Since the election, there have been a couple large themes going from article to article. The first is that far more people over age 65 voted than people under 30. The percentage for those over 65 was higher than usual, and the under 30's were especially abysmal. The other one is that turnout overall was the lowest since 1942, and remember, that was a year that many were away fighting WW2.
I have a small group of friends who discuss things like this, and attached to the FB post was a comment from a friend who said, in response to a comment about voter suppression being one of the factors that kept turnout low, which said in part:
Turnout was low, but I think voter suppression played only a small role in it.
I think there are two big things that kept turnout down:
1) This really wasn't a particularly important election. ...
Really? Not important?
So here we have, from a man who is not under 30, and who is very smart, and someone interested in politics and policy, the pronouncement that there are elections that are not important.
If people like this man hold that opinion, the overall problem is more serious than I'd thought.
ALL elections are important, and I'm incredibly confused as to why someone would think otherwise. Here in Pennsylvania, our primaries are late because that's when school budgets and some ballot initiatives show up. Where my taxes go are important to me.
In odd numbered years, in a lot of states, that's when the state legislatures are elected. You remember them, the folks who write the redistricting maps every 10 years and in some states appoint judges. Also in odd years are often row officers, the ones that set local policies, run the schools, decide whether local potholes are fixed and storm water problems are solved, to name a few.
Off-year even year elections? EVERY member of the House of Representatives and a third of the Senate. You remember them: the folks who set policy on things like health care, climate change, foreign policy, declaring war not to mention confirm presidential nominees like SCOTUS. The current Congress is why we have measles at the highest rate in 30 years and no Surgeon General.
There is no such thing as an unimportant election. And since too many people are mistaken about that, individual votes in local and off-year elections count more. Which is how some elections are won or lost by five votes, or one vote.
Voting matters. Being involved matters. Get involved NOW. Carry voter registration forms in your car, so when you come across someone who isn't registered you can fix that problem quickly and easily.
Sometimes I email copies of my articles to a distribution list. I did that with this article. I received a note back which asked why I was sending it because it was preaching to the choir. Why? Because that's how you get them to sing.
World War I – known at the time as “The Great War” - officially ended when the Treaty of Versailles was signed on June 28, 1919, in the Palace of Versailles outside the town of Versailles, France. However, fighting ceased seven months earlier when an armistice, or temporary cessation of hostilities, between the Allied nations and Germany went into effect on the eleventh hour of the eleventh day of the eleventh month. For that reason, November 11, 1918, is generally regarded as the end of “the war to end all wars.” [...]
An Act (52 Stat. 351; 5 U. S. Code, Sec. 87a) approved May 13, 1938, made the 11th of November in each year a legal holiday—a day to be dedicated to the cause of world peace and to be thereafter celebrated and known as "Armistice Day." Armistice Day was primarily a day set aside to honor veterans of World War I, but in 1954, after World War II had required the greatest mobilization of soldiers, sailors, Marines and airmen in the Nation’s history; after American forces had fought aggression in Korea, the 83rd Congress, at the urging of the veterans service organizations, amended the Act of 1938 by striking out the word "Armistice" and inserting in its place the word "Veterans." With the approval of this legislation (Public Law 380) on June 1, 1954, November 11th became a day to honor American veterans of all wars.
And honour we should. (Hi daddy, I love you.) I don't know if there are any surviving vets from WW1, but we all know vets from WW2, Korea, Vietnam, Iraq and Afghanistan. Not to mention the men and women who voluntarily joined the service in times of peace, ready to serve.
Whether voluntary or conscripted, and whether serving in a "good" war or a "detested" war, these men and women went off to stand for America. In freezing cold, blistering heat, in daily danger. They deserve our respect and our thanks. A special call out to those conscripted for Vietnam: we should have been much more kind when you came home.
Shamefully, we as a society do not give to these brave men and women what they deserve. Last year, 2,266 vets died because they lacked health insurance. An inordinate number live on the streets. Too many suffer from physical and mental afflictions for which they cannot get treatment. There is a new website to help vets find jobs. It comes NOT from the Department of Veterans Affairs, but rather from Homeland Security.
So today, instead of using this as an excuse to shop the sales (how is it that we commercialize EVERYTHING?) call a vet you know. Say thanks.
The DNC is about to embark on a costly, time-consuming deep dive into what when wrong in 2010 and 2014. It's a waste of their time and our money. The process will be run by a lot of the same people who caused the problems, and will be published filled with pretty pronouncements of "cure" that are never implemented.
Allow me to present both diagnosis and cure:
Give Democrats reasons to be Democrats.
Diagnosis: We do a lot of good that people appreciate. We then run away from our successes, dwell on our failures, message poorly, and enable the Republicans to move the goalposts.
Cure: Stop it.
More detailed explanations:
#Bold Progressives, and a whole lot of progressive Democratic groups on Facebook constantly list successes related to everything from the ACA (PEOPLE HAVE HEALTH INSURANCE WHO NEVER DID BEFORE!!!!!) to Gay Marriage to decreased unemployment, lowered Federal debt....here is a list of 269 of them. We do these things and then we keep quiet. We need to message these things constantly NOW. When it doesn't matter in terms of turning out the electorate, so that people vote like they brush their teeth.
We need to be proud of our positions. For years, the DSCC has run "safe" candidates in purple districts. We need to run people who support the platform positions on both social issues and economic issues. And have them run ON the party line. Create a clear contrast between our positions and those of our enemies (and yes, we need to view them as enemies). This needs to begin at the local level. We should be recruiting local, county and state candidates for the next cycle (which is 2105, kids, and not 2016) because these are the people who should be banging doors in January 2015. We win by taking our country forward at every door, and we start early. It's not all about the White House. Face it, the Congressional District maps are the way they are because of the STATE legislatures. Think about it, acti on it.
We need to spend money to fight the war chests of the plutocracy. We should be advertising nationwide on TV, by web ads, radio ads and print ads. Pointing out "this is what we've done for you lately". As a corollary, we need to publicize what we try to do that gets stomped by the Republicans and call out our enemies by name.
Our elected officials, especially in the Senate, need to avoid capitulation at all costs. Filibuster when the Republicans try to pass clean coal legislation that kills the economy. Publicize WHY we're doing it. And stand up publicly and make a floor speech, no secret holds. Elected officials from Boards of Supervisors on up should email/snail mail missives regularly to Democrats encouraging them to attend local meetings, and to contact their Republican reps (think: my state Senator is a Democrat, but my Assemblyman is a Republican, or my favourite Supervisor is a Democrat, but the full board runs red, etc.) and tell them "this is how I, your constituent, want you to vote." It matters - people want to get reelected and listen to the majority who contact them.
We need the 50-state program reactivated. We need people who have money to give until it hurts (for my plan, not the current DNC plan). We need people who don't have money to knock doors in their neighborhoods to tell their neighbors WHY they're Democrats and why organizing NOW matters.
We need to support the door knockers with materials paid for by the people who have money and no time. We need to get VoteBuilder to the point where it works for local levels as it does for national candidates: share the data, enable lie updates to the database that hold.
When the Republicans do nasty, underhanded things that move the country towards even greater corporatism, we need to not only call them out, but also the media that buy into and promote those agendas. Write letters, send emails, make calls.
We know what works in presidential years, we need to mirror that as local, platform based and not just personality based. We need to get the campaigns to work together. We need to build local Democratic organizations that depend on people power and not the powers that be. We need to engage young people.
We need to support one another. We need to stand up for our president who is the veto pen between us and the Middle Ages. We need to push the positive and ignore things less perfect. We - EACH AND EVERY ONE OF US - need to be proud of the good things, and flash back to what a Democratic Congress can do. We need to leverage the recent accomplishments of California as a blue state, and point out what could happen elsewhere.
We need to support independent, progressive blogs. Our news sources cannot be the MSM only. We can't depend on Facebook to cull the information we need. Back in 2008, there were several hundred progressive blogs, with varied voices, now there are very few. We need voices to speak and be heard. This is how resistance works.
We, each and every one of us, need to stand up and be counted. We need to activate our friends, family, coworkers and neighbors. We need some direction from the party, but we need to run our party. Think about 2008: the platform was designed at the local level which wrote priorities at small gatherings, moved those line items up to the counties, then the states and finally the National committee. Six years later: all gone. When WE THE PEOPLE lose our participation, we lose elections. If you don't remember "WE THE PEOPLE" click here. Quiz on Tuesday.
Start now. Tell your local committee, your state and county committees, that you're ready to get involved. Write the DNC. Let them know that you are holding them accountable to work WITH you, and not just asking for money.
It's up to all of us. We're the resistance, and in the end, we will prevail.
When same sex marriage was last in the news, the U.S. Supreme Court had declined to review decisions striking down bans on same sex marriage from the first three circuits of the U.S. Court of Appeals to address the issue since the U.S. Supreme Court invalidated part of the Defense of Marriage Act. Shortly afterward, the Ninth Circuit made the count 4-0.
Today the U.S. Court of Appeals for the Sixth Circuit (Kentucky, Michigan, Ohio, and Tennessee) made the count 4-1. Aside from the impact on the residents of these four states, this decision changes the picture in a legally significant way. While there is no requirement that the U.S. Supreme Court take any case, the U.S. Supreme Court in its own rules suggests that it sees the need to resolve splits between the various circuits of the U.S. Court of Appeals on issues of federal law as a primary consideration in determining which cases to hear. Five weeks ago when all of the appellate courts had reached the same result, there was no split to resolve. Today, there is.
At this point, the couples in these cases (the Sixth Circuit heard six separate cases from all four of its states together) have a decision to make as to the next step. Which option they take might matter to folks in the other courts still considering appeals on this issue.
Option Number 1 is to file a motion for rehearing. Because of the number of appeals filed in federal court each year, the federal court of appeals is divided into regional circuits and, even within those circuits, judges hear cases in panels of three. To assure consistency in the decisions within a circuit (and to avoid a meritorious claim failing due to bad luck in the process of randomly assigning cases to panels), parties can file a motion to have the case re-heard by all of the judges of the court. While these motions are rarely granted, there is no legal downside to requesting a rehearing. The very act of filing a motion for rehearing extends the deadline for requesting the U.S. Supreme Court to take the case.
Option Number 2 is to give up the chance for rehearing and proceed directly to the U.S. Supreme Court. There is no legal advantage to this option, but there is a practical advantage -- it gets your case to the U.S. Supreme Court sooner.
This is where other considerations enter into the equation. First, while the cases were heard together, these are still technically six separate cases. Each set of couples get to make their own decision on what they want to do next. Similarly, there are four sets of state officials who get to decide how to respond.
Second, aside from the fifteen days to make this decision, there is a second time crunch. The U.S. Supreme Court briefing rules effectively require the U.S. Supreme Court to accept a case by mid-January in order to hear the case in April and decide the case by the end of June. While the proponents of same sex marriage would prefer a favorable decision from the U.S. Supreme Court sooner rather than later, it's not clear that trying to cram this case onto the April argument calendar is the best way to get a favorable decision. Even if the couples want that quick of a decision, the states will have thirty days to respond to any application and it is not unusual for parties to get an extra thirty days to file the response. Thus even if the couples want to force a decision this term, the states could push it off to next term without any unusual tactics. Under these circumstances, the delay from filing and losing a motion for rehearing will probably have little impact on the Supreme Court hearing the case in Fall 2015.
Third, given the composition of the full Sixth Circuit, there is a decent chance that a motion for rehearing would be granted. If a rehearing is granted, the full Sixth Circuit might find in favor of the couples. While this would be good for couples in these four states, it would eliminate the split in the circuit and, thereby, make it less likely that the Supreme Court would take one of these cases.
Fourth, while a split between the circuits is a factor in the U.S. Supreme Court's decision to take a case, it does not have to take any case. In not taking the earlier applications, the Supreme Court Justices potentially gave a sign that they do not want to take any same sex marriage cases at this time (as opposed to a sign that they approved of the lower court decisions in the earlier case). By not asking for rehearing, the couples give up a chance for getting relief from the Sixth Circuit without any assurance that the Supreme Court would take their case. Additionally, if the Supreme Court declines to take a case upholding the bans on same sex marriage, such a decision would clearly signal that the Supreme Court has not yet taken a position on the validity of such bans (encouraging the remaining, more conservative, circuits to uphold the bans in their states).
Fifth, there is a school of thought that the Supreme Court is not going to take a case on whether a state has to accept same sex marriage until almost every state allows same sex marriages. If that is the case, the only chance that these couples has is a motion for rehearing.
Sixth, there are actually two separate issues in these cases. Some of the cases involve couples seeking the right to marry in their home state. The rest of the cases involve the more limited issue of whether a state has to recognize a same-sex marriage performed in a state that allows same-sex marriage. This second issue is more narrow, and some think that the swing votes on the Supreme Court might be more willing to consider this issue (which after all would merely extend the earlier ruling that the federal government has to recognize such marriages to the state governments). Thus, it is possible that the couples seeking "recognition" might decide to go directly to the Supreme Court (after all, if the full Sixth Circuit recognized a right to marry these couples would still effectively win) while the parties seeking the right to marry ask for rehearing by the Sixth Circuit.
It was worse than imaginable - Virginia? Really? VIRGINIA? That certainly wasn't on anyone's radar. Add in the unknowns of Louisiana and Alaska, and it can get even more gut wrenching.
But it's not just the Senate.
It's the governors. Congrats to Rhode Island for your first female governor. Congrats in Pennsylvania. But Vermont a squeaker? Maine went to LePage over feeding donuts to bears? (Not kidding). Even in Kansas where prominent Republicans signed that they would not re-elect Brownback, and he wins?
Not to mention the House - largest Republican majority in 70 years.
There will certainly be issues for the Republicans going forward. The Senate will be fun to watch, and we'll see how big the tea bag contingent really is in the House when the Speaker election comes up. But for now, there's that issue of placing blame.
And blame sits firmly with the Democrats. We need to take a lot of blame for what happened, we need to analyze the hell out of it, and then we need to do the right things.
I live in a small town with a Democratic Committee. Over the 30 years I've lived here, the demographics have changed from lily white Republican WASP, to a more inclusive society, where Democratic registrations have gone from well under 20% to approaching 40%. I don't generally get along with the local Democratic Party. I tell them the same thing year in, year out. In certain ways, I have the relationship with them that Sheriff Bart has with the town he serves in Blazing Saddles. I have a few friends, but mostly, I get pie from people who don't want other people to know they don't hate my positions. It's actually not that bad, but when it comes to how to run things, we are diametrically opposed. It's a microcosm of a lot of what happened in last night's tsunami.
Democrats have a good ground game, and that shows nationally in Presidential years. But what we suck at is giving people a reason to be a Democrat when it's not that last six months running up to said Presidential election. We are character-driven, instead of platform and policy driven. Our messaging is terrible, and we are too quick to throw our people under the bus in lieu of defending them.
We don't coach our young people. The biggest problem for us in 2016 will be the young people who decide to vote Libertarian because they don't really understand what that means, and they fall for the pseudo-libertatians using the cloak of individual rights as a front for what they really want to do.
This needs to stop now. Today. We need to coalesce around a set of beliefs, stick with them and fight for them. We need to watch what is going to unfold in the Senate and be vocal about it every day.
Think about it: McCain will have Armed Services, Inhofe will have Environment, I don't even want to think about Judiciary. They are going to align with Darrel Issa and hold hearings like we've never seen. They'll put poison pills on funding bills, They are going to impeach Obama in the House, and possibly convict him in the Senate. They are going to try and repeal the ACA. They are going to refuse to sign the UN Climate Change agreement. More troops will go off to war. Taxes will go up for everyone but the über rich. Abortion and certain birth control forms will be outlawed. Common Core is dead. Voter suppression on a mass scale will continue, and this time with no oversight from Justice. And let's not forget that we'll not only be without a Surgeon General, but also an Attorney General and a bunch of other positions, including judges.
Think a return to the Dark Ages.
Yes, kids, they are that bad.
There are things we can do. We need to analyze what happened, improve our messaging, and work hard to keep things in the sunshine.
A blog like this may well disappear, and we are one of the few small, independent progressive blogs around. Six years ago, there were hundreds that have now folded into larger blogs, or just died off. Tom Wheeler's FCC is looking for new ways to make the internet pay-to-play, and we won't be able to afford the cost of a direct pipe to the internet. Wheeler will have brand new allies in the Senate to help him.
I recommend that we take a few days to lick our wounds. Personally, if I had the time, I'd spend the next four days in the bathtub. And then we need to come out fighting. We need to take a serious look from the local committees on up - let the blue successes lead the purple areas, and outreach to the red ones. We need to blog, comment on blogs (not on Facebook, because we need the records), pick issues, write position papers and work when it doesn't seem to matter. My local position has always been that if we give Democrats good reason to BE Democrats when it doesn't matter, they'll turn out to vote for the same reason they brush their teeth: muscle memory.
We need to support our President, for Obama is all that stands between us and annihilation.
So lick your wounds, and remember, as of January, you're either part of the resistance, or you're a collaborator.
I wish I could be as optimistic as when I wrote my last projection in August, when my number was 53. I've seen the Saturday polls, and it's taken me all day to pull out my research and face things.
The first thing I want to say is that we will not know on Tuesday night whether or not we hold the Senate. Louisiana is going to a run-off, and there's a slight chance Georgia will also. Further, Alaska won't be decided until the absentee ballots come in.
Here's what I got wrong: first, I had expected the first domestic Ebola patient in November, not September. You wouldn't think that could affect things the way it did, but the disease of fear is galvanizing. And the Democrats made a very wrong decision in playing into fear instead of going with science. And especially refusing to become very vocal on the issue that the reason funds to CDC and NIH were cut, and the reason we lack a Surgeon General is 100% the fault of Republican obstructionism.
The other problem was that too many Democrats ran away from President Obama - while his personal numbers aren't great, a lot of what he did (think ACA) is something that our candidates should have used.
Plus, there were some terrible mistakes that some of our candidates made, most notably Bruce Braley. Stuff normally reserved for right wingnuts. So -- let's take a look:
Alaska, Mark Begich
I still think he holds. He's got a good ground game, especially in the far reaches.
Arkansas, Mark Pryor
Pryor had a good shot here, and lost it. This is a case where he made no glaring error, except he should have run on women's issues and the ACA , as he had earlier in the campaign.
Colorado, Mark Udall
While the polls don't look as good as I think they should, I believe Udall will pull it out in the end. Plus, this is the first year of all mail-in ballots, and that might encourage people to vote who wouldn't go to the polls.
I just don't know. Certainly, the biggest gaffe of the year belongs to Braley who shouldn't have said anything anti-farmer. And the Des Moines Register has never called Iowa wrong that I can remember. The paper said last night that Ernst was up by 9, but I am hoping that the Democratic ground game pulls through. Joni Ernst is a John Bircher! EGADS!!!!!
Louisiana, Mary Landrieu and a run-off
She'll win on Tuesday, but likely won't break 50%. Thus, this will be a December run-off. Whether Landrieu holds is a function of what the DNC can do to support her. The second biggest gaffe of the year belongs to Mary who pointed out that people in the south hate Obama for being black. True, but truth doesn't normally carry the day in American politics.
Michigan, Gary Peters
North Carolina, Kay Hagan
Oregon, Jeff Merkley
Georgia, Michelle Nunn
I keep hoping she'll break 50%, but am unclear. The run-off here will be in January.
Kansas, Greg Orman
Who woulda thought? And we don't know which side he'll choose.
This is another Iowa. It looks like Mitch will win again, and that as a function of the nastygrams he sent out last week, about which Grimes sued. It will be closer than the polls suggest, I think, and it's painful.
So there you have it. Clear as mud, and we won't know Tuesday. The only silver lining in all this is that if the Senate does flip, it will only be for two years, and if you think you saw obstructionism between Harry Reid and John Boehner, you ain't seen nothing yet. The far right of the House won't be able to align with the Senate. And the Democrats in the Senate will add amendments that put a lot of Republicans up in 2016 in the hot seat. PLUS, don't forget that a lot of Senators (Rubio and Paul to name two) won't be in the Senate most of the time as they'll be out running for President - thus it will be hard for Mitch to get to 51.
While most folks are paying attention to Tuesday's election, the Supreme Court will be hearing arguments on Monday morning in what might be the most politically charged case of the term.
Back in 2002, Congress passed a law allowing American citizens born in Jerusalem to designate Israel as their place of birth on their passports. The State Department for the past twelve years has simply ignored this law, continuing long-standing U.S. policy of treating Jerusalem as disputed territory with its status to be resolved by negotiations between Israel and the Palestinian Authority.
Around the time that Congress passed this statute, Menachem Zivotofsky was born in Jerusalem. His parents, U.S. citizens, sought to have Menachem's passport reflect that he was born in Israel. When the State Department declined, they filed suit on Menachem's behalf.
Thirty years ago, the courts would have dismissed this case as a political question, finding that this dispute was a matter for Congress and the State Department to resolve. While the lower federal courts agreed with this traditional approach, in March 2012, the U.S. Supreme Court set aside two hundred years of history and held that this case presented nothing more than resolving the constitutionality of a statute and sent it back to the lower courts to address the validity of the statute.
Not too surprising, the case is now back before the Supreme Court after the lower courts found that the statute represented an improper interference with the power of the Executive Branch to conduct foreign policy. Technically, this case is not about whether (at the end of negotiations) Jerusalem should be part of Israel. Most Americans support Israel's position in on-going negotiations that Jerusalem will be on the Israeli side of the final borders (and any proposed map from the State Department has reflected this position). The State Department believes that, since the status of Jerusalem is on the table (as the Palestinians still want part of Jerusalem) and the U.S. wants to have a role as a mediator on this issue, the U.S. should not take the position that the status of Jerusalem has been resolved.
The Zivotofsky's take the position that this case (and the statute) merely involve Congress's authority to govern the content of passports. The State Department takes the position that the statute goes beyond the general content of passports and, instead, trespasses on the presidential power to recognize nations and governments (including recognizing borders).
The State Department seems to have the better argument. Nobody is questioning that Congress can require that passports note the place of birth of an individual as a means of identifying the bearer of the passport. The issue is whether Congress can, by statute, decide that a certain city is within a certain country. If Congress can declare by statute that passports will reflect that Jerusalem is part of Israel, Congress could also declare by statute that Belfast and Londonderry were part of the Republic of Ireland (instead of the United Kingdom) or that Kirkuk was part of the nation of Kurdistan (instead of Iraq). Such decisions seem to go to the core of the President's authority to conduct foreign policy.
Transcripts of the argument (as well as a recap) should be available on Monday afternoon on SCOTUSblog with the actual audio being available on Friday. A decision will likely not come down until February (or possibly later).
Imagine for a second. It is Wednesday morning, November 5. The numbers in Alaska are too close to call waiting for the votes from small towns all over the state to come in, Louisiana and Georgia are heading to run-offs (with Georgia's taking place after the Senate convenes in January), and the current numbers the Senate is 47 Republicans, 45 Democrats, and 5 Independents (with newly elected Senators Greg Orman and Larry Pressler, joining Bernie Sanders, Lisa Murkowski, and Angus King).
While it is almost certain that, in the end, Bernie Sanders will caucus with the Democrats and Lisa Murkowski will caucus with the Republicans, there might be a period of time when these five will work together to make some changes to how the Senate operates to make it less dysfunctional and less party-based. If the election results theoretically turn the independents (especially King, Orman, and Pressler) into the balance of power in the Senate, what changes do you think will take place? What changes would you like to see take place?
For me, I would like to see changes to the filibuster rule. I do not oppose having a filibuster, but I think that the filibuster should be limited to final passage of a bill. Let the bill come to the floor for a debate by majority vote, let amendments to the bill pass by majority vote, prevent the leadership from just substituting a new version for the amended bill at the last second (any leadership substitute being treated as just another proposed amendment), and then permit a filibuster only on the final vote after the Senate has had a chance to address all of the objections to specific provisions in the bill (making it clear that the filibuster is to the concept of a bill and not the substance).
Keeping the requirement for sixty votes for cloture on the final bill would also give the declining number of centrists in the two parties (of course, if we are replacing centrists in the two parties with independents, the result is the same) a chance to work out a compromise version that centrists on both sides can live with.
The fact that an MSF doctor came home with Ebola is not surprising. He will not be the last. We should all thank him for his service during the scourge, and feel lucky that he lives in New York City and was taken to Bellevue in one of the 36 ambulances outfitted by NYC to handle Ebola..
Back when Kent Brantley and Nancy Writebol were taken to Emory, Bellevue started training for Ebola. Bellevue is the oldest public hospital in the United States, dating back to the early 1700's. It has seen its share of things like Tuberculosis and AIDS. Owing to being a public hospital that accepts all comers, it has experience with serious infections like MRSA and CDiff, along with tropical and other foreign illnesses. Its people are world class. Months ago, they not only repurposed eight communicable disease rooms for Ebola, they started training: what to do to care for patients, how to protect the employees from doctors and nurses through security guards and housekeepers. Pair this with the fact that the State of New York included Bellevue on its list of 8 hospitals ready for Ebola, came up with a plan, and have been holding open trainings for a few weeks now. Craig Spencer is in good hands.
Last night, after the Bellevue lab confirmed Ebola (to be re-confirmed by CDC) a press conference was held. Governor Cuomo, Mayor De Blasio, representatives of the Public Health Service, even Tom Frieden via remote connection. They talked, they took questions and they gave direct answers to those questions.
Will Dr. Spencer survive? Statistically, his chances are good. While the mortality rate from this Ebola outbreak is 70%, that's in Africa. That's the inverse of the patients who have been cared for here in the States, with a mortality rate of 10 - 20%. Modern medicine's palliative care is working, and being in specialized facilities instead of tent clinics is also helpful. In addition, the medical community has been taking lessons from what DOES work in Africa: the salt-sugar-electrolyte mixture attributed with helping immensely in Nigeria, keeping the spread rate lower amoungst health care workers. Also, adopting the buddy system and gallons of antibacterial hand sanitizer through the process of removing protective gear.
Will Ebola spread throughout New York City? Highly unlikely. The three people with whom Dr. Spencer had close contact are being quarantined, and it doesn't appear that anyone else, other than the properly protected Bellevue personnel have/had contact with him while he was contagious. Nonetheless, New York is tracing contacts, as the NY Public Health Service has done successfully in prior communicable outbreaks.
The only question is why other states and large cities have not picked up the banner of training, ordering materials, designating hospitals and giving more training. And then more training.
Ben Bradlee, Washington Post editor, passed away yesterday at the age of 93. He will be missed by those who loved him, and remembered thankfully by so many of us involved in writing.
There's a good chance that without Ben Bradlee's leadership and vision, people like me (read: women) wouldn't be writing in public forums about anything other than fashion and letters to the lovelorn. One of the first things he did when remaking the Post was to take the women's section, and make it the Style section - a clean and upstanding forerunner to Page 6 and all that came after. He inspired a whole generation of reporters who dug with his support of Woodward and Bernstein, pushing them to be the best they could be, to check and doublecheck their sources, and to strive to do even better the next day.
We owe him a great debt. He was fearless in publishing the Pentagon Papers after being scooped a few days earlier by the Times, which was enjoined by Justice to quit publishing. He believed in truth and honour.
My favourite story about him is that he was twice divorced when he started seeing Sally Quinn in the 1970's. She wanted to get married, he was gun shy, and famously told her that they'd get married when there was a Polish Pope. They were married 36 years when he passed away.
Go find one of the in-depth obits and learn about his fascinating life: his bravery and decency, his friendship with John Kennedy, the changes he brought to politics and government. He was truly inspirational.
First and foremost, a travel ban to the United States from West Africa will be counterproductive and will help to spread, not contain, the outbreak. Science knows that, medicine knows that, but politically, it's close to inevitable, even though there are no direct flights from that part of Africa to North America.
The saddest part about our fractured politics and polarized electorate is that reason takes a back seat to the political whims of idiots. (For those of you who like to write me about the difference between idiots and morons, yes, I'm using the right choice here with "idiots".)
When doctors do what they're supposed to do they treat the cause of the disease, not the symptoms. When there is no cure, they provide palliative care. In this case the cause is in Africa, and we should be undertaking treatment there. We should be making it easier for doctors and nurses to go to West Africa by insuring that the few planes available to transport Ebola victims are not denied access to America. We should make military transports available for the healers who agree to travel to the region, we should help prop up the private companies equipped to transport sick people.
Further, we should honour our pledge to WHO, and encourage other countries to do so. We can argue later about the disaster that WHO's African branch has been, as now Dr. Chan and her cohorts are coordinating out of Geneva. Of the $20 billion (with a b) that has been pledged, only $100,000 has been received. That was from Colombia. Shame on the rest of us.
And the medical personnel? Only one country has sent its doctors and nurses (the rest are all through aid groups). Want to guess? Cuba. The same only country who sent doctors and nurses to fight cholera after the Haiti earthquake. If we won't support Cuba with matching humans, at least we should help transport their medical personnel here to the US's nine Ebola beds when some of them contract the disease. And they will. Because doctors and nurses are the most likely to contract Ebola - not strangers on a train, not the person across the airport lobby and certainly not someone who just happened to be in the city of Dallas. That's right kids, an idiot city in Maine put a teacher on leave because she was 10 miles from Texas Presbyterian for a conference. I am not making this up.
In addition to sending medical personnel, we should continue to utilize the troops we've sent, and we should send more, to build medical facilities in Africa. Including related infrastructure like roads, sanitation, food distribution. The things our military is actually really good at. I concur with the idea that we should stop bombing for a few days and take those dollars and do something good with them: like save West Africa. This is, for sure, a contrarian view, as polls show most Americans want to kill in Syria, Iraq and the rest of that region rather than save lives in Africa. Most people are idiots.
We should also stop blaming the nurses and doctors in Dallas for not following protocol and admit that Texas Presbyterian HAD no actual protocol. CDC lacked clear guidance, which will likely be issued today and will follow MSF guidelines, modified for places with running water and autoclaves. It will include full body coverage, a buddy system, and rigorous, on-going training. Until then, medical personnel and first responders should err to the side of caution, and stay 3 - 6 feet away from potential Ebola victims until someone dressed properly arrives.
We should also realize that our health care system is stratified, much like our population. Texas Presbyterian has been nicknamed the Neiman-Marcus of hospitals. It is dedicated to rich people and their first world problems. I haven't seen their stats, but I'd bet they see a lot more heart disease, cancer, births and plastic surgery than they do MRSA, CDiff, AIDS or Tuberculosis. They weren't ready. Most private hospitals that spend money attracting rich patients with suites and private chefs are not. Put the money into training and supplies. Increase your nursing staffs and pay them correctly. And, oh yeah, Single Payer....but I digress.
The politics of Ebola are the politics of panic and pandering to the uniformed. The chances of contracting Ebola through the air are nil, and the chance that the virus will mutate to an airborne form are minuscule. Yet, the right wing, the science-averse, and even some people in tight races who should know better prey on the fears of people facing something they don't understand. Something new.
The way we eradicate Ebola is not any different from how we went after other scourge diseases like smallpox, polio, typhoid or plague. We treat what we can, we contact trace, we quarantine, we endeavor to develop drugs and vaccines. We stamp it out as close to the root cause as is possible. We understand that with diseases in new places, there will be deaths, and those are sad and unavoidable. Most likely, those deaths will come more from medical personnel than anyone else.
Thus, we seek to eradicate this outbreak in West Africa by moving people and money there. We protect the medical personnel, aid workers, and soldiers as best we can. We care for those who get sick. While we're there, we endeavor to make the continent better in terms of sanitation and infrastructure, because that will help going forwards.
In this country, we leave the panic behind, and protect our first responders and health care personnel with full body garb, training, and proper procedures for removing, disinfecting and destroying Personal Protective Equipment. We make sure that facilities utilized by Ebola patients are equally disinfected and that the staff who does that work are also protected.
We should focus on what WILL kill Americans in vastly higher numbers in the next months: flu, enterovirus 68, heart disease and cancer.
Finally we should remember that we live in a wholly interconnected world. The reason we didn't look for Ebola cures back in the 70's was because it was Africa's problem. Ditto for AIDS, which first reared its ugly head in Africa in the 1800's. (Yes, 1800's.) And let's not forget Marberg, another African hemorrhagic fever. Not to mention the Middle Eastern MERS, nor bird flu and SARS which hail from China. We need to funnel dollars to researching these diseases before they, too, spread.
So my advice for you? Are you a health care provider or first responder? Full body suits, proper protocols. The rest of you? Live your lives, wash you hands (as always, fingers, nails, fingers, fingers, fingers.) Vaccinate your kids. If you're sick, stay home. If you think you, or your child, is sick with something communicable, stay home and call your doctor. Can't afford a doctor? VOTE, you know the drill.
Above all else, avoid panic and idiocy. This too shall pass, and hopefully we'll learn from our mistakes.
Ebola developed in Africa. It's not a new disease, potentially a very old one, harboured by fruit bats and other fauna. It was first found in humans in 1976, and most outbreaks were limited in scope by geography.
So why is it emerging now? Let's take a look at Africa. It's a young continent, due to massive growth over the last half century. Currently about 1.1 billion people live on the continent. The continent has gone from about 200 million people in 1950. In many countries, half the population is under age 25, owing to war, disease, famine and drought. And that continent is HUGE, second largest in the world. From the northernmost point to the southernmost point, is about 5,000 miles, and from west to east, again, the largest spread, it's about 7,500 miles across. The population is relatively mobile for a lot of reasons. Again, war, disease, famine and drought cause people to migrate. Increasing population leads to growth of both cities and villages. Further, there is little true infrastructure throughout most of the continent. More people have cell phones than landlines. Roads are in many areas non-existent, as are the things we take for granted like potable water, indoor plumbing, walls and roofs. There are tons of natural resources, but they're owned by very corrupt governments. Think a kind of unimaginable poverty.
Illness is a huge problem. Not just malnutrition, starvation, and general infections. Malaria is endemic. Five times as many children are blind in Africa then elsewhere in the world due to a combination of Vitamin A deficiency and measles. Health care? In Liberia, when Ebola broke out this year, there were 51 (native) doctors meaning one doctor for every 76,000 people. More doctors have arrived from MSF and other aid organizations since then.
As people move around, and populations shift geographically, there is more interaction with wildlife. Further, when people are hungry, they'll eat what there is, and that, in Africa, often means bushmeat, which is often infected with all sorts of diseases, including Ebola.
Further, there are certain cultural priorities in Africa, such as interaction with corpses, no matter what the matter of death, and a belief in non-Western healing. Far too many people trust a witch doctor over a European or American one.
The emergence of Ebola in a highly populated area was always a matter of time.
So what is Ebola? It's a hemorrhagic fever. There are five different strains identified so far. It is passed from fruit bats and bushmeat to humans, and then from human to human by exposure to bodily fluids. A full description of the history and epidemiology of Ebola can be found here.
Of note, the viral load of a person with full-blown Ebola is very high. "Viral load" relates to the number of viral cells in an amount of human fluid such as blood, urine, etc. With Ebola, the virus keeps multiplying even for a short time after death. In half a teaspoon, we're looking at thousands of virus cells in AIDS, half a million in Hepatitis C, and up to 10 million in Ebola. Thus, it is more contagious in later stages than other viruses.
And this brings us to why the rate of infection in medical personnel is as high as it is. You've likely seen articles about the huge rate of infection, but not all groups were infected similarly. In African hospitals, there have been many deaths. But MSF has had hundreds of people on the ground with little transmission. And Samaritan's Purse had one infected doctor, Kent Brantly, who is now recovered and donates blood factors to other patients, including today Nina Pham, the Dallas nurse.
Two things: first, Samaritan's Purse personnel were trained by MSF and strictly follow their guidelines. MSF guidelines have been developed since they worked the first epidemic in 1976. These folks REALLY know what they're doing, and their protocols are much more stringent than the "standard" CDC guidelines which are outdated, limited in scope, and not actually useful. The personnel at Emory and in Nebraska follow protocols even more stringent to the MSF ones, as they have access to things like autoclaves that are not exactly easy to find in Africa.
Second, people go into medicine to help people. As people get sicker, they try all sorts of life-saving measures, even when those attempts are futile. Treating Thomas Eric Duncan with intubation and dialysis was too little, too late, and the increased risk from those procedures easily overran the CDC protocols.
The question I keep hearing is whether Ebola will end up making the US look like West Africa. It's unlikely. I am hopeful that the CDC, in concert with NIH will come around to updating their protocols, and that patients will be treated in Ebola centers and not community or even teaching hospitals.
In Part 3, we'll take a look at what governments need to bring an end to this epidemic before Ebola becomes endemic to Africa, and then really does start reaching other continents in epidemic numbers.
There's a lot of panic going around about Ebola. A nurse who cared for the first person to bring Ebola to our shores via public transport has contracted the disease, and doubtless some of her co-workers will, also. There is fear-mongering, and a movement to cease allowing people who have been to West Africa to enter the U.S.
This article is about what we know, and what needs to be done. Future articles in this series will focus on the medical, historical and political aspects of Ebola.
First, and above all, avoid panic. If you want to worry about catching something, worry about CDiff, MRSA, Measles, Mumps, Whooping Cough and Polio. And as always, fingers, nails, fingers, fingers, fingers. Wash your hands. Then wash them again.
Most of the US was unprepared for a patient with Ebola. There are four facilities that are capable of taking care of this level of infectious disease: the Nebraska Biocontainment Patient Care Unit, in Omaha, the specialized unit at Emory University Hospital in Atlanta, the National Institutes of Health in Bethesda, Md., and St. Patrick Hospital in Missoula, Mont. Other hospitals have facilities to treat infectious and communicable diseases but Ebola is of the class Filoviridae, which is hardly ever seen in the Americas. (We'll talk more about the virus itself in Ebola: Part 2 - Medicine.) Most of what is seen here are airborne, and thus reverse pressure suites and "standard" infection protocols are enough. Filoviridae are different, and require health care worker protection more akin to hazmat suits.
Further, despite warnings since February from Doctors Without Borders (MSF, known as Médecins Sans Frontières in most of the world) and other aid organizations with medical teams on the ground in Africa, we didn't take the potential of patients arriving here seriously. No one did: not the government, nor the medical community. No systems were in place, they still aren't. We'll look at this in Ebola: Part 3 - Science and Politics.
There is a reason that the people who care for patients, most likely medical personnel, are most likely to contract the disease. With Filoviridae, the patient becomes more contagious as the disease progresses, in fact, the patient is most contagious when he/she passes away. There are certain protocols we know work to prevent transmission. The two most interesting come from Firestone (yes, the tire people) and their facility in Liberia, and a young nursing student who nursed 4 family members, and saved 3, without becoming infected herself. These two anecdotal incidents should give hope that it is possible to treat patients successfully, if and only if, the strictest of protocols are followed. None of this happened in Texas.
If you're a medical professional, you give up the right to let fear dictate your actions: you depend on your training, and the best information available. I say this as someone who treated AIDS patients in the 1980's, when there was still some question about whether the virus could be spread by tears. You're a doctor, you're a nurse, you chose that profession to save lives. I have great sympathy for those medical personnel who have become infected doing what they love, and that to which they are committed.
But the medical personnel in Texas were led astray by a number of factors. First, as the investigation will likely show, the CDC likely disseminated poor advice, or perhaps rather advice that wasn't stringent enough. No buddy system. No space suits as exist at the four "really ready" facilities. Not enough training. Second, in a great shame to America, we have no Surgeon General, and we've been underfunding science for way to long (thank you, Republican knuckle-draggers, she said with dripping sarcasm.) Third, not enough people have been individually following the blog posts and missives that have been coming out of Africa since February, explaining what is working and what is not working. Finally, as a country, we rely on technology instead of base knowledge.
There are a lot of things that we could do over the next several days that would be of great help in this country. First, we could designate facilities in every major population center, especially ports of entry, that would be exclusive facilities for Ebola patients. They do not have to be hospitals, as Firestone has proven, just facilities. Better that they be hospitals, but facilities can come on line much more quickly. The staffing could include people from the four facilities who could adequately train additional workers. Second, we could set up 800 numbers for people who think they've been exposed. Then, teams could come to them instead of having them come into hospitals. Third, people arriving from West Africa could be quarantined in safe, secure environments. As we've learned from Nancy Snyderman and her crew, people cannot be trusted. Hell, she's a doctor, she should have known better.
There are other actions we should take which will take more time. Nominate and confirm a Surgeon General. Release funds for vaccine and drug research without asking for an offset. (Personally, I'd use the money we're wasting on the ISIS air raids, but that's a different rant.) Start training people.
So that's it for the overview.
Coming up in Part 2 - some history about the disease, the chances of Ebola becoming endemic, and the other related diseases.
This time two weeks ago, most court watchers thought that the United States Supreme Court was certain to agree to review at least one of the cases from the Fourth, Seventh, and Tenth Circuit striking down the state bans on same-sex marriage in Indiana, Oklahoma, Utah, Virginia, and Wisconsin. Then the Supreme Court turned down all of the applications and things began to happen quickly over the past five days.
First, the Ninth Circuit (not too surprisingly) joined the other three circuits by striking down same-sex marriage bans from Idaho and Nevada. Idaho filed a stay application with the U.S. Supreme Court, and Justice Kennedy temporarily granted the stay (preventing the enforcement of the Ninth Circuit decision). This stay application and stay caused some confusion as the application and the original stay referred to both the Idaho case numbers and the Nevada case numbers, but. by the end of the day. it was clarified that the stay only applied to Idaho. Even that stay was listed by the end of the week.
Second, state officials in Colorado (part of the Tenth Circuit) dismissed their state court appeal and agreed to lift the stay on the federal appeal. While not completely final, same-sex marriage is currently legal in Colorado.
Third, a stay on further judicial proceedings has been lifted in the West Virginia case and state officials will not be defending their state ban. West Virginia's official response is due on October 21 and the ban will probably be struck down officially shortly afterwards.
Fourth, a federal judge in North Carolina struck down that state's ban on Friday. As of now, there is no stay on that decision, and it is unlikely that one will be granted.
Fifth, while there is no currently pending federal case in Kansas, a state judge ordered that local clerks begin issuing same-sex marriage licenses, and a review of that decision is pending on an emergency basis in the Kansas Supreme Court.
Right now, there are federal cases pending in Alaska, Arizona, South Carolina, and Wyoming. It is likely that those cases will soon be resolved with the marriage bans in those states being struck down.
The real legal action is in the remaining four circuits that have not yet addressed the issue. The Sixth Circuit (Kentucky, Michigan, Ohio, and Tennessee) heard argument at the start of August. It is not unusual for a court to take three to four months to write an opinion (particularly if it ends up being a 2-1 decision); so most likely a decision will not occur until November.
The Fifth Circuit (Louisiana, Mississippi, and Texas) currently has cases from both Louisiana and Texas. Briefing is complete in the Texas case, but no argument date has been set yet. There will probably be a decision from the Sixth Circuit before the argument date (most likely December or later).
In the Eleventh Circuit (Alabama, Florida, and Georgia), there is a pending case from Florida, but the district court judgment was only at the end of August. With a normal briefing schedule, the argument in the Eleventh Circuit will probably be some time next Spring.
Finally, in the Eighth Circuit (Arkansas, Iowa, Minnesota, Missouri, Nebraska, North Dakota, and South Dakota), cases are moving more slowly with some state court actions and only one federal court actions. It is unlikely, that there will be any decision from the Eight Circuit before the remaining three circuits have addressed the issue.
With its actions of the last week, it now seems unlikely that the Supreme Court will take any case unless one of the four remaining circuits upholds a same-sex marriage ban. Given the current pace of decisions from the lower court, it seems likely that any case on this issue will not reach the Supreme Court before October 2015 (with a decision in the Spring of 2016). If there is no split, the Supreme Court might take a case after the 2016 election to issue a decision after same-sex marriage is de facto recognized in all fifty states merely to ratify those decisions.
With the Supreme Court back in session, the fireworks have already started. As discussed in the previous parts of this series, there are interesting cases working their way to the Supreme Court (with the next key decisions on same-sex marriage now due from the Sixth Circuit -- probably toward the end of this month or in November) as well as several interesting cases in October and November.
We pick up in December. Despite having more argument slots (12 arguments) than either October or November (10 arguments each), December seems to be more about technical cases specific to certain legal practice areas than cases of public significance with two major exceptions.
One case that has drawn a lot of attention is Young vs. United Parcel Services. This case involves the intersection of several anti-discrimination statutes. In particular, the Americans with Disability Act requires employers to provide reasonable accommodations to employees with a physical disability. Title VII of the Civil Rights Act has (at least since 1978) provided that discrimination against a pregnant employee is illegal gender discrimination. The issue posed in this case is whether -- if pregnancy causes a temporary inability to perform certain job-related tasks -- employers need to make the same accommodations to the pregnant employee that they would make for an employee who could not perform those tasks because of a permanent disability.
The other significant case for December is Elonis vs. United States. Technically, the issue in this case is the mental state required by a federal criminal statute. (Traditionally, a crime requires both the commission of a prohibited act and a mental state -- i.e. that the act is reckless or done knowingly or done intentionally). What makes the case significant is that the statute in issue is the federal harassment statute which prohibits the act of threatening others. Because the crime involves speech, there is a First Amendment component to the case. While it has probably been most noticed in the campaign finance area, since the Chief Justice and Justice Alito joined the Supreme Court, there has been a lengthy list of pro-free speech decisions. To the extent that the First Amendment plays a significant role in this decision, it could have a substantial impact on similar state laws (including laws criminalizing the violation of order of protection/restraining orders). These laws tend to be use to protect victims of domestic violence from continued threatening conduct from their exes, so a broad opinion that greatly restricts the conduct that can be reached such laws could result in law enforcement being unable to step in before the ex actually commits a new assault.
At this point, the Supreme Court has not yet set its January argument docket (presumably ten cases). Even before last weeks grant of eleven new cases (the most significant of which were covered in Part 1), the Supreme Court already had five cases available for argument. Three of these cases are potentially of general interest/political significance.