Thursday, November 18, 2021

A firefighter’s experience with bariatric weight loss surgery

From Fire-Rescue 1 Nov 18, 2021

“Rates of overweight and obese individuals in the fire service are higher than those found in the general public, ranging from 73 percent to 88 percent of firefighters.”

This disturbing finding comes to us from the National Volunteer Fire Council.

Other major fire service organizations have come to similar conclusions, with further research showing the outcomes of our poor health. The National Institute for Occupational Safety and Health (NIOSH) reports that in 2019, over 50% of all line-of-duty deaths (LODDs) were the result of sudden cardiac arrest.

"Throughout my fire service career, I constantly felt that I had to work harder and do more simply to break even with the 'in-shape' firefighters," writes Philip Clark. (Photo/Philip Clark)

We’ve been hearing these stats for years – but that doesn’t always mean we take action to avoid becoming a statistic ourselves.
“I was falling behind”

I cannot remember a time in my adult life, or most of my childhood for that matter, that I was not overweight. It was a constant struggle. I ate from boredom, I ate from depression, I ate just to eat. I did not have healthy habits.

Slowly I went from husky to chubby to big to fat to morbidly obese. Much like a frog in a pot of heated water, the change was so gradual that I didn’t notice it was killing me. I didn’t wake up one morning overweight; it was a series of bad choices and poor self-care that led me to my own downfall.

Throughout my fire service career, I constantly felt that I had to work harder and do more simply to break even with the “in-shape” firefighters. But if I was being honest with myself, I wasn’t breaking even. I was falling behind. My crew would have to work harder to complete the task because I wasn’t keeping up. I remember a time when working at a structure fire would be the only event of my day because I was physically spent after the call. I realized that I was putting not only myself but also my family and my fellow firefighters at risk.

The sobering statistics above, along with several personal realizations, led me to make a life-altering decision. I needed to make a change. I needed to start taking my health seriously.
“Preparing for the rest of my life”

In June 2020, I started the process of meeting with a bariatric center for weight loss surgery. The process, as I would learn, was more involved than I had realized. I would spend the next three months preparing for the rest of my life. I met with a dietician to discuss my eating habits, and together, we created a plan for success. I met with the surgeon who laid out all the requirements for my surgery to take place. I started a diet almost immediately following my first appointment, and over the next few months, I had regular checkups with my team to ensure that I was sticking to the plan.

At two weeks out from the surgery, I was put on a full liquid diet that consisted of creamed soup, yogurt, pudding, Jell-O and protein shakes. At the time, I was working a full-time night shift in a busy 911 system. Meal prep was a must because, as you can imagine, there aren’t many options for a liquid diet from a gas station at 3 a.m.

Finally, in October, the day came that changed my life. I joined the “Loser’s Bench.”

The surgery was simple enough, at least according to the doctors. Through five small incisions in my abdomen, they would remove around 80% of my stomach, essentially turning my stomach from a ball shape to a banana shape. The surgery not only creates a smaller “pouch” for food to fit in to but also suppresses appetite. The doctors projected that I would lose 75-80% of my excess weight simply from the surgery. The rest would be up to me and the lifestyle changes I enacted.
“The weight began to come off”

Recovery went well. My first two weeks after surgery required a clear liquid diet. This is like the full liquid diet, but it removes any liquid you cannot see through. If you’re thinking that this sounds unenjoyable, you’re right! I lived off of Jell-O and beef or chicken broth.

"I had cinched up my turnout gear as much as I could, but after losing 50 lbs., I looked like a little kid wearing his dad’s suit for dress-up," Clark said. (Photo/Philip Clark)

As the days passed, the weight began to come off.

For the next two weeks, I was back to the full liquid diet. By the end of my first-month post-op, I was allowed to eat soft puréed food. Let me tell you, chicken mush never tasted so good! By this time, I had lost about 25 pounds, and I was beginning to see and feel the changes.

January brought more good news. I was down about 50 pounds, and my clothes were starting to sag off my body! Even more impressively, I was starting to realize the difference that this weight loss was going to make. I wasn’t winded as easily. I had more energy. During training, I had more to give. I had cinched up my turnout gear as much as I could, but by this point, I looked like a little kid wearing his dad’s suit for dress-up.

As the pounds kept coming off, my mental health began to improve as well. I started to feel better about myself on both the outside and the inside. It was a whole new experience for me, but the best was yet to come.
“Is this how healthy people feel?”

By early summer, I was down almost 100 pounds. It was at this point that two very big events occurred – eye-opening events in my weight-loss journey.

The first was a working fire that just a year ago would have wiped me out and required at least a day of recovery. I found that I was able to make my SCBA breathing air last longer and that I didn’t feel as tired afterward. It was amazing to me that I had more to give when the job was done! Is this how healthy people feel?! Even though I am a paramedic, I had no idea that my extra weight was putting such a strain on my body, and I couldn’t believe that I had waited this long to take on this problem head-on.

The second event was the physical agility test for the career department to which I had applied. In the past, I talked myself out of these kinds of tests by making excuses – all out of fear of failure. I would wait to get the medical release signed until it was too late. I would make sure I was working on the day of the test and that I “wouldn’t be able to get off.” I was trying to protect my pride by making sure that if I didn’t take the test, I wouldn’t fail. On the day of the test, I was more confident and felt better prepared than I had felt about anything in a long time. It was hard, but I passed! Not only that, but I passed with a significant amount of time leftover! After successfully passing the agility test and the interview process, I was hired to be a full-time firefighter.
“You need to make the choice”

This journey has been hard. I still struggle with emotional eating, and I work every day to try to better myself. I find that there are days when I backslide, but it only takes a quick trip down memory lane through my photos to see how far I have come and to remember how much I do not want to go back to where I was.

I would like to encourage everyone reading this to take a moment to perform a self-assessment. Ask yourself the following questions:
“If my loved one – my daughter, my son, my spouse, my parent – was trapped in a fire, would I want ME being the one to have to make that rescue?”
Could you, without a doubt, do the job?
Could you give it your all and still have some left over?

If the answer is no, there is only one person who can fix it. You need to make the choice to make yourself better.

There is a quote from Greek philosopher Heraclitus that says the following: “Out of every one hundred men, ten shouldn’t even be there, eighty are just targets, nine are the real fighters, and we are lucky to have them, for they make the battle. Ah, but the one, one is a warrior, and he will bring the others back.”

Are you one of the 10 that shouldn’t be there, the 80 who are just targets, or are you the one? I may not be the one – I don’t think that anyone can label themselves as such – but I am now confident that I am one of the nine real fighters. I will continue to strive every day to be the one, and to never go back to being one of the 90 ever again.

So come with me, and together we can achieve our goals. Believe in yourself. BE THE ONE!

Sunday, November 14, 2021

Wednesday, November 10, 2021

Unvaccinated Texans 40 times more likely to die of covid than those fully vaccinated in 2021

From the Washington Post

Unvaccinated Texans 40 times more likely to die of covid than those fully vaccinated in 2021, study says
Paulina Firozi1:23 p.m. EST

A medic from the Houston fire department prepares to transport a covid-19 patient to a hospital on Aug. 24. (John Moore/Getty Images)

A vast majority of Texans who have died of covid-19 since the beginning of the year were unvaccinated, according to a grim new Texas health department report released Monday.

The report from the Texas Department of State Health Services examined data from Jan. 15 to Oct. 1 and found that unvaccinated people were much more likely to get infected and die of the coronavirus than those who got their shots.

Of the nearly 29,000 covid-linked fatalities in Texas during that period, more than 85 percent were of unvaccinated individuals. Nearly 7 percent of the deaths were among partially vaccinated people, while nearly 8 percent were fully vaccinated.

The figures highlight just how much more at risk the unvaccinated population has been this year: In all age groups, the state’s unvaccinated were 40 times more likely to die than fully vaccinated people. The study also found that the unvaccinated in all age groups were 45 times more likely to have a coronavirus infection than fully vaccinated people. It also looked closely at data from September and underlined the impact of the highly contagious delta variant, which fueled a surge in Texas, as it did in much of the country.

The report from Texas health officials underscores the risk that cases and death counts would spike among the unvaccinated, echoing the alarms that public health officials have been sounding throughout the year. The report, which Texas health officials say is the first statistical assessment of the real-world effect there of vaccination against the coronavirus, also highlights the impact in a state where Republican leaders have sharpened attacks on public health strategies throughout the pandemic. Last month, Texas Gov. Greg Abbott (R) banned any entity in the state from mandating vaccines for workers or customers.

“This analysis quantifies what we’ve known for months,” Jennifer A. Shuford, the state’s chief epidemiologist, said in a statement. “The COVID-19 vaccines are doing an excellent job of protecting people from getting sick and from dying from COVID-19. Vaccination remains the best way to keep yourself and the people close to you safe from this deadly disease.”

Shuford’s remarks echo statements from other health leaders, including Rochelle Walensky, director of the Centers for Disease Control and Prevention, who has described the nation’s ordeal as “a pandemic of the unvaccinated.”

While Texas is still averaging more than 3,200 new daily infections and almost 110 deaths a day, the state, like the nation overall, has seen case and death totals fall, according to data tracked by The Washington Post.

Nearly 54 percent of the state’s population is fully vaccinated, trailing the national vaccination rate of 58.4 percent.

The state data “shows what we already knew — that the unvaccinated are increasing their risk of severe covid disease and death, and we have the data now to prove this,” said Bhavna Lall, a clinical assistant professor at the University of Houston College of Medicine.

She said she’s troubled by leaders questioning public health mitigation measures and vaccination mandates, particularly in a state that’s had more than 70,000 deaths since the pandemic’s start — one of the highest total death counts in the country.

“By debating mitigation measures, we’re not helping in any way,” she said. “We know what works for decreasing the spread of covid. We know that vaccination works, we know masking works.”

Recent findings from the CDC similarly highlighted risks for the unvaccinated. A CDC study published in September found that people who were not fully vaccinated in the spring and summer were more than 10 times more likely to be hospitalized and 11 times more likely to die of covid-19 than people who were fully vaccinated.

Unvaccinated people were 11 times more likely to die of covid-19, CDC report finds

The new report from Texas also breaks out findings from the weeks between Sept. 4 and Oct. 1, which the health department said researchers wanted to analyze to measure the vaccine’s effectiveness as the delta variant surged in the state.

In that time frame, unvaccinated people were 20 times more likely to experience a covid-associated death than fully vaccinated people, and were 13 times more likely to become infected with the virus than the fully vaccinated.

The Texas data strengthens scientists’ assertions “that vaccines work,” said Rama Thyagarajan, an assistant professor at the University of Texas at Austin’s Dell Medical School.

She noted that the small percentage of fully vaccinated Texans who died probably were “the oldest and sickest of the group.”

The report said 35 percent of deaths were among people 75 years and older, and 25 percent were among those 65 to 74.

While the vaccination against the coronavirus had a strong protective effect for all people, the report notes, the findings varied by age on the protective impact for covid-related deaths. Unvaccinated people in their 40s were 55 times more likely to die of covid-19 in September than fully vaccinated people of the same age. For people age 75 and older, the unvaccinated were 12 times more likely to die than the vaccinated in that time frame.

The report also highlighted the severity of the impact of the delta variant overall. Regardless of vaccination status, the report says, Texans were four to five times more likely to become infected with the coronavirus or to suffer a covid-linked death in August, when the variant was prevalent in the state, than in April, before its presence was widespread.

Lall said it was “sad to see that during the time when delta was surging, we had so many people … dying because they just didn’t get the vaccine.”

She said the latest report from Texas, which shows the protection offered by vaccination, underlines the need to encourage not only more vaccinations but public health measures that can help stop the virus from surging.

“We need to be aware that other parts of the world are surging — Europe has high covid cases right now — and if we don’t get more people vaccinated in America, we’re still at risk,” she said, adding: “No one wants to go through these surges again and again.”

Saturday, October 23, 2021

As coronavirus cases mount and vaccine mandates spread, holdouts plague police and fire departments

Washington Post
Mark Berman October 2, 2021, at 9:00 a.m. EDT

When the coronavirus vaccines were first rolled out, the national Fraternal Order of Police went to the federal government, pleading for law enforcement officers to have “expedited access” to the shots. Police, the group wrote, needed the vaccines “to keep them, and the public with whom they interact, safe from infection.”

But to the group’s surprise, officers did not rush to get the shot. And months later, with the vaccines widely available across the country, scores remain unvaccinated.

“We worked very hard, along with others, to ensure that police officers had early availability on a premise that they’d all want it,” said James Pasco, FOP executive director.

Nearly a quarter of Americans age 18 and older remain unvaccinated, according to a Washington Post analysis of federal data, frustrating officials and fueling bitter debates. Yet the continued resistance among the first responders included in those tens of millions is particularly troubling and creates a different kind of threat, experts say.

Foxboro Police Officer Brendan Fayles checks in at the Putnam Clubhouse at Gillette Stadium in Foxboro, Mass. to receive his coronavirus vaccination on Jan. 15. (Mark Stockwell/AP)

Due to the nature of their jobs, first responders regularly have close contact with the public, which increases their risk of contracting and spreading the coronavirus among themselves, their families, and the people they are sworn to protect, experts in public health and policing said.

“They’re going to get infected because they have more contact with people than most,” said Vincent Racaniello, a professor of microbiology and immunology at Columbia University. “It doesn’t work any other way.”

Changing recommendations for boosters leads to confusion for the vaccinated and their doctors

The resistance to vaccination is surprising, some said, given how the virus has battered law enforcement’s ranks since the beginning of the pandemic and continued to do so as the delta variant has taken hold.

Covid was the leading cause of line-of-duty deaths last year, killing at least 182 officers, according to the National Law Enforcement Memorial Fund, which tracks such deaths. That’s nearly double the number killed by gun violence and vehicle crashes combined. At least 133 officers have died of covid so far this year, according to the organization.

But despite the toll the pandemic has taken, tensions over vaccinations have only increased as unions and individual officers and firefighters have railed against mandates, filing lawsuits and threatening to quit if the shots are required.

Pfizer, partnering with BioNTech, and Moderna has created effective coronavirus vaccines that scientists hope will lead to medical breakthroughs using mRNA. (Joshua Carroll, Brian Monroe/The Washington Post)

When Chicago Mayor Lori Lightfoot (D) announced that all city employees would have to be vaccinated by Oct. 15, the head of the city’s largest police union compared it to the Holocaust.

“We’re in America, G------n it. We don’t want to be forced to do anything. Period,” FOP President John Catanzara told the Chicago Sun-Times. “This ain’t Nazi f---ing Germany, [where they say], ‘Step into the f---ing showers. The pills won’t hurt you.’” he said.

Catanzara later posted a video apologizing for the comments, which were condemned by the mayor and Jewish leaders.

The Los Angeles County Health Department identified hundreds of coronavirus outbreaks at police and fire agencies across the county, according to records obtained by the Los Angeles Times. The outbreaks accounted for more than 2,500 cases — more than half of which were in the Los Angeles Police Department and Los Angeles Fire Department, the paper reported. The fire department said recently that more than half its sworn members have been fully vaccinated, while police chief Michel Moore reported this week that more than 60 percent of his agency’s 12,000 employees — sworn officers and civilians — are fully vaccinated.

Yet employees of both departments have been fierce critics of vaccine requirements and have filed lawsuits in response to a mandate that all municipal employees be vaccinated by Oct. 5, unless they have a medical or religious exemption. Thousands of police employees have indicated they will seek such exemptions.

While there has been much national debate over vaccine mandates in the workplace, experts say first responders are a special case because of the unique position they hold in American life.

Officers wield significant authority, and many of the public’s interactions with police are initiated by officers or by 911 calls summoning them, with people having no choice about whether to engage.

“Somebody gets stopped at a traffic light for a traffic violation, the window goes down, the officer leans toward the person … if they go to a house where there’s been a complaint, they go into the house,” said Jack Greene, professor emeritus of criminology and criminal justice at Northeastern University. “They’re always going into public spaces.”

When police knock on someone’s door, “more often than not, people accede to that request,” said Greene, who has consulted for police departments. “And if they don’t, the door might get broken down. It really boggles the imagination” that any first responder could respond to a call and potentially expose someone else to the virus, he said.

“At the risk of sounding a little bit snide, maybe we should take protect and serve off the sides of patrol cars and put down show up and infect,” he said.

They’re called mild cases. But people with breakthrough covid can still feel pretty sick.

Experts were split about the reasons behind so many officers remaining resistant to vaccination. Some point to the same misinformation and fear impacting the decisions of other Americans.

“Police officers are no different than other people in their community,” said Pasco, with the FOP. He said his initial surprise that police did not flock to the vaccines in larger numbers faded as he saw how fractured the general public was on the topic.

“I’m better informed today as to the depths of divisions on this issue than I was when vaccines first became available,” Pasco said. “The country has not embraced vaccines to the degree that most people anticipated.”

West Virginia was an early leader in covid-19 vaccinations, but health officials say they have hit a wall of vaccine resistance and misinformation. (Jorge Ribas/The Washington Post)

In a recent policy statement, Pasco’s group reiterated its support for vaccinations and said “whether or not to accept the vaccine is a personal decision” up to individual members.

Chuck Wexler, executive director of the Police Executive Research Forum, who frequently speaks to police chiefs, said it appeared to be “predominantly younger officers who do not want to get vaccinated.”

Wexler called the trend “puzzling,” saying he couldn’t explain it.

Charleston police Lt. Robert Gamard reported that some of his department’s officers have said they were still “meaning to do it,” while others remain adamantly opposed. There is no vaccine mandate, he said, but the department has been pushing information to its officers and is exploring making vaccinations available during roll call.

“We’re going to keep trying,” said Gamard, who oversees training for the force.

David J. Thomas, a professor at Florida Gulf Coast University and a retired police officer, described policing as “very conservative in nature.” He noted that in the past, officers have resisted other measures meant to protect them, such as body armor, and are hesitant to adapt to changes.

Officers have the “belief that it’s just not going to happen to them,” he said. Thomas said one police chief told him, “We’ve done everything we can to get them vaccinated, and they won’t listen.”

Thomas said he also believed some officers are vaccinated but not admitting it, comparing it to the work he does with law enforcement on mental health issues. Some officers are hesitant to admit they need help, fearful of seeming weak, and admitting they are vaccinated might be similar, he said.

But as the delta variant-fueled virus surge continues to sweep the country, the prospect of significant numbers of first responders falling ill raises other issues.

“I’m going to use a term the Pentagon would use: It’s a matter of force readiness,” said Sandra C. Quinn, a professor at the University of Maryland School of Public Health. “Will they have a healthy workforce that’s vital for protecting public safety and well-being?”

A vaccine mandate fractures a state fair, leaving children as ‘pawns’

Miami police chief Art Acevedo said he found officers’ resistance to vaccination “very surprising” and “disappointing.”

Acevedo has been an outspoken advocate for vaccinations, and when he signaled support for a mandate last month, local and national police groups lashed out. Pasco called it “management by tantrum,” while the local police union’s president in a letter called the chief’s comments “flat out demoralizing.”

After the pushback, Acevedo, who was chief in Houston before becoming the Miami department’s leader in April, was undeterred, saying unions arguing against mandates were practicing “labor leadership by hypocrisy” after demanding more protective equipment for officers early in the pandemic.

“We need to do everything we can to keep each other alive,” Acevedo said in an interview. “And the one thing when it comes to covid that we know, that the data shows, that’ll help you stay alive … is being vaccinated.”

However, Charlotte-Mecklenburg police chief Johnny Jennings said while he believes in vaccination, he does not support a mandate. Jennings said he preferred to “continue to educate and get cooperation from people to go and voluntarily get vaccinated.”

He noted that the pandemic has “been devastating” for police.

“We don't have the luxury of putting … Plexiglass between us and the people we come in contact with,” Jennings said. He said police “have to be responsible to protect ourselves.”

Yolian Y. Ortiz, a spokeswoman for the FOP lodge representing officers in Charlotte, similarly backed vaccinations while pushing against any requirement.

“We are asking everybody to get vaccinated,” she said. “But we believe it’s a personal choice and should not be mandated.”

Officers, she said, are going through the same thought process as others who have not gotten the shots.

“You want your employees to be able to exercise that personal choice, like religion or your freedom of speech. You don’t want that to be infringed upon,” Ortiz said.

Some departments have been able to obtain high compliance without mandates. Ian Adams, a former police officer in Utah who is a doctoral candidate at the University of Utah, studied police vaccination rates in Salt Lake City and found that most of the department’s officers were vaccinated in a matter of days. Adams said the department’s leadership helped fuel the outcome. (A spokesman for the department said the police chief was not available for an interview.)

“My question for people talking about mandates, is there an alternative to consider? It requires a lot of leadership and hard work and transparency, but none of that’s impossible,” said Adams, who also is also executive director of the Utah State Fraternal Order of Police. “And I think that’s what this case demonstrated.”

Exactly how many officers nationwide are vaccinated is unknown. There are more than 15,000 local police departments in the United States, each with its own policies, and no government agency tracking the information.

The Washington Post requested vaccination rates and policies from dozens of police, fire and city officials. Several said they did not keep track of vaccination rates or had incomplete statistics, while some departments reported numbers suggesting thousands of their employees remained unvaccinated.

Police officials in Atlanta, Austin, Dallas and San Antonio — cities that are home to some of the country’s largest departments — said they have not kept records of vaccinations among their forces, nor were mandates in place. In Chicago, home to the country’s second-largest local police force, officials have not kept track of how many officers are vaccinated although a mandate for city employees goes into effect later this month.

Four patients, two dialysis machines: Rationing medical care becomes a reality in hospitals overwhelmed with covid patients

Of the major departments that are keeping track, Las Vegas officials said more than half of that city’s force is fully vaccinated. The department also said that vaccinations are required for newly-hired police employees.

There is no mandate for New York City police, the country’s largest local department, which said about 62 percent of its workforce — which includes 36,000 officers as well as 19,000 civilian personnel — had gotten vaccinated as of Sept. 23. By comparison, 74 percent of adults in New York are fully vaccinated, according to city data.

Data reported by fire departments also varied. In Austin, vaccinations are not mandated, but fire officials said that 4 in 5 personnel were vaccinated. Both New York and Los Angeles departments reported that more than half of employees are vaccinated.

In Denver, a vaccine mandate covering government workers — including police, fire and sheriff’s department employees — went into effect at the end of September, and those who refuse risk losing their jobs.

Even without mandates, experts said, first responders have an obligation to get vaccinated to protect the public.

They are in “very public-facing positions, and they really have a responsibility to keep the public safe,” said Racaniello, the Columbia professor.

Friday, October 15, 2021

COVID-19 Vaccine Mandates—A Wider Freedom

Lawrence O. Gostin, JD
Author Affiliations Article Information
JAMA Health Forum. 2021;2(10):e213852. doi:10.1001/jamahealthforum.2021.3852
COVID-19 Resource Center

President Biden has required COVID-19 vaccinations across much of the US workforce, reaching nearly 100 million workers. Opponents call it unconstitutional, a violation of personal freedom, and even “un-American.” The truth is that vaccine mandates are lawful and deeply entrenched in US history and values. They constitute a “wider freedom” so that everyone in society can feel safer where they work, learn, worship, and live.

Vaccine Mandates Integral to US Culture and Tradition

Vaccine mandates are very much part of US culture and tradition dating back to the colonial era, even before Edward Jenner’s 1796 discovery of cowpox vaccinia. George Washington required smallpox inoculations for the Continental Army in 1777, writing that “we should have more to dread from [smallpox], than from the sword of the enemy.” He condemned a Virginia law restricting inoculations, saying he would rather move for a law to compel inoculation of all children “under severe penalties.” Massachusetts enacted the first law mandating immunization in 1809, and by the time the US Supreme Court upheld its constitutionality in Jacobson v Massachusetts (1905), municipal and state smallpox vaccination mandates were prevalent across the US.

States began requiring childhood vaccinations as a condition of school entry by the mid-19th century and by 1963, 20 states had school vaccine mandates. Although the US Centers for Disease Control and Prevention (CDC) has a recommended schedule for child and adolescent immunization, it does not set vaccination requirements for schools. The CDC points out that each state makes its own decisions about which vaccines are required for school attendance in that state. All school immunization laws grant medical exemptions, 44 states grant religious exemptions, and 15 states allow philosophical exemptions. Although vaccines are not routinely required for adults in most settings, they are often mandated for military service members, new immigrants seeking permanent US residence, college and university students, and health care workers. Previous epidemics like the 2018-2019 measles outbreak in New York City were quashed by emergency vaccine mandates for adults in affected zones. Even before President Biden’s COVID-19 vaccine mandate announcement, several cities and states, businesses, and institutions of higher education had issued their own COVID-19 vaccine mandates.1

COVID-19 vaccine mandates, therefore, should not be viewed as an aberration but as the continuation of a long tradition in the US to prevent or mitigate infectious disease outbreaks and epidemics. The CDC recognizes vaccinations as among the top public health achievements of the 20th century.

Vaccine Mandates Lawful

Cities and states have broad “police powers” to require vaccinations, upheld twice by the US Supreme Court in 1905 and 1922. The Pfizer-BioNTech COVID-19 vaccine is fully licensed for individuals aged 16 years or older and has received Emergency Use Authorization for children aged 12 to 15 years. (It is likely that vaccines will soon be authorized for children aged ≥5 years.) The police powers of cities and states enable them to require eligible individuals to be vaccinated against SARS-CoV-2 for school attendance, as the Los Angeles Unified School District recently did covering more than 600 000 students. New York City’s “Key to NYC” program requires proof of COVID-19 vaccination for indoor activities such as dining, fitness, and entertainment. The courts have upheld Jacobson v Massachusetts for more than a century, affording municipalities and states wide discretion in exercising public health powers, including mandatory vaccinations.2

Unlike cities and states, the federal government does not have broad public health powers. The president has only limited public health powers and could not, for example, issue a nationwide vaccine mandate. President Biden’s 3 vaccine requirements, however, have strong legal support. First, President Biden ordered all federal workers and contractors to be vaccinated. There is no option to be tested for COVID-19 instead of being vaccinated. As head of the federal workforce, Biden has the power to set evidence-based safety standards, including mandating masks and vaccines. The Equal Employment Opportunity Commission and the Department of Justice both advised that governments and businesses can require COVID-19 vaccines as a condition of employment, so long as they provide religious and medical exemptions. Courts also have upheld COVID-19 vaccine mandates for employees as well as college students.

Second, President Biden ordered all health care facilities to require COVID-19 vaccinations as a condition of receiving certain Medicaid or Medicare funding. The Supreme Court has ruled that the federal government can set reasonable conditions for the receipt of federal funds. In South Dakota v Dole (1987), the Supreme Court upheld a law requiring states to adopt a minimum drinking age of 21 years as a condition of receiving certain federal highway funds. So-called conditional spending must be reasonable. For example, the Supreme Court struck down a requirement in the Affordable Care Act for states to expand Medicaid as a condition of receiving all Medicaid funding, ruling that the amount of funding at stake made the contingency unduly coercive.

President Biden’s third, and most controversial, vaccine mandate requires businesses with 100 or more employees to either mandate COVID-19 vaccinations or institute weekly testing and other risk mitigation measures. Opponents have called it an “overreach” and unconstitutional, but President Biden is acting at the height of his presidential powers. He is not making a unilateral executive decision but is rather acting through specific congressional authorization. In 1970, Congress enacted the Occupational Safety and Health Act precisely because of a weak patchwork of state worker safety regulations. It empowered the Department of Labor to set uniform national workplace safety standards, including emergency temporary standards in response to workplace hazards. Exposure to SARS-CoV-2 can be just as hazardous as workplace injury risks. The Occupational Safety and Health Administration (OSHA) has already set emergency temporary standards for COVID-19 exposures in health care settings. Previously, OSHA set bloodborne pathogen standards that included hepatitis B vaccinations. OSHA is currently devising emergency temporary standards for COVID-19 vaccination or weekly testing, which is expected to be issued soon.

Two Freedoms

Freedom holds deep ethical and legal value in the US. There are at least 2 types of freedom—freedom from personal restraint and a wider freedom to engage in daily life without significant risk of exposure to safety hazards. Vaccine mandates are justified under both notions of freedom. Certainly, competent adults have the right to bodily integrity and to make their own health care decisions. Yet, the right of informed consent has clear limits. No one has the right to expose others to a potentially serious infectious disease. Even though breakthrough SARS-CoV-2 infections after vaccination do occur, vaccinated individuals pose transmission risks for much shorter periods compared with unvaccinated individuals. Thus, a fully vaccinated workforce, especially if layered with other risk mitigation measures such as wearing a mask and improved ventilation, creates a far safer environment for everyone.

In his annual address to Congress in 1941, Franklin D. Roosevelt identified “Four Freedoms”—for speech and worship, as well as freedom from want and from fear. By freedom from fear, he meant that the public has the right to engage in daily social and economic life without fear of avoidable harms. It is unknown how much COVID-19 vaccination coverage is needed to contain SARS-CoV-2, but it probably requires rates exceeding 80% of the population. It is important to remember that everyone in society is interconnected. Our individual choice to not get vaccinated poses avoidable risks to the people we interact with and those with whom they interact. The higher the vaccination coverage, the safer we all are.

Highly vaccinated populations create a wider freedom to return more safely to the ordinary activities people value—such as going to work, school, cafés or restaurants, the theater, or sporting events, as well as traveling. COVID-19 vaccines are a remarkable scientific tool that enables society to live in greater freedom and with less fear. Using every tool—including mandates—to achieve high vaccination coverage enhances freedom.
Back to top
Article Information

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Gostin LO. JAMA Health Forum.

Corresponding Author: Lawrence O. Gostin, JD, Georgetown University Law Center, 600 New Jersey Ave NW, Washington, DC 20001 (

Conflict of Interest Disclosures: None reported.
Gostin LO, Shaw J, Salmon DA. Mandatory SARS-CoV-2 vaccinations in K-12 schools, colleges/universities, and businesses.  JAMA. 2021;326(1):25-26. doi:10.1001/jama.2021.9342
ArticlePubMedGoogle ScholarCrossref
Gostin LO. Jacobson v Massachusetts at 100 years: police power and civil liberties in tension.  Am J Public Health. 2005;95(4):576-581. doi:10.2105/AJPH.2004.055152PubMedGoogle ScholarCrossref

Wednesday, October 13, 2021

The Right Answer and the Effective Answer

The comment below was written by an orthopedic surgeon in response to this article

October 8, 2021

Steven Zeitzew, M.D. | West Los Angeles VA Healthcare Center
There is a large difference between being correct and being effective. As an orthopaedic surgeon I learned long ago that telling patients what to do is less effective than informing them effectively about the consequences of the choices before them, and gently guiding them so they can make the correct choice willingly. Sometimes mandates are effective and necessary, such as vaccines for schoolchildren or for healthcare workers in at least some circumstances. What we are learning is that telling people we are forcing them to do the right thing is sometimes not an effective technique for getting them to actually do the right thing. Sometimes telling a "biker dude" that he cannot put weight on his leg after fracture surgery won't work, because he won't do something just because he is instructed to, and is in fact more likely to do the opposite. That same patient is smart enough to make a good decision if he is informed of the poor prognosis associated with excessive premature weight-bearing before fracture healing. That is human nature. We don't like being told what to do. We do like making well-informed decisions on our own. Even a well-intended mandate based on the best evidence will sometimes be a less effective technique for getting people to make the right choice.

It might be more effective to provide reliable information and allow patients to decide about vaccination on their own in many circumstances, even though some will make the poor choice of declining vaccination, in spite of the overwhelming and persuasive evidence supporting COVID vaccination. Liberty and freedom are important to human beings, and threatening to take it away will have consequences. We will find we cannot force all people to do the right thing. We will also find that most people will make the choice to do the right thing when they are allowed to give informed consent, the same standard we use for other medical interventions, even when they face a life and death choice that affects them and those around them. Yes, sometimes we must impose a choice in order to protect others. Forcing our choice may not be the most effective technique in this instance.

Thursday, October 7, 2021

In case you're in Irving and or headed here....

Captain Jeff Wright secured the funding and filed the mandatory Certificate of Insurance (COI), the course for event number 518 was set up and ready to go. 

Then the DFW fire marshals descended with the grim news. The event cannot be held on an empty parking lot that can accommodate a 747. They delivered the news after the close of business sending us into General Quarters status with an after-hours search for Plan B.

As we packed up under the dark sky, we secured an alternative location: The Irving Mall. 

So, we'll take the tower down first thing tomorrow and the show will go on at 4p CDT. 6.7 miles away

See you there: 

Saturday, October 2, 2021

Opinion: Covid-19 is sticking around. Time to stop pretending it’s not your problem.

Eugene Robinson

Washington Post, Oct 1, 2021

It is mystifying to me, and to many others, that such a divide could possibly exist. Yet an estimated 70 million Americans who are eligible to protect themselves against being hospitalized or dying from covid-19 have not done so. To be as generous as possible, some of those people may still worry about losing days off work to side effects or fear that getting a shot could reveal their undocumented status. But the selfishness and foolishness of people who don’t face those obstacles endanger not only their own health but everyone else’s as well.

Not getting vaccinated is indeed a decision, at this point, given the practically universal access to safe and effective vaccines that the entire nation enjoys. Guaranteeing protection from this highly infectious and deadly disease is no more difficult or complicated than dropping by your neighborhood pharmacy once or twice and rolling up your sleeve. Serious side effects are astonishingly rare, and more routine ones are manageable and often, as was true for me, nonexistent. And the benefits are massive, both for individuals and society.

Are you a lover of freedom? Do you hate all those covid-19 restrictions? Have you been impatient for life to get back to the old normal? Then get yourself vaccinated immediately and do everything you can to make sure your family and friends do the same. Aim your torch-and-pitchfork anger at the covid-19 virus — not at the experts and officials who are trying to save your life even as circumstances and available evidence shift around them.

The willfully unvaccinated are covid-19’s enablers. They are giving the virus an enormous supply of potential hosts, allowing it to thrive and evolve — perhaps someday in a way that evades the vaccines. They are filling intensive-care hospital beds and keeping beleaguered doctors and nurses under constant, and unnecessary, siege. They are prolonging a crisis that we have the resources to get under control.

Incredibly, cynical politicians are actively boosting the death toll. Florida, where Gov. Ron DeSantis (R) has sought to further his presidential hopes by pandering to the anti-vaccination crowd, suffered 14,334 covid-19 deaths this summer, according to figures compiled by Johns Hopkins University.

Sen. Ted Cruz (R-Tex.) earned membership in the Pandemic Hall of Shame on Wednesday by tweeting that “I stand with” the handful of National Basketball Association players who have publicly refused to be vaccinated. Similarly enshrined are Texas Gov. Greg Abbott, Missouri Sen. Josh Hawley, and a host of other ambitious Republicans who seek to curry favor with the party’s populist base by painting vaccination as a question of free choice rather than an imperative of public health.

Ultimately, however, there comes a point where this crisis is not about unscrupulous presidential wannabes. Yes, they may be persuading some of the tens of millions of holdouts, but they’re also doing it to win the approval of those who have decided not to protect themselves and others. Given the negative impact these free-riders are having on the rest of us, we have every right to be ticked off.

Fortunately, there is an intervention that works to eliminate vaccine hesitancy: employer mandates. If workers are told they must be vaccinated as a condition of keeping their jobs, it turns out that the vast majority comply.

In early August, United Airlines announced that all of its roughly 67,000 U.S. employees would be required to show proof of vaccination or be fired. On Thursday, the airline announced that 99 percent of its workers had complied — and that 320 workers who had neither gotten their shots nor filed for exemptions would be terminated, and are perfectly free to work somewhere else.

It’s clear now that we will be living with covid-19 for some time, though hopefully as an endemic disease like the flu rather than in a state of pandemic urgency. The keyword there is “living” — the vaccines give this country the chance to reduce covid-19 to more of a nuisance than a plague.

Millions of Americans who received the Pfizer vaccine at least six months ago are now eligible to get a booster shot, which experts hope will offer additional protection against covid-19. Boosters for those who got the Moderna or Johnson & Johnson shots will likely soon be offered as well. Those additional shots will make us safer — but if the unvaccinated did their duty, we would all be safer still.

And yes, it is a duty. If you refuse to get vaccinated — without a medical reason — you are failing your family, your community, and your nation. Just get the shot. Today.

Sunday, September 26, 2021

Evidence shows that, yes, masks prevent COVID-19 – and surgical masks are the way to go

Laura (Layla) H. Kwong September 22, 2021 8.55am EDT

Do masks work? And if so, should you reach for an N95, a surgical mask, a cloth mask or a gaiter?

Over the past year and a half, researchers have produced a lot of laboratory, model-based and observational evidence on the effectiveness of masks. For many people it has understandably been hard to keep track of what works and what doesn’t.

I’m an assistant professor of environmental health sciences. I, too, have wondered about the answers to these questions, and earlier this year I led a study that examined the research about which materials are best.

Recently, I was part of the largest randomized controlled trial to date testing the effectiveness of mask-wearing. The study has yet to be peer-reviewed but has been well received by the medical community. What we found provides gold-standard evidence that confirms previous research: Wearing masks, particularly surgical masks, prevents COVID-19. Laboratory studies help scientists understand the physics of masks and spread.
Lab and observational studies

People have been using masks to protect themselves from contracting diseases since the Manchurian outbreak of plague in 1910.

During the coronavirus pandemic, the focus has been on masks as a way of preventing infected persons from contaminating the air around them – called source control. Recent laboratory evidence supports this idea. In April 2020, researchers showed that people infected with a coronavirus – but not SARS-CoV-2 – exhaled less coronavirus RNA into the air around them if they wore a mask. A number of additional laboratory studies have also supported the efficacy of masks.

Out in the real world, many epidemiologists have examined the impact of masking and mask policies to see if masks help slow the spread of COVID-19. One observational study – meaning it was not a controlled study with people wearing or not wearing masks – published in late 2020 looked at demographics, testing, lockdowns and mask-wearing in 196 countries. The researchers found that after controlling for other factors, countries with cultural norms or policies that supported mask-wearing saw weekly per capita coronavirus mortality increase 16% during outbreaks, compared with a 62% weekly increase in countries without mask-wearing norms

Researchers gave surgical masks to adults in 200 villages in Bangladesh to test whether they reduce COVID-19. Innovations for Poverty Action, CC BY-ND
Large-scale randomized mask-wearing

Laboratory, observational and modeling studies, have consistently supported the value of many types of masks. But these approaches are not as strong as large-scale randomized controlled trials among the general public, which compare groups after the intervention has been implemented in some randomly selected groups and not implemented in comparison groups. One such study done in Denmark in early 2020 was inconclusive, but it was relatively small and relied on participants to self-report mask-wearing.

Watch this Youtube Comparision with four different scenarios; 
Four scenarios

From November 2020 to April 2021, my colleagues Jason Abaluck, Ahmed Mushfiq Mobarak, Stephen P. Luby, Ashley Styczynski and I – in close collaboration with partners in the Bangladeshi government and the research nonprofit Innovations for Poverty Action – conducted a large-scale randomized controlled trial on masking in Bangladesh. Our goals were to learn the best ways to increase mask-wearing without a mandate, understand the effect of mask-wearing on COVID-19, and compare cloth masks and surgical masks.

The study involved 341,126 adults in 600 villages in rural Bangladesh. In 300 villages we did not promote masks, and people continued wearing masks, or not, as they had before. In 200 villages we promoted the use of surgical masks, and in 100 villages we promoted cloth masks, testing a number of different outreach strategies in each group.

Over the course of eight weeks, our team distributed free masks to each adult in the mask groups at their homes, provided information about the risks of COVID-19 and the value of mask-wearing. We also worked with community and religious leaders to model and promote mask-wearing and hired staff to walk around the village and politely ask people who were not wearing a mask to put one on. Plainclothes staff recorded whether people wore masks properly over their mouth and nose, improperly or not at all.

Both five weeks and nine weeks after starting the study, we collected data from all adults on symptoms of COVID-19 during the study period. If a person reported any symptoms of COVID-19, we took and tested a blood sample for evidence of infection.
Based on current evidence, many places across the U.S. have some form of mask requirements. AP Photo/LM Otero
Mask-wearing reduced COVID-19

The first question my colleagues and I needed to answer was whether our efforts led to increased mask-wearing. Mask usage more than tripled, from 13% in the group that wasn’t given masks to 42% in the group that was. Interestingly, physical distancing also increased by 5% in the villages where we promoted masks.

In the 300 villages where we distributed any type of mask, we saw a 9% reduction in COVID-19 compared with villages where we did not promote masks. Because of the small number of villages where we promoted cloth masks, we were not able to tell whether cloth or surgical masks were better at reducing COVID-19.

We did have a large enough sample size to determine that in villages where we distributed surgical masks, COVID-19 fell by 12%. In those villages COVID-19 fell by 35% for people 60 years and older and 23% for people 50-60 years old. When looking at COVID-19-like symptoms we found that both surgical and cloth masks resulted in a 12% reduction.
The body of evidence supports masks

Before this study there was a lack of gold-standard evidence on the effectiveness of masks to reduce COVID-19 in daily life. Our study provides strong real-world evidence that surgical masks reduce COVID-19, particularly for older adults who face higher rates of death and disability if they get infected.

Policymakers and public health officials now have evidence from laboratories, models, observations and real-world trials that support mask-wearing to reduce respiratory diseases, including COVID-19. Given that COVID-19 can so easily spread from person to person, if more people wear masks the benefits increase.

So next time you are wondering if you should wear a mask, the answer is yes. Cloth masks are likely better than nothing, but high-quality surgical masks or masks with even higher filtration efficiency and better fit – such as KF94s, KN95s and N95s – are the most effective at preventing COVID-19.

Tuesday, September 14, 2021

Time to instill integrity into vaccination verification


By Howard L. Smith, Ph.D.; David N. Gans, MSHA, FACMPE; Zung Vu Tran, Ph.D., FACSM, FSS; Nina Nichols; Brett Goldman; Ryan Hawkos; and Neill F. Piland, Dr.PH.

Even before COVID-19 vaccinations began to be widely disseminated, concerns were expressed about which agencies would document and monitor them. Just as quickly, the federal government took the position that it was not going to institute a system of passports. Those who were inoculated would receive a CDC vaccination card and that was the end of discussion at that time. Well, not quite. Wishful thinking on the part of our government to avoid vaccination documentation and verification has created a formidable crisis about the integrity of vaccinations at a pivotal juncture. 

Vaccinated and unvaccinated alike want to return to some semblance of normalcy that reflects any of the millions of ways that people work, play, pray or interact. This has become possible due to widespread immunization of the U.S. population coupled with prudent social distancing and mask use, which momentarily dampened COVID-19 case counts until variants proliferated. However, as long as a sizeable number of people avoid vaccination, the virus will find ways to thrive.

Increasingly, businesses, bars and restaurants, entertainment venues, sporting events, colleges, state and municipal governments, the Veterans Administration and federal agencies require proof of vaccination or continual tests. This has nurtured fertile ground for counterfeit cards. Anti-vaxers do not want to be prevented from partaking in such activities; plus, many people simply enjoy beating the system or proving that no one can make them do what they do not want to do regardless of the expense to their health or society. This self-centeredness is costing the United States some $2.3 billion in hospitalization for unvaccinated people during June and July 2021 alone.1

As we struggle to reopen our society and rejuvenate our economy, the long-ignored challenge of instilling integrity into vaccination documentation must be overcome. But does anyone really trust that the person sitting, standing or otherwise in their personal space has actually been vaccinated as they espouse or claim with a little sheet of paper? Remember, it only takes one exposure to acquire a virus that might kill you.

The preceding thoughts clearly underscore that it is past time for a viable and efficient vaccination verification system. Such a system would function much like the Good Housekeeping Seal of Approval or OSHA’s “Nationally Recognized Testing Laboratories,” in which valid third-party organizations with appropriate qualifications perform safety testing and certification of products. The CDC, or other health-related agency, could oversee a national vaccination verification system. For example, sources approved by the CDC (e.g., Nationally Recognized Verification Entities) could create highly recognizable electronic passports that substantiate COVID-19 vaccination. The technology and products already exist as private firms have looked ahead to now — when vaccination certification would be paramount to a functioning society.

Currently, the lack of a secure verification system is facilitating fraud as people falsify credentials, forge vaccination cards or hack digital certification tools to meet entry requirements for health facilities, mass gatherings and places of business. Physical and digital health records such as the CDC card and IBM’s Excelsior pass have been easily falsified.2

Cell phone-enabled vaccination verification should be an immediate reality. The world relies on cell phones to do most anything and everything. Verification needs to be easy to use at point of entry (e.g., into a restaurant, bar or entertainment venue), inexpensive, and widely recognized as one of the CDC-approved “Good Health Keeping Passports of Vaccination.” This will facilitate disease prevention, efficient use of health services and facilities and reduce healthcare costs, as well as invigorate economic activity and development.

It is time to quit stalling. All along we have known that there would be a need for bulletproof verification of vaccination to re-boot societal functioning. Let’s invest a modicum of resources in a reliable vaccine verification/certification system of high integrity as we have in developing the vaccines and confidently move onward and upward.

Sunday, September 12, 2021

The Physiology of Treading Water Efficiently

OUTSIDE magazine
Alex Hutchinson
Sep 9, 2021

A new study measures the physical and cognitive load of four different treading techniques. 
The key? Generate lift.  

On a canoe trip down the Spanish River in northern Ontario last month, my friends and I kept noticing an unusually high concentration of really, really big leeches lurking at the shores of our campsites. As a result, our pre-dinner swims involved paddling our canoes out to deep water then jumping in from there. 

This gave me lots of time to think about treading water: how long I’d be able to keep it up if necessary, if I was doing it properly, and whether that even mattered. Imagine my surprise, then, when I got home and saw this paper, just published in Frontiers in Physiology by Tina van Duijn of the University of Otago and her colleagues: “A Multidisciplinary Comparison of Different Techniques Among Skilled Water Treaders.” 

They put 21 volunteers, all experienced water polo players, synchronized swimmers, or competitive swimmers who self-identified as water-treading experts, through a series of physiological and cognitive tests while performing four different styles of treading. 

The verdict: some techniques really are substantially better than others. The four techniques are as follows: 

Running in the water: This one is pretty self-explanatory. Hands and feet are moving up and down in a running-like motion. 

Flutter kick: Your hands are sculling back and forth along the surface of the water, while your legs do a flutter kick. 

Upright breaststroke: Your hands are still sculling along the surface of the water, but your legs are doing the distinctive frog kick of the breaststroke. 

Eggbeater: It’s similar to the upright breaststroke, with the key difference that your legs are kicking one at a time instead of synchronously, producing an eggbeater pattern of alternating circles with each leg. 

Like pretty much everyone who took swimming lessons as a kid, I was taught the eggbeater. But as I floated down the Spanish, I realized that over the years I’ve settled into a comfortable upright breaststroke style as a default. In fact, I wasn’t really sure how to do the eggbeater anymore—which, as I thought back to an article I wrote a few years ago called “How to Survive 75 Hours Alone in the Ocean,” vaguely worried me. 

Was I working way harder than I needed to in order to stay afloat? It turns out I’m not alone in my habits. Among the expert water treaders in the study, 71 percent of them opted for eggbeater in their warm-up, but 14 percent each chose upright breaststroke and flutter kick. There were clear differences in how efficient the different techniques were, with running and flutter kick performing equally poorly, and upright breaststroke and eggbeater performing equally well. This pattern showed up in every outcome measure. 

For example, here’s the oxygen consumption (VO2) during the last portion of 3.5-minute test bouts, measured through a breathing mask attached to a snorkel: (Photo: Frontiers in Physiology) Oxygen consumption is roughly proportional to energy consumption, so the lower values for breaststroke and eggbeater mean they’re more efficient than the other two strokes. Aside: these values are adjusted based on the “wet weight” of each participant, which was measured by weighing them underwater. 

Normally VO2 measurements are adjusted for weight, since heavier people burn more energy—but in this case, wet weight was used to also account for differences in buoyancy. 

As a guy who sinks like a stone in water, I found this interesting! Similarly, heart rate was higher in running (140 beats per minute, on average) and flutter kick (147) than in breaststroke (129) and eggbeater (129). 

Same for perceived effort: 14 and 13 on the Borg scale from 6 to 20, versus 11 and 11, respectively. For cognitive load, they used the NASA-Task Load Index, which assesses things like effort, frustration, and perceived performance, and they tested reaction time in response to visual and audible signals. In both cases, breaststroke and eggbeater produced better results than the other two. 

There’s some interesting physics in the stroke comparisons. The two inferior techniques largely rely on pushing down against the water to move the body upward. This has two problems: water is too thin to provide much support, and even when the pushing works you get a lot of wasted up-and-down motion. The two better strokes, in contrast, involve lateral movements of the arms and legs: your cupped hand acts like an airplane wing or sailboat sail, generating lift forces perpendicular to the plane of motion. This is more efficient than pushing on the water, and produces less wasted vertical bobbing. 

 There’s one key difference between upright breaststroke and the eggbeater: in the former, your legs are kicking outward at the same time, while in the latter they’re alternating. This means that breaststroke produces some of that undesired up (when you kick) and down (between kicks) motion—and that effect is exacerbated if you stop sculling with your hands. 

In the eggbeater, there’s always one leg moving, so you get a smoother, more continuous lift that can keep you up even without your hands. The study didn’t test anything that required using your arms—but if you want to throw a water polo ball, strike a fancy pose during your synchro routine, or signal frantically to a passing ship that you need rescue, eggbeater looks like a much better bet. Next time I’m in deep water, I’m going to see if I can get the hang of it again.

Wednesday, September 8, 2021

Surprising ways you may be getting sun-damaged skin (From Kaiser-Permanente)

Make coffee. Eat breakfast. Brush your teeth. Take a shower.

This typical morning routine is missing an important step: Put on sunscreen.

Why should you wear it every day? Because sun-damaged skin may be sneaking up on you.

You know you and your family should wear sunscreen before spending a long afternoon outdoors, but sun damage is cumulative — short periods of unprotected sun exposure add up over time, eventually leading to visible damage to your skin and a higher risk of skin cancer.
What is sun damage?

Sun damage, or photoaging, is when ultraviolet (UV) light from the sun prematurely ages your skin. There are 2 kinds of UV light — UVA and UVB. UVA light damages skin at all levels, from the surface to the deepest layer, breaking down collagen and elastin fibers. UVB light damages the outer layer of skin and your DNA, which can lead to cancer. A simplified way to remember the difference is that UVA rays are aging and UVB rays are burning. If you have darker skin, it’s less likely to burn — but it can still be damaged by UVA rays.

Signs of sun-damaged skin include:
• Broken capillaries, usually around the nose
• Loss of skin elasticity
• Pigmentation changes, such as age spots and brown patches of discoloration (known as melasma)
• Red blotches
• Uneven skin texture
• Wrinkles

For a safer, healthier summer glow, try sunless tanning.

Surprising Ways you may be getting sun damage

Direct sun exposure occurs anytime you’re outdoors unprotected. Indirect sun exposure is when something is partially protecting you from the sun, like a window. If you’re not wearing adequate sunscreen, these exposures add up and lead to lasting sun damage.

“People are running errands — 5 minutes here, 10 minutes there — or walking their dog, and they’re not taking into consideration the cumulative, short bursts that they’re getting,” says Sarah Adams, MD, a dermatologist at Kaiser Permanente Southern California. “All of the sudden, they’ve been outside for an hour and a half and they haven’t worn any sunscreen or any sun protection.”

Some examples of surprising sun exposure include:
• Short trips outdoors, like walking from a parking lot to a building
• Being under shade, like an umbrella
• Clouds covering the sun
• Sitting next to a window — including in your home office, working at a drive-thru, or traveling in a car, bus, or airplane

And yes, you read that last one right — you should even wear sunscreen when you’re home all day if you’re near a window. Windows usually block UVB rays, but not UVA rays.

“When I see patients in clinic, I notice more photoaging — more dark marks, more pigmentation — often affecting the left side of their face,” Dr. Adams says. “I can often tell that someone was a driver versus a passenger because of the amount of sun damage that there is on one side of their face versus the other.”

Your skin can also become more sensitive to the sun if you’re on certain medications or skin products — so take extra care to protect yourself. Read the labels or check with your doctor if you’re using:
Acne medications like Accutane
Antibiotics, particularly tetracyclines
Some birth control pills
Some heart medications for arrhythmia
Topical skin products such as retinols, glycolic acid, and other alpha hydroxy acids
How to protect your skin from sun damage

Use sunscreen with SPF 30 or higher on yourself and your kids every day to prevent sun damage. Look for a broad-spectrum formula, which protects from both UVA and UVB light. Encourage your teens and older kids to use it daily, too.

Besides your face, be sure to apply sunscreen to commonly overlooked areas, such as your ears, the sides and back of your neck, the V of your chest, and the backs of your hands.

Get fast, easy coverage by wearing long-sleeved shirts and pants, a wide-brimmed hat, and sunglasses. Invest in clothes with UPF (ultraviolet protection factor) for extra protection.

Limit how much time you and your family spend outdoors between 10 a.m. and 2 p.m. when the sun’s rays are strongest. But remember, UV rays can be a concern anytime the sun is up. Use your smartphone’s weather app to check the current UV index — if it’s 3 or higher, you should protect your skin.

Some good news — you don’t need to reapply sunscreen throughout the day if you’re not sweating or swimming. Just make it part of your daily morning routine.

Monday, August 30, 2021

I Can’t Stop Thinking About This Subreddit That Collects COVID-19 Deniers Who Then Suffer the Worst

From Digg

On Reddit, there’s a forum called r/COVIDAteMyFace. It’s a sort of spin-off of r/LeopardsAteMyFace, which is a repository for news steeped in the repercussions of someone’s actions. “Revel in the schadenfreude anytime someone has a sad because they’re suffering consequences from something they voted for or supported or wanted to impose on other people,” reads the r/LeopardsAteMyFace description.

“Leopards Ate My Face” is a reference to a viral tweet from author Adrian Bott (@cavalorn) in October 2016, following the Brexit vote: “‘I never thought leopards would eat MY face,’ sobs woman who voted for the Leopards Eating People’s Faces Party.” I’ve been subscribed to r/LeopardsAteMyFace for a while, because, well, there is a certain kind of schadenfreude that results from seeing people realize that the terrible policies they vote for—often with callous or intentional disregard for other people—can hurt them, too.

But r/COVIDAteMyFace feels very different. After a friend sent me the link yesterday, I read through the posts there for hours and felt only sadness, shame for America, and a white-hot rage at those who knowingly peddle disinformation about the pandemic, along with the social media networks (primarily Facebook, but also increasingly places like TikTok) that have allowed awful COVID-19 memes and outright lies to spread.

Even after Facebook vowed to combat disinformation back in February, their own recent reports have shown that the most popular posts on the network cast doubt on vaccination. Many of the anti-mask and anti-vax Facebook screenshots shared by people r/COVIDAteMyFace were posted just days ago.

Again and again and again throughout the entries on r/COVIDAteMyFace, we see the same patterns. Someone has spent months sharing Facebook memes and status updates about medical “freedom,” not being a vaccine “lab rat,” conspiracies about the vaccine, relentlessly mocking apparent go-to boogeyman Dr. Fauci, the disparagement of masks and mask mandates, and more.

Alongside these screenshots, there are then follow-up posts from the same people or their family members reporting that they are now in serious condition in the hospital with COVID-19 and usually asking for prayers and “prayer warriors.” More often than not, there’s an additional post reporting that the COVID-19 denier and/or anti-masker/anti-vaxxer has died. With the rise of the wildly infectious Delta variant, the number of cases like this has skyrocketed.

There’s no satisfaction to derive from these posts. They’re a vast human tragedy told in the arc of screengrabs from social media. The subreddit also hosts article after article recounting further tragedies: the anti-vax parents who died weeks apart, leaving behind four children; a 34-year-old father who died after wanting to wait a year because social media made him feel uncertain about the vaccine; unvaccinated pregnant people and babies dying; endless testimonies from those hospitalized or on their deathbeds expressing regret that they did not get the vaccine.

If I read another story about people begging for the vaccine when they’re being intubated, I may scream. The pandemic was already a nightmare, but the rampant ignorance and active campaigns to make people afraid of highly effective, widely researched vaccines or to push back against the simple act of wearing a mask feel criminal at this point.

Who is responsible for making anyone think and believe that “this isn’t that real of a virus”? And why do people continue to believe this 18 months in, with more than 4 million people dead?

I am usually in diametric political opposition to many of the people whose stories are on r/COVIDAteMyFace. I am furious at anti-vaxxers and opportunistic politicians instituting laws against basic health protocols for political clout. But I grieve the death of every person lost to COVID-19—and every loss of human life is a catastrophe with ripple effects far beyond that person.

These people were often beloved spouses, lovers, parents, siblings, aunts, uncles, grandparents, cousins, friends, coworkers. Some were primary caregivers and breadwinners who will leave despair in their wake. They had vibrant lives that went far beyond political parties and bad memes.

Losing someone that you love, especially at a young age, is one of the most difficult things that will ever happen to those left behind. I know this personally. But I cannot even begin to imagine how it would feel to grapple with the knowledge that your loved one’s death could have been prevented with a free and immensely effective vaccine. Even from the outside, that knowledge feels crushing. Worldwide, at least two million children at minimum have lost a parent or a grandparent caregiver to COVID-19. It’s unfathomable to imagine the suffering that people will carry with them.

r/COVIDAteMyFace serves an important purpose. It documents for posterity how America’s response to COVID-19 went completely off the rails, and yes, it demonstrates how personal actions can have devastating consequences. If scrolling through the tragedies there makes even one “vaccine-hesitant” person get the vaccine, it will have served a great purpose.

Some of the commenters on this forum seem to revel in the outcomes as anti-vaxxers getting their due, and that can feel ghoulish. Yet many are also exhausted at fighting disinformation for more than a year, and rightfully upset about the impact COVID-19 deniers who then get COVID-19 can have on others. It can feel hard to extend sympathy to people who seem to be choosing Facebook medical advice over the combined endorsement of the majority of doctors and scientists around the globe.

Beyond the ramifications of death or serious illness to those in the person’s circle, these people can also infect others in their disregard for health measures. They can be responsible for more deaths or horrifying cases. They’re impacting the ability of businesses and offices to reopen. They’re making schools dangerous for kids, many of whom cannot yet be vaccinated. And the trauma experienced by the healthcare professionals who must care for and try to save everyone involved is already at a disastrous crisis point.

There are no easy answers, but what is starkly revealed when reading through r/COVIDAteMyFace is just how much social media has influenced people’s opinions amid the crass politicization of an international medical emergency. Social media networks, alongside politicians against mask mandates and “news” outlets that push vaccine skepticism and virus conspiracy theories, all have blood on their hands. In America, a lot of initial blame can be laid squarely at the feet of Donald Trump and the GOP for their constant downplaying of the virus and pushback against masks. But Trump is gone now and the misinformation has only dug in its heels.

Were Dante to write a modern-day Divine Comedy, I think there’d be a special layer of hell in “Inferno” for those who broker in pandemic disinformation for fun or profit. I imagine it as an infinite pediatric COVID ward where the only people you can speak to are the souls of once-vehemently anti-vax right-wing radio hosts who have died.

If anyone should feel the ramifications of their actions right now, it’s those who pushed others into the realm of fear and paranoia. It was found that just 12 people were responsible for generating a majority of “misleading claims and outright lies” about the pandemic on social media. It’s wrenching to consider the countless people suffering the consequences.

(via Reddit, image: Pexels, r/COVIDAteMyFace)

Tuesday, August 24, 2021

Telephone Disruption

 For reasons that we cannot discern, our primary line (301.421.4433) is not ringing through the switchboard. Our other numbers, which do not roll over, are working: 301.421.9529 and 301.421.0096 are working. You can choose an extension and leave a voice message any time of day. 

Wednesday, August 18, 2021

THOUGHTS ON AFGHANISTAN, from a senior military officer

I ask that you not use my name. I am a currently serving General Officer and what I have to say is highly critical of our current military leadership. But it must be said.

I don’t blame President Biden for the catastrophe in Afghanistan. It was the right decision to leave, the proof of which is how quickly the country collapsed without US support. Twenty years of training and equipping the Afghan army and all that they were capable of was a few hours of delay in a country the size of Texas. As for his predecessor, the only blame I place on President Trump was that he didn’t withdraw sooner.

We should blame President Bush, not for the decision to attack into Afghanistan following 9-11, but for his decision to “shift the goalposts” and attempt to reform Afghanistan society. That was a fool’s errand any student of history would have recognized. And yes, we should place blame on President Obama for his decision to double down on failure when he “surged” in Afghanistan, rather than to withdraw.

However, most of the blame belongs to the leadership of the US military, and the Army in particular. The Washington Post’s “Afghanistan Papers” detailed years of US officials failing to tell the truth about the war in Afghanistan, “making rosy pronouncements they knew to be false and hiding unmistakable evidence the war had become unwinnable.” That report was two years ago, and the stories within it began more than a decade before that. Afghanistan was, and always will be, “unwinnable”.

Of course, I blame President Biden for the disastrous retrograde operation still unfolding. But let us not allow that to deflect us from heaping even more blame on military leaders. They stonewalled President Trump rather than beginning deliberate preparations to exit the country when he told them to. They thought that they could outlast him and then talk sense to his successor. Then after the inauguration, they pressed the new president to reverse course. He wisely chose withdrawal. Then and only then did the generals begin their preparations in earnest. But it was too late to do it well.

The war in Afghanistan lasted more than twice as long as the Vietnam War. Although the cost in terms of American blood was thankfully far smaller, the mistakes are the same: America got involved in a long land war in Asia, in a peripheral region, in order to prop up a floundering and unreliable government, and at a time when there was a much bigger looming threat. In fact, Afghanistan was worse than Vietnam in that at least the Vietnam War was tangentially related to the effort to stop the global spread of communism during the Cold War. Afghanistan was worse than Vietnam in another respect: the military’s leaders of the Vietnam era had no precedent to dissuade them from a disastrous path. Today’s military leadership has the precedent of not just Vietnam, but also Iraq, Lebanon, Libya, Syria, and Yemen. That much obtuseness must be punished and removed from the system.

General Milley must resign. Not only is he the Chairman of the Joint Staff, prior to that he was the Chief of Staff of the Army. While all services share the blame, the Army is the land domain proponent. The 20 years of failure in Afghanistan is an Army failure. Scores of other generals also deserve a thorough evaluation; many of them are complicit in the lies to protect a decades-long failed strategy.

Secretary of Defense Austin also must be fired. The recently retired Army general and former CENTCOM commander was, and still is, part of the culture that is impervious to the fact that 20 years of trying it their way did not work.

Just as it did after Vietnam, the military, and especially the Army, must conduct a comprehensive review of why it exists. The purpose of the Army is to visit profound violence on our nation’s enemies; it is not to rebuild failed states. We have decades of experience: counter-insurgencies and nation-building does not work for America. We do not have the stomach for long wars of occupation—and that is a good thing. We are a nation of commerce, not conflict. A constellation of retired stars will tell you that the two can coexist. They are wrong. Retired Vice Chief of Staff of the Army General Jack Keane said only two months ago that because Afghanistan consumes just a small portion of the force, America “can afford the cost of fighting” there. What he does not see is that for 20 years, that “small portion” was the most important portion of the military. Everything else necessarily is subservient to the portion of the force in conflict. It has altered who the Army is and how it thinks. 

There exists only a handful of officers below the general officer ranks who served during the Cold War and who have lived through an era of great power conflict. From private through brigade commander, virtually every Army Soldier serving today has experienced little other than counterinsurgencies or nation-building while operating out of secure FOBs. Large-scale combat operations and insurgencies require different cultures and mindsets. In a resource-constrained environment, the same service cannot do both well. The Army today could not win a major war. Yet, winning a major war is the number one reason why an Army exists. It will take a generation to break bad habits, to think in terms of closing with and destroying the enemy versus winning hearts and minds. Keane sees raw numbers (and ignores the stark evidence that there was no progress over 20 years) and thinks that America’s Army can sustain that level of commitment. It cannot, and the opportunity cost to the culture of the force is much too great. Ignore him. Ignore Petraeus, McMaster, Stavridis, and the rest of their ilk.

Concurrent with its review of purpose, the Army must reevaluate its size and how it is organized. The active component is much too large. That makes it too eager to get involved in irrelevant theaters where failure is likely or even preordained. It should be very difficult for an American president to deploy the Army without the National Guard performing most combat operations. You argue that that takes time? Yes, that’s the point: it should take time to make the case to the American people that war is worth it.

The Marine Corps must provide the nation’s rapid response forces. It is a self-contained deployable multi-domain force. Some would argue that the service has both insufficient combat power and staying power. However, that is a feature, and not a flaw, as it forces the nation to rely on its Army—and hence its reserve components—before engaging in heavy combat or lengthy operations. The current Commandant of the Marine Corps, General Berger, already seems to recognize his service’s role—hence his decision to eliminate armor from the Corps.

Congress must reevaluate the authorities contained within Sections 12301 through 12304 of Title X. The president has too much latitude to, on his own authority, mobilize tens or even hundreds of thousands of Guardsmen and Reservists without congressional approval. It must be the policy of the United States that we do not place our service members in harm’s way without first making the case to the American people. This also means ending the 2001 and 2002 Authorizations for Use of Military Force as well as strengthening Congress’ role in the War Powers Act such that, absent an actual declaration of war, there can be no war.

Some would argue that such a constraint would limit the nation’s ability to respond to a Russian incursion in the Baltics or a Chinese attack on Taiwan. However, recent open-source studies conclude that the US military already is unable to defend against either attack. Pretending otherwise while not having the means to back up our assurances unnecessarily emboldens our partners and allies, making such an attack more likely. We lose nothing by making the law match the reality.

Let us not forget the intelligence agencies. They reported that Kabul was at risk of falling in as little as 90 days. That report was from last Thursday! The capital fell in less than 90 hours. Failure must be punished. And punishment in a bureaucracy means mass firings and a smaller budget—not more money so that they might be better the next time. Congress must consolidate and collapse our intelligence agencies. And when its reorganization is done, if the overall size of the nation’s intelligence apparatus is a quarter of what it is now, that still is too large.

And while we are on the topic of “too large,” DoD must be halved. There are too many flag officers, too many agencies, departments, and directorates. It is the only secretariat with independent but supposedly subordinate secretaries. There are too many Geographic Component Commands—each led by a 4-star virtual proconsul whose budget dwarfs what the Department of State spends in their regions. The result is a foreign policy that is overly military and underly diplomatic, informational, and economic. Congress must revisit the 1947 National Security Act and the 1986 Goldwater-Nichols Act. Both were good for their times, but after decades of experience, there clearly are new reforms necessary.

Unreformed, DoD is an inscrutable labyrinth that invites fraud, waste, and abuse. The excess attracts unscrupulous camp followers. Amazon did not choose Crystal City to locate its new headquarters because of low rents and ease of transportation access for its 25,000 employees. It chose the Arlington, Virginia neighborhood because it is two blocks from the Pentagon. That building controls the distribution of three-quarters of a trillion dollars every year. Most of it is wasted. The excess is apparent in the scores of class-A high rises housing defense contractors just blocks from the Pentagon. To end that waste, nothing so concentrates the senses as austerity.

Let me conclude with one last thought: the generals, the intelligence analysts, the defense contractors, and the pundits all leveraged America’s rarest resource: the American serviceman and woman. They are the ones who fought, and sweat, and bled, and died for what is now clearly a failed strategy and a doomed mission. Even after its failure was apparent to their leaders, they continued to enlist and reenlist, largely because their superiors—the experts—assured them that success was possible. It was not. It never was. Absent American support, Afghanistan collapsed over the length of a long weekend. That is proof enough that the last 20 years were in vain, and proof enough that the system is broken from within.

“Failure must be punished.” An idea so crazy it just might work.