Immigration

“Root Causes”

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The Biden administration wants to find and solve the ‘root causes’ driving the flood of refugees to the US from the south, and has assigned that task to VP Kamela Harris.  More generally, liberals and ‘progressives’ like to talk about ‘root causes’ for all kinds of things: crime, for example: instead of arresting criminals, just solve the Root Causes of crime!

Someone needs to explain to these people the concept of ask why five times, and how that concept is properly implemented.  Example:

PROBLEM: There is oil on factory floor.  Why?

Looks like it’s coming from that machine over there.

ACTION: Clean up the oil. But then ask…
WHY is there oil leaking from that machine.

The machine has a bad gasket.

ACTION: Replace the gasket. But then ask..
WHY was the gasket bad?

Check out the condition of the gaskets on some other machines.
Looks like we’ve been buying inferior gaskets.

ACTION: Change the specifications so we don’t get any more of these. But also ask..
WHY did we decide to buy the gaskets that we did?

Uhh…they were cheap? Turns out the purchasing policy for supplies like this says “always buy the low bid.”

ACTION: Change the policy to give more weight to quality as well as price. But also ask…
WHY did the head of Purchasing ever approve a policy like this in the first place?

Maybe because his *incentive program* includes a big component for year-over-year reductions in supplies cost, with no measurement for downtime impact of bad items?

ACTION: Change the incentive program.
WHY did a one-sided incentive program like this get created and approved?

And so on. (There is nothing magic about the number Five)

But importantly, you don’t wait until you run all the way up and down the chain of causation before you clean up the oil on the floor before someone slips on it and hurts himself. You don’t go through analysis of why inferior gaskets are being purchased before replacing the gaskets before the machine loses oil again and shuts down or destroys itself.

Democrat politicians often act like they don’t understand these points, even informally and intuitively. Many of them really don’t, I think…but also, many of them just don’t care; accumulation of political power for themselves and their faction is all that matters.  Among their voters/supporters, though, there may be some who can be brought to understand the fallacies of root-causes-only thinking.

And, very importantly, if you pursue the chain of causation upward to enough levels, you are likely to find causes which are either beyond your ability to influence, or for which such influence has a very long time constant.  In the manufacturing example, for instance, you may be a factory manager in a large company with very little influence on the incentive policies that drive Purchasing to acquire inferior gaskets.  That still doesn’t mean you don’t need to clean up the oil and replace the failed gaskets, anyway.  In the Biden/Harris policy case, serious thought would show that the ability of American leaders to influence the policies, economic systems, and cultures of our southern neighbors is strictly limited, and what influence we can exert is likely to have a very long time constant. That doesn’t mean we don’t need to do anything about the border crisis.

Better Explanations?

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We might be forgiven for thinking that China does not have our best interests in mind, given their halt of all national movement from Wuhan and encouragement of all international travel from Wuhan in the pandemic’s early months, given the secrecy that surrounds the Wuhan Institute and the belated admission of and tight controls on the WHO inspectors, etc. etc.

The tragedy at our border is huge and this seems almost a small part of it, but some acts seem to parallel China’s: Why are Americans expected to isolate themselves from useful pursuits (such as work and education and church), while Covid-infected illegal immigrants are sent on planes and buses to the interior (not that I’m all that crazy about how their policies are also refreshing the epidemic in Texas).

Stirring division, encouraging wokeness and discouraging economic recovery in Atlanta, ignoring the vulnerability of the border to human trafficking and terrorist entry, encouraging defunding the police and justice systems that show little (in some cases any) respect for property or the victims of violent crime: the quantity of “ironies” might be more easily explained as expected consequences to Biden/Harris policies. And so we might be forgiven for thinking that they, too, do not have our best interests in mind.

With Trump I’d turn to Instapundit and notice every day little and big things that seemed to free us or make the future more attractive, one of the values was that doing and speaking seemed aligned and Orwellian obfuscation was not omnipresent; it is, now, as opposite patterns can be easily discerned. Both seemed to be “busy” presidents – though that this seems to be coming from Biden seems hard to believe, it certainly is coming from “his” White House. And one’s busyness leads to productivity and the other’s to stasis – the position of a sitting duck.

A (partially successful) attempt at a reasoned response

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to Harris/Biden in Atlanta on Friday. Or an exercise explaining Why I swear at the tv. Mid-way to rational thought, it is at least better than ***!!!###. Aside: Posting here is a great gift. Writing – like speech with others – forces us to use words. Our founders would use the word deliberate, to move from gut response to reason. Let’s begin with them for perspective:

“We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.–That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed . . . “

“Hate crimes” violate not only our laws but our core belief that in each (and all) is a divine spark, that is one way we are truly equal. However, “hate” for an individual or a random act of pointless violence is also hate. Inchoate anger is hardly virtuous. Haters choose the weak, the dependent, the isolated, the outlier; they want neither consequences nor pricks of conscience. “Knock out” punches throw the weak, the elderly, the unprepared to the ground and are often too random to easily assign blame; knowing society identifies less with such victims makes quick punishment less likely; an important distance comes from convincing one’s self such a victim is not “equal”, is not human – that stills the conscience.

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Texas Aggie Doctor Reports — Clinical Pearls Covid 19 for ER practitioners

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The following information is from a front line ER doctor using the handle of ‘nawlinsag’ on a Texas Aggie web site.  I’ve included the link below. I’ve also included the complete text of his post in full in hopes medical professionals and lay people could get the most benefit from his observations of the course of COVID-19 in a small front line Louisiana hospital.

Short form: This is not the flu.  It is a horror show of death and disablement that is crowding out all other medical care including an immediate downgrade of life saving cardiac care.  Only on in seven people put on ventalators in this hospital is surviving, and then only after 10-t0-12 days of ventalator support.

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https://texags.com/forums/84/topics/3102444?fbclid=IwAR3s13SRnw7YNgtu-7LZyrMUSMIRRWScU67lwbuwZM8fna-6R8k4tqrtO3w

I just spent an hour typing a long post that erased when I went to change the title so I apologize to the grammar and spelling police. This one will not be proofread and much shorter.

I am an ER MD in New Orleans. Class of 98. Every one of my colleagues have now seen several hundred Covid 19 patients and this is what I think I know.

Clinical course is predictable.
2-11 days after exposure (day 5 on average) flu like symptoms start. Common are fever, headache, dry cough, myalgias(back pain), nausea without vomiting, abdominal discomfort with some diarrhea, loss of smell, anorexia, fatigue.

Day 5 of symptoms- increased SOB, and bilateral viral pneumonia from direct viral damage to lung parenchyma.

Day 10- Cytokine storm leading to acute ARDS and multiorgan failure. You can literally watch it happen in a matter of hours.

81% mild symptoms, 14% severe symptoms requiring hospitalization, 5% critical.

Patient presentation is varied. Patients are coming in hypoxic (even 75%) without dyspnea. I have seen Covid patients present with encephalopathy, renal failure from dehydration, DKA. I have seen the bilateral interstitial pneumonia on the xray of the asymptomatic shoulder dislocation or on the CT’s of the (respiratory) asymptomatic polytrauma patient. Essentially if they are in my ER, they have it. Seen three positive flu swabs in 2 weeks and all three had Covid 19 as well. Somehow this ***** has told all other disease processes to get out of town.

China reported 15% cardiac involvement. I have seen covid 19 patients present with myocarditis, pericarditis, new onset CHF and new onset atrial fibrillation. I still order a troponin, but no cardiologist will treat no matter what the number in a suspected Covid 19 patient. Even our non covid 19 STEMIs at all of our facilities are getting TPA in the ED and rescue PCI at 60 minutes only if TPA fails.

Diagnostic
CXR- bilateral interstitial pneumonia (anecdotally starts most often in the RLL so bilateral on CXR is not required). The hypoxia does not correlate with the CXR findings. Their lungs do not sound bad. Keep your stethoscope in your pocket and evaluate with your eyes and pulse ox.

Labs- WBC low, Lymphocytes low, platelets lower then their normal, Procalcitonin normal in 95%
CRP and Ferritin elevated most often. CPK, D-Dimer, LDH, Alk Phos/AST/ALT commonly elevated.
Notice D-Dimer- I would be very careful about CT PE these patients for their hypoxia. The patients receiving IV contrast are going into renal failure and on the vent sooner.

Basically, if you have a bilateral pneumonia with normal to low WBC, lymphopenia, normal procalcitonin, elevated CRP and ferritin- you have covid-19 and do not need a nasal swab to tell you that.

A ratio of absolute neutrophil count to absolute lymphocyte count greater than 3.5 may be the highest predictor of poor outcome. the UK is automatically intubating these patients for expected outcomes regardless of their clinical presentation.

An elevated Interleukin-6 (IL6) is an indicator of their cytokine storm. If this is elevated watch these patients closely with both eyes.

Other factors that appear to be predictive of poor outcomes are thrombocytopenia and LFTs 5x upper limit of normal.

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Books That I Cannot Wait Not to Read

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Amanda at Mad Genius Club posted last week with some musings on the current publishing scene – er, that is what I took to calling the Literary Industrial Complex, back when I first went indy around 2008 – Indy Publishing that is. When people ask me who my publisher is, I look at them loftily, and reply, “I own the publishing company!” Which I do – a nice little small enterprise that I came into as junior partner, and which the original founder sold to me when she regretfully concluded that she could no longer carry on. We do other authors’ books, as well as my own; regional and small-press stuff, nothing which would ever excite the interest of the Literary Industrial Complex or the minions thereof. No point to it at this late date; as one of the other indy authors I associated with at the time often repeated – “If readers love-love-love the book, they don’t really care who published it.”

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