Category Archives: healthcare

April 5, 2020 · 17:51

Perpetrators, Victims, and Bystanders in the Age of COVID-19

Friends of Padre Steve’s World,

We are now living in an age where established norms of civilized peoples have been turned upside down and inside out. This is due to combination of events, some that I mentioned in my last post. however, the most troubling that I see is for people in positions of power where they could actually do good to mitigate our losses in the novel Coronavirus 19 Pandemic, either directly contribute to its spread, or turn their backs knowing what is happening. Holocaust Historian Yehuda Bauer wrote: “Thou shall not be a perpetrator, thou shall not be a victim, and thou shall never, but never, be a bystander.”

But here we are again with that choice. Like the Holocaust it comes down to the question of who lives and who dies. But unlike the Holocaust where those decisions were made by people who killed their carefully selected  victims by bullets, gas, medical experiments, euthanasia, or who worked and starved them to death, we are brought to this point by the lack of preparation and callous indifference to the disease when it had a chance to be stopped, slowed, or brought under control until a vaccination or an effective treatment can be found. Now, doctors and nurses, themselves potential victims because they do not have adequate personal protective equipment, will have to make choices about who lives and who dies because they do not have enough ICU beds and ventilators to treat everyone. Last week I wrote  about the coming combat mass casualty triage that many hospitals will have to implement in the coming days and weeks. To those who have not seen combat, been in mass casualty situations, or really their history, the decisions will seem cruel, and maybe even unjust, but that is the reality that we are soon to face here.

Honestly I don’t see the doctors and nurses who have to make such decisions as perpetrators, as they too are being infected and dying. They are also victims, as are the infected and dying. The real perpetrators are those that allowed this virus to spread, who denied it being a threat, minimized the threat, those who delayed acting, and those who have profited by it are the perpetrators.

The rest of us have a choice. We can take the side of and do everything we can to help the victims, or we can join the list of perpetrators by perpetuating their lies and crimes, or be bystanders who turn a blind eye to what is happening, neither taking a stand for or against what is happening. Sophie Scholl who lost her life at the age of 22 by writing the truth about the evils of the Nazi regime wrote:

“The real damage is done by those millions who want to ‘survive.’ The honest men who just want to be left in peace. Those who don’t want their little lives disturbed by anything bigger than themselves. Those with no sides and no causes. Those who won’t take measure of their own strength, for fear of antagonizing their own weakness. Those who don’t like to make waves—or enemies. Those for whom freedom, honour, truth, and principles are only literature. Those who live small, mate small, die small. It’s the reductionist approach to life: if you keep it small, you’ll keep it under control. If you don’t make any noise, the bogeyman won’t find you. But it’s all an illusion, because they die too, those people who roll up their spirits into tiny little balls so as to be safe. Safe?! From what? Life is always on the edge of death; narrow streets lead to the same place as wide avenues, and a little candle burns itself out just like a flaming torch does. I choose my own way to burn.”

I haven’t mentioned the numbers lately. They started to remind me of the nightly casualty counts that were shown like baseball box scores on the nightly national news broadcasts on ABC, CBS, and NBC. Sadly, every one of these numbers is a real person. The infected and dead are of all races, religions, genders, rich and poor, good and bad alike.

So I ask that when you read them to remember that, each one a real person with hopes and dreams, either ended or put on indefinitely by the virus. Then there is the ripple effects, all the family members, friends, acquaintances, and colleagues left behind. There are now holes in lives of people who have lost loved ones or friends, that cannot  be filled by pious talk, blaming others, or by saying that this is God’s will or judgement.

Each of these people, the infected, the dead, and even those who recover bear the physical, emotional, and spiritual know the feeling of the God forsaken, as do those who knew them, loved them, and suffered with them. Forgive the intrusion of faith here, but for me it is the image of Jesus the Christ, hanging on a cross, forgiving a thief, comforting his mother, can crying out to his God and Father in defense of those killing him, “forgive them they know not what they do.” But then there were the bystanders who just sat back and watched, whose inaction be it from their agreement to what was occurring or fear of speaking out allowed them to do nothing. Elie Wiesel wrote “What hurts the victim most is not the cruelty of the oppressor, but the silence of the bystander.” 

So here are today’s latest numbers. Worldwide the toll stands at 1,261,095 infections, 68,468 deaths, and 260,032 recoveries. A death rate that is now up to 21% based on the resolved cases, be they recovered or dead. Of the 932,595 active cases we have no idea as to how their cases will resolve. Hopefully the numbers of recoveries against deaths in these cases will begin to lower the death rate number. However, we cannot know that number until the cases are resolved, but the death rate among resolved cases has climbed from the 14%-15% rate to 20-21% in about ten days worldwide.

But in the United States, for once we are now leading the world in terms of the number of infections, despite the fact that our intelligence agencies wanted the President as early as mid January of what was coming. The President, denied, delayed, dithered, and dispersed the blame to everyone but himself until he saw the stock markets tank.

So with that being said let us talk about the United States and how many people are infected, died or recovered here. In the Good Ol’ USA, which if we remember the words of our President had become  great again under his personal leadership, there are now 331,285 total cases, 9,479 deaths, and 17,091 recoveries from the virus. That is a 36% death rate. That rate among the resolved cases has remained constant between 35-40% over the last week and a half. additionally we have only tested 1,751,296 people, and thousands of they tests have not been processed because the laboratory system is overwhelmed.  But the number of Americans tested is just slightly over one half of one percent of the Census Bureau’s 2019 population estimate of 329,450,000. So we cannot be sure of how many people have been exposed to, infected by, recovered, or died of the disease.

Likewise we now lead the world in total infections, our deaths only trail those of Spain and France. We’re number three, can I get a cheer for that? I doubt it because within a week at the most we will also lead the world in deaths. So let’s hear that chant of USA! USA! USA! And We’re number One!”  Can I get an Amen brothers and sisters? I hate to sound flippant and sarcastic at such a time, but with so many people ignoring social distancing and doing nothing to stop the spread of the virus, including pastors who flaunt their state laws and Federal recommendations and continue to gather, or Florida’s Governor Rick DeSantis who reopened his states beaches barely two days after he closed them, how can I not be somewhat sarcastic and flippant? It’s gallows humor. These people are going to spread the virus or contract it themselves. The data shows that each infected person spreads the virus to an average of 2 to 3 other people. Do these people want others to become infected, or spread the virus to their friends and families, or do they have some kind of death wish?

I’m sorry, but those are rhetorical questions No sane person would want that to be the case, unless they are brainwashed cult members, apocalyptic Christians, or sociopaths who only want the worst for others in order to achieve their own salvation or annihilation. You cannot be too sure about religious ideologues, some of them get a kick of thinking that they will be martyrs for their cause, even if that cause were a lie. Just ask the 9-11 hijackers, but they are all dead. Ideologues, religious or otherwise who seek to kill people and then want the honor of martyrdom are simply narcissistic sociopaths who could care less about the death they inflict and the subsequent consequences, because it is really all about them.

But the President was not alone in first dismissing the virus or the impact that it would have. It appears that China’s President Xi did the same thing, as did Russia’s President Putin, and many other world leaders. No matter who they are or what country they lead, if they denied, delayed, or otherwise left their people unprotected in the face of this virus they are the perpetrators. Especially leaders that ignored the warnings of their medical and scientific advisors and urged people to go back to work as if things were still normal and the virus couldn’t kill them. Admittedly, their is a scale of culpability in this, early on many nations said that they were not like China, or then like Italy. Denial is not just a river in Egypt, but the sooner a nation and it’s leaders got over denial, the sooner they began to actually take action to protect the lives of their people.

Likewise so so called religious leaders who encourage the ignorant sheep in close proximity of each other fully realizing that some or many could be contagious, supposedly in the name of religious freedom, but more to gather their cults and collect their money as for profit prophets, promoting imaginary cures based on supposed secret “words from God” or miracle cures that can be purchased, and providing you have faith will work. They and others like them are the perpetrators.

But that leaves the rest of us. Will we speak? Or will we for whatever reasons, as logical as they may seem to be we have a choice of what we will do.

But then there are the heroes who save lives and are punished for doing so. One of them is Captain Brett Crozier, the Commanding Officer of the aircraft carrier USS Theodore Roosevelt, tried to inform his chain of command of an large outbreak of COVID-19 on his ship that was threatening to overwhelm the capacities of his medical department. He did not get a satisfactory answer so he blasted out an email to many Navy officials, which was leaked by someone and published by the San Francisco Chronicle. But his email got attention, and he was allowed to take the ship to Guam, where he was able to begin transferring infected sailors off the ship and arranged to have the rest of the crew tested, and placed in safe quarters.

He was also bound by the DOD’s decision to follow CDC guidelines and not to have his crew wear Personal Protective Equipment if they were not medical personnel, or already infected and showing symptoms. That CDC guidance was finally changed Friday, and I just received a text saying we were now allowed and encouraged to wear cloth masks. Thankfully, during this period many of our workers were teleworking or on paid administrative leave due to they or their family members are in high risk groups for contracting the virus. Commanders of ships at sea didn’t get that opportunity.

The strange thing to me is that multiple Naval Commanding  Officers whose negligence, lack of adherence to Naval Regulations, or concern for the welfare of their crews and safety of their ships enjoyed the benefit of a full hearing by experienced Naval Officers before they were relieved of their commands. This did not occur with Captain Crozier, who was relieved by Acting Secretary of the Navy Thomas Modly against the advice of the Chief of Naval Operations. Modly has noted that he understood and admitted that President Trump, a man who fired Modly’s predecessor Richard Spencer who publicly stated that the President’s defense and pardoning of convicted war criminals harmed good order and discipline in the Armed Forces, wanted to fire Captain Crozier, despite the fact that he protected his ship and crew. However, against the advice of the Chief of Naval Operation and other senior Naval officers, Mr. Modly relieved Captain Crozier before such a board of inquiry could be convened, which meant that there is no chance of one occurring now, except as a means to decide if he should be prosecuted for his actions.

Of course any such board would have probably affirmed Captain Crozier’s actions, unlike the Commanding officers of other ships who covered up their ship’s training, manning, and technical or mechanical deficiencies and who by doing so sacrificed the lives of their sailors, and grave and costly damage to their ship which rendered those ships non mission capable for more than a year each. Despite the lies being presented by the President aided by his media and political apologists, Captain Crozier exhibited the finest of Naval tradition in protecting his ship and crew, and boldly risked his career for the defense of his crew and the nation. And it appears that he too has contracted COVID-19 and may be prosecuted for his actions. In this case it appears to me that the Navy’s justice system has been turned inside out and upside down.

So I must make a judgment. Captain Crozier acted in the best interests of his ship, sailors, the Naval tradition, sore values, and truth. In doing so he was afforded less justice then men whose lack of concern for their ships, crews, and the nation were given. Likewise, though his actions saved lives, and will result in the ship and crew being fully mission capable with a few weeks. Yet he was given less respect or protection for his actions, by the President has in pardoning convicted war criminals.

But as a veteran of over 38 years of military service, in peace and war,  I have to admit that I am ashamed of our political, military, and moral leadership which would pardon war criminals, give full hearings to men whose actions led to deaths of their crew members and long term costly repairs to their ships, before relieving them, who then condone and defend their actions against Captain Crozier whose real offense was trying to save his crew. He is a victim of both the disease, and the Navy leadership, who have become perpetrators of injustice.

Captain Crozier was denied a fair hearing, and and condemned because the President wanted it to happen. That my friends, as an officer whose oath is to “defend the Constitution against all enemies, foreign and domestic” and not the actions of any a political party or President, demands that my honor is based on defending the Constitution, and at the same time knowing that it is not my career that is sacred, but the honor and reputation of the nation in upholding our laws, Constitution, and institutions of the nation, against usurpers who  only seek to expand their power and gratification at the expense of the United States, and its citizens, even using the police and military power of the state against them to do so, I have to make a stand for truth, and like General Ludwig Beck who resigned his position as Chief of Staff of the Wehrmacht in defiance of Hitler’s invasion of Czechoslovakia, and who lost his life in Operation Valkyrie in 1944, I have to state like Beck:

“Final decisions about the nation’s existence are at stake here; history will incriminate these leaders with bloodguilt if they do not act in accordance with their specialist political knowledge and conscience. Their soldierly obedience reaches its limit when their knowledge, their conscience, and their responsibility forbid carrying out an order.”

For me, my friends, that is the heart of the matter. This is about the public health and the welfare of my neighbor, not about me. If any order is issued in contradiction  to the  the Declaration of Independence, the Bill of  Rights, the U.S.Constitution, or the Uniform Code of Military Justice,  I must raise my voice against it, and as a matter of honor defend those accused  of breaking them. How can a man with any sense of honor not due so?

We all have a choice. Will we be a perpetrator, victim, or bystander during this crisis? I cannot be a bystander, I cannot be silent. I have to echo and proclaim the words of Dr. Martin Luther King Jr. “Our lives begin to end the day we become silent about things that matter.” 

So until after that tomorrow  and I wish you all the best, and please be careful out there.

Peace,

Padre Steve+

 

 

2 Comments

Filed under Coronavirus, Diseases Epidemics and Pandemics, ethics, healthcare, History, laws and legislation, leadership, national security, natural disasters, Political Commentary, Religion, US Navy

April 2, 2020 · 03:07

The COVID-19 Tsunami is Here and The Pro-Life is Exposed as Profit over People

Friends of Padre Steve’s World,

The disaster that few prepared for, including our President despite having verified and validated evidence of it in January is here. Back then we were given a moment in time to prepare, something that people that experience tsunamis ever get. An administration in denial dismissed evidence that could have mitigated the novel Coronavirus and minimized the number killed by it. I will not go through the litany of deception and false claims that he made made, and the actions of his administration in giving away tons of vitality needed Personal Protective Equipment  from our national stockpile, to China. PPE that our doctors, nurses, and other medical personnel are crying out for because they are having to reuse or use makeshift gear to treat the victims of the novel Coronavirus. 

Back in January there were only a few cases, which the President said would soon disappear along with the virus, and the President’s “band played on,” to borrow words the late Randy Shilts in his monumental volume about the initial response of the Reagan Administration to the AIDS pandemic. However, despite the warning the President played politics by minimizing the threat, and later bragging about how he has responded to it, constantly upstaging, and contradicting the experts of the CDC including Drs. Fauci and Brix, while ignoring the rising infection rate and death toll until it became a political liability. When that happened he and is enablers, supporters, and propaganda network, you know them well Fox News began to deflect the blame to the Democrats, the impeachment hearings and Senate trial, the Chinese, the media, and anyone else for his multiple failures when simply listening to experts and being honest with the American people would have been far better. In fact he took his impeachment trial and COVID-19 so cavalierly that he kept having campaign rallies beating his chest, demonizing his opponents, bragging on himself, and exposing his followers to to a deadly virus in massed rallies who God knows how many were exposed to satiate his vanity. That is the mark of a true sociopath, he doesn’t even care about his supporters. Think about that.

Just 24 days ago, on 8 March, the United States reported 541 infections and 22 deaths. By March 18th there were 9,259 cases and 150 deaths. Four days later we were at 46,182 cases and 582 deaths, a death rate of 66%, well over the worldwide percentage. Two days later we were over 66,000 infections and over 1,000 deaths. Now we lead the world in number of infections, as infections and deaths are spiking, and the healthcare system is being overwhelmed without enough resources to care for the victims or protect their caregivers. In two and a half months we went from a barely noticeable situation, unless you pay attention to potential pandemics. But in 24 days we went from a noticeable wave to a tsunami of infection and death, not to mention economic carnage, and worldwide instability. But, instead of doing what almost all of his 44 predecessors did, President Trump declared “I don’t take responsibility for anything.” Forget President Harry Truman who declared “the Buck stops here,” or any other President, this President denies any blame for anything regardless of how serious it is. But that is his history: draft dodging, divorces, affairs, corporate bankruptcies and failures, leaving employees, contractors, and now the American people in the lurch to protect himself.

As of now the United States has 215,300 of the world’s 936,204 infections, or 23% of the world total. That is a 338% increase since 8 March. Our death rate since 8 March has gone up by 223%. By the way we have the unfortunate distinction of having the most infections or any country in the world. But wait, there’s more. Of the 47,249 deaths we went from 3,ooo to over 5,000  deaths in 48 hours. Our death toll is now 5,110, or 11% or the worldwide death total, and supposedly we have the best medical system in the world.

But that is not the case. Public health ranks at the bottom of our priorities. Expensive specialty procedures and interventions are at the top, not to include medical procedures performed simply for our vanity and good looks. Preparation for pandemics and disasters  is also low, because our medical system is profit based predicated on what insurance companies will pay for, if an American is fortunate enough to have medical insurance. The fact is that our private and even public hospitals operate with very little surge capacity, because it takes profits down. ICU beds, ventilators, and the highly trained staff need to man them are expensive. Insurance companies don’t like to pay those costs, nor do hospitals and medical systems. For the corporations, profit takes priority over people, even when the doctors, nurses, and other staff are committed to life and the Hippocratic Oath.

As of today that number is far lower than it was a week ago, as failing businesses end their COBRA policies, and then fire their workers. It looks great on a corporate balance sheet but it fucks all of their employees, especially those who devoted their lives and careers to those corporations, while the Trump Administration refuses to let the millions of people impacted by this to purchase health insurance through the Obamacare exchanges. The President rejected that today, it is quite obvious that he would rather destroy the lives of people than to save them and then claim victory despite the loss of 100,00-240,000 people or more. Those are not the actions of a man who stands for the sanctity of life, but rather a sociopath willing to sacrifice lives to keep power.

The cruelty of profit over life exposes that our real civil religion and morality is not life, but profit. As a historian and scholar of Nazi Germany and the Holocaust, I have to ask when palliative care transitions to euthanasia, and those deemed life unworthy of life, are euthanized by the people who supposedly there to care for them and protect the sanctity of their lives. As this cris continues, and the Trump Administration remains in change that such a decision will be made, not to protect the sanctity of life, but to enhance corporate profits, and political power, regardless of the human cost.

It is late and I am tired, but as of now of those whose cases were resolved by death and recoveries, 36% resulted in death. The worldwide death rate has gone up to 20%, up from 16% at the end of last week.

I believe in God, faith and prayer, but without the actions of responsible human beings in leadership positions, elected, appointed, or commissioned, we are headed to a human, economic, sociological, and eventually war based solution, regardless of whatever nation starts it,

So until tomorrow I wish you all the best. Please be careful out there.

Peace,

Padre Steve+

 

 

 

 

 

2 Comments

Filed under civil rights, Coronavirus, Diseases Epidemics and Pandemics, economics and financial policy, ethics, euthanasia, faith, healthcare, History, holocaust, laws and legislation, leadership, life, national security, natural disasters, News and current events, Political Commentary, pro-life anti-abortion

Tagged as , , , , , , , , ,

April 1, 2020 · 00:33

COVID-19: Living with its Reality While Being Brave and Caring While Acknowledging our Fears

Friends of Padre Steve’s World,

T.S. Elliot penned these words: “Humankind cannot bear very much reality.” 

The sad fact is that Drs. Birx and Fauci have been quietly trying to brace the President and many of us for reality. Despite all the falsehoods and false hopes that emanated from the mouth of the President  between January and the beginning of March they, like them or not, soldiered on when many would have quit. All the President’s  denials, delays, disinformation, claims of fake news, bragging about his success, attacking  political opponents, and demonizing real news agencies, and reporters by name did not keep them from pushing back. I am not sure, but I suspect that Vice President Pence began to trust them helped push the President into accepting reality that the numbers that will die in the United States are far beyond anything that he ever would admit. Today they admitted that 100,000 to 240,000 could die, and that with successful mitigation. The same models predict a million and a half to two and a half million deaths without “successful” mitigation efforts. Who knows what April will bring, but I don’t think most American leaders or their followers are willing to deal with the hard truth that lay before us.

What our states are now beginning to do may be too little and to late to prevent an even higher death toll. Truthfully, based on the deadliness COVID-19 has demonstrated in our country where a lot more people in the 20-50 year old bracket are falling victim than was expect, I think, though I desperately  want to be wrong, and a quarter of a million is a low estimate based on the historical tendency for Americans to not obey the rules, trust science, or the government.

The terrible thing is that now the President would consider a death toll of 100,000 a “victory.” Had the President and  administration prepared for the virus when they were warned, we would have had a chance at minimizing the death toll, like South Korea.

But here we are facing one of the most catastrophic moments in the history of our country. We have to pull together, work together, and fight this together. Political, ideological, and religious animosity has to be chucked over the rails of this ship called America if we are not to sink. As one of the signers of the Declaration of Independence said, “we either hang together or we hang separately.”

Sadly, I have the feeling that many Americans will not believe until they, their family members, and friends start dying. As C.S. Lewis wrote in A Grief Observed:

“We were promised sufferings. They were part of the program. We were even told, ‘Blessed are they that mourn,’ and I accept it. I’ve got nothing that I hadn’t bargained for. Of course it is different when the thing happens to oneself, not to others, and in reality, not imagination.”

That my friends is the reality that we face. No matter our religion, lack thereof, or ideology may be, we are all human. Unless we are true narcissistic sociopaths, the deaths of friends and loved ones strike the very core of our innate human finiteness. They remind us that we too are mortal, and part of a community. I have friends across the religious and political spectrum, even people who disagree with me vehemently on various matters. But the death of any of them would involve grief that I cannot explain.

So now the latest COVID-19 casualty report. Worldwide there are 858,669 cases, 42,151 deaths, and 178,099 recovered. The get the death rate we do not uses the total infections. John’s Hopkins uses the total number infected, but since that number is always changing it is unreliable. Instead you have to use the total cases completed by either death or recovery, as the denominator. You divide the number of deaths by the number of completed cases. That rate is now 19% worldwide. In the United States there are now 188,530 total cases, 3,889 deaths and  7,251 people who have recovered, a 35% death rate. Of course as the minor infections recover the rate will most likely go down, to between 5 and 10%, not the 1-3% that some estimated just weeks ago. This is a killer virus, much worse than any flu. I’m not a scientist, but a historian. The great Spanish Influenza of 1918-19 killed over 600,000 Americans, and based on the latest estimates nearly 50 million deaths worldwide, and the populations, especially those living in major metropolitan cities, were far less than they are today.

John Barry, author of The Great Influenza: the Story of the Greatest Pandemic in History  wrote:

“overstate to make a point—warned, civilization could have disappeared within a few more weeks. So the final lesson of 1918, a simple one yet one most difficult to execute, is that those who occupy positions of authority must lessen the panic that can alienate all within a society. Society cannot function if it is every man for himself. By definition, civilization cannot survive that. Those in authority must retain  the public’s trust. The way to do that is to distort nothing, to put the best face on nothing, to try to manipulate no one. Lincoln said that first, and best. A leader must make whatever horror exists concrete. Only then will people be able to break it apart.”

The lesson is that truth even in the face of unimaginable disaster and loss of life, must be told. The same is true with how to mitigate the threat. Fear is a natural response, and anyone involved in a war, which this is, is not unreasonable, especially when there is no vaccine, should demonstrate a measure of reasonable fear. General George Patton wrote words that should be absorbed by everyone facing this virus today:

“If we take the generally accepted definition of bravery as a quality which knows no fear, I have never seen a brave man. All men are frightened. The more intelligent they are, the more they are frightened.”

That means that we can be frightened, yet brave. We must continue to life life and care for others even as we use social distancing and other prevention measures.

As Captain Jean Luc Picard in Star Trek the Next Generation said: “the first duty of every Starfleet officer is to the truth, whether it’s scientific truth, historical truth or personnel truth…”

Our leaders regardless if the are political, scientific, media, military, religious, or medical leaders must tell the truth, and then do the hard things in order to survive without becoming the dystopia of a world like the Mad Max films, novels like 1984, or so many examples from history and fiction.

We need leaders who tell the truth, and we need to act, despite our fears to defeat this threat. As Winston Churchill said in Britain’s darkest hour, “I have nothing to offer but blood, toil, tears and sweat,” our leaders regardless of party or ideology have to stop offering meaningless but comforting words, and tell the truth. If they don’t we will experience worse than we could imagine. As the English comedian Rowan Atkinson uttered in the BBC comedy series, Black Adder: “a fate worse than a fate worse than death.”

100,000 to 2400,000 preventable deaths is not a victory, it is a needless sacrifice of human life. Each of the dead is more than a number or name, they are human beings who leave behind parents, brothers and sisters, sons and daughters, grandchildren, friends, and coworkers. Each death leaves a hole in the heart of someone who loved and cared for them, that cannot be filled by empty words.

Until tomorrow, and with hope for the future. Please be careful out there,

Peace,

Padre Steve+

 

 

3 Comments

Filed under Coronavirus, Diseases Epidemics and Pandemics, ethics, faith, film, healthcare, History, laws and legislation, leadership, News and current events, Political Commentary, Religion

Tagged as , , , , , , , , , , , , , , , , , , ,

March 30, 2020 · 00:00

Very, Very, Very Dreadful: COVID-19 and Our Future


At Kroger Today 
Friends of Padre Steve’s World,

Albert Marrin wrote in his book Very, Very, Very, Dreadful: The Influenza Pandemic of 1918: 

“No other disease, no war, no natural disaster, no famine comes close to the great pandemic. In the space of eighteen months in 1918–1919, about 500 million people, one-third of the human race at the time, came down with influenza. The exact total of lives lost will never be known. An early estimate, made in 1920, claimed 21.5 million died worldwide. Since then, researchers have been continually raising the number as they find new information. Today, the best estimate of flu deaths in 1918–1919 is between 50 million and 100 million worldwide, and probably closer to the latter figure.”

The current novel Coronavirus pandemic may not kill as many people as the Great Influenza pandemic did, but the numbers that it will kill will be catastrophic, not only in the number of lives lost, but in the unrest it causes in so many nations will lead to civil wars, usurpation of powers by authoritarian regimes of various ideologies, and subsequent wars that it helps spawn in the coming years. And frankly, after 75 years of relatively small wars, which admittedly have and tragically killed millions of people, the global order has remained relatively stable, until now.

The instability in the global markets, rising unemployment, shortages of so many items that we have come to rely upon, is just the beginning, and the virus has just begun. If it follows the course of the 1918-1919 pandemic, which most scientists believe that it will this is just the first phase. The second will be a slight lessening of infections and deaths in the summer followed by an explosion of it in the fall and winter, and the third wave will be far deadlier than today’s. It may even mutate into a far deadlier strain, as of now we know of two strains of it, and who knows how many there will be in the fall and winter? I cannot say, but I would put money on at least two or three, which even if we can produce a vaccine for the current ones, in record time, the mutations may be immune to it.

We were completely unprepared for this despite knowing that we were due for a pandemic. While industry can produce record numbers of ventilators and PPE, in a relatively short period of time, even which may not be deployed soon enough for this first phase of the pandemic; they cannot produce qualified ICU doctors, nurses and technicians that fast.

Even when we get the beds and ventilators, as well as additional rooms, we will have to staff them with doctors and nurses without or with minimal ICU experience, most gained during their medical or surgical residencies, or rotations through them during nursing school. It takes a special breed of physician or nurse to work in critical care, just as it does to be a cancer specialist, Emergency Medicine Doctor or nurse, or name the medical field. The fact is that you cannot make such specialists in a limited amount of time, and thanks to our managed care, for profit, system we don’t produce enough of them anyway. They are much more valuable than the equipment they have to use.

If the hospitals of the First World are being overwhelmed, just imagine what will happen when the virus begins to explode in the Third World, where a lack of basic medical care is standard, and critical care physicians and nurses are at the university and government run medical centers in major cities, most often the national capitals. The virus will spread through the major cities with a vengeance, and then to the hinterlands. Millions will die, simply because they live in countries too poor, and often politically unstable to deal with it.

As of tonight the numbers continue to explode. As of this moment there are 722,916 cases of the COVID-19 Virus worldwide, and 33,976 deaths. This is up from 532,362 cases of COVID-19 and 24,090 deaths Friday.  Today 536,454 of the cases are still active. Of the closed cases 151,756 have recovered and 33,976 have died for a 18% death rate, up from 16% less than 48 hours ago. That is a increase in infections of 190,553 cases and an increase of 9,886 deaths in just 48 hours. Say what you want, but the numbers don’t lie.

The same is true in the United States the numbers are not encouraging because we are so far behind the testing and preparation stage. As of now there 142,178 cases, and 2,484 deaths, and 4,559 recoveries a death rate among the closed cases of But at this same time on 27 March there were 85,984 total reported infections with 1,300 deaths and 1868 recoveries. Currently 135,135 of these cases are active. The mortality rate among the closed cases is 35%. Sadly we are nowhere close to the peak, which despite efforts to mitigate the spread in some states, others are refusing to make take any precautions, including those bordering some of the hot spots where the virus is now exploding.

Thankfully, despite his many lies, obfuscations, and refusal to take responsibility for anything, while blaming state governments and even health care providers for the growth of the virus, has at least admitted that many more lives may be lost and expanded his restrictions on gatherings to at least April 30th. I expect that he will have to push it further back.

But Americans, especially his supporters hate this, and are likely in states they control will ease restrictions as early as next week.

However, it is late and I have to get ready to go to bed so I can get to work in the morning.

Until tomorrow,

Peace,

Padre Steve+

 

 

 

 

 

Leave a comment

Filed under Coronavirus, economics and financial policy, ethics, healthcare, History, leadership, natural disasters, News and current events, Political Commentary

Tagged as , , , , , , , ,

March 16, 2020 · 02:01

“I Don’t Take Responsibility at All: Trump Tells the Unsettling Truth about Himself

 


Friends of Padre Steve’s World,

President Abraham Lincoln noted:

“In times like the present, men should utter nothing for which they would not willingly be responsible through time and eternity.”

I was able to watch both of President Trump’s speeches on Coronavirus 19 this week. Both were uninspiring to say the least, and he quite obviously understands nothing of being a leader, or even more so, the Commander in Chief.

However, in his Friday Afternoon the President, who is a man whose lies, evasions, of the truth, blame of others, and failure to stand on any principle,  finally spoke one truth. In the midst of other lies and evasions of responsibility, false claims about the availability testing kits, a website run by Google which has denied it would be running by the time the President said it would be, the availability of drive through testing, and the fawning praise of big business leaders, and members of the administration, he spoke the truth.

To NBC reporter Kristen Welker, who asked what responsibility he took for the delays and problems in rolling our the test kits. He replied:

“Yeah, no, I don’t take responsibility at all, because we were given a set of circumstances and we were given rules, regulations, and specifications from a different time. It wasn’t meant for this kind of an event with the kind of numbers that we’re talking about.”

In a follow up question asked  NPR reporter Yamiche Alcindor, who nailed him with a question of his responsibility for eliminating the CDC Pandemic Response team and removing a member of it from the National Security Council. Her question was direct and to the point:

“You said that you don’t take responsibility, but you did disband the White House pandemic office. The officials that worked in that office said the White House lost valuable time because that office was disbanded.”

The President, having been caught twice responded and passed the blame. It was hardly a Harry Truman “the buck stops here,” moment. Nor was it a humiliated John F Kennedy, after the failed Bay of Pigs invasion. He took sole responsibility for it, stating, “because I’m the responsible officer of the government…” time of honesty. Instead the President lashed back, attacking her, and blaming everyone but himself.

“I just think it’s a nasty question. When you say me, I didn’t do it. We have a group of people, I could ask, perhaps my administration.” Turning to Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Disease, who has been the most consistently honest official during this crisis; “Perhaps I could ask Tony about that? Because I don’t know anything about that. Perhaps they do that to people,” he said to Alcindor, a former New York Times who left it for PBS. “You used to work at another newspaper. Things like that happen.”

The President often states how he is the Commander in Chief, and his sycophants claim is therefor above the law, however he has never taken responsibility for anything, unless he is claiming success for that of others. The list of his evasions of responsibility for anything, including the deaths of soldiers that he sent into battle, defies the final responsibility of a true commander, at any level. A commanding officer in our military is responsibility is responsible for everything his unit, base, or ship is assigned to do. If he or she fails, there is no evading responsibility by blaming it on others. Numerous commanders in every branch of the military are relieved of their commands, and sometimes face trial at Court Martial, regardless, most are never promoted again, and find that their careers are over. Sir Winston Churchill, a man of legendary success, and failure noted: “The price of greatness is responsibility.”  President Trump, who has a bust of Churchill in his office should heed those words.

Another British military officer, whose life is shrouded in mystery and controversy, Colonel Richard Meinertzhagen, did write truth in these words:

“A successful leader of men must have character, ability and be prepared to take unlimited responsibility. Responsibility can only be learned by taking responsibility; you cannot learn the piano without playing on one. Leadership is the practical application of character. It implies the ability to command and to make obedience proud and free.”

Admiral James Stockdale, who spent years in a North Vietnamese Prison, enduring constant torture, later noted:

“Leadership must be based on goodwill. Goodwill does not mean posturing and, least of all, pandering to the mob. It means obvious and wholehearted commitment to helping followers. We are tired of leaders we fear… What we need for leaders are men of heart who are so helpful that they, in effect, do away with the need of their jobs. But leaders like that are never out of a job, never out of followers.” 

President Trump has demonstrated none of this, except as Admiral Stockdale said, “posturing and… pandering to the mob,” and has shown his unwillingness to learn, unwillingness to listen to experts, and unwillingness to accept responsibility as President. That is a problem, especially in a time like this, General and later President Dwight Eisenhower said:

“The supreme quality for leadership is unquestionably integrity. Without it, no real success is possible, no matter whether it is on a section gang, a football field, in an army, or in an office.”

On Sunday afternoon the President opened an update on the COVID-19 pandemic stating the most obvious lie imaginable, that the virus “was completely under control,” only to be undercut by Anthony Fauci, who said that it would get much worse.

Trump is failing as President. His denial of the virus for months, his actions to delay any response, and his prior action in 2018 to disband a key component of our National Security Team, the CDC Pandemic Response Unit, created by President Barack Obama and his Administration was irresponsible and has made the situation worse, not better.

Our disease increase curve is similar to that of Italy. Within a few weeks we are going to see tens of thousands of infections and thousands of deaths. The measures taken by the administration were too little, too late. The current measures may help mitigate the effects, but COVID 19 is going to wreak havoc on our society, economy, and way of life.

If Trump was a real leader he would inspire us as Winston Churchill did the British in 1940, “I have nothing to offer but blood, toil, tears and sweat”. We have before us an ordeal of the most grievous kind. We have before us many, many long months of struggle and of suffering.” Or those of Franklin Roosevelt who said at the opening of his first inaugural address:

“So, first of all, let me assert my firm belief that the only thing we have to fear is fear itself—nameless, unreasoning, unjustified terror which paralyzes needed efforts to convert retreat into advance. In every dark hour of our national life a leadership of frankness and vigor has met with that understanding and support of the people themselves which is essential to victory. I am convinced that you will again give that support to leadership in these critical days.”

My friends, that is leadership, that is command, that is the mantle of supreme command that our President has never understood, before or after he became President.

I could write more, but I have been playing with this article for two days.

So, until tomorrow,

Peace,

Padre Steve+

 

9 Comments

Filed under Diseases Epidemics and Pandemics, economics and financial policy, ethics, healthcare, History, laws and legislation, leadership, Military, News and current events, Political Commentary

Tagged as , , , , , , , , , , , ,

March 7, 2020 · 00:54

The End of an Exhausting Week: Community, Coronavirus, and Comparisons to the Past

Friends of Padre Steve’s World,

The past week has been difficult with the corporate destruction of what used to be our version of Cheers, battling the emotions that came with that, as well as a couple day relapse into coughing most of the night and being unable to get any sleep, and obey the directive, that if one was sick one should not go to work. But, even so I was unable to get anything of substance accomplished, tired, and drained both emotionally and physically, by Wednesday night I was on the mend and able to go back to work yesterday and today. However, Thursday was busy but at the same time productive, even though I was running as if my Warp Core had been drained and I could barely get by on Impulse power. I slept fairly well Thursday night and today my propulsion and other systems were nearly back to normal.

Friday evening we were able to reunite with a good number of friends and some of our former bartenders and General Manager of our Gordon Biersch met at a locally owned Irish restaurant and bar, where the management and employees welcomed us, expressing the shock and surprise at what happened. It was a night to reunite with our friends, our extended family and community. It was nice, we were all on the same side on the bar, and the former customers were paying for the meals and drinks of those who over the last decade did so much to take care of us.

I have a number of things I will be writing about over the next few days; the Coronavirus 19 pandemic and our government’s mostly inane response to it, Season Three of Babylon Berlin, and the anniversary of the historic duel between the USS Monitor and the CSS Virginia, as well as the race for the Democratic Party nomination to run against President Trump in November, and the challenges that face the United States and World in light of the Coronavirus. Likewise, I need to update you on my Reading Rainbow. 

There are some interesting historical parallels to now and the events during the years between the First and Second World Wars which are worth exploring, including the Spanish Flu Pandemic of 1918-1919, world economic fluctuations which culminated in the Great Depression, as well as the rise of Left and Right Wing extremist parties that brought about the authoritarian rule of various Fascist, Communist, and Racist parties in Europe and Asia, which also spread to the United States and Great Britain, but in the latter they did not seize control, as they did in Germany, Russia, Italy, Hungary, Poland, Japan, and other smaller, less powerful countries; nor did they destroy the democratic and constitutional underpinnings of government as they did in France in the 1930s. However, as always I digress.

I am tired and need to get to sleep. I promise to get back on schedule, even as I watch Izzy and Pierre having their nightly Papillon war at my feet. So until sometime Saturday night or Sunday morning I wish you all well.

Peace,

Padre Steve+

2 Comments

Filed under Diseases Epidemics and Pandemics, healthcare, History, Loose thoughts and musings, Political Commentary

Tagged as , , , , , , ,

September 8, 2019 · 23:01

Nazi Crimes Against Humanity: The Medical Experiments

Hypothermia Experiment at Dachau

Friends of Padre Steve’s World,

Moving  on from last night it is time to look at other crimes committed by the medical establishment of Hitler’s Germany. Unlike the killing of those considered Life Unworthy Of Life, this involved medical experiments on Jews, Prisoners of War, especially Russians, Gypsies, and others deemed to be subhuman. All of these people were deemed by the Nazi establishment as suitable subjects for a wide range of medical experiments which inflicted incalculable suffering on the victims for little or nothing in medical or scientific advancement. However, the sponsors and practitioners of these experiments subjected their victims to some of the most inhuman experiments imaginable.

Victim of High Altitude Experiment

The vast majority of these experiments were conducted in the concentration camps at Dachau and Buchenwald. The included experiments in which the victims were immersed in near freezing water to simulate what Luftwaffe aircrews might be subject to when ditching their aircraft in the North Sea. The did the same to others in simulations of what should happen to Luftwaffe aircrew at high altitudes with varying amounts of oxygen deprivation.  Others were exposed to malaria, typhus and other diseases and treated with vaccines of questionable value. Others were subjected to bone and nerve experiments, and exposure to white phosphorus and other chemical burns. Almost all the victims that survived were killed.

       Buchenwald: the SS Medical Institute, Victims, and Tools of Torture 

The depth and depravity of the medical experiments at Dachau, Buchenwald, Mauthausen, and other camps is hard to imagine. The fact that they were carried out by medical professionals even more unimaginable.

I will write more on this subject at a later date, as most of my books on the subject are at my work office. but I thought this a good time to introduce my readers to a subject that they may not know much about.

So until tomorrow,

Peace,

Padre Steve+

3 Comments

Filed under crime, ethics, healthcare, History, holocaust, nazi germany

Tagged as , , ,

August 12, 2019 · 17:13

Recovering: Calmer but Still Anxious, yet Determined

Friends of Padre Steve’s World,

Today has been a day of recovery from the physical and emotional stress of being run off the road last week. Despite having dealt with the effects of PTSD for almost a decade and pretty well versed in what happens in the brain and body during a traumatic event, but it has been a long time since I have actually been through something this traumatic.

It’s funny, when it happened I was pretty much pumped up on norepinephrine and cortisol. They control the  fight or flight response, and norepinephrine is similar to adrenaline. When I pulled my damaged car into the grass median I didn’t have anyone to fight. So the initial rush wore off and my anxiety and fear began to build. Since I went over that yesterday, I’ll move on.

Judy was a tower of strength to me over the weekend. She understood and even this morning was willing to take me to early fat boy PT, then to the Naval Medical Center for my other appointments and the pharmacy. I thanked her but said I needed to do it on my own. I was nervous on the road, but extra careful. I gave myself lots of time, kept good following distances, and kept a sharp eye out.

My early morning PT was good for me, as was the aquatic physical therapy. I think they helped release some endorphins, which combined with some time in the sauna calmed me down. Of course I had to wait an ungodly amount of time at the medical center pharmacy for my antidepressant prescription, but such is life. But, I was able to get my paperwork to the orthopedist so he can approve me to take the Physical Readiness Test this fall.

The past two PRT cycles after the fall that injured my knees, ankles, and hip, and has resulted in so much pain and inconvenience as I tried to recover, I wasn’t cleared to participate. The injuries, the failed treatments, and failed meniscus surgery left me unable to physically do much, so I gained weight and got depressed because I saw no hope in sight. I could only walk with the aid of crutches or a cane for months. Of course I gained weight and came in over my maxim body fat allowance.

Since then things have changed. I was switched to aquatic physical therapy and the orthopedics Department Head made me his patient. Despite the injuries to my knees, I am not yet a candidate for knee replacement, so he decided a last ditch effort to relieve my pain, which had been a consistent 7-10 on the pain scale for months. He decided to repeat the gel injections in both knees before trying any other surgeries. This time they worked and soon I was walking relatively normally without the aid of crutches or canes, and the pain level went down to the 2-3 range. I do a lot of walking and swimming and since the first week of June have lost about 17 pounds. My goal is to lose another 10-15 pounds by the 15th of October. I am now up to walking, on a good day, 8-10 miles. I hope  by eating nothing but soup, salad, fruit, and low carb/calorie yogurt over the next week that I meet my allowed body fat allowance by next Monday, on the next “fat boy” weigh in. I think I need to lose about 5 pounds to make it. That won’t stop me from working to lose all I need for my last official weigh in before retirement. If I don’t succeed, under the revised regulations it could screw up my retirement. I won’t let that happen, even if I die in the attempt.

So until tomorrow I leave you with less anxiety, more determination, and a desire to kick ass and take names. I’ll start catching up with current events tonight and tomorrow.

Until then,

Peace

Padre Steve+

 

 

 

Leave a comment

Filed under healthcare, Loose thoughts and musings, Military, US Navy

Tagged as , , , , , , , , , , , , , , , ,

July 13, 2019 · 23:45

Eliminating Political Opposition and Laws Enabling Crimes Against Humanity: Germany July 14th 1933

Friends of Padre Steve’s World,

On July 14th 1933 two laws were passed by the Nazi led government, less than five and a half months after Hitler’s legal accession to power, and four and a half months after he, under the Weimar Constitution’s Article 48 seized power following the Reichstag Fire. 

One law, under the policy of Gleichschaltung (coordination) all political parties other than the Nazi Party were prohibited. The Parties of the Right and Center voluntarily dissolved themselves, the Communists had already been made illegal and their surviving leaders went underground. The Social Democrats resisted until the end, but were banned.

The second law, was much easier to enforce without official political parties to oppose it was much more drastic. It did not only deny people their political rights, it determined that some people were life unworthy of life and people who could not be allowed to reproduce and would be sterilized in order to purify the the Aryan race. That law was called Gesetz zur Verhütung erbkranken Nachwuchses or the Law for the Prevention of Genetically Diseased Offspring. 

It read:

The Reich government has passed the following law, which is hereby promulgated:

§ 1.  Anyone suffering from a hereditary disease can be sterilized by a surgical operation if, according to the experience of medical science, there is a high probability that his offspring will suffer from serious physical or mental defects of a hereditary nature.
Anyone suffering from any of the following diseases is considered hereditarily diseased under this law:

1. Congenital mental deficiency

2. Schizophrenia

3. Manic-depression

4. Hereditary epilepsy

5. Hereditary St. Vitus’ Dance (Huntington’s Chorea)

6. Hereditary blindness

7. Hereditary deafness

8. Serious hereditary physical deformity.

Furthermore, anyone suffering from chronic alcoholism can be sterilized.

§ 2.  Applications for sterilization can be made by the individual to be sterilized. If this person is legally incompetent, has been certified on account of mental deficiency, or is not yet 18, a legal representative has the right to make an application on this person’s behalf but needs the consent of the court of guardians to do so. In other cases of limited competency, the application needs to be approved by the legal representative. [ . . . ]

§ 3.  Sterilization can also be requested by the following: 1. the state physician. 2. In the case of inmates of hospitals, nursing homes, and penal institutions, by the head thereof.

§ 4.  The application is to be made to the office of the Eugenics Court; it can either be made in writing or dictated to the court. The facts upon which the application is based should be supported by a medical certificate or confirmed in some other way. The office must inform the state physician of the application.

§ 5.   Responsibility for the decision rests with the Eugenics Court that has jurisdiction over the district in which the person to be sterilized officially resides.

§ 6.  The Eugenics Court is to be attached to a district court [Amtsgericht]. It consists of a district court judge acting as chairman, a state physician, and another physician certified by the German Reich and particularly well trained in eugenics…

§12. Once the Court has decided on sterilization, the operation must be carried out even against the will of the person to be sterilized, unless that person applied for it himself. The state physician has to attend to the necessary measures with the police authorities. Where other measures are insufficient, direct force may be used.

This law comes into effect on January 1, 1934.
Berlin, July 14, 1933.


The Reich Chancellor
Adolf Hitler

The Reich Minister of the Interior
Frick

The Reich Minister of Justice
Dr. Gürtner

During the first year of the law over 64,000 people were forcibly sterilized. During the course of the Reich’s existence over 400,000 people were forcibly sterilized. Fewer than 1% of those who appealed the decision for sterilization gained a reprieve. The law was the first in a series of laws and policy decisions that would lead to the Holocaust. 

Many of the Eugenics laws in the Third Reich modeled themselves on Eugenics laws in many American States, as well as the studies of well know American, and English Eugenicists Of the time, men who approved of the German laws when they were published.

In our own country there are those who want to deny care and insurance for care for people whose conditions are considered a drain on the economy, and while there is a strong political lobby opposed to abortion, most of those allegedly pro-life people and politicians seem to care about the health and quality of life once it emerges from the womb. The law Hitler signed forbade the abortion of Aryan fetuses, but allowed for the abortions of fetuses who might be less than perfect or require expensive medical care to maintain.

With the systematic devaluation of life in this country based on the economic value of people, and the very obvious belief that the lives of racial and certain religious minorities as not having the same value as Americans of European descent. While some would like to believe that a problem isolated to the radical right wing backers of President Trump, there are places where well off white liberals and progressives attempt to insulate themselves from racial and religious minorities.

Irregardless of the seeming contempt for well off white liberals and progressives For the lives and circumstances of minorities so long as they are not their neighbors, the greater threat to life is the political and economic ideology of so called conservatives that devalues life to its economic and racial benefit; the same kind of people who support President Trump’s racial, economic, and medical policies. The same people who espouse explicitly racist views, and whose leader calls his opponents, be they political, educational, or those who dare to criticize him in the media as “enemies of the state.”  The only thing keeping the President and his followers total control is the fact that our constitutional institutions are barely holding and there has been no crisis such as the Reichstag Fire a terrorist event, a Major War to suspend the Constitution and to enable the Executive Branch to take total control of the country, possibly ban political opposition, and freedom of speech and association.

That is what I worry about. Once the basic freedoms under the Constitution are abrogated, once citizens are determined to be enemies of the state then it is possible for that same executive branch to pass laws laws by decree that suspend the liberties, or take the lives of those deem life unworthy of life.

So until tomorrow,

Peace

Padre Steve+

 

1 Comment

Filed under economics and financial policy, ethics, healthcare, History, holocaust, laws and legislation, nazi germany, News and current events, Political Commentary

Tagged as , , , , , , , , , , , , , , , , , , , , , , , ,

May 17, 2019 · 21:46

Late Night MRI’s

Friends of Padre Steve’s World,

Well for the second time in two weeks I am making a trip for an MRI of a knee deep in the night at Naval Medical Center Portsmouth. They do quite the business there, the MRI and CT suite is in operation 24/7 all year long. My last MRI revealed more damage to my right knee, but it looks like it will not require a knee replacement, but an alternative to have Interventional Radiology cauterize the nerves to the right knee. The bone and joint surgeon doesn’t think that majority of the pain is coming from the knee itself and he wouldn’t want to replace the knee and have no reduction in the pain. I am now waiting for that procedure to be scheduled.

My left knee, which will be scanned tonight, about 1:30 AM was operated on to repair a torn meniscus in February. It now hurts worse than it ever did. The surgeon who did the original surgery mentioned that I probably will need a knee replacement at some time. All I hope is that the results of this MRI give a way forward to either fix or reduce the pain in my left knee. If it requires replacement fine, if the pain can be controlled with the treatment by Interventional Radiology, I would be very happy.

I should know something on that in the next week or so. The surgeon who did the original surgery has been great about keeping in contact, providing test results as soon as he has access to them, even on weekends, and providing additional referrals.

So, I will drive over to the hospital about midnight and hopefully they will be get me in earlier. I really don’t like to be on the road at such an hour. If all goes well I’ll be home and in bed by 3:00 AM. I need to be up by 9:30 to watch Bayern München play for the Bundesliga championship.

So until tomorrow,

Peace,

Padre Steve+

9 Comments

Filed under healthcare, Loose thoughts and musings

Tagged as , , ,