Friday CDC released its guidelines for communities to respond to pandemic flu. It adopts a hurricane warning analogy (Category 1 to Category 5 pandemic). The Categories are keyed to case fatality ratio, with the lowest category being roughly the experience of seasonal influenza (less then 0.1% CFR and illness rates of 5 - 20%), Cat 2 being the experience of the 1957 and 1968 pandemics (CFR of less than .5%) ratcheting up to Cat 5, the experience of the 1918 spanish Flu, whose CFR has been roughly estimated to be around 2 - 3%. By these measures, if H5N1 went pandemic at its current CFR of 60%, we'd be at Cat 12 or something. Mercifully Cat 5 is the highest in the scale. The interventions will have maxed out by then anyway.
I've read good chunks of this document and it leaves much open but given the present state of our knowledge I think it is a good effort. It is just a start, however, and what remains to be done is daunting. Jeff Levi, Director of the Trust for America's Health (TFAH), was gentlest:
"CDC's release today of guidelines for public health measures to respond to pandemic flu should be the start of an important national conversation about how to better prepare the country for a possible outbreak. (TFAH Press Release)
Levi notes the guidelines raise difficult "practical and policy issues."
For instance, if a sick individual is expected to stay home and a household member is expected to remain home to care for them, we must consider implications regarding sick leave and paid family leave that would encourage people to comply with such guidance. We also need to think about how vital medical and food supplies will reach those who are quarantined. If schools are expected to close for extended periods, we must address how children will be cared for and how kids who rely on school meal programs will be fed.
Hillel Cohen, an epidemiologist at Albert Einstein College of Medicine is blunter:
. . . the CDC guidelines "repeats the errors that were made in preparation for Hurricane Katrina."
In particular, the guidelines acknowledge but do not provide any means to account for the great social inequalities that exist based on race and class," he said.
In the event of a major pandemic (Category 4 or 5 according to the new, hurricane-based, classification scheme) workers who are sick with flu symptoms should stay home.
"Many workers have little or no paid sick time and those who live paycheck to paycheck will not be able to do this. The government proposal that employers voluntarily provide pay to workers who stay home is not serious."
"Similarly, the idea that workers telecommute or avoid public transportation shows that the planners are not sensitive to the fact that lower paid workers have jobs that make this impossible and that many don't have access to alternate transportation."
Dr. Cohen pointed out that the New Orleans approach to rely on voluntary evacuation directly led to the disaster of people without the means being stranded.
"It is ironic," he said, "that the government's main stated public health goal is the elimination of health disparities by 2010 and yet these guidelines completely ignore the social disparities." (Einstien College of Medicine, Press Release)
I'm not so unforgiving as Dr. Cohen but I would go much farther than Dr. Levi. One of the most important responses to the threat of a pandemic -- a response that would pay dividends across the board, pandemic or no pandemic -- is to strengthen the nation's commitment to public health. This means investing in the public health and social service infrastructure across the board.
Our public health system is in worse shape now than at any time in my 40 years in the profession, and the fault for this goes to many people. The Reagan administration started the destruction in the 1980s as part of the conservative revolution and it was taken up by Bush I, continued by Clinton, and reached new intensity under Bush II, who has all but administered the coup de grace. It's not just Presidential administrations that bear the blame. State governments and legislatures have ruthlessly cut taxes and are also culprits. And there has been precious little leadership from us in academia.
Thus a missing piece of this plan is an urgent call for investment in our social infrastructure. Many public health and social service agencies are barely hanging on, rotting in the care of administrative babysitters.
I like the CDC document for what it is, but am dismayed by what it isn't: A call to rebuild and rededicate. so we can face the future with more than ad hoc and on the fly responses.
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The inequalities thing bothers me Revere. It is government by the people for the people. Can you in any other way than to say beefing up the national healthcare system that in doing so it would change the outcomes? So far it is a flat rock on the head scenario for getting this stuff. Sure you might save what a couple of hundred if there are ventilators, power and people to operate them along with superextraordinary measures being taken. I havent seen any of the socialist countries come up with squat for this too. France and Sweden both are acknowledging that AI would first swamp their system, then without taxpayers to pay into the system post of the disaster, it would bankrupt their countries.
Lot of nervous and jerky situations here. I dont discount what you say. I get a mental picture of the people who would swamp the hospitals here if UHC was in place and then the lawsuits when XYZ didnt get the healthcare he paid for. Sitting out in the ambulances they would be dying and found dead. Or at home having made the pickup call. The butt covering has already begun on this and I dont like what I am seeing. You are right they could do more such as stockpiling food and all of the other goodies but it costs a fortune for starts. Then maintaining it is another fortune as this stuff is time dated.
So I pose the question...What do you propose specifically they do for a disease thats almost 100% fatal right now? 83% for the rolling one year average in fact. I am not slamming you on this one as its an ambiguous question for a more ambiguous problem. I cant see that they could really do anything at all. Infrastructure is what the Feds are in to. UHC wouldnt protect more than a couple hundred more per state, probably save less than half.
I am interested in what you think would be good.
Randy: If there is 100% fatality there's isn't much anyone can do. Same with 20%. It would be a catastrophe. But if our system is so brittle it can't stand a 5% or 3% or 7%, that's a problem. Many countries can handle it better than the US, and the US could have handled it much better 25 years ago. We have lost much of our hospital capacity. The syhstem is much worse than it used to be.
If a 30% CFR comes down the pike in the next year, the best thing for an individual to do would be to put his/her head between their legs and kiss their ass goodbye. But if we have time and it is the ore usual flu, then we have a chance to get ready if it takes a couple of years to ripen. Same thing for global warming (which I realize you don't think is happening).
Revere,
I'm sure you've probably presented your case previously (or perhaps elsewhere), but specifically, what can we do, to revamp healthcare?
The two most easily identifiable problems (at least to me) is:
1. Health care is becoming increasing difficult to afford, even if sharing the risk, through health insurance.
2. Misuse/Overuse of the ER for treatment for "non-emergency" care.
OK...I lied..maybe 3? The third being cutting expenses and downsizing capacity?
How do we fix this?
PS - I admire your patience with MRK
Ah, a rare day, when I find that revere and I are in perfect agreement on something...that if the cfr gets much above cat 5 (2-3%) the government realizes that it has no way to mitigate the effects and all bets are off. At the current rate, forget it. It's going to be the lucky and the prepared that might make it, but making it through the pandemic is only the beginning.
But MRK already knows this: he's about the most prepared person I've ever heard, Brave New World/Jericho style. Lawsuits? Randy, you're kidding, right? One good thing about this will be no more lawyers! UHC? Not for a pandemic. In good times, stable times, run of the mill slow moving disease times, yes, we need UHC badly. But it almost seems silly to bring it up in terms of a flu pandemic. No matter how big and comprehensive the health care system, you simply would never have a high enough HCW to patient ratio to do much good.
Mary...Yeah I was kidding. On another part of the blog I suggested that we mutate it to get the politicians...Sorry, it was an oversight on my part. I should have included lawyers too.
BTW Revere I never said global warming wasnt happening. I said that they could definitively account for one degree of temp rise due to humans. Thats really a lot but thats nothing compared to what has happened in the past. Kyoto sucks and everyone knows it. It is flawed because the Chinese and others dont have to comply for 40 years. With as much shit as those guys put into the atmosphere it wouldnt matter what we did here. They would produce enough for everyone -e.g. the MODIS satellite display I sent you. So even if we do pull back, tank the economies of the world the population is projected to increase by 1/3rd in the next 50 years. So no matter what we do, its going to matter not one whit because of the total number of drains on the system.
Back to the subject. Wasnt Asian flu in the sixties something like 3% and localized pretty much to SE Asia? You are right they held it and we survived. But if this stuff comes rolling in at 83% or even 5% which is what they are telling everyone (well roll out the happy, happy pills) we are going to be in deep shit and fast. That 47 day timeline is a real number by the way. It is the estimated full exhaustion of all food if everyone who needed food and waited to the last minute got a full load (NOT). Then recieved a small supply at about the three week mark. About two weeks worth. After that its deer meat.
Even if they didnt restrict the travel, it would still be too little too late.
MIH is in a great place. No deer that I am aware of but the ocean is only a few miles down the road. Again, this is what I suggest they start stocking up on-food.
Okay, I know--or at least assume--this is a joke, Mary and MRK, but I have to say I'm very tired of this kind of comment re lawyers. Dh is one, and a more hard-working, caring, ethical person you will not meet. There are times when individuals and communities need people with knowledge of the law to defend their interests. It's a cornerstone of democracy, so a surprising thing to be talk about throwing away. I'm also disheartened by the continuing human urge to find a group it's acceptable to objectify, stereotype and denigrate.
Now, I suppose, I've been earnest and humourless. It must be the news.
After Revere brought in the Global Warming issue, I thought of this line from samsonblinded.org, the website of a Jew in Israel, where the whole nation of Israeli people face multilayered threats of life and death to themselves and their families on an immediate and long term basis.
Science fiction cost pennies. The Global Warming science fiction cost hundreds of billions and calls the nations to sacrifice trillions of dollars to combat a no-problem with uncertain causes and solutions.
Economist's calculations are based on a calculation of the optimal setting for a carbon tax to produce the greatest nett economic benefit. Yale economist William Nordhaus (Nature, Nov.92) pioneered this concept and estimated that the optimal carbon tax was $5.00 per tonne, rising to $20 per tonne by 2100 AD. Economist Stern acknowledged that he used Nordhaus technique, but with different engineering assumptions reportedly found the optimal tax setting to be $85 per tonne. Consensus seems to be that Stern has overestimated, and the optimal setting should be $10-$15 per tonne.
So far as I can see, nobody except Greenpeace & their ilk are even thinking of considering a return to either status quo ante or even aiming to retain status quo on GHG concentration. With GW there is no hint that millions will die. The UN itself said some time back (lost the reference) that if we are to spend money on world problems, GW is waaay down the list.
As to the pandemic subject: there will be no country in the world, also not 'my' Netherlands where taxes are very high, that can keep the national health system running in case of a pandemic as described in your posts.
IMHO the only thing I can think of as a means of surviving a virus with a CFR higher than 5 % by not letting it spread; that is prevention, prevention, prevention. So scientific research, motivating people to behave in such and such a way, informing people in a proper way, building social structures in order to get everything well organized just in case, and so on.
E.g. Jakarta is inundated in the worst way they can remember in these days, and all those backyard chickens are floating around. More could have been done at a time the infection wasn't spread amongst so much poultry. So primary, secondary, tertiary prevention can be thought of and I am convinced that's quite another thing than running after every fire and trying to extinguish it.
I apologize Karen. Yeah it is the news and all bad. I can only say I am poking fun at the two groups as one is wont to do.
My problem with them is simple. We have Congress and State legislatures that are full time bodies or just about and they feel that they have to do something all the time to justify midnight raises. Both of these never fail to see a law or program they want to make that will line their pockets along the way with someone elses gold. As for the lawyers, they always find that the laws or programs were made were inadequate or infringes on someone elses rights. Alice thru the Looking Glass-Where is that damned Mad Hatter when I need him?
Thanks, MRK. I suppose there are self-serving individuals in most lines of work. I can understand your frustration.
Question for Randy: Regarding the 47 day supply. Why can't we use the same strategy as the Swiss. They have a 3 month supply of food, water, and fuel for every person. They are able to pull this off by having the wholesalers carry this extra inventory on a regular on-going basis (therefore no need to stock and restock), at a tiny extra cost (part of a cent I believe) passed on on a regular ongoing basis to all consumers as a tiny increment to the end goods. In the event of any supply disruption crisis, these goods are immediately available. The distribution becomes the key operational issue. No equity issues. This cost in avoiding exposure to the bug ( by allowing people to shelter in place, or their family to eat while they sit out a voluntary quarantine) is ridiculously small, especially compared to after the fact medical interventions (which we would be so expensive, if we could deliver them, which we cannot). What do you think?
Randy: I mean augment the current 47 day supply by this mechanism.
Aileen, I wonder how many wholesalers in the US even have the space to hold extra inventory. We've gotten so used to the just-in-time delivery system that I imagine most companies wouldn't consider building/buying/leasing extra space to hold more inventory than they're used to keeping on hand. And to take that a step further, I know quite a few people who say they don't even have the space in their own homes to store an extra 2-3 months worth of food and water!
Revere - thanks for addressing the CDC's new pandemic guidelines. I was surprised at first that the 1918 pandemic was considered the worst-case Category 5 scenario when current CFR's were so much higher. I know TPTB don't want to even consider anything as catastrophic as a 20-50% CFR event, but I still wish they had included it. Even if the only prep they advised for a Cat 6+ was, as you say, kissing your ass good-bye!
Cougar: What about the government paying for warehouse space? It is alot cheaper than after the fact healthcare, or ramp up for vaccines that can't reach production volumes in time. Seems like an excellent cheap investment.
Aileen-1700 calories a day minimum. 2200-2500 if you are moderately active, 3000 if you are full blown working your ass off in a pandemic. Go to the cupboard and check the total caloric value of the foods in there. Do the math of how many this and thats you are going to need to feed yourself and plus or minus lets call it an average of 2300 calories minimum to keep you at your glowing weight now.
Lets just use pork and beans-Bush's (yeah, I did that one for a reason Revere) which has 140 calories per can. So call it the equivalent of about 20 cans of beans per day per person-kids dont try that at home. Methane production will be off the scale.
20 cans of beans per day x 300 million census counted people x 120 days (4 months DOC business recommendations from last month) is 5,040,000,000,000 cans of beans. We could bury Switzerland under cans of beans. Using only beans I checked on the annual production of pork and beans by Bush.. (Who in Hell do you know that would go to this amount of trouble?) But they make a whopping 1,000,860,000 cans of beans annually. Its a rounded number-something to do with hot cans exploding screws the count up. Anyway, you can see that even if we stockpiled that unless that inventory was constantly rotating the stuff in front would be going bad before the stuff in the back even made it into the warehouses and thats a lot of bad and a lot of money that would be thrown away or given to food banks. Not to mention that if the government had all of the production geared towards pandemic.
Switzerland has just a hair bit more than the population of the state of Tennessee at 7.5 million and change. They on the other hand would only need 126,000,000,000 cans to survive and all things being equal, which they aint and arent going to be.
The Swiss Aileen are a much more socialistic country than we are. They can easily order this augmentation as their system is much different. E.g. we ordered the mandatory evacuation of New Orleans-very few of the poor left. There they will haul you out of your house if they issue a government order or so I am told but I have no first hand knowledge of that.
Me I was royally pissed that they started increasing the NSPR (National Strategic Petroleum Reserve) during a time this year when the oil prices were so high and also when B. Clinton was still in. Enron made billions off of that (then managed to lose it all). Sure we needed to, but not at the time when it was happening. They could have caught odd lots of oil and built it slowly. Nope, not our government under Bush OR Clinton. Cant have comon sense rule. Nope, just go out and order god awful amounts of oil under a contract and then have it delivered. BINGO, automatic rise in oil prices. I am sure that both sides of our aisle made a bundle off of that and oil futures.
So a can of beans costs 40 cents. For them to ensure that all Americans (or the Swiss extrapolated) it would cost the US government $2,016,000,000,000 to ensure the survival of all Americans. I cant even begin to pronounce that number. The billion I got, but I think its like 2 trillion dollars.
Now you know what I mean when I say, "I see dead people" and its not a crack, its a fact. Unless Americans and really everyone on this blog get their own little butts moving not only might they die of bird flu, but they might survive only to die from starvation if its a four month event. I mean it will get six kinds of serious in the developed world because even the Swiss run down to the corner markets to collect what they need and assume it will be there. I dont want to even think about what will happen if its multi-waved.
My bent on this Aileen is that you really need a years worth, rotating it out of your storage to your front cupboard. You dont go to the store, you got the storage and pull what you need and rotate the new stuff in. I have gone hungry for days in the military before. I was five days without a food drop due to weather once and my boots were starting to look good to me, along with Juan my translator. I will happily lose a pound or two to feed some neighbors kid, but not the neighbors who didnt prepare. This is also the reason that I am fully locked and loaded for what I consider to be an inevitable post flu disaster. Transportation will be shattered, fuel will be low or non existent and no electricity is very possible. That answer it ?
Patch. You apparently think that all of the ills of the entire world and the US would be remedied by UHC. All I can see is a socialist state emerging from a capitalistic one. Germany is having to revamp their UHC program yet again as of this week because the program is going broke. Does this sound like the record that is being played and broken in the Netherlands, Sweden and now Germany. The French are next to downsize it yet again. The Brits did it last year. They had to go back to supplemental insurance to cover the equivalent of their MediGap.
This is nothing more than a cash flow scheme to balance a budget and they'll steal from this just as they did from Social Security. Government run programs are a disaster. I admire my patience with those who just think that what we have is so bad and that healthcare is a right. Its not. Its not in the constitution and in no state constitution that I am aware of. Applaudable, Commendable and every descriptive adjective out there. But someone has to pay for it. You can decide if you are in the US if you want a job or healthcare. If they implement it, it would take the country down in about 10 years or they would have to raise taxes so high that we would just be working for the government, rather than the other way around. Hey, Tan-6 is in a situation over there and they are changing their system AGAIN and now leaving it to the local districts to handle. Tan can tell you horror stories about it and she is in the profession.
For those of us who think its bad I have seen a lot worse. When such a program collapses they'll be left with absolutely nothing to back it up, a totally bankrupt country rather than a moderately bankrupt one now. It also will bring the country to a halt. The last thing that I would ever want is the government in charge of my healthcare. Fill out this form, send it in, contracted pay agents.... Kind of like what we had in Tennessee. Maybe you dont read the Wall Street that did an article or two on it and how it killed this states financial condition. It was UHC.and it sucks. Personally, I think that UHC for indigents and the mentally ill should be provided. But only to the nutcases, wheel chair types, and to the single parents. That wouldnt kill us. But UHC across the board is fraught with problems and to just stand back and say this is the way we should go is ridiculous. It will result in everyone having it available, but only WHEN it is available. That WHEN is up to the government and participation would be mandatory to get healthcare. Spreading out costs is bull. It spreads nothing but the wallet from someone who has something to those who have nothing. Is it an individuals problem that someone else has nothing. I think not.
The thing we can't bring ourselves to admit here is that in a high-CFR pandemic, nothing we can do is adequate, and we'll be dropping dead by the millions.
I say deal with this as if it was a terminal illness diagnosis: get over the denial phase, get over the anger phase, get over the bargaining-with-God phase, and move on to the acceptance phase. Make peace with the fact of death and be glad if a new treatment or a miracle comes along to snatch you from the jaws at the last moment. None of us are exempt anyway, each and every one of us who is reading this now, is going to be dead before the end of this century.
In a high-CFR pandemic, we can't prevent the megadeaths so let's stop worrying about doing so. (And if anyone thinks this is mere callousness, I dare you to come up with a practical solution.) What we can do is save the system, the Constitutional republic and perhaps also the free enterprise economy.
To be fair there ought to be mass education about preparedness, along with various incentives to encourage it, and perhaps some kind of cross-subsidization for the poorest (i.e. government stockpiles that can be redeemed with food stamps). Beyond that, it has got to be up to the foresight of individuals and their communities-of-interest (family, friends, coworkers, neighborhoods) to know what to do and how to do it, and Darwin take those who don't care enough to even try.
How to keep the Constitutional system running is fairly easy. After the emergency, after the mountains of corpses have been unceremoniously shoved into mass graves by Caterpillar D9 dozers, our political process can continue to run: there is nothing intrinsic to it that would cause it to break in a structural sense under those conditions. We can hold new elections, put new people in office, and keep using the same legal institutions as we did before.
The free enterprise economy is a different matter, dependent as it is on a financial system that is leveraged to the gills. But even if that breaks, the natural inventiveness of humans will reinvent markets and restart again, if perhaps at a level closer to the 19th century. Or perhaps a small measure of socialism now, is a reasonable price to pay in order to maintain the underpinnings of an economy-of-essentials, that can be re-started and then transitioned back to a market system.
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Re. lawyers: In our sustainable community group there is much discussion and agreement on supporting the institutions of law and order during a societal collapse scenario. As we put it, "Consider that you've filled up the wagon with fresh produce, hitched up the horses, and are about to head on down the road to the farmers' market. Consider how it goes if you know the Sheriff and the courts are functioning. Consider how it goes if there is no Sheriff and no courts: now you have to worry about roadside bandits, and about looters & robbers raiding the market. No one in their right mind would prefer the latter." So be glad we have lawyers. The social excesses of too much lawyering are a hell of a lot less than those of none at all.
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Re. global warming: It's the consensus of scientists, vs. the consensus of talk-radio blabbermouths. Who do you choose to believe? Scientists or blabbermouths? When you come down with a nasty illness, are you going to call the doctor, or call up the blabbermouth and ask for a diagnosis? When your kid gets sick, who are you going to call? Do you use electricity and running water? Do you use any of the other products of science-turned-technology? (sure you do, you're reading this)
If you want to reject science, don't be a wimp about it. Reject the whole damn thing. Forget about the germ theory of disease. Stop washing your hands after you poop, and stop washing your fresh vegetables before you make salad. Get your drinking water from a rain barrel and don't bother dosing it with bleach or filtering it: just drink it right from the barrel, dead bugs and all. Now go outside and find the big gray box on the side of your house. Open the box and look for the handle on the left. Pull it all the way down until you hear a "clunk!" and you see all your lights go out. Now go back in and light a candle. And enjoy the new Dark Ages.
G5-Your last paragraph may be our epitaph.
You cant ignore CLIMATE CHANGE, but global warming caused by humans is accountable for one degree. 1-degree. My contention is that being a little older and coming from the 50's that we are seeing a normal cycle coupled up with that one degree. It used to snow all the time in the early sixties. Then a lull, then the mid-70's again. Even if you are right and we do something about our emissions, the population will continue to grow. We are doomed as a species because those people have rights that arent even born and will pull on the system and create more and more emissions. They will simply keep raising the bar until we die of poisoning or wars as the resources dwindle.
Carbon Monoxide that orginates from China spans the globe now in the winter months and does a good job of it in summer too. We can cut our emissions and destroy our economy as the businesses move to China because they have no regulations at all. (Feel free to email me at memphisservices@bellsouth.net and I'll forward on a satellite picutre of this to you). MIH was stunned to find that the emissions in Hawaii didnt originate there, but in China. She is a big proponent of the science of this and one picture is worth ten thousand bullshit movies that Al Gore makes. Alaska doesnt meet the clean air standards in winter and you know it has to be from the manufactuing that goes on there. That is my entire point. Our manufacturing continues to move offshore, yet our emissions keep going up.... We arent generating it G.
The stuff that gets put out is supposed to be consensus, its not. Its hype to achieve a goal. Gore has to explain to me those Chinese election campaign contributions. Manchurian candidate? I dont know. But to sign on to Kyoto would doom this country to incredible hardships and we would slip to 3rd world nation status within a generation.
Answers? Bird Flu, SARS, Ebola.... or wars. Big wars, big pandemics. I can see it coming, most cant. They can hype about Iraq but this war actually started at the turn of the 1900's when we found oil in the middle east. Might want to consider that 50's bomb shelter again.
Randy: We get it. You are a human caused climate change denier. You are in a tiny minority, which doesn't include many scientists. You wanted a consensus statement and you got it the other day. For a view different than the energy industry talking points you put forth you might visit RealClimate.com, a blog by respected climate scientists who address the issues you raise (over and over again). For now, let's just agree to disagree about this. We'll be fine. It is our grandchildren that will be paying any price that is due.
I am old enough to have seen the advent of television, jet engines and antibiotics. By now, I had hoped (past tense) we humans would have gained a little wisdom. However, history seems to continually repeat itself without us learning any lessons from it.
Occasionally, I speculate on the demise of dinosaurs, perhaps disease, stupidity, predation, "heavenly bodies" slamming into the Yucatan. Then I surmise, gosh, BIG animals, BIG emissions?
Sorry, figured such a depressing subject deserved a little levity.
Far from denying it Revere. I agree it is. Its the methodolgy that I contest and you have to admit its happened without SUV's throughout history and the fossil record. If you are right and me wrong, I dont think our grandchildren will be around. I have been reviewing that sediment core data that was pulled from last month. It pretty astounding at how fast climate change occurs when it does (here is where we diverge) and how it has in the past. 1300's were very, very quick for a cool down. Glaciation was on the march then, but it receded about 200 years later -slowly. Same in the 1700's. Happened again in a hard and fast method at 5000 BCE. VERY cold apparently except in the Equatorials. All in all about every 1000 or so years there's been a surge, then recession of the ice. My point? Dont jump until all the frogs are ready to race because if we go the wrong direction that could be as bad for the g.kids as the warming itself.
"save the system, the Constitutional republic and perhaps also the free enterprise economy"
the people and systems...that got us this far into why H5N1 is out of control, and why we're this unprepared? We don't need some of those politicians, officials and CEOs if this is their best...
Major changes need to be made, (and go back and find the Constitution might help, too, after we figure the "don't catch panflu"/ "grow food" things out).