The Online Photographer

Health workers don't have adequate PPE.

That's something I have to be careful about when I write—explaining acronyms. If you know what a JPEG or an EXIF is, the terms communicate, and you don't stumble over them. But if I use the term DJST, say, and you don't know what DJST means, I've just tripped you up and interrupted your flow as a reader. It's certainly not acceptable for a writer to think everybody knows what DJST is and move on. You have to know your audience.

Anyway, I had to Google "PPE." I had been reading an article that introduced the acronym cold, so I went back to re-read the first part of the article to find out what the hell PPE means. As you probably know, the convention in short-form writing is that the first time an acronym is used, it is written out, with the initials it's thereafter to be known as in parentheses after it. Like this: "personal protective equipment (PPE)." And no, it's not proper to capitalize the words of the term just because you're going to make an acronym out of it, so you wouldn't write "Personal Protective Equipment."

...And technically, PPE is not even an acronym. It's an intialism, which is a term composed of the initial letters of successive words. Initialisms that are pronounced as words are acronyms, like POTUS or SNAFU. Initialisms are terms where the letters themselves are pronounced, like DoJ (dee-oh-jay) or USA (you-ess-ay). PPE is an initialism because we say it pee-pee-ee.

Shocked
Health workers don't have adequate PPE.

This is such a shocking scandal that I can't believe it's not what everyone is talking about. Here we are talking about projected shortfalls in hospital beds and ventilators, but what's the very most essential and most difficult to resupply link in society's medical lifeline?!

Personnel!

You think it takes a long time to test a vaccine?! Dear Lord. Try replacing an experienced. knowledgeable, highly trained nurse.

Dr. Marcello Natali was a general practitioner who treated patients in the town of Codogno, where Italy's outbreak of novel coronavirus originated. He was a second-generation doctor. He died because his hospital ran out of PPE—disposable gloves, it is believed, in his case. (He had been reduced to using hand sanitizer to protect himself.) Like any doctor of his age, he was the product of years of medical school training and decades of experience. Can he be replaced with a snap of the fingers?

Italy, hard hit by the pandemic, lost 627 souls on Friday, up from 427 the day before. Gruppo Italiano per la Medicina Basata sulle Evidenze (GIMBE) published a report last Wednesday saying that more than 2,600 health workers in that country have been infected, amounting to 8.3% of all cases there.

And of all the countries in the world, the USA's trajectory with the virus so far resembles Italy's the most closely.

The supply of doctors and nurses is limited. And if they're not there, it's going to take a long, long time to refill that pipeline. That is, if anyone still wants to be a doctor or a nurse in countries where they aren't even provided with adequate PPE in dangerous crises. And you think running out of toilet paper is bad? STFU. (Okay, maybe I'm getting a little carried away with the initialism leitmotif here. Sorry.)

Abandoned
Marcello Natali died all alone, isolated in an ICU. He was 57. On Facebook, his friend Silvestro Scotti, President of Italy’s National Federation of Doctors and General Practitioners, said "I have no more tears."

As a former manufacturing powerhouse, it's pathetic that the USA now can't even supply doctors and nurses with enough N95 masks. Never mind ventilators for all the people who will, very soon, need them. As I'm sure you've heard, on Thursday the Centers for Disease Control and Prevention (CDC) updated, for the second time in a week, its guidelines for health workers concerning the use of face protection such as N95 respirators and surgical masks. As the Center for Infectious Disease Research and Policy too drily put it, "To the surprise of many, the guidance recommended that nurses, doctors, and staff fashion homemade masks out of scarves and bandanas if there is a shortage of face masks in clinics and hospitals."

So that's what America has become, then: a Bandana Republic.

Pathetic and sad. The more I researched this yesterday, the angrier I got.

Health workers don't have adequate PPE. Why is this not being treated as a matter of the highest possible urgency? What more valuable and critical resource do we have right now than our healthcare workers?

I don't know what we as private citizens can do. Agitate, I guess. All I know is, this isn't an afterthought. I don't know how we as private citizens light bigger fires under the butts of the idiots in charge, but we need to do something. Health workers are our front-line soldiers, our bastion of defense, our thin scrubs-green-colored line, and they might be your (or your parent's or child's or friend's) life preserver when you are drowning and literally can't breathe.

Agitate we should. However we can. Health workers' lives are at stake.

Don't just sit there! (Hey, there it is: DJST).

Mike

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Featured Comments from:

JimH: "Don't forget the other workers who are keeping us safe—those who operate and maintain utilities like electricity, water, and the Internet.

"With everyone working from home, the Internet has become another critical utility. My doctors are doing phone and online consultations to stop visits to offices. Emergencies depend on wireless and Internet communications. We worry that the internet is going to be overloaded. Service providers are already dropping bandwidth caps and stepping up. But users can help too. If you are working at home, it's best to not stream movies in the middle of the day when workers are busiest. Wait till the evening when you usually do it. If you can, change your settings to regular video resolution not high definition—that reduces bandwidth tremendously. Watching video on your mobile device eats up cell phone bandwidth. Emergency workers depend on wireless devices to do their job. They use the same cell phone networks we do. And also conserve water and electricity. We really depend on these services, as do our healthcare workers."

Chris Kern: "(Somewhat off-topic even for an off-topic post.) Mike said: 'Initialisms that are pronounced as words are acronyms, like POTUS or SNAFU. Initialisms are terms where the letters themselves are pronounced, like DoJ (dee-oh-jay) or USA (you-ess-ay).'

"I don’t know whether you ever took a course with John Kemeny while you were at Dartmouth, but, as I’m sure you know, he and his collaborator, Tom Kurtz, invented an early, extremely easy-to-learn computer programming language known by the acronym BASIC. Kemeny was a brilliant man and an outstanding lecturer, and while English was his second language (he was born in pre-war Hungary) he had acquired a mastery of and great affection for it. Anyway, more than once I heard him opine on the proper way to concoct an acronym in his adopted language. It should not only be a real English word, he insisted, but the word must also be descriptive of the thing being named by the acronym. Anything else simply wouldn’t do.

"BASIC? It stands for 'beginner’s all-purpose symbolic instruction code.' Perfect!"

Mike replies: Now this is really off-off-topic (like off-off-Broadway), but I'll tell the story anyway. I was fortunate when I was at Dartmouth in that I got to have a number of personal, one-on-one conversations with President Kemeny.

It happened like this. I was all aggrieved about some issue of the day or another, and marched into the Administration building (actually I forget where his office was, although I have a visual mental picture of the inside of it) and asked to see him. I was told he had office hours at a certain time. Somewhat taken aback at the idea of actually speaking to him, I signed up for one of his office hours.

When the time came we had a very satisfying, far-reaching conversation, at the end of which his secretary tried to interrupt several times because he had gone too long. I think we talked for something like an hour and twenty minutes vs. the allotted hour. Then when we were wrapping up, he said something to the effect that it was nice to talk to a student, because frequently no one took advantage of his student office hours and he would sit there by himself! Well, I didn't need more encouraging than that—I figured if no one else wanted to talk to him during his open office hours, I would. So I went in most weeks and would talk with him if no one else was around wanting to see him.

He took to using me as a sort of casual, impromptu bellwether of student opinion, and several times asked me to sound out students about various issues of campus life. I would then bring up his topic, whatever it was, with friends, or at keg parties, or in the dining hall, and "report back" so to speak. We often talked about various ideas he had for changes and reforms to student and campus life and activities. He had lots of ideas, and the window he opened to me of the difficulties of running a college was fascinating. It was naturally much more complicated than I could have imagined.

The only problem was that his secretary very much didn't care for me, because often our talks went past the time allotted and she would have to interrupt and nag him with increasing insistence to get him back on his schedule. He would resist her for a while and then, with reluctance, bow to her wishes and bring the chat to an end—although sometimes he would conclude and then we'd talk for ten more minutes. I recall that I had read in a book some phrase like "shooting daggers with her eyes" or something like that, and had no idea what it could have meant...until I met Dr. Kemeny's secretary! She didn't look at me much, but when she did....well, "shooting daggers" was about it all right.  :-)

He was a fascinating guy with far-ranging interests. I never did draw him out much on the topic of Albert Einstein. I wrote more about him here.

I like to exaggerate and say we talked every week for the better part of a year, but being flatly honest with myself it's possible we actually spoke six times altogether, as few as that. Might have been a few more. I don't recall exactly. Still, I feel very privileged—felt so at the time, too—to have had those conversations with him.

robert quiet photographer: "Among the problems we have in Italy is that we do not have enough PPE because they are not produced in our country. They were believed to be a 'poor'" article and the production was left to other countries. Now we need them and they have not been available even for doctors, nurses, volunteers...robert, from north Italy."

Tim Bradshaw: "The PPE thing is shocking. Given plausible trajectories of the disease (if you have not read the Imperial College paper from Monday then you should) it's not surprising that countries are likely to run out of intensive care unit (ICU) capacity, or even ventilators: it's likely that the number of cases needing ICU care could be of the order of 10 times capacity, and it would be just hugely expensive to keep a reserve of a factor of 10 very expensive ICUs just sitting there in case of, well, this. Ventilators are probably much the same. But PPE is f***ing cheap (sorry for swearing, but no, not sorry): just keep enough of it that your effectively irreplaceable staff don't ever have to choose between doing their job and not dying.

"'Doing their job' is going to be awful for the next many months in any case: they will be hugely overworked and patients are going to die untreated, while they watch, unable to do anything because ICU capacity is not available. To expect them, for instance, to make the choice between offering palliative care and their own health is inhuman."

Fred Haynes: "Mike, in all the years I’ve been coming to TOP, this is the most important, powerful, and emotionally charged post I’ve ever read. Thank you, and God bless you! I made a quick list of friends, and sent it out to everyone! Monday, I’ll be calling senators Gilibran and Schumer’s offices. I got very emotional reading this, got teary-eyed telling my wife. I just hope it hits the mark with everyone who reads it. We really have to do what we can, and quickly!"

Rick Popham: "Yes, this is a huge problem. Much of the manufacture of this gear has moved overseas, and to China in particular. When the pandemic started over there, none of that equipment made it out of the country anymore. I found this story on NPR summed up the situation pretty well. It's going to take a national (Federal) effort to keep essential manufacturers going here at home. The government will have to keep a national stockpile going and buy this equipment regularly to keep production at a useful level so it's there when we need it. Hospitals CANNOT do this alone: they have neither the funds to spend nor the storage space."

Mike replies: That's a very interesting link for those interested in the problem. Thanks for that.

R. Edelman: "Thank you for your sentiments, Mike. I've been a physician for 42 years. I only heard of the term 'PPE' a few weeks ago. The problem that Italy had is the same one that the US had: politicians at the highest levels of government who denied to the public that there was an emerging pandemic threat, and who avoided taking drastic but necessary steps early to prevent a crisis that would occur only a few weeks later. This was a failure of imagination coupled with greedy politics. They didn't understand that they could not wish the problem away. Ethically, the worse cases were the two senators who knew of the evolving disaster and, instead of sounding a warning to the public, kept quiet and sold off stock for their own financial benefit. I also take great offense to a President who chides health care workers for being wasteful by not reusing protective masks which, when properly used, are single use only. This is an attempt to blame health care workers, who are risking their lives to help others, for the shortage of critical supplies that is the responsibility of this President and his administration."

Marek Fogiel (partial comment): "I am in Italy, locked down like everybody else. At this moment in time, it does not matter if Trump is incompetent and how many mistakes have all politicians made. What counts, is not to spread the epidemic around, and survive. Eventually, the elections will come and people will judge. Meantime: take this very seriously. Most infections come from people with no symptoms and most of them are kids. You also get infested from virus left over on surfaces—it can survive up to five days on hard surfaces.

"General rule is: wear a mask and gloves, if you have no mask, take a piece of cloth, it is for not spreading anything. Pretend that anybody who comes into your house does the same. Sanitize all your shopping or set it aside for a week before you touch it with bare hands, After you come back from a shop, take off the mask, gloves and shoes outside the main dwelling and wash your hands right away. Above all stay home and don't see anybody. Good luck!"

giulio: "I'm writing while at home, home working in Northern Italy, reading scaring bullettins every evening. It's quite descouraging, but I see the same mistakes repeating again and again…. No PPE even for health workers, days or weeks lost before closing schools, shops and factories hoping the virus run away on its own. First in Italy, now probably in Spain, maybe Switzerland, reading your post you looked set for the same path (hope I'm wrong!).

"Sure, closing everything in a country is a bold step, has serious consequences, panic is dangerous, but how it is possible that again and again countries get caught without PPE, gloves or testing equipment? Or how it is possible that health care systems everywhere are designed in a kind of just-in-time supply chain, with little resilience? Flu pandemics are rare, but hardly a surprise: it's the third in roughly a century; I'm not too pessimistic, sure we are getting smarter (Spanish flu, 20–100 millions casualties, Asiatic flu, two millions, this one hopefully a lot less), but it looks that, in general, we are not even ready to believe that things can go wrong.... Good luck!"

Mike replies: And to you.