Of Air and Breath

“Breathing dreams like air”.

― F. Scott Fitzgerald, The Great Gatsby

The world is a tiny place now, as each of us folds in on ourselves.

There’s a dislodging, perhaps, from sensibility. Like Alice peering through the Looking Glass, we are prone to illusion, to falling into a boondoggle of thought and action.

It’s a dangerous time. Who would doubt that? We feel the loss and grief of pandemic, and the constant news of mortality from COVID-19.  But there’s equal danger, too, from the rub of constant rhetoric. And panic from words that, at times, seem disrupted from any frame of intellectual honesty, words and sentences that have been jettisoned into the public sphere without a full vetting of fact.

We are gripped by the fear of ventilator shortages. It’s a story that has rocked the news. Fear is air, like the very contagion we are guarding against.

It’s a fear that is stoked by Facebook and Twitter, as friends confabulate scenarios of panic, their worst fears gathered around words that convey a paralyzing angst. And it’s a fear that goes straight to the gut. It’s a fear that can’t be walked back or negotiated with. A fear that resides in each of us.

The loss of air and breath.

Anyone who has seen a human life stretch forward on a ventilator knows a special kind of dread.  Each mechanical breath is a small and finite hope, a measure of life that is plotted forward, one hour or day at a time. And for some, there will be a time when that measure of breath must be circumscribed,  and cannot be sustained. And the loss will be indescribable for those left behind, a separation resurrected in memory time and again.

Purveyors of fear know this. They amplify our terror, deconstructing data and re-configuring it, pulsing strings of fractured information into the public square. It’s what fear is made of – memory and lineage formed through space and breath – all the things we have taken in and collected over time.

Reality, though, is tethered to more than fragments of information circulating at any given time. It’s what we need to remember, no matter what the age.

It’s the will to think, to take in information without partitioning knowledge, parsing it left and right, that makes us whole and strong. And now it’s more important than ever to be an independent thinker, to look beyond the headlines, the tricksters of despair.

Disease and death leave us blindsided. We are never prepared for an event of such magnitude. Pandemics are not foreseen, at least not with the acuity and precision that we would like. We know that the next one will come, but it is never certain when.

Still, plans have been laid out by governments, public health experts and the like.  But just who is it that has the authority to lead, to plan for the exigencies of pandemic? Which individuals, government entities or experts have the agency to inform, and to execute plans without inciting panic?

There’s no secret here. In fact, medical literature is replete with articles about pandemics, and preparedness. Authorities in public health, anesthesiology, pulmonary and critical care medicine have studied and reported on the problem for years, even decades. Computer models extrapolate the possible number of patients who might need mechanical ventilation if their ability to breathe is compromised from a respiratory assault. Some literature expounds on the ethics of allocating scarce resources during a sustained period of pandemic, one deemed “high severity”, in which vast numbers of people are afflicted with disease.

Ultimately, though, it’s each state that has the agency to plan, to pull on expert knowledge and draft guidelines against despair. It’s each state that has the structure, the responsibility, to provide vital equipment to sustain life. And it’s each state that maps the course and the configuration of life sustaining strategies when widespread contagion takes hold.

Predictions and warnings and about pandemics have sounded. Most hospitals lack the capacity to respond to large-scale infection disease outbreaks, the Government Accounting Office stated, in 2003.

And from the President’s Council of Advisors on Science and Technology, a report on preparedness for swine flu in 2009:

[C]ases requiring mechanical ventilation or intensive care could reach 10 to 25 per 100,000 population, requiring 50 to 100 percent or more of the total ICU capacity available in the United States and placing great stress on a system that normally operates at 80 percent of capacity.

The insight and the foresight-has it been taken in? Or have the structures that govern us lacked the agency to bind knowledge to action? And do we have the will to understand the workings of bureaucracy, the sense to know that the rhetoric of fear is not always what it seems.

 In the end, all the things that shudder us, or not, have been here all along, like augur, like breath expelled, air waiting to be taken in.