough aid to go around!' does not mean that the position that more vulnerable communities should receive more of it is garbage. It is in fact one of the core elements of that position. Let me break it down for you thus:

1. There is a major outbreak that, disproportionately kills those with a number of chronic illnesses and the elderly;
2. There aren't enough supplies to go around
3. Those supplies should be used where they will do the most good (however defined)
4a. Some communities have disproportionately larger numbers of the chronically ill and/or elderly at risk people;
4b. Preventing the deaths of these people is a good, thus;
5. These supplies should be distributed to help protect those communities at disproportionate risk of elevated fatalities.

You see why pointing out part 2 exists doesn't negate parts 3, 4 or 5, right? You need to establish that either 3 doesn't apply or 4 is invalid. Asserting 2 is just - yeah, no shit. It's the entire basis of the following argument.

(EDIT: I missed a clause in 4.)

You aren't showing me that it's complete garbage - you're showing me that you feel communities that are at special risk should be left to fend for themselves while resources are prioritized to those who are at less risk. You're showing me, when you make this argument that because there's a pre-existing deficit the community shouldn't get extra aid to try and overcome that deficit during a potentially devastating outbreak, that despite your 'a life is a life' rhetoric, you value the lives of those who haven't been systematically marginalized over the lives of those who have.

If all lives have equal value, Jub, then those that have been put at special risk deserve special protection. To do the opposite - to look at those who are at special risk and say 'hey, too bad, but you're fucked anyway' - is to value the lives of the fortunate and privileged more than the unfortunate and the dispossessed. It is the precise opposite of the view you espouse.

You're asking for aid above and beyond what other areas are getting and have yet to prove that it will make enough of an impact to be worth prioritizing. None of your articles are showing the value prospect of sending aid to the IHS versus keeping it with the CDC and sending to to regions they cover.

Okay Jub. I'm going to be over here listening to the people calling for extra aid who actually know what they're talking about, while you can be over there ignoring them for... reasons? Because they think their communities are at extra risk but aren't giving you cost-benefit breakdowns?

EDIT:
You know, I note that you don't actually defend your position about 'equal value' here either. Are you abandoning that position, or do you just dispute that people at special risk deserve special protection?

[Jub]

That's not what a vulnerable population means. Again, you wish to argue NYC is as vulnerable as Indigenous communities - prove it. To do so, you'll need to show that they have similar rates of chronic illness and socioeconomic factors that make Indigenous communities as vulnerable as they are and inflate the potential risk factor.

Or you can admit that you don't actually think NYC as a whole is more vulnerable, and that you just think resources must be concentrated on larger populations and outbreak hotspots regardless of relative vulnerability.

NYC as a whole right now is more vulnerable than most places because it is already overwhelmed. Are any of the first nations in the US currently in the same situation?

I don't know, and neither do you. But the experts seem to think it will - so why shouldn't we listen to them?

Do they though? Sticking to just the US, because that's where this debate started, the first two articles you posted were mostly just wanting that $40 million aid to actually get pushed through to where they can access it. Only in the Australian article, where you massively shifted the goalposts, were things as basic as tents requested.

I see. So it's a lost cause because there isn't enough to go around and therefore discussions on where it should go are... a lost cause? Is that the logic here? Because I'm struggling to see how that explains why it's a lost cause to send the relatively small amounts of aid requested to Indigenous communities.

Why can't these remote communities isolate? Why can't people in more populated areas use existing services?

Again, I can't do that, and you can't show that they won't. But the experts in the field all seem to agree that the resources are especially needed in Indigenous communities because they're especially vulnerable. Why shouldn't we listen to that advice?

Are they saying that? They're especially vulnerable but they're also not currently pilling bodies in the streets, so perhaps they should continue with the prevention steps using the resources they already have.

Yes. And that's why the discussion about where that aid should go is important. 'Well, there's not enough aid to go around!' does not mean that the position that more vulnerable communities should receive more of it is garbage. It is in fact one of the core elements of that position. Let me break it down for you thus:

1. There is a major outbreak that, disproportionately kills those with a number of chronic illnesses and the elderly;
2. There aren't enough supplies to go around
3. Those supplies should be used where they will do the most good (however defined)
4a. Some communities have disproportionately larger numbers of the chronically ill and/or elderly at risk people;
4b. Preventing the deaths of these people is a good, thus;
5. These supplies should be distributed to help protect those communities at disproportionate risk of elevated fatalities.

You see why pointing out part 2 exists doesn't negate parts 3, 4 or 5, right? You need to establish that either 3 doesn't apply or 4 is invalid. Asserting 2 is just - yeah, no shit. It's the entire basis of the following argument.

3. The supplies should continue to go to areas where there are the most potential victims as should additional nurses because if things get any worse in these areas the potential for harm is far worse than if some 250 person village in the middle of nowhere gets the disease.

4. In areas where the disease has already hit they're currently letting these at-risk people die, why should we devote extra resources to saving people that many regions are currently palliating?

Okay Jub. I'm going to be over here listening to the people calling for extra aid who actually know what they're talking about, while you can be over there ignoring them for... reasons? Because they think their communities are at extra risk but aren't giving you cost-benefit breakdowns?

Hint, everybody thinks their community is at extra risk, ask doctors in an area like Vancouver right now and they'll tell you that additional supplies will help them save our city's at-risk population. When everybody is screaming for their share of limited resources each side needs to prove that their cause saves the most lives. Given you're the one asserting that natives need extra supplies you need to provide the proof that these supplies will do the most good there.

In short, put up or shut up.

EDIT:
You know, I note that you don't actually defend your position about 'equal value' here either. Are you abandoning that position, or do you just dispute that people at special risk deserve special protection?

I dispute that we should devote extra supplies to a population that many regions are currently forced to let die, especially on the grounds that they're somehow special because of knowledge they should have already been passing on.

[loomer]

That's not what a vulnerable population means. Again, you wish to argue NYC is as vulnerable as Indigenous communities - prove it. To do so, you'll need to show that they have similar rates of chronic illness and socioeconomic factors that make Indigenous communities as vulnerable as they are and inflate the potential risk factor.

Or you can admit that you don't actually think NYC as a whole is more vulnerable, and that you just think resources must be concentrated on larger populations and outbreak hotspots regardless of relative vulnerability.

NYC as a whole right now is more vulnerable than most places because it is already overwhelmed. Are any of the first nations in the US currently in the same situation?

That isn't what a vulnerable population means, dude. We just went over this. First, you asked for a definition, and you've now proceeded to ignore it twice. So let me make it very clear:
A vulnerable population is one with significantly elevated risk factors that increase the chance of morbidity from disease. Those factors include heart disease, lung disease, diabetes, obesity, cancer, and hypertension for COVID-19 - and they're all massively overrepresented in Indigenous communities.

You want to assert NYC is a vulnerable community, as defined. So do it - prove it. No one is disputing NYC is a hotspot, but that doesn't mean that it's suddenly had an explosion of the factors that inflate the fatality rate. Or, again, you can just admit that it isn't a more vulnerable community and that you'd rather focus on the fact it's a hotspot or a larger community. This isn't hard, dude.

I don't know, and neither do you. But the experts seem to think it will - so why shouldn't we listen to them?

Do they though? Sticking to just the US, because that's where this debate started, the first two articles you posted were mostly just wanting that $40 million aid to actually get pushed through to where they can access it. Only in the Australian article, where you massively shifted the goalposts, were things as basic as tents requested.

There was no shift in the goalposts, dude. That would require me to be arguing for a suddenly different standard, where I am instead consistently arguing that these communities need to have their requests met to reduce the risk of devastation. If you follow the other articles I've posted, there are also calls for water access, additional staff, PPE, testing kits, and ventilators. So yes - I'd say that the experts seem to think more aid is needed.

Do you, by contrast, have a single piece of evidence for Indigenous communities not being more vulnerable? Any who are saying 'yeah no we don't need additional resources, we're confident this won't hit us like a sledgehammer compared to the general population'?

I see. So it's a lost cause because there isn't enough to go around and therefore discussions on where it should go are... a lost cause? Is that the logic here? Because I'm struggling to see how that explains why it's a lost cause to send the relatively small amounts of aid requested to Indigenous communities.

Why can't these remote communities isolate? Why can't people in more populated areas use existing services?

They're doing both, dude. They're still calling for aid even as they do. They're locking down borders in a way that settler communities simply aren't in many areas, but that doesn't magically mean that if the virus gets in it won't have a severe impact.

Again, I can't do that, and you can't show that they won't. But the experts in the field all seem to agree that the resources are especially needed in Indigenous communities because they're especially vulnerable. Why shouldn't we listen to that advice?

Are they saying that? They're especially vulnerable but they're also not currently pilling bodies in the streets, so perhaps they should continue with the prevention steps using the resources they already have.

Yes, they're saying that. Have you not been reading the articles that I've posted, which are expressly calling for more aid?

Yes. And that's why the discussion about where that aid should go is important. 'Well, there's not enough aid to go around!' does not mean that the position that more vulnerable communities should receive more of it is garbage. It is in fact one of the core elements of that position. Let me break it down for you thus:

1. There is a major outbreak that, disproportionately kills those with a number of chronic illnesses and the elderly;
2. There aren't enough supplies to go around
3. Those supplies should be used where they will do the most good (however defined)
4a. Some communities have disproportionately larger numbers of the chronically ill and/or elderly at risk people;
4b. Preventing the deaths of these people is a good, thus;
5. These supplies should be distributed to help protect those communities at disproportionate risk of elevated fatalities.

You see why pointing out part 2 exists doesn't negate parts 3, 4 or 5, right? You need to establish that either 3 doesn't apply or 4 is invalid. Asserting 2 is just - yeah, no shit. It's the entire basis of the following argument.

3. The supplies should continue to go to areas where there are the most potential victims as should additional nurses because if things get any worse in these areas the potential for harm is far worse than if some 250 person village in the middle of nowhere gets the disease.

Okay, so. You want to define things in terms of the 'most potential victims'. From your example, I take it you want to talk only about raw population since you leave out the issue of disproportionate illness. But that's a mistake.

It's a mistake because COVID-19 is more lethal to certain groups. Let's take our earlier example of a city of 10 million healthy young people. By a raw population metric, if the disease strikes that city, it could kill millions! But that population group has the lowest fatality rate. That population is the least at risk even in a completely uncontrolled outbreak. The city next door, with 1 million people of mixed health, has a higher rate. It needs more aid than the city of 10 million, not less, because the people are both more likely to get sick and more likely to die if they do. Raw population as the metric, though, would prioritize our fabled city of the perfect youth over the city of the grumpy coughers - even though the disease will strike the latter worse than the former.

I wonder if it's because you're unaware of just how much higher the risk factors for increased COVID-19 morbidity are in regional and rural Indigenous communities and reservations? Because when we're talking total number of victims, that is why there's special alarm for Indigenous communities. Let's take one of the most common, diabetes. It raises your morbidity significantly (7.3% versus 2.3% according to the CCDC), so that's not great. Native American populations have twice as many diabetics as white populations and exceed the rate for both African American and Hispanic populations - something on the order of 16% rather than 8% of the population (or even higher if you listen to the PCORI). This diabetes also usually has more complications and worse management than it does in White folk (and here I specifically refer to Whites rather than all settlers as African-American communities (leaving aside the complex politics of settler privilege on that front) also experience worse outcomes on that front), which means that the level of complications it's going to cause COVID-19 will be disproportionate to those among Whites.

What about another common one, hypertension? Well, you don't want hypertension and the Vid at the same time. 6% over the 2.3%. What about relative proportions? 27.2% of the Native American population has hypertension, versus 24% of Whites. Heart disease (probably the single biggest risk factor for COVID-19 morbidity other than advanced age)? 8.6% versus 5.6%. Chronic health issues of the exact kind that raise morbidity are an epidemic among Native American populations, and the situation is similar in First Nations peoples north of the border, the Maori of Aotearoa, and Aboriginal and Torres Straight Islander peoples here. These rates worsen in the remote communities and reservations, too - so the already elevated level of chronic illness rises even higher over that of the general Indigenous population in the specific communities we're discussing.

So let's look again at this idea of the most potential victims. Vulnerable communities - those with these health issues and limited infrastructure - have more potential victims per capita as a result of these factors. These communities have substantially elevated risks of death. So when you go 'well, we have to focus on saving as many people as we can, it has to be about where has the most potential victims' and you don't take these factors into account, you treat those with insignificant risk exactly the same as those of elevated risk. And you wind up with the earlier example of looking only at how many will die overall, and not the per capita rate and the way that figure masks devastation. This is why the calls for more supply are so serious - the death rate will be higher because of the disproportionate health risks these communities already possess.

4. In areas where the disease has already hit they're currently letting these at-risk people die, why should we devote extra resources to saving people that many regions are currently palliating?

Because you can still prevent the outbreak from striking them with the resources being requested, dude. That's why they're asking. The intention is specifically to try and contain and minimize the spread as much as possible to avoid the at-risk being infected, but since there's a much larger segment of the population at-risk, it's a harder task.

Okay Jub. I'm going to be over here listening to the people calling for extra aid who actually know what they're talking about, while you can be over there ignoring them for... reasons? Because they think their communities are at extra risk but aren't giving you cost-benefit breakdowns?

Hint, everybody thinks their community is at extra risk, ask doctors in an area like Vancouver right now and they'll tell you that additional supplies will help them save our city's at-risk population. When everybody is screaming for their share of limited resources each side needs to prove that their cause saves the most lives. Given you're the one asserting that natives need extra supplies you need to provide the proof that these supplies will do the most good there.

In short, put up or shut up.

My position is that vulnerable communities need more supplies to try and counteract the effects of the virus and that Indigenous communities are particularly vulnerable. Do you dispute that Indigenous communities are more vulnerable? I am aware that you dispute that we should provide extra supplies to vulnerable communities, but we'll get to that below.

The expert opinion on the matter seems pretty clear. Is there anyone saying 'no, Indigenous communities aren't more vulnerable, they don't need more supplies, those supplies will be wasted'? Because all I see so far is plenty of experts agreeing that they need more supplies and are at substantially higher risk of absolute devastation. Neither of us is otherwise qualified to provide a benefit analysis on sending masks to these communities versus others (unless you're secretly an epidemiologist?), so as far as I'm concerned, we need to listen to the expert opinions when they say 'this will make a difference'. What we then do is a matter of morality and ethics.

EDIT:
You know, I note that you don't actually defend your position about 'equal value' here either. Are you abandoning that position, or do you just dispute that people at special risk deserve special protection?

I dispute that we should devote extra supplies to a population that many regions are currently forced to let die, especially on the grounds that they're somehow special because of knowledge they should have already been passing on.

They already have been passing on that knowledge, dude. It doesn't happen instantaneously - it takes time, especially in the aftermath of a genocide. But more than that, the argument isn't just to do with the knowledge they have. The argument is this:
1. Indigenous communities have greater vulnerability generally to the coronavirus because of the general state of health in these communities;
2. This means many more members of these communities will die compared to settler communities if they are exposed, and this should be avoided;
3. Many of those who die will be elders, who possess currently irreplaceable knowledge; this should also be avoided.

Cultural vulnerability is only one part of why Indigenous communities should receive more aid. The other part is, quite simply, that they will be worse impacted. They will experience more deaths. They will lose more people. I think this should be avoided, and I'll make it very clear why. My moral position is that those of greater vulnerability to the disease need more protection. They are not to be sacrificed to a greater good, because they possess an inherent human value.

This includes Indigenous peoples. But it also includes those with disabilities, the elderly, the immunocompromised, refugees, prison inmates, the homeless, and other marginalized groups. Those at the highest risk of transmission, and the highest risk of death, are the ones who need extra resources to avoid exposure, and to survive it if it comes. Those in good health who nonetheless wind up in the most severe category of illness need to be helped as well - but to prioritize those in good health pre-emptively is to write those at greater risk off to die.


By doing so, you are abandoning the 'all lives have equal value' line. Because the thing about abandoning entire population groups that are at special risk is that you don't think they're equal, because if they were genuinely of equal value then you would invest additional resources to give them the same chance as everyone else. The human tragedy of what's going on is horrific - but to point to the fact that the elderly died elsewhere to justify not taking additional measures to protect the most vulnerable is utterly fucked from where I'm standing.

Think of it this way. There's a classic illustration of equity with three people trying to see over a fence and three boxes. There's a tall fella who can see without difficulty, a short fella who can nearly see over, and a really short fella who can't at all. If you give the shortest fella two boxes, he can. If you give the short fella one, he can. The tall fella could already see, so he doesn't need a box. If we treat them equally, the shortest fella still can't see, and the tall fella has a box he doesn't need. If we treat them as though each has equal value, then we hand the shortest fella the two boxes, the short fella one, and they all get to see. This is equity, rather than strict equality, but it produces an equal outcome - it's the way to actually treat all three as having equal value, by recognizing that different people have different needs and vulnerabilities.

What we're talking about here is harder to balance, because no matter what we do, people will die. But the same basic principle applies. If we want to actually treat everyone's lives as having equal value, we cannot preemptively write off entire communities with special requirements when they ask for additional supply, nor can we send the same amount as everyone else. The first might be practical, but it does not treat their lives as equal to those of others. The second might be equal in its treatment, but by failing to take into account the special requirements of a community, it does not produce actual equality or equity. It doesn't give them the same chance of survival as everyone else.

You may, if you wish, continue to argue that we should sacrifice populations with special vulnerability, whether actively or just by denying them the extra supplies needed to give them the same chance of survival as everyone else. You might justify that as a utilitarian good, if you like. But it does not treat everyone's lives as having equal value. It treats the lives of those who need more help to have the same chance of survival as less than the lives of those who need less.

I won't try and convince you not to think that, because bluntly, I can't. There is no magic formula to resolve the utilitarian versus deontological issue, and once we reach this point of fundamental ethics, we move into the purely normative domain, and normative beliefs are notoriously hard to prove or disprove. Mine is that we need to focus our resources on minimizing fatalities by protecting the most vulnerable communities where we can, precisely because if an outbreak strikes them they're the first to die, the ones most at risk. This is the position you define as garbage. Your position is that when the disease strikes, these groups will die anyway, so we shouldn't expend extra effort to protect them from that. Yours may have merit in making decisions in the actual ICU, but to adopt it when there's still a chance of containing and excluding the outbreak in the communities that need help to do it and who will be devastated by it? This, to me, is garbage.

[ray245]

For fuck sake, can you guys stop de-railing a fucking pandemic thread???

[loomer]

Gladly, so long as people stop jumping me for posting news about it.

[mr friendly guy]

Disney parks to remain close until further notice. Understandable given the situation. Hope they eventually bounce back, from someone who has been to Disneyworld twice and Disneyland once.

https://www.theverge.com/2020/3/27/2119 ... pn-cruises

Disney originally aimed to reopen its various theme parks by April 1st, but in light of the rapid spread of the novel coronavirus and recommendations from both local authorities and health experts, Disneyland and Disney World will remain closed until further notice.

“While there is still much uncertainty with respect to the impacts of COVID-19, the safety and well-being of our guests and employees remains The Walt Disney Company’s top priority,” a tweet from an official Disney Parks account reads.

The company will continue paying its hourly parks and resorts employees through April 18th, the statement added. It’s unclear if this also applies to parks around the world, including in Paris, Tokyo, Shanghai, and Hong Kong, but The Verge has reached out for more information