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Healthcare delivery systems and chronic non-diagnosable illnesses

Sigh.

I became involved in a discussion about the problems that healthcare systems have with patients with long-term chronic, difficult-to-diagnose conditions. I don’t know if a satisfactory discussion is ever really possible on Twitter, with its 480 character limit placing a severe constraint on how much information can be conveyed in a single response.

I already had one person stomp off and Block me because I told her that her responses were wild and not helpful. She converted my observations about the limitations of the healthcare system in coping with long-term chronic conditions into an allegation that I was ignoring the issue altogether, because I noted that what we least need, at a time when medical professionals are under attack from the twin pincers of anti-vaccination activists and Covid deniers, is another campaign against the medical profession. This was apparently me ignoring the issue. At that point she was off and running on a predictable rant about how I was part of the problem. Nope. Next discussion time.

What I left unsaid because of lack of space was that the healthcare delivery systems that we have created in the USA and elsewhere have incentives built into them that militate against the correct levels of investment and attention to both mental health issues, and long-term chronic conditions that in many cases have no obvious root cause.

The medical profession operates to a classic paradigm:

Evaluate –> Diagnose –> Treat

The ultimate end point is a healthy satisfied customer. (Unfortunately, as we all understand, this is not always possible. Some people, despite the best efforts of the medical profession, leave this life. The profession may, however, be able to facilitate them leaving this life in a peaceful and painless fashion).

The challenge is when step 2 (Diagnose) fails to find an obvious cause. Instead of a narrow range of treatments (relatively), an unclear diagnosis leads to potentially hundreds or thousands of possible treatments. This is confusing enough for doctors and specialists. The entire treatment regimen becomes a crapshoot, with low chances of initial success.

At that point, however, in the USA, the insurers also insert themselves into the equation. Sometimes payment for certain treatments is denied, then a tussle develops between the the patient, the doctor and the health insurers, which leaves the doctor stuck in the middle, with both of the other parties unhappy. I once talked to a PCP about this, he was getting ready to retire rather than continue to be “caught in the middle” as he put it.

The incentives in the system, in short, work in favor of easily diagnosed issues, with clearly defined outcomes. Everybody benefits. The medical profession and the hospital systems get happy smiling patients who are cured of whatever malady ailed them, and the health insurers get clean closure, and all bills paid (until the next illness).

Chronic unexplainable maladies are usually not amenable to quick fixes, either pharmaceutical or surgical. Patients may require years of care. This upsets doctors, who see those unhappy patients over and over again, hospitals are largely out of the picture, and insurers see open-ended treatment plans that cost them more money than they can recover.

The result is that many chronic long-term afflictions, many of them with probable auto-immune origins, and now (recently) what is known as “Long Covid”, are not well-served by the healthcare delivery system. People presenting with chronic fatigue and other real but non-diagnosable symptoms are, in some cases, being referred to psychologists and psychiatrists because their primary care physicians are unable to locate a physical cause for the problem. Unsurprisingly, the reaction from most patients to this idea is not a favorable one. No matter how tactfully presented, it is difficult to process the message “the root cause is in your brain”. It feels like a kiss-off.

Unsurprisingly, many unhappy people with chronic but not-treated conditions adopt a cynical mindset, best summarized by this actual quote from my earlier discussion:

Of course there are outliers, but many many doctors hate the idea that they can’t have a obvious win and so would rather deny the existence of chronic illness all together.

The inevitable result of (as they see it) being ignored by the conventional “Western Medicine” system leads many people to DIY remedies, based on OTC drugs, or cannabis, or other naturally occurring substances. More dangerously, some seek help from the fringes of the medical profession, that world inhabited by a motley collection of amateurs with big ideas, cranks, charlatans and outright deceitful criminals. Run-down, depressed and vulnerable people are often easily persuaded that a new and exciting sounding treatment will cure that affliction that those damn doctors have been no help in addressing. Quite often, people spend lots of money for poor outcomes, but failures are often not discussed. The patients often have no recourse, because those shadow areas are unregulated or poorly regulated, and, equally importantly, it is difficult for anybody to admit “I was conned”. The mainstream medical profession is, by contrast strictly regulated, despite what some conspiracy-dazzled cranks would tell you.

At this point I can offer my own personal recent experience. I am a recent observer of the limitations of the healthcare system with respect to what is now known as “Long Covid”. I contracted Covid-19 in late December 2020, and despite only being mildly affected (it was like 12 days of intermediate flu, and I was never sick enough to need medical attention or hospitalization) I have since been impacted by a number of consecutive maladies, none of which I previously ever suffered from. In nearly all of these cases, despite my informing the doctors that I had contracted Covid, the doctors listened, nodded sagely, and then appeared to default to the standard approach of their specialty and looked at my malady through their standard evaluate–>diagnose–> treat lens.

The positive result is that some parts of my body (notably my entire GI tract) have been thoroughly inspected this year. This is good. I know that those parts of my body are basically in good shape. However, I have been left with the uncomfortable feeling that the medical profession is very slow at “joining the dots” on the impacts of Covid-19 on the human body. It was only recently, on a follow-up GI appointment, that I sat and heard a GI specialist say “yes, your GI issues have probably been caused by Covid-19”. Up until that point, I felt that the medical professionals I was consulting with saw the malady as “here is a guy who has X for some undetermined reason” instead of “here is a guy who has X, has had Covid-19, therefore this might be an after-effect of that virus”.

I hesitate to classify myself as a Long Covid sufferer, because it is less than 7 months since I was infected, and my current health seems to be good. I was not hospitalized, and I have only had 2 diagnostic procedures since. However, nobody yet knows what the long-term effects of Covid-19 infection are on the human body. There simply has not been enough elapsed time to evaluate that. Has my lifespan been shortened? I don’t think we have any way to know that. Were my maladies all the result of Covid? After all, I am now moving towards the end of middle age. There is no easy answer to the question, without me becoming some sort of laboratory test subject.

IMHO, the initial failure to take Long Covid seriously, and instead treating sufferers as suffering from a conventional affliction spectrum, has held back detail examination and research of the possible effects of Coronaviruses on the human body, medium-term and long-term. It is also a very real exposure of the limitation of the current 3-stage medical treatment model, which dominates the profession at this time, and which is reinforced by incentives all throughout the healthcare delivery system.

Is there any easy fix to this? Nope. The healthcare delivery system, dominated by insurers in the USA, is also not a great place to start. I suspect that innovative solutions will come from a country that has a well-run government healthcare system and wants to address the two endemic blind spots of the healthcare world – Mental illness and Chronic (sometimes lifetime) health issues with no immediate and obvious cause.

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The pathologies of the rich – 1

Many years ago, when I was a member of Riverside Racquet Centre in London, I played regular doubles tennis 3 evenings a week with different groups of people.

One of the guys I played with, I found out, ran an interior decorating and kitchen remodeling business. We were talking about clients one evening, and he mentioned that he had once done work for Andrew Lloyd-Webber. He then, without any further questioning, said “never again”. Long story, but he met Lloyd-Webber only once, at the beginning of the work, and thereafter had to deal on daily basis with one of his assistants, who behaved like a chiseling asshole, arguing over anything and everything, constantly acting as though Andrew Lloyd-Webber was doing him a massive favour by even deigning to use his services in the first place. When the work was completed, they refused to pay him, inventing an irrelevant dispute over scope of work, and only paid up after he threatened them with a default court judgement.

This fits with a number of stories that I have heard over the years about how many wealthy people are chiseling assholes. There is a common thread to the pathology. They justify it with glib cliches like “if you look after the pennies the pounds will take care of themselves”. I guess when you are worth squillions of pounds, then 20,000 on a kitchen remodel does indeed, in the grand scheme of things, look like pennies.

From what I can gather, the underlying pathology is that they are indeed driven people, but not necessarily in a good way (otherwise I would not have the material for this blog posting), and in many cases, it is a narrow materialistic view of success as measured by possessions and how many zeroes you have after your name in your asset balance. Nobody, for example, is going to convince me that a person needs $15m a year to live on. The premise is ridiculous, and deserves only ridicule. Once you get into that zone, money becomes a measurement device, a way of keeping score.

Many wealthy people, especially those who did build a large fortune, genuinely believe that the only factor that determines success is how hard you are prepared to work. I have worked with at least two entrepreneurs in my time in I.T. and both of them genuinely believed that that was the main factor. One of the guys used to say to us “anybody can do this if they are prepared to put in the work”. He appeared to genuinely believe that.

In their world, the rich and wealthy are rich and wealthy because they earned it. This leads to two obvious conclusions that get baked into their value systems: (1) the poor must be poor because they are feckless and lazy (2) taxes are confiscation from them of money that they worked to accumulate and are therefore entitled to, to be given to those people who do not deserve money because they do not work hard.

The idea that there are millions of people for whom success, in their value systems, is not measured in net worth, never seems to occur to them, or if it does, they dismiss it as stupid and, well something that only the feckless and lazy would think anyway.

As you move through life, you can find a lot of evidence that, as the old saying goes, money will not buy you happiness, but it can buy you a better class of misery. There is plenty of obvious evidence that a lot of highly driven and successful people are unpleasant, dysfunctional train-wrecks of humans. They might be worth a lot of money, but it certainly didn’t make them a better class of human. In fact it might be the other way round.

Quite why rich people like to chisel is another question entirely. One might naively expect them to be a bit more generous. I have to conclude that it is due to their need to win at all times. Realistically, making serious money is a tough competition, not a hobby, and people whose life is devoted to making money tend to see every activity where money changes hands as a competitive event, and often a win:lose scenario. If they have to hand over money to anybody without getting more money in return, that looks like a failure to them. So actually paying regular folks for anything is…eeek, why do I have to do this?

The attitude of the Lloyd-Webber flunky, that the regular guy should be grateful that Lloyd-Webber chose him at all, is symptomatic of that mindset. It is not uncommon in business, though. Another one of our friends once worked for the Dallas Cowboys on live sound (he eventually quit after his recommendations were consistently ignored). One thing he told us was that many medium-sized businesses were told that they could acquire the title of “official supplier of X” to the Dallas Cowboys, but only if they were prepared to essentially supply goods or services for free. Same attitude, just in a large commercial business. (In that situation, those businesses had to make a commercial decision as to whether losing money supplying the Dallas Cowboys would be compensated for by the marketing bragging rights and networking opportunities bringing in other profitable business).

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GB News – misunderstandings

GB News, the new UK news network, launched this week.

There has been a lot of comment on social media, most of it based on witheringly negative assessments of the studio, the production values and other aspects of the channel. There is also already a campaign to persuade corporations to pull advertising.

The old era of media outlets being owned by corporations and hands-off old-money owners is over. The new generation of newspaper owners are not in it for higher ideals. They are a mixture of hedge funds, which expect a quick return on investment, or they will revert to slash and burn management, and oligarchs operating via front companies.

Oligarchs expect their media properties to be their personal mouthpieces. Sheldon Adelson, the Las Vegas-based casino mogul, bought his local paper, the Las Vegas Review-Journal, for $140 million in 2015 via News + Media Capital Group LLC, a front company. The newspaper promptly became his personal mouthpiece. Jeff Bezos bought the Washington Post for $250m in 2013, which for one of the richest men in the world, was chump change. There is a pattern here.

In the current world in which we live, with the ease of creating internet-based TV streaming channels, a newly-minted oligarch with $100m a year to burn can easily afford to fund an entire operation the current size of GB News. As I am fond of saying, disinformation networks are a lot cheaper to run than an aircraft carrier with a squadron of F-35s. The real world war is the Information War, and the West is currently losing. Some of the oligarchs and plutocrats operating in the disinformation space are almost certainly acting as fronts for governments.

The funding for GB News should be a big Tell as to its intended positioning. The majority of the funding is from corporations not domiciled in the UK, and a lot of the funding comes from the “front” corporations of oligarchs and plutocrats. This is not a benign news channel, trying to thread the needle down the middle, or engaging in fearless investigate reporting. It was intended as a propaganda channel for pluto-populism. Its presenter roster is dominated by a combination of established UK tabloid blusterers, and newer internet-based provocateurs, long on mouth and short on information.

As for the crappy production values…the cynic in me says that GBNews doesn’t mind having YouTube production values, since it is appealing to people who mostly get their news from YouTube.

GB News is not competing with the BBC, Channel 4, Sky or any of the other established UK news channels. It is a propaganda outlet largely funded by oligarchs, designed to generate dopamine clickbait for nativists and fans of plutocrat-controlled fascism. Comparing it with those channels is tempting and easy, but misses the entire picture in terms of its underlying objectives and market positioning.

The campaign to pull advertising may well succeed. However, like Fox News in the USA, the funding model of GB News is not dependent on advertising. If all they have are gold and crypto-currency snake oil salesmen as advertisers, they won’t care. The purpose of the network is not to be a commercially successful news channel with blue-chip corporate advertisers. This is already obvious from the decision by the network to launch a smear attack on Ikea, one of the corporations that pulled its advertising. Ikea is a European corporation headquartered in an EU country. Attacking a European corporation ticks all the right boxes when your intended audience is nativists, and nationalists.

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Property Market notes – local

The property market in our subdivision is…bonkers.

There is very little property for sale anywhere in the USA right now. I have been looking at Hawaii and California at intervals, and our across-the-street neighbor is a realtor.

She confirmed my suspicions a few weeks ago when we briefly discussed the state of the market. Normally, in a price boom, there is a lot of inventory as lots of people are trying to move up or cash out, but there are also a lot of buyers, so prices are being bid up.

Right now, prices are booming, but there is no inventory to speak of. There are very few properties coming onto the market, but there are willing buyers. So any time even a half-way decent property comes onto the market, there is an unseemly stampede and, quite often, a bidding war. This results in many properties, even sub-standard ones, going for way more than the initial asking price. This has been happening in Hawaii, where even tired condos from the 1960s and 1970s have been selling significantly over the asking price. (Quite why a 367 square foot tower block box should attract such interest is not clear to me, unless speculators are buying, which is very possible).

Here in our subdivision, a very nice 4 bedroom 3000 square foot 1978 house went up for sale 8 days ago, and is now Under Offer. Not sure if it is under offer for more than the asking price, but we saw lots of people visiting it last weekend immediately after it hit the market. The house is well looked after, with an excellent frontage, but no pool, and the interior is dated. (All medium color wall wood, typical of many houses here built in the mid-to-late 1970s).

2 doors down, a property with not much kerb appeal, also appears to have sold, after being on the market and vacant for 3 or more months. We saw evidence of people moving in this weekend.

We have mentally upped the value of our house based on watching local price trends in this area. It may not help if we stay in the USA, because prices are rising everywhere, but if we move to Costa Rica, it might give us the ability to buy a better house there.

UPDATE – The latest feature of the market is apparently that sellers are demanding that prospective buyers waive their right to an inspection in order to even be considered as buyers.

From a safety perspective, this would be unacceptable to us. When we lived in a rented house in 2009, we found out that the property company that owned it had filed Chapter 7 bankruptcy, which meant that the house was up for sale. We actually attended a court hearing in Fort Worth to validate this. When the trustees confirmed that the house was for sale, we ordered up an inspection. When we both returned from work, the inspector was finishing his report on his laptop in the kitchen. He said “you will have a 30 page report in a few minutes, but I can sum up my findings in one word. Run”. The report detailed a long list of issues, which would have cost upwards of $70k to fix before we could even be sure of getting a mortgage. We passed, and found our current home a few months later.

Asking buyers to waive an inspection is understandable from people who want a quick sale. It enforces information asymmetry, with the buyer being less informed than the seller. This is favorable to the seller. Some people will take the gamble. We won’t.

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The art and science of Kompromat and Jeffrey Epstein

It is clear by now that the late Jeffrey Epstein, over a period of over 20 years, operating behind the front that he was a hedge fund owner and money manager (and it was a front with little substance to it, as this article makes clear), was running some sort of covert operation to befriend, flatter, and ingratiate himself with a large number of plutocrats, oligarchs, businessmen, academics and other sorts of celebrities.

Epstein had an expansive and expensive lifestyle with no obvious means to finance it, and traveled wide and far on personal jets with all manner of people. Logically, the only tenable explanation was that Epstein was collecting money (and lots of it) from people who suddenly found themselves either indebted to him, or people who controlled him and were paying him for the influence that he was exerting on those indebted people.

The list of people who Epstein befriended and ingratiated himself with is a long one, and the extent to which some of those people interacted with Epstein is slowly becoming clearer by the day.

The most recent burst of re-examination has been triggered by the news that Microsoft co-founder Bill Gates and his wife Melinda French Gates will be divorcing. Gates, it is now clear, was spending a lot more time with Epstein than was previously known or publicly admitted. Allegedly, the relationship between Gates and Epstein, dating back to 2011, was the root cause of Melinda French Gates initiating the divorce. (It now seems that Bill Gates was also playing away with other women during their marriage, an ironically unsurprising event when you consider that his marriage originally started as a workplace romance with Melinda).

Since retiring from Microsoft, Bill and Melinda Gates have been devoting their time to their charitable foundation. Gates, richer than Croesus, probably had no need of basic financial advice, and as this article points out, it is unclear why Bill Gates thought that Jeffrey Epstein should be any better as a source of philanthropic advice than any one of hundreds of other well-connected people. The excessive contact with Epstein led to Gates resigning from the Microsoft board in 2020, under the pretext that he needed more time for philanthropy.

The general public’s conspiracist worldview of Jeffrey Epstein, who, it is well-established, had a liking for girls well under the legal age of consent, has coalesced around the conviction that his strategy was to ingratiate himself with the rich and famous (always men, you will notice) and then entrap them by offering them female juveniles as sexual playthings. Epstein’s arrest and extraordinary plea deal in Florida, when he eventually pleaded guilty in 2008 to state charges of procuring a person under 18 for prostitution and felony solicitation of prostitution, was essentially an escape from what could have been many years of incarceration. He served 13 months, most of it on work release in a private wing of a county jail. The deal has been criticized ever since it was revealed, and the States Attorney who agreed to it, Alex Acosta, has taken the brunt of the criticism, ultimately resigning from his role as US Secretary of Labor in the Trump Administration.

Epstein’s arrest on further sexual abuse charges and his mysterious death in jail have cemented him in the public gaze as primarily a pedophile and pimp for would-be pedophiles. However, that seems way too simplistic. Not every adult male is a pedophile-in-waiting. Some, after all, are gay or bisexual, which are also traits making them vulnerable to entrapment.

If Epstein’s business was entrapment and capture of assets for his controllers (who, I believe, were Russia and Israel, with Ghislaine Maxwell as the intermediary for the Israel connection), then there were plenty of other behaviors, many related to business, that Epstein could have facilitated, that would provide leverage to make people compliant and willing accomplices.

Money laundering is the main alternative explanation. Ever since the collapse of the USSR in the 1990s, Russian oligarchs and business leaders have been adept at moving large sums of money out of Russia to other countries for investment and enjoyment purposes. This is particularly true in locations like the UK, which appeals to Russian oligarchs because of its low taxes and plaintiff-friendly libel laws. There is plenty of evidence that wealthy Russians have been laundering large sums of money into and via the USA, often using a well-established process of buying apartments or property using cash instruments from overseas corporations, often paying well above market rate for the property, in which case a later-kick-back occurs to the buyer, moving cash into the buyer’s US bank account. Once you have engaged in money laundering, you are highly vulnerable to prosecution if that scheme is revealed.

In due course, I expect that it will be revealed that large parts of Donald Trump’s business empire were maintained by money laundered from Russia. There are all manner of businesses and business transactions inside Trump’s empire that in pure business terms, make no sense, but which do make sense in the presence of money laundering. The connection between Trump and Epstein was probably part of a web of people all working covertly to move money around the world, mostly in defiance of local and international laws.

My verdict is that Epstein wasn’t too concerned about how he entrapped people. He would get to know them, discern their vulnerabilities and primitive desires, and create a scenario which capitalized on those vulnerabilities and desires to get them to engage in activities which were highly illegal. If the activity was recorded in detail, with Epstein in possession of the evidence, then that person was now beholden to Epstein, and he could call in one or more favors from them at a later date, or get them to support covert activity on behalf of his controllers…or else…

Epstein was smart and cunning enough to realize that he needed to create a fig-leaf of intellectual heft for his activities. He also befriended academics and intellectuals, even if, in most cases, it is not likely that he was going to get any RoI from them for his controllers. Most likely he wanted to burnish his credentials as a mover and shaker, and provide a veneer of sophistication for his activities. Many intellectuals are vulnerable to flattery, and being sat next to world leaders in business or technology at dinners at posh venues would inflate their egos significantly. Ditto world leaders. The likes of Bill Gates would no doubt be flattered to be able to converse with leading intellectuals, as a form of validation that they had ideas of substance, and were not simply driven assholes who had been ruthless enough and/or lucky enough to accumulate large piles of money.

The underlying purpose of Epstein’s social strategy remained the same; to seduce wealthy and influential people who could be manipulated for the benefit of his underlying client controllers. Intellectuals like Steven Pinker were a bit of glitter dust to provide a veneer of sophistication and class, and occasional help in the form of testimonials as to Epstein’s probity (cough).

Was Jeffrey Epstein murdered in jail? Given how much information he must have possessed on hundreds of people, it is safe to assume that many of those people desperately wanted him to be silenced. His controllers would also not have wanted his role for them to be revealed. The two prime suspect nations have a track record of eliminating people who might threaten the security of the state. Never mind the individuals whose predilections for under-age girls would prove deeply awkward. (Including a certain member of the UK royal family). Quite simply, too many people would have benefitted greatly from Jeffrey Epstein’s demise. So, he obligingly died.

Whether enough evidence has survived Epstein’s demise, we do not really know. However, Ghislaine Maxwell is still alive and is in custody, and she may, to use an old phrase, know where many of the bodies are buried.

Ghislaine Maxwell is probably also terrified of being eliminated in jail. However, if she is released, I expect that she will disappear, and then show up either dead, or in Israel, which has no extradition treaties with any other countries. I am still puzzled about why she did not flee to Israel when she first disappeared. It may be because Trump and Netanyahu had, by all accounts, a tenuous relationship, with Trump pissing off Netanyahu with some of his clumsy attempts at Middle East power plays. Or it may be that with Trump still in power in the USA, she considered herself safe in the USA, or likely to be pardoned (which would be a tribute to her hubris, since as we are now seeing, Trump pardoned few people. Narcissists regard people who are no longer useful as totally expendable).

We will continue to see more revelations about more people who were, even transiently, in Jeffrey Epstein’s orbit. I expect that in due course some of them will end up in receipt of felony charges. I also expect that politicians of both parties will be found to have been pulled into the Epstein circle. Epstein was shrewd and calculating, and if politicians of both parties were beholden to him, then he and his controllers would have influence, no matter which party held power in the USA.

The recent plea deal by Joel Greenberg has led to excited talk that Matt Gaetz is due to be indicted any day now. My suspicion is that the plea deal by Greenberg may turn out to be more related to Jeffrey Epstein. Both men had homes near each other in Florida. Greenberg, superficially, looks to have been engaging in similar (albeit lower-budget) activities to Epstein, but there might be more of a connection between the two men than many people realize. (Although Greenberg probably doesn’t want to suffer the same fate as Epstein). The fact that Greenberg bargained 33 felony charges down to a guilty plea to only 6 suggests that he must have offered a LOT of information (translation: Names) to trade away to make those other 27 felony charges disappear.

None of this will unfold on the timeframe that people want. The wheels of justice do grind exceedingly slow. But they grind.

 

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Long Covid – my saga continues

Without going into too much detail, I am a Long Covid sufferer.

I contracted Covid-19 at the end of December last year, and although I was never sick enough to require medical treatment or hospitalization, I have been impacted since mid-January by an array of medical conditions and symptoms, none of which I have previously encountered. While none of the issues has been remotely life-threatening, the fact that I am now suffering from at least 4 conditions that I never previously suffered from is, at the very least, concerning, and on a practical level, worrying or worse. Quite simply, I am having to face the possibility that my quality and duration of remaining life may have been shortened by exposure to Covid-19. That is forcing a re-appraisal of what I want to do on several different levels.

One of my frustrations is that it is clear that the medical profession currently has no effective process for dealing with Long Covid. At the moment most medical professionals seem to treat the symptoms as disconnected from Covid, as if they were somehow random events. When I explain to medical professionals that I was infected by Covid in December 2020 the reaction is “meh”. There seems to be no willingness to take seriously the concept that a seemingly transient viral infection can cause numerous medium-term (and possibly long-term) symptoms. The medical process of observe–> investigate –> determine –> treat breaks when exposed to Long Covid patients, since in many cases there is no obvious root cause, and the possible culprit (the Covid-19 virus) seems to have disappeared from the body. As a result, many Long Covid sufferers are reporting that doctors are deciding that their symptoms have mental causes, so they are being referred to psychologists and psychiatrists. When you have a physical ailment, being referred to a psychologist is going to be seen by most people as a rather unsubtle message of “I don’t really believe you”.

Can I prove that my medical issues since January 2021 are caused by exposure to Covid-19? Maybe, maybe not. I am in my mid-60s, so my body is getting older, and with age comes deterioration in some fundamentals of the operation of the human body, especially the immune and circulatory systems. Could this deterioration have coincided with my exposure to Covid? That is possible. However, when a formerly very healthy person like me suddenly suffers from at least 4 different medical conditions that I previously never suffered from, I start to regard coincidence as a low-probability explanation.

 

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Briefs – Monday 30th June 2020

  1. Covid-19

Covid-19 is running up exponentially in Dallas County.

We need another lockdown IMMEDIATELY. We are staying locked down. I wish I could say the same for other people, but not only are a lot of people swanning about without a care in the world, some of them are still not wearing masks.

2. A week of UK government ineptitude in a Thread

Yes, it really is this bad. The government is incompetent, venal and corrupt. And way too many electors in the UK voted for it. Buckle up kiddos, it’s going to be a wild ride. Especially after 1st January 2021, when the full impact of the UK’s departure from the EU is felt for the first time.

The government’s decision to invest up to £500 million in a bankrupt satellite internet service provider looks more foolish the more you examine it. 

Tonight the deadline for the UK to request a Brexit extension passed. The UK is now on the clock and on the path to the original wet-dream outcome of many Brexiteers – a No Deal crash-out at the end of the year.

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Thoughts about The New Normal

Here, in no particular order, are some thoughts about what will happen in the wider world.

Inflation

Any business model that relies on packing people into a confined space will either adapt to packing in fewer people, or the business will not survive. This means that any and all businesses relying on human contact for sales will, in order to survive, have to raise prices significantly. This will ripple through the economy in nearly all countries. Food supplies, eating out and other social interaction events, travel and vacations will all substantially increase in price.

Doomed Business Sectors

1. Commercial real estate

Apart from when I am on the road doing consulting with clients, I work from home, and I have done so since 2007. My wife’s employer has moved all of their employees to home working in Dallas since Covid-19 showed up. That is 500 people no longer commuting to work in Farmers Branch, most of whom will not need office space in the future. This is happening all over the business world. Many service industries that do not require human contact for the delivery of services do not need to have everybody working in the same physical space. The idea of co-locating people is a historical relic from before telecommunications. 

I expect massive drops in the value of commercial real estate over the next 2-5 years, with associated bankruptcies and the calling in of bulldozers to eliminate old buildings. Many business districts will shrink in size.

 2. Large commercial jet manufacturers

Boeing and Airbus, in their current form, are doomed. They will need to adapt current and future designs to include better air quality management (including micro-particle scrubbing) and re-configure seating to allow for physical separation. Right now, any pending orders for new jets are highly likely to be cancelled. There are no airlines with the money to buy new planes. It would not surprise me if they are already looking at Ultra-Wide-Body design changes. The move in recent decades has been away from wide-bodies (747, A380) back to narrower-body planes. Airlines (those that survive) may want wider planes so that they can impose wider separation between passengers. It would not surprise me, for example, to see a radically reconfigured A380 with only 200-250 seats total.

3. Cruise Line companies (except the eco-nichers)

Despite the trumpeting of cruise lines about late Summer bookings, their business model has just been holed below the waterline. A lot of smarter people are going to regard the idea of sharing a virus incubator with 3500 other people as…not smart. Your $10k cruise to the Galapagos Islands on a 50-cabin luxury liner will still be available, but the $599 dash down to Cancun for a week on Leviathan Of The Seas? Not likely to be available any more. 

I expect many current cruise ships to be laid up by the beginning of 2021, and scrapped by 2025. The cruise lines, like the airlines, will need to retrofit their vessels to implement the concept of social distancing. That will, at the very least, reduce the number of passengers, and will increase cruise costs substantially.

4. Sports bars

Many city restaurants and conventional bars have been transformed into sports bars, because people tend to drink more standing up, and alcohol sales are more profitable compared to food sales. Those venues are going to rapidly disappear. They can clearly be seen as proximity incubators.

5. Major sports and entertainment stadiums (especially NFL)

Any large-capacity venue of this type has a major challenge. The worst impacted will be the NFL, where the economic case for a permanent stadium for a team guaranteed less than 10 home games a year has always been tenuous. The leap-frogging of stadiums (bigger and better) has always been driven by owner vanity rather than proven practical need. Baseball ballparks do at least have a significant number of home games a season. The NFL…nope. Most of the venues have other facilities to try and make them economic. Those other facilities such as conferencing and concerts are going to be doomed (see 1 above).

Concert venues are most likely doomed. Those arena rock stars are going to have to find other sources of income in the next 1-2 years. Major venue owners have to pray that the pandemic fizzles out before they have to close, unless they can figure out how to go drive-through (see below). 

Impacted Business Sectors

  1. Restaurants 

Any venue relying for its business model on packing people in close proximity for lenghty periods of time either adapts or will not survive. A lot of smaller restaurants are going to disappear. The economics of restaurants in most countries have always been marginal. 

2. Tourism

The move to a two-tier travel world (see below) is going to reduce the size of the tourist sector in many countries. 

Boomed Business Sectors

  1. Aircraft scrapping and recycling

Many airlines are going out of business, and we can expect major reductions in routes, especially internationally. Companies that recycle old airliners are going to enjoy a boom. 

2.  Drive-in cinemas

Suddenly, the idea of driving into a location in your car and watching a movie sealed in your car or, at the very least, physically distanced from others, looks rather smart. 

3. Home delivery services

For people who can afford it, having items delivered instead of engaging in superfluous human contact will look very attractive.

4. Immunization registries

Any IT corporation selling an Immunization registry product is going to…become very busy. I expect immunization records to become an essential document in the pandemic era. We will all need an immunization record, and if we do not have one, our movements will be restricted. This may apply inside and outside of the USA.

Two tier global travel

There is evidence that countries who regard themselves as having successfully managed Covid-19 contagion are already forming alliances with other countries. This is rapidly going to create a two-tier travel world. The Tier 1 countries will allow residents from other Tier 1 countries to enter with normal travel documents. Any traveler from a Tier 2 country who arrives will either be rejected and told to go elsewhere, or will be admitted only under strict quarantine rules (usually a 14 day lockdown).  The same conditions will apply in reverse. Travelers from Tier 1 to Tier 2 countries will be admitted, but when they return to their country of origin, they will probably be forced into quarantine, which means that unless they work from home, foreign travel will become logistically impossible for many.

(NOTE: This will eliminate a lot of tourism). 

Right now, the USA and the UK would be Tier 2 countries. The majority of European countries, with the exception of Sweden, are likely to be Tier 1. Most Eastern countries are comfortably Tier 1. 

Note that the Tier classifications of countries could change. Countries that relax lockdown too soon and too much may suddenly find themselves hit by a second wave of virus contagion, and if the virus mutates sufficiently to eliminate all prior human immunity, the entire contagion cycle could begin all over again. 

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