What To Do When You're Stopped By Police - The ACLU & Elon James White
What To Do When You're Stopped By Police - The ACLU & Elon James White
Know Anyone Who Thinks Racial Profiling Is Exaggerated? Watch This, And Tell Me When Your Jaw Drops.
This video clearly demonstrates how racist America is as a country and how far we have to go to become a country that is civilized and actually values equal justice. We must not rest until this goal is achieved. I do not want my great grandchildren to live in a country like we have today. I wish for them to live in a country where differences of race and culture are not ignored but valued as a part of what makes America great.
"Hostility toward immigrants is hurting the fight against the pandemic.
The editorial board is a group of opinion journalists whose views are informed by expertise, research, debate and certain longstanding values. It is separate from the newsroom.
Three weeks ago, with much of the United States already gearing up to limit the spread of the coronavirus, the Trump administration’s chief immigration judge sent out a stern order to immigration courts nationwide to take down all public health posters, printed in English and Spanish, on how to deal with the pandemic. “Per our leadership,” the order said, immigration judges did not have the authority to post fliers. “If you see one (attached), please remove it.”
Soon after the order was revealed by The Miami Herald, the Department of Justice, which oversees the immigration courts, reversed course and told the paper that “the signs shouldn’t have been removed.”
A bureaucratic blunder? More like a case in point of how the administration’s obsession with immigrants, undocumented, legal or aspiring, has infected its efforts to control the spread of a pandemic, exacerbating the crisis.
Tough times call for tough measures, to be sure, and the administration’s anticipated order to turn back all asylum seekers and other foreigners trying to cross the southwestern border illegally makes sense in the context of measures already taken to severely restrict movement across other American borders, land and sea.
The immigration system along the southern border is overtaxed, and detention centers across the United States are already bursting with nearly 40,000 people, at enormous risk of contagion. The coronavirus doesn’t discriminate between carriers who are held behind bars and those whose job it is to guard them. The Immigration and Customs Enforcement agency has continued to make arrests and has shown no intention of releasing nonviolent detainees, though judges in some states have ordered some released out of health concerns.
Rounding up undocumented immigrants and shutting down the border is something President Trump has yearned to do since long before the coronavirus began its fateful spread. And his animosity toward undocumented immigrants is affecting the efforts to contain the coronavirus far beyond the border.
As Miriam Jordan of The Times reported, the virus has spread more fear among immigrants, legal and undocumented — the fear that seeking medical or financial help will put them in the cross-hairs of the administration’s repressive immigration policies.
At the beginning of March, more than 700 public health and legal experts addressed a petition to Vice President Mike Pence and other federal, state and local leaders asking, among other things, that medical facilities be declared enforcement-free zones (ICE currently classifies them as “sensitive locations,” where enforcement is avoided but not precluded). The Citizenship and Immigration Service subsequently appeared to signal that it was suspending enforcement of a new “public charge” rule, which makes it harder for immigrants to obtain the green card of a permanent resident if they tap federal benefits, but the suspension has not been publicized.
Those who are not documented are afraid that going to a public health facility will expose them to ICE agents. Immigrants in the country legally and hoping to obtain a green card fear that seeking help will ruin their chances under the public charge rule, which went into effect in February after injunctions blocking it were lifted by the Supreme Court.
These immigrants are particularly at the mercy of the pandemic. They often live in crowded conditions, have little money and no paid sick leave, and so lack the ability to self-quarantine. And according to the Kaiser Family Foundation, 23 percent of noncitizens lawfully in the country and 45 percent of those who are undocumented lack health insurance.
Most immigration courts, meanwhile, were still working at full steam long after state and federal courts across the country sharply scaled back their activities. On Monday, several groups representing lawyers who work with immigrant clients sued the administration to stop in-person immigration hearings during the pandemic. It was only last week that the Executive Office for Immigration Review, the Justice Department agency that oversees immigration courts, closed down some courts and suspended hearings for immigrants not in custody.
The coronavirus does not care which passport its human hosts may carry or tongue they speak. Nor does it serve global public health for only American citizens to wash their hands and practice social distancing. Those are best practices that should transcend borders and walls and help us acknowledge our common plight, and humanity."
This is one of the issues that scares me most about this pandemic given how America has always discriminated against people of color. Can America change in a crisis? I seriously doubt it. Please prove me wrong.
"How do doctors and hospitals decide who gets potentially lifesaving treatment and who doesn’t?
A lot of thought has been given to just such a predicament, well before critical shortages from the coronavirus pandemic.
“It would be irresponsible at this point not to get ready to make tragic decisions about who lives and who dies,” said Dr. Matthew Wynia, director of the Center for Bioethics and Humanities at the University of Colorado.
Facing this dilemma recently — who gets a ventilator or a hospital bed — Italian doctors sought ethical counsel and were told to consider an approach that draws on utilitarian principles.
In layman’s terms, a utilitarian approach would maximize overall health by directing care toward those most likely to benefit the most from it. If you had only one ventilator, it would go to someone more likely to survive instead of someone deemed unlikely to do so. It would not go to whichever patient was first admitted, and it would not be assigned via a lottery system. (If there are ties within classes of people, then a lottery — choosing at random — is what ethicists recommend.)
In a paper in The New England Journal of Medicine published Monday, Dr. Ezekiel Emanuel, vice provost for global initiatives and chairman of the Department of Medical Ethics and Health Policy at the University of Pennsylvania, and colleagues offer ways to apply ethical principles to rationing in the coronavirus pandemic. These too are utilitarian, favoring those with the best prospects for the longest remaining life.
In addition, they say prioritizing the health of front-line health care workers is necessary to maximize the number of lives saved. We may face a shortage of such workers, and some have already fallen ill.
In a recent article in The New York Times, a British researcher said, “There are arguments about valuing the young over the old that I am personally very uncomfortable with,” adding, “Is a 20-year-old really more valuable than a 50-year-old, or are 50-year-olds actually more useful for your economy, because they have experience and skills that 20-year-olds don’t have?”
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Dr. Emanuel disagreed with that interpretation: “The 20-year-old has lived fewer years of life; they have been deprived of a full life. If they have roughly comparable prognoses, then the fact that the 20-year-old has not had a full life counts in their favor for getting scarce resources.”
Some organizations, states and federal agencies have anticipated challenges like these and developed resources and guides for hospitals and health systems.
The Hastings Center has curated a list of resources that health care institutions can use to prepare for responding to the coronavirus, including for shortages. In 2015, the New York Department of Health released a report on the logistical, ethical and legal issues of allocating ventilators during a pandemic-created shortage. This and many other states’ plans are modeled on guidance from the Ontario Ministry of Health on critical care during a pandemic.
Federal health agencies, including the Department of Veterans Affairs and the Department of Health and Human Services, have also published guidance that includes approaches for allocation of scarce resources during a pandemic.
A study in Chest in April 2019 imagined a 1918 flulike pandemic in which there weren’t enough I.C.U. beds and ventilators to meet demand. The authors engaged focus groups in Maryland about views on how to ration care. The preference of the focus groups? Direct resources to those with the greatest chance of survival and the longest remaining life spans — in other words, also the pragmatic utilitarian approach. This study stemmed from work for a Maryland report on allocating scarce medical resources during a public health emergency.
“Key is to be transparent about the principles, save as many lives as possible, and ensure that there are no considerations such as money, race, ethnicity or political pull that go into allocation of lifesaving resources such as ventilators,” said Dr. Tom Frieden, president and C.E.O. of Resolve to Save Lives and former director of the Centers for Disease Control and Prevention.
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Another principle recommended by medical ethicists is to take tough choices out of the hands of front-line clinicians. Instead, have dedicated triage officers decide. Also, decisions should be free of financial considerations or the social status of patients, something that seems to have been violated in the provision of scarce coronavirus tests to N.B.A. players, for example.
“Ethically speaking, rationing by ability to pay is the worst way to allocate scarce medical resources in an emergency,” said Dr. Jerry La Forgia, chief technical officer of Aceso Global and former lead health specialist for the World Bank.
Nevertheless, precisely this kind of rationing is commonplace in the U.S. health system during more normal times.
The Hardest Questions Doctors May Face: Who Will Be Saved? Who Won’t?March 21, 2020
Health economists have also thought deeply about how to allocate finite health care resources, in government budgets for instance. Often there are winners and losers in these calculations — some treatments covered and some not — but they’re not always individually identifiable.
During a pandemic, the winners and losers are both clearly identifiable. They’re right in front of the doctor at the same time. “This shifts the ethical and emotional burden from society or government to the clinician,” said Christopher McCabe, a health economist and executive director and C.E.O. of the Institute of Health Economics in Alberta, Canada. “There’s no perfect way to choose who gets lifesaving treatment. At times like these, society may be more forgiving of utilitarian decision making.”
History offers examples of competing values. During World War II, soldiers received penicillin before civilians. In Seattle in the 1960s, social worth was among the criteria used to ration dialysis machines.
In 2005, Hurricane Katrina caused acute shortages under emergency conditions in Louisiana health centers. “Health care workers were forced to make things up as they went along, amounting to life and death decisions,” Dr. Wynia said. “This was widely viewed as unfortunate for patients, doctors, and not what we want as a society.”
Today, there is greater demand for some organs for transplants than supply can accommodate. The United Network for Organ Sharing is a system for prioritizing patients for transplants. It combines medical condition, waiting time and prognosis into a scoring system that varies by type of organ.
“It has elements of utilitarianism,” said David Vanness, Professor of Health Policy and Administration at Penn State. “But it’s not designed for the urgency of a pandemic.”
In particular, society has had time to consider how to cover the care for patients needing transplants. The vast majority of end-stage kidney disease patients are eligible for Medicare at any age, for example.
When antivirals or vaccines become available, those too will initially be in short supply, and undoubtedly discussion will arise on who should get them first.
Dr. Emanuel predicts we will soon see in the U.S. the kind of rationing happening in Italy, where there are too few ventilators and I.C.U. beds for all the patients who need them. Estimates by researchers at Harvard show that without drastic expansion of supply, many areas of the U.S. will have inadequate numbers of hospital beds.
“When you consider the shortage of coronavirus tests, we’re already seeing rationing,” he said.
Austin Frakt is director of the Partnered Evidence-Based Policy Resource Center at the V.A. Boston Healthcare System; associate professor with Boston University’s School of Public Health; and a senior research scientist with the Harvard T.H. Chan School of Public Health. He blogs at The Incidental Economist, and you can follow him on Twitter at @afrakt
Our leaders need to speak some hard truths and then develop a strategy to prevent the worst.
“Respirators, ventilators, all of the equipment — try getting it yourselves,” President Trump said on a recent conference call with U.S. governors.Erin Schaff/The New York Times
Of all the resources lacking in the Covid-19 pandemic, the one most desperately needed in the United States is a unified national strategy, as well as the confident, coherent and consistent leadership to see it carried out. The country cannot go from one mixed-message news briefing to the next, and from tweet to tweet, to define policy priorities. It needs a science-based plan that looks to the future rather than merely reacting to latest turn in the crisis.
Let’s get one thing straight: From an epidemiological perspective, the current debate, which pits human life againstlong-term economics, presents a false choice. Just as a return to even a new normal is unthinkable for the foreseeable future — and well past Easter, Mr. Trump — a complete shutdown and shelter-in-place strategy cannot last for months. There are just too many essential workers in our intertwined lives beyond the health care field — sanitation workers; grocery clerks, and food handlers, preparers and deliverers; elevator mechanics; postal workers — who must be out and about if society is to continue to function.
A middle-ground approach is the only realistic one — and defining what that looks like means doing our best to keep all such workers safe. It also means leadership. Above all, it means being realistic about what is possible and what is not, and communicating that clearly to the American public.
When leaders tell the truth about even near-desperate situations, when they lay out a clear and understandable vision, the public might remain frightened, but it will act rationally and actively participate in the preservation of its safety and security.
Our leaders need to begin by stating a number of hard truths about our situation. The first is that no matter what we do at this stage, numerous hospitals in the United States will be overrun. Many people, including health care workers, will get sick and some will die. And the economy will tank. It’s too late to change any of this now.
In three to four weeks, there will be a majorshortage of chemical reagentsfor coronavirus testing, the result of limited production capacity, compounded by the collapse of global supply chains when the epidemic closed down manufacturing in China for weeks.
The second hard truth is that at this stage, any public health response that counts on widespread testing in the United States is doomed to fail. No one planned on the whole world experiencing a health conflagration of this magnitude at once, with the need to test many millions of people at the same time. Political leaders and talking heads should stop proffering the widespread-testing option; it simplywon’t be available.
Much better, instead, to immediately gear up for epidemic intelligence, based on techniques used for many decades. Among those is so-calledillness surveillance, in which epidemiologists survey a sample of doctors’ offices in a given geographic region each day to learn how many patients sought care for illnesses with symptoms of fever, cough and muscle aches. The increasing or decreasing occurrence of patients with these symptoms provides a reliable estimate of influenza activity during the winter months — or now, the incidence of Covid-19.
A third hard truth is that shortages of personal protective equipment — particularly N-95 masks — for health care workers will only get worse in the United States as global need continues to rise precipitously. There is no point holding out the false hope that theDefense Production Actwill save the residents of the United States. Not enough manufacturing activities can be converted to produce masks in a matter of weeks. You can’t turn engine-making machinery into an N-95 respirator assembly line just because you want to.
For example, even as3M was producingat 100 percent of its capacity (35 million N-95 masks a month), a single hospital in New York City used up more than two million masks in February,beforethe surge in Covid-19 cases there. Andnew production won’t happen for many months.
If you can’t make nearly enough masks to meet the need, then you must conserve the masks you can make. Unfortunately, some hospitals in the United Statesare not employingscience-based methodsfor conserving these invaluable lifesaving masks.
Making ventilators — machines that breathe for patients who cannot effectively do so on their own — poses an even more formidable challenge. For example,a Medtronic ventilatorhas about 1,500 parts, supplied by 14 separate countries. More machines might, at best, be manufactured by the hundreds a month — but not by the thousands, as is needed right now.
It is precisely in the face of such hard truths that a national strategy and leadership are crucial. Otherwise, hospitals, governors and politicians will only vie against one another in the reasonable service of their own constituencies.
“Respirators, ventilators, all of the equipment — try getting it yourselves,” Mr. Trump said on a recent conference call with governors. “We will be backing you, but try getting it yourselves. Point of sales, much better, much more direct if you can get it yourself.”
This is exactly the wrong message. The White House must take charge, keeping track of national inventory, purchasing the precious resources and distributing them where they are mostneeded at the moment.As Andrew Cuomo, the governor of New York,has suggested, ventilators could then be redistributed as outbreak hot spots shift around the country.
More than anything, what the United States needs right now is for the president to undertake an intellectual Manhattan Project: gather the best minds in public health, medicine, medical ethics, catastrophe preparedness and response; political leadership; and private-sector manufacturing and the pharmaceutical industry.
It took nearly three yearsto develop the atomic bomb. The effort against Covid-19 will need to be bear fruit within days — and come up with a comprehensive but realistic blueprint for getting America through the next 12 to 18 months, or however long it takes for a vaccine to become widely available or herd immunity to take hold in the population. Once a plan has been devised, the president will have to dispense with any happy talk and instead actually convey what the experts are telling him. He will have to define the new normal for a frightened nation that is looking for facts, direction and a common purpose.
Michael T. Osterholm is director of the Center for Infectious Disease Research and Policy at the University of Minnesota. Mark Olshaker is a writer and documentary filmmaker. They are the authors of “Deadliest Enemy: Our War Against Killer Germs.”
