When Narrative Takes Flight

We have been writing about the Widening Gyre for more than five years now.

In 2016, we wrote about the transition we observed within our national politics from a coordination game to a competition game. In more familiar terms, we argued that our politics were rapidly careening toward the bad equilibrium of a Prisoners’ Dilemma, where everyone knows that everyone knows the only way to survive is to defect against the other participant(s). To rat them out, in the terms of the classic game theory problem.

In 2018, we argued that the increasingly bi-modal distribution of political preferences observed by many was a feature of this transition. Because defection was now the optimal strategy in every social or political conflict, we argued not only that political division would increase, but that the need for a high-peaked distribution would cause more and more of apolitical society and culture to be sucked into the gravity of political division. Things that had nothing to do with politics would now take on an explicitly political dimension.

We called that effect the Widening Gyre, a term we shamelessly stole from Yeats’s The Second Coming.

Turning and turning in the widening gyre
The falcon cannot hear the falconer;
Things fall apart; the centre cannot hold;
Mere anarchy is loosed upon the world,
The blood-dimmed tide is loosed, and everywhere
The ceremony of innocence is drowned;
The best lack all conviction, while the worst
Are full of passionate intensity.

― W.B. Yeats, “The Second Coming” (1919)

We have since written and spoken about those many things that have been sucked into the gravity of our dysfunctional politics. We have lamented that the defining feature of American society in the 2020s is that belonging and identity are largely determined by having Correct Opinions, as judged by one group or another. That meant, we argued, that those with affinity for one group or other would be under pressure (more than normal, that is) from inside and out to auto-tune their opinions, news consumption and thought processes to that of the group. It also meant that those with divergent or nuanced opinions on a topic would be ostracized by both of the political poles, their identity imposed on them from the outside.

Anyone who was, for example, a believer in the seriousness of the Covid pandemic and deeply supportive of indoor mask use and social distancing, yet also deeply skeptical of needless business lockdowns and hygiene theater in 2020 knows this all too well. There were a great many Americans who had the singular experience of being simultaneously Full MAGA and Literally Communists, depending on who you asked.

Most recently we wrote about auto-tuning of the apolitical scourge of inflation to political dimensions. But despite its influence on nearly every facet of life for more Americans, the easily cartoonified nature of inflation data makes it unlikely it will ever be the primary theater for our narrative wars.

A year from now it will almost certainly be something else. But today’s chief battlefield of identity narratives is, without question, vaccine mandates.

It is a bit awkward to write about this topic. Ben and I are on the same page, which isn’t always the case. More importantly, we are back in the heretical, heterodox, totally-MAGA-and-somehow-also-literally-communists camp on the topic. We think, given the transmissibility of Covid, that vaccination is a serious and important civic duty. We also think that antibodies from prior infection should generally be accepted as an analog for vaccination. We think government-imposed vaccination mandates on private citizens are not new and that the effort to pretend that they are is bizarre and constructed. We also generally strongly dislike such government-imposed mandates, both old and new. The same principles of liberty which lead us to that conclusion also lead us to believe that private enterprise ought to be able to impose whatever requirements they deem sensible, especially if they operate in industries where concentrated, indoor public contact, especially with vulnerable populations, is unavoidable.

But sometimes a topic gets so tangled up in its own strings of stupid that something must be said.

So yes, ladies and gentlemen, we find ourselves together now at the stage of the Widening Gyre in which your political identity now determines the reality you wish to accept about three days of moderate operational difficulties at the ninth largest global airline, as measured by passenger-miles.

God help us.

Or you know what? No, maybe just send a meteor.

Alright, in case you have not been following closely or don’t have family flying in from Hobby Airport down in Houston to experience something we call “seasons”, the facts and circumstances of the story and its coverage are mostly straightforward:

  • Over a period of a few days, and especially over the Columbus Day weekend, Southwest canceled thousands of flights. Depending on the days you count as part of the disruption, roughly 25-30% of flights were canceled and far more were subject to heavy delays;
  • Operations stabilized very early in the week of 10/11;
  • The company publicly blamed problems in air traffic control (ATC) capacity and weather;
  • Curiously, other major carriers did not experience remotely similar issues on either count;
  • Likewise, the FAA publicly denied any problems in ATC other than a minor disruption in Jacksonville, Florida; and
  • The Friday before Columbus Day weekend (i.e. shortly before the sharp rise in cancelations), the Southwest pilots’ union asked a court in a filing to block the company’s plans to mandate the vaccination of pilots.

As the cancelations started to pile up, rumors began to spread. Most such rumors took the form of a redacted text message from a ‘credible source’ and spread on social media, usually asserting that the cancelations were primarily the result of a sickouts in protest of vaccine mandates. The first such rumors attributed the slowdown to a sickout being conducted by air-traffic controllers in Jacksonville. As time went on, many more began to attribute the cancelations to similar actions by Southwest pilots. Among the first of these came from Twitter user “I_Kill_Art_Hoes” in a purported post of a text from his father that quickly went viral. Copied versions of this text were recreated with different provenance on other platforms.

Now, I haven’t the foggiest idea if any of these rumors were true. Clearly, given the union’s stance, there is at least some irritation within the ranks of pilots. It wouldn’t surprise me in the slightest if some number of pilots or air-traffic control workers decided among themselves to undertake a bit of an informal sickout. Between the timing of the filing and the pretty plain evidence that Southwest corporate was being less than forthright about what was going on, I don’t think anyone should be shocked that this kind of speculation emerged. I don’t think anyone should be shocked if it ends up being true, at least in part.

But the speed with which circumstantial cause for speculation turned into a definitive “heroes are rising up against vax mandates!” narrative WAS shocking. It took mere hours for the rumors and circumstantial evidence to be promoted as the Correct Understanding of the Event by practically every prominent media and political missionary of the right side of our bi-modal political spectrum. Tucker Carlson. Ted Cruz. Sean Hannity. Donald Trump, Jr. Ron Johnson. Alex Berenson. Jack Posobiec. The Washington Times opinion pages. RedState, who kindly gave credit to I_Kill_Art_Hoes’s dad for the scoop. The Buck Sexton and Clay Travis podcast. Apocalyptic prophecy blogs. Breitbart, which snuck it in their news section under the newsworthiness standard of ‘famous people said’. Newsmax, which did the same. It’s a fun gag that publishers from both political modalities enjoy: “Oh, we’re not saying that’s true, we’re just reporting that someone famous that our readers listen to think that it’s true, and their statement is what’s newsworthy.”

Among the 1,239 articles we identified discussing Southwest’s cancelation issues over this brief period in October, approximately 45% specifically referenced this speculation.

The below network graph presents each of those 1,239 articles. Each dot represents a single article. The articles are organized by linguistic similarity. When articles are very similar to one another, they will be grouped into an area and share a similar color. If very similar articles exist in different ‘neighborhoods’ of similar articles, they may in turn be connected by one of the many lines on this graph. Up, down, left and right have no meaning other than distance – closer means greater linguistic similarity, and further means less linguistic similarity.

The nodes highlighted in bold below are those articles which contain language we believe is related to speculation about the primary role of an ‘uprising of Southwest pilots against vaccine mandates’ in the recent spate of flight cancelations. Based on the phrases of meaning extracted from the articles, I would generalize the gold, green and rust colored clusters in the southeast quadrant of the graph as being largely articles which rely on that framing. I would generalize the pink cluster in the northeast quadrant as being heavily populated by articles with language dismissing or fact-checking the theory.

Source: Epsilon Theory, Quid

It is interesting how many articles reference the speculation. But it is really interesting how tight the cluster membership is, both for those using the framing and those referencing it critically. It implies strongly that the language about the vaccine mandate speculation is the language which most defines the shared characteristics of these articles. That is, if you wrote about the Southwest cancelations by framing it as being about a pilots’ work stoppage over vaccine mandates, the language you were using was probably very similar to the language being used by others writing about the intersection of Southwest and vaccine mandates. When we talk about the construction of narrative and the creation of common knowledge, this is what we mean: the viral spread of linguistic abstractions as a means of interpreting facts about the world.

In this case, the viral spread was so rapid that by October 10th, that an uprising of Southwest Airlines pilots against vaccine mandates bore primary responsibility for the flight cancelations over the Columbus Day weekend was an article of faith.

But it wasn’t the only viral spread of narrative that took place in connection to this event. Nor would it be the only article of faith to emerge.

If it took hours for social media-fueled rumors to emerge as talking points for sitting members of the United States Senate, it took minutes for the fact checking machinery of the nudging oligarchs in America’s left-leaning media and social media institutions to fire up with the counternarrative.

If you didn’t do so when it was mentioned above, try clicking on the Instagram post that took credit for the scoop that I think we all believe rightfully belongs to I_Kill_Art_Hoes’s dad. You should see something like this.

Instagram wasn’t alone. Fact checks quickly emerged from USA Today, Snopes, the Washington Post, Politifact, AFP, Newswise and more. In every case, false, false, false! And in every case, the argument provided for the false characterization was also the same: that the airline denied that a pilot anti-mandate sickout was taking place, and because the pilots’ union denied that an anti-mandate sickout was taking place. So there! False!

Indeed, the pink-colored cluster in the network graph above is largely populated by fact check-adjacent articles; that is, the cluster consists almost entirely of and is in most respects defined by language that characterizes the claims of pilot sickouts as a cause for travel disruptions as false. I say fact check-adjacent articles because not all belong explicitly to that genre. Just as many are “look at what crazy stuff these guys are making up now” pieces that reference similar arguments and conclusions.

Yet in not a single one of these articles that I reviewed – and I read all 60 in that cluster – did I see a journalist or opinion writer ask two simple questions that would be necessary to render an intellectually honest “false” evaluation on the circumstantial claims being made: (1) do statements from the airline and union indicate definitively that some pilots are not engaging in an informal sickout, and (2) is there any reason the airline or union might have an incentive not to make a public statement characterizing it as a sickout?

The answers to those two questions are very obviously (1) no and (2) yes. A recognition by the airline that matters within its control were to blame would have meaningfully different economic consequences, and a public recognition by the union that its members were organizing a job action would have meaningfully different legal consequences. I’m sorry, but if you are a professional journalist and your reaction when you read a statement from SWAPA that says, “Under the Railway Labor Act, the Union is forbidden from taking job action to resolve labor disputes under these circumstances. SWAPA has not authorized, and will not condone, any job action” is to say to yourself while nodding sagely, “CASE CLOSED”, you should consider another profession.

But let’s not go crazy here. The fact that the farce of fact check media doesn’t take its own “the primary elements of a claim are demonstrably false” standard seriously and didn’t probe the strange elements of the event any further doesn’t change the fact that there really wasn’t anything beyond statements of unclear provenance and circumstantial relevance to go on from a news perspective. Those largely unsourced social media claims were at best and at worst unproven, and for that reason, there is zero reason for anyone to be shocked that most news coverage ignored it, beyond coverage of it as a social or cultural phenomenon. If your expectation is that the media needs to cover the assertions present in every text message from I_Kill_Art_Hoes’s dad, I’d say that is a pretty unrealistic one that misunderstands the purpose of the press in a free society. As mentioned above, even conservative media outlets like Newsmax and Breitbart realized that if they wanted to promote the speculation on their news pages, they would have to do so by treating the definitive statements of famous conservatives on the topic as newsworthy themselves.

But that doesn’t mean that looking more closely into that news coverage isn’t still useful. And, as it happens, when we do so we find something very interesting indeed. Here, once again, is a network graph of the coverage of Southwest cancelations. But instead of marking in bold those containing the linguistic patterns of discussions of a pilot sickout over vaccine mandates, we mark those which contain language that explicitly reference the claims of adverse weather and ATC causes of the cancelations and which OMIT any mention of the speculation of a formal or informal job action.

Source: Epsilon Theory, Quid

This group accounts for 421 articles, or about 34% of our dataset. Like the speculative blogs, most of these articles are concentrated in the same clusters, namely the red, green and gray clusters in the northeast quadrant of the graph. Here, once the dataset is constrained to articles referencing ATC and weather, the language used in the remaining set of articles is deeply similar. Why?

Because the news articles which (correctly, I think) omit speculation about a pilot sickout are functionally slightly different presentations of the statements released by Southwest Airlines, SWAPA and the FAA.

Because – I think – out of concerns that doing otherwise might give aid to the narratives of the political right, left-leaning news outlets, opinion outlets and blogs as a whole did practically no digging into the absurd and contradictory explanation provided by Southwest Airlines for such a significant disruption.

Why do I think that?

Because three articles, or about 0.2% of those covering the cancelations, referenced the nature and robustness (or lack thereof, in certain circumstances) of Southwest’s less hub-and-spoke-dependent network design.

Because nine articles, or about 0.7%, referenced the >$3 billion dollars Southwest Airlines received in the 2020 bailouts.

Because twenty-one articles, or about 1.7%, grapple in any measure with Southwest’s profitability, among which only one or two consider whether the aggressive over-optimization of Southwest’s network and staffing in order to produce that outcome might have had anything to do with the events of Columbus Day weekend.

Because twenty-five articles, or about 2.0%, referenced the demonstrable public statements of pilots, air-traffic control and other employee groups about their workload and exhaustion due to current staffing levels.

Because twenty-six articles, or about 2.1%, discuss the logistical and infrastructural challenges facing air carriers in any capacity.

Most importantly, in all of those cases, the articles are scattered all over the network graph, with almost no internal linguistic similarity. In other words, there is NO narrative about Southwest’s flight cancelations other than (1) “heroes are rising up against vax mandates!” and (2) “heroes are not rising up against vax mandates!”

Outside of the narrative battleground du jour, the story here is that in the best case, a minor disruption in weather and a small ripple in staffing could cripple the service provided by a major air carrier whose near-monopoly status in some short-haul routes is effectively subsidized by the US government.

The story is that the airline to whose shareholders the American people gave $3.2 billion ($1B in low-interest loans) clearly continues to operate with the kind of logistical and operational leverage that maximizes short-term results over long-term stability, reputation and service quality.

And that is the problem with the Widening Gyre.

Missionaries who align with the right wing of our bi-modal political distribution almost immediately and violently aligned their statements with the framing of the Southwest Airlines delays as being about resistance to vaccine mandates, especially among the pilots’ union.

Missionaries who align with the left-wing of our bi-modal political distribution almost immediately and violently aligned their statements with the framing of the Southwest Airlines delays as being about anything but vaccine mandates (we fact-checked it, so there!), explicitly avoiding challenging the explanations provided by the airline and union so as not to accidentally lend credence to the opposing political faction’s narrative.

Guess what happens to us in Reality World when missionaries marshal our energies and identities to fight go-nowhere battles in Narrative World?

Southwest cancels flights out of Midway due to no de-icing | Daily Mail  Online
Source: Associated Press

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  1. Avatar for jewing jewing says:

    Psst - “The Second Coming” is correctly attributed in the paste, but not in the text. It’s Yeats not Keats - though I do wish we had a bit more Keats in our lives these days…


    PS - feel free to delete this comment once the appropriate edit has been made. No reason to keep it up here…

  2. Avatar for rguinn rguinn says:

    If you would believe it, I have submitted three notes with this exact dumb mistake. I’ve only been fortunate that my editor caught it both other times. Thank you for spotting it for me (once again).

    However, your comment must remain up as a badge of my dishonor and shame!

  3. Yet in not a single one of these articles that I reviewed – and I read all 60 in that cluster

    My God, man. And here I thought I read too many irritating and time-sucking things on any given day.

  4. No issue with your central points about MSM framing around vaccine issues. And you correctly noted the MSM had ignored relevant issues such as bailouts and employee workloads/exhaustion. But I would point out two other SWA narrative issues, based on my career in aviation

    1. Every article I saw uncritically quoted SWA managemnt claims that the problems were explained by weather and ATC. But even the articles that noted that no other airlines had been badly hurt by weather and ATC (usually buried in a later paragraph) failed to highlight the contradiction, or to openly tell readers that management’s claims were dubious, or even bothered to ask SWA why people should accept their claims when no one else was affected?
    2. No article included anything that would cause readers to doubt the longstanding narrative that SWA is an incredibly dependable well run airline with wonderful employee relations, despite the evidence from last week’s debacle. In fact their operational and IT systems have been second rate for decades, and the days of management and employees marching together arm-in-arm ended a long time ago. Not to say SWA is a bad airline, but reporters are working strictly within a manufactured PR image that no longer reflects reality. Similarly, reporting still assumes that SWA fares are always lower than the Legacy airlines when that also hasn’t been true for a long time. Antagonisms between management and staff (especially pilots) at SWA have been high for years, partially explained by boneheaded managers living off the goodwill Kelleher created 25 years ago, and partially explained by pilot militancy.

    Perhaps the problem wasn’t totally driven by media desire to shoehorn SWA’s meltdown into an unjustifiable vaccine framing, although I’m sure that’s what happened with outlets focused on their owners’ political objectives. But in many MSM outlets, it seems the problem was that reporters couldn’t deal with a story that contradicted the official SWA-is-pretty-wonderful narrative and were struggling to come up with anything (including unverified twitter/facebook posts) that might possibly provide an alternate explanation

  5. Avatar for rguinn rguinn says:

    Focus groups have consistently shown my personal suffering to be a moderately compelling feature of the Epsilon Theory subscription.

  6. Avatar for rguinn rguinn says:

    Hubert, I think both of your points are 100% correct, and I’m grateful to hear your expertise.

    I think that I at least tap-danced or alluded to the first point you made in some ways, but your second point, the more specific existing Southwest narrative, is spot on, too. Everything that everybody knows about SWA probably affected the willingness to challenge certain implications of the inconsistency. In fairness, I think that will probably happen to some degree in the latter part of this news cycle that unfolds over the next week or so, but it has not yet.

    Even speaking personally, it’s hard for me to overcome the good brand equity SWA has in my mind/heart.

  7. SWA, as you and most of your readers know, deserved much of its positive reputation. It grew rapidly in the 80s and 90s because (unlike any Legacy carrier) it carefully focused on markets where it had a large competitive advantage, and established an internal culture where everyone knew its financial success would be widely shared. While at Northwest I did a study (correctly) predicting SWA could profitably grow to 10-15X its current size. I wrote the business plan after America West came out of bankruptcy in 1995, the only carrier that was competing with SWA head to head. A major obstacle was when America West’s chairman, focused on killing off the tiny union presence, outsourced all of line maintenance, teaching me what an operational meltdown looked like. The lead WSJ story was about how all the SWA staff at Phoenix bought pizza for all the America West staff who had taken the brunt of customer anger (and handed SWA massively profitable traffic).
    But that SWA was dead by 2005. They had exhausted all the market opportunities where they had strong competitive advantage, but still felt that robust profitable expansion was their god-given right. Given their proven industry-leading profitability staff began insisting on industry-leading wages, but management demanded the wages appropriate to a struggling 1980s startup was all they could pay. McKinsey was suddenly everywhere. Their strategy has been to raise fares almost as fast as United, and allow service to deteriorate as long as they were still less worse than United (not a difficult standard).
    ET has written a lot of good stuff on conventional wisdom and how it can change. Based on that I would disagree with your point about the SWA narrative changing in the next week (or anytime soon). There are no Harvey Weinstein type events that could suddenly burst the narrative bubble. Your comment about your continued belief in SWA’s good image reflects a very common view. And more importantly the MSM will absolutely refuse to print anything that even vaguely suggests its reporting about SWA has been badly wrong for a very long time.

  8. Avatar for bheit bheit says:

    I don’t disagree with the idea that a private entity should be able to mandate certain things such as a vaccine, but there needs to be discussion around whether these companies are truly private anymore. After being bailed out by the government, it’s easy to see how many of the organizations will do whatever is directed to them so that they can remain eligible for that sweet sweet bailout in the future.

  9. This is so good. Herb stepped down right before 9/11 iirc. But the SWA I knew & flew in the 80’s and 90’s was dead by the middle aughts.

  10. One of the first thoughts I had hearing about Southwest, which airline will NOT require vaccine and advertise it? Highly doubtful, but it is 2021.

    A guy I graduated with, is a pilot for Southwest. he generally post very positive messages saying that he loves the company, but did post a negative meme yesterday about not getting the vaccine. If I had to guess, I’d say vaccine mandate fade for Southwest.

    Completely off topic, but the other thought I had when watching Blue Origin yesterday, we remotely pilot capsules to space but are still relying on pilots for air travel. I know, I know, a lot more hurdles to get to pilotless flying, but I preprogram every mission on Google maps with my drone and have for a few years now.

  11. "We also think that antibodies from prior infection should generally be accepted as an analog for vaccination. " - Just a comment (with my clinical virologist/infectious diseases hat on) - When you compare those who experienced natural SARS-CoV-2 infection vs those with 2 doses of mRNA vaccine, the risk of acquiring delta variant is about twice as high in the natural infection group on average. This is well documented/published, and not really that debatable, and is why WHO and CDC recommend a full series of vaccination post-CoVID-19 infection. I realize I just lost half the readership mentioning those two organizations, but these 2 states of immunity are not the same. An assumption worth re-visiting, although might not change your conclusions.

  12. Avatar for rguinn rguinn says:

    I think we were pretty clear in saying we both see vaccination as a civic duty and in not identifying pre-existing infection as identical but as being comparable in meaningful ways. Hybrid immunity, as I’m sure you know even better than we, also demonstrates powerful synergies, and so we would not only agree with but reinforce your very fair points.

    But from a policy perspective, we think that the treatment of natural immunity as a non-entity closer to the absence of immunity is a major narrative error, hence our position on this. That is, we see letting the perfect be the enemy of the good as a fatal flaw in the present political environment.

  13. Avatar for rguinn rguinn says:

    Sorry, Hubert, I think I may have been slightly unclear in my response. I am not at all arguing that SWA’s long-standing narrative will change in the next week - I’m arguing that I think that we will probably see a bit more exploration of what’s going on at Southwest in the next part of this news cycle, especially in financial media.

  14. First, that’s great info. And it makes me want to ask more questions. But that’s so insignificant to the one key point you make. You’ve identified the biggest problem as Rusty’s note addresses. I’m just thankful to hear a true medical expert actually acknowledge it, because my guess is that you are the only way out, except for mass social unrest or war. But I know that you are one way out that will work.

    Now what to do about it? I personally think the fastest fix would be for very public humble pie by heads of both organizations, followed by resignations. Even if Fauci simply said,
    "yes, when we told you at first masks weren’t helpful, and to wash your hands because it isn’t airborne, we were trying to avoid panic and profiteering so that our front line workers could get masks. We should have admitted this sooner. We should have earlier than today admitted our failure to require hospitals stock PPE during prior scares of Sars1, MERS, Ebola, bird flue, H1N1, etc. especially before adding water features to lobbies or another layer of administrators.

    Looking forward from this once in a lifetime health crisis, I believe my successor has learned that being completely forthright with what we know, and admitting where prior guidance ended up being shown as likely wrong with new information, is important even concerning information.

    That failing to treat the public as adults, but instead trying to manage to desired behaviors opens the door to wild conspiracies and destroys the authority and credibility of this organization in enough minds to more than jeopardize any expected benefits.

    Here’s my successor, who was thoroughly investigated by Fox News and CNN and Shawn Hannity and the NYT, etc. and found to have no possible involvement or connection with anything related to the NIH grant to WIV or Trump or Biden or whatever other objection du jour to tell you what we know at this moment about natural immunity and vaccination for various strains and over time."


    1. They’re not going to do that on their own until it gets a lot worse, which terrifies me,

    2. It won’t convince everyone, but it will convince some and others will be more likely to move beyond the denial / anger / bargaining stages towards acceptance.

    3. It’s not going to happen unless experts demand it, first privately, then publicly. Right now the “experts” are MDs from low end med schools with unrelated specializations, wearing lab coats in front of cameras with the time and energy to organize, create websites, jump on social media, and travel around speaking. Or even my kids’ seemingly dementia suffering biology teacher (Biology BS), on local news calling herself an immunologist before making claims about masks and test accuracy.

    4. I know that you actual experts, you are tired- more tired than you have ever been. And you are emotionally spent, numb even. You have nothing left in the tank. You are not hiding in your home in fear. You are still fighting, or just getting a few hours of sleep, or trying to catch up on EMRs. You have been spending endless hours in labs running tests, tracking strains, or in the ED fighting to save lives, now for those fearful of a small risk vax suffering a bigger one given their comorbidities. You have missed a few years of your life and family. But for those of you 45+, that’s why your residency was unbearable. You were being prepared exactly for this. You know how to do this. You know you can. WE NEED YOU TO.

    5. If nothing changes, I also fear the medical profession takes a credibility hit that could take decades to recover. Fauci and Rand Paul may currently be the faces of your profession to the public. :worried:

    If you don’t / can’t, if you retire or switch careers after this, I won’t blame you. This has been and still is your generational professional war. Nobody blames a soldier with PTSD for retiring. They are still honored for their contribution.

    You know better what needs to be done. It probably seems too daunting. One step at a time. Elephant bites and all. Here’s my thoughts that I don’t think you need:

    1. Call out the top-heavy healthcare bloat. 3 layers of high comp management was an unacceptable drag in crisis, whose policies forced decisions into bureaucratic hell hole. Whose building monuments with their names on cornerstones instead of stocking a large room with PPE, or adding ED beds, actually killed people, even their own employees. Yet they worked from home for safety while collecting 6 or 7 figure comp (and now 2 or 3 layers of hierarchy). Demand change. Back to MD at the top with business manager as assistant. Board of community and physicians. Simple. Nimble. Efficient. No more studies by someone earning $500k on how to save $100k by making RN work even harder.

    2. Organize locally. Have community outreach. Both in person and streaming online. Answer questions. And please, please, debate answers. Show the public that not everything is known or absolute, but what can be taken from that, especially for certain risk categories. Encouraged people to pursue general health. Speak the unspeakable. If you wouldn’t have your family living in an NYC high rise with shared air handling and little outside exposure, then say it. Use the same group to talk to local and state officials and school boards, and not just in back channels. Let the public know they are getting expert advice. You don’t have to say someone is an idiot. Show your credentials, state the facts as you know them to be, not as you were told by an org only half the people will trust. The other person will have violated the “better to be thought a fool, than open your mouth and remove all doubt”.

    Lastly, thank you again for all you have done and continue to do to help us get through this. And I am sorry for the so many times you have been discouraged because it seems like nobody is listening. I think it’s often because the wrong people, with plenty of time, debatable motives, are taking advantage of the confusing and silent fog to talk the loudest. Lots of people are ready to shut off the 24 hour news and go on with their lives once you tell us how.

  15. Absolutely perfect summation of where we are vs where we should be (or better yet, should have been). As a 45+ ED physician I can vouch for the accuracy of this assessment and can attest to the significant impact it has had for the “essential workers” victimized by the mismanagement of corporate medicine. All of this of course has been surpassed by blinding arrogance, stupidity and dishonesty of virtually every federal agency involved in the COVID-19 response.

  16. Avatar for rguinn rguinn says:

    I think it’s undoubtedly true that acting as though natural immunity were non-immunity would increase vaccination rates, and I think increasing vaccination rates is an unequivocal social good. I think relying on that method also carries social costs, and it sounds as though I may apply somewhat more weight to those costs.

  17. Avatar for Zenzei Zenzei says:

    Lord knows, I feel you.

    At our EMS corps we got our flu shots from the ED doctor that is also our medical control for all emergency matters in the field that need a consult. We are all Moderna vaxxed. He urged us to get boosters. When we explained that fact. He said I understand.

    Then making it clear he was talking to absolutely no one and just commenting on life he said - “a you know, it’s amazing, at CVS they just don’t care. they will give you a whatever booster - even Moderna even though CDC hasn’t yet done their thing. a couple of Drs and nurses I know have gotten boosted already with Moderna there…can you believe it?”

    Which was obviously (at least to me) a clear indication that we should not let the CDC and the government get between us and our boosters. So I checked with various MD friends of mine and they all said variations on the same thing.

    Yup. This is how 911 works people.

  18. Avatar for jrs jrs says:

    I’m an ER doc. There is currently an oversupply of ER docs since the big ER staffing companies have come to own many of the residency programs.

    I would love to call out all the bloat and regain a little control over my own work environment.

    But I work for a big ER staffing company. The bloated managers at that corporation pay me a little bit, and if I call them out, they will fire me. But they own the means of production (or rather my contracted hospital does, but same thing effectively in our big-fish-eat-the-little healthcare economy). Then I’ll have to spend more time at my lower-paid second job to feed my kids and I’ll have even less time to call them out.

    So, mostly I just whine about all this to my ER nurses. They, in turn, whine to me about how vaccine mandates are evil and vaccines are not our civic duty. I humor them because the alternative gets ugly.

    (Oversimplifying for brevity.)

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